2008.21 This reauthorization legislation extended the USG’s commitment to global HIV/AIDS programs for another 5 years, from 2009 to 2013 (PEPFAR II)22 and provided continuity of support in the core program areas that had been initiated by PEPFAR I. The legislation authorized up to $39 billion for PEPFAR bilateral HIV/AIDS programs as well as U.S. contributions to the Global Fund.23 The major contrast in the reauthorization from the original legislation was a focus on a transition to activities and goals that would use different tools and processes for the USG to contribute to a more independent and sustainable response in and by partner countries to their HIV epidemics. The act called for a new 5-year global strategy to expand efforts in the program areas supported by PEPFAR; provide capacity-building assistance to countries; ensure the role of civil society in the response; and identify appropriate criteria, methods, and measures to encourage transparency and benchmarks for success for framework agreements with partner countries for sustainability and accountability.24
The Lantos-Hyde Act of 2008 set performance targets that included the prevention of 12 million new infections worldwide (no proportional goal was stated for women or children), the provision of care for 12 million people living with or affected by HIV/AIDS including 5 million orphans and other children made vulnerable by HIV/AIDS, and the training and retention of 140,000 new health care workers. The reauthorization legislation also established the goal of supporting the provision of ART to people with HIV/AIDS, beyond the initial goal of 2 million under the Leadership Act of 2003, and set new programmatic requirements, many of which were related to prevention activities.25
In addition, it removed almost all of the highly specific fiscal benchmarks that were instituted in the original legislation. The benchmarks remaining were a preservation of the earmark to use 10 percent of funding for orphans and vulnerable children26 and a revision to now require that more than half of the funds be spent on ART and other care and treatment services.27 For prevention, the Lantos-Hyde Act of 2008 required the Coordinator to establish a balanced HIV sexual transmission prevention strategy to govern expenditures for prevention activities in countries with
21Supra, note 1.
22 In this report the program across its entire history is referred to as PEPFAR. When a distinction is made between phases of the program, the program during the years covered in the first legislation and the first Five-Year Strategy (2004–2008) is referred to as PEPFAR I, while the program during the years since the reauthorization legislation and the second Five-Year Strategy (2009–2013) is referred to as PEPFAR II.
23Supra, note 1 at 303(b).
24Supra, note 1 at 101(a).
25Supra, note 1 at 101(a).
26Supra, note 1 at 403(2), 22 U.S.C. 7673(b).
27Supra, note 1 at 403(3), 22 U.S.C. 7673(c).