submitted reports on workforce capacity, food and nutrition, supplying antiretrovirals, primary and secondary education for children, and refugees and internally displaced persons (OGAC, 2006b–f).

Performance Targets

The Leadership Act did not provide a rationale for the derivation of the performance targets for prevention, treatment, and care. However, the Committee did learn at one of its public meetings that the prevention target represented roughly half of the expected new infections in the focus countries (Dybul, 2005). The Committee also learned that a group of economists with UNAIDS was consulted to help derive the targets (personal communication, Stefano Bertozzi).

Budget Allocations

The Leadership Act specified several budget allocations that were originally intended as guidance for the first 2 years of the legislation, but many became mandatory beginning in fiscal year 2006. They include the following:

  • 55 percent for “therapeutic medical care of individuals infected with HIV, of which such amount at least 75 percent should be expended for the purchase and distribution of antiretroviral pharmaceuticals and at least 25 percent should be expended for related care”

  • 20 percent for “HIV/AIDS prevention, of which such amount at least 33 percent should be expended for abstinence-until-marriage programs”

  • 15 percent for “palliative care of individuals with HIV/AIDS”

  • Not less than 10 percent for “assistance for orphans and vulnerable children affected by HIV/AIDS, of which such amount at least 50 percent shall be provided through non-profit, nongovernmental organizations, including faith-based organizations, that implement programs on the community level”


The Leadership Act required development of a comprehensive 5-year strategy, guided by the legislation (Box 2-3). The strategy (which includes elements cited in Box 2-4) was developed and presented to Congress by Ambassador Tobias, the U.S. Global AIDS Coordinator, on February 23, 2004, 9 months after the act had been signed into law. The Ambassador stressed that the strategy should be viewed as a “work in progress,” something that

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