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1 1 (March 14, 2019)

handle is hein.crs/govybb0001 and id is 1 raw text is: Updated March 14, 2019 PEPFAR Stewardship and Oversight Act: Expiring Authorities Congress has prioritized fighting HIV/AIDS globally, having authorized related activities and appropriated over $82 billion for HIV/AIDS programs since FY2001 (Table 1). The 108th and 1 10th Congresses enacted two pieces of legislation that have shaped U.S. responses to these diseases: the Leadership Act of 2003, P.L. 108-25, and the Lantos-Hyde Act of 2008, P.L. 110-293. Among other things, these acts authorized appropriations for the President's Emergency Plan for AIDS Relief (PEPFAR), a government-wide initiative to combat global HIV/AIDS. In 2013, when authorizations in the Lantos-Hyde Act were set to expire, congressional commitment to fighting HIV/AIDS remained strong, but concerns about recovering from the Great Recession had depressed support for enacting legislation that authorized the provision of billions of dollars over several years. Ultimately, the 113th Congress enacted P.L. 113-56, the Stewardship Act of 2013, which did not authorize a particular amount, but permitted further appropriations, extended programs, and enhanced oversight. Many of these provisions were set to expire at the end of FY2018 (Table 2). On November 13, 2018, the House passed H.R. 6651, the PEPFAR Extension Act of 2018. The bill was agreed to in the Senate and presented to the President on November 30, 2018. The President signed the bill into law on December 11, 2018. Among other things, the PEPFAR Extension Act * required the Inspectors General of the Department of State, Broadcasting Board of Governors, HHS, and USAID to jointly coordinate annual plans for oversight activities through 2023; * required the Global AIDS Coordinator to publish annually reports on HIV/AIDS spending by the U.S. government, the Global Fund, and governments in partner countries through 2024; * limited U.S. Global Fund contributions to 33% of all contributions received and permit withholding portions of those contributions through 2023; * required that more than half of U.S. international HIV/AIDS appropriations be used for treatment of HIV/AIDS and other associated opportunistic infections, as well as nutritional support and medical care for people living with HIV/AIDS through 2023; and * required that at least 10% of funds be used on care and support for orphans and vulnerable children until 2023. PEPFAR-Related Legislation The Leadership Act. In January 2003, President George W. Bush announced PEPFAR. PEPFAR supports a wide range of HIV/AIDS prevention, treatment, and care activities and is the largest commitment by any nation to combat a single disease. Later that year, Congress enacted the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, P.L. 108-25, which authorized $15 billion to be spent from FY2004 to FY2008 on bilateral and multilateral HIV/AIDS, TB, and malaria programs. The Leadership Act (and the legislation that it amends) is the primary vehicle through which U.S. global assistance for fighting these diseases is authorized. The act included language to instruct how the funds should be spent, list program goals and targets, and establish the Coordinator of the United States Government Activities to Combat HIV/AIDS Globally (known as the Global AIDS Coordinator) at the Department of State. The Office of the Global AIDS Coordinator (OGAC) distributes the majority of the funds it receives from Congress for global HIV/AIDS programs to U.S. federal agencies and departments and multilateral groups like the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The Lantos-Hyde Act. In 2008, Congress enacted the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, P.L. 110-293, which amended the Leadership Act to authorize the appropriation of $48 billion for global HIV/AIDS, TB, and malaria efforts from FY2009 to FY2013. The Lantos-Hyde Act mostly amends the Leadership Act, although it also amends some other acts, such as the Foreign Assistance Act of 1961, and includes some stand-alone authorities. The Leadership Act and the Lantos-Hyde Act (primarily through amendments to the Leadership Act) created frameworks for how the funds should be spent, established program goals and targets, and established offices for coordinating government-wide responses, among other things. PEPFAR Stewardship Act. In 2013, Congress enacted P.L. 113-56, the PEPFAR Stewardship and Oversight Act of 2013. Unlike its predecessors, this act did not authorize a particular total amount for global HIV/AIDS, TB, and malaria programs. It primarily focused on enhancing oversight for related programs; preserving requirements to apportion 10% of HIV/AIDS funds for orphans and vulnerable children (OVC); mandating that more than half of related funds be spent on HIV/AIDS treatment and care; and requiring that at least 50% of prevention funds be used for activities that promote abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction. https://crsreports.congress go

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