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Updated March 6, 2019
PEPFAR Stewardship and Oversight Act: Expiring Authorities
Congress has prioritized fighting HIV/AIDS globally,
PEPFAR-Related Legislation
having authorized related activities and appropriated over
The Leadership Act. In January 2003, President George
$76 billion for HIV/AIDS programs since FY2001 (Table
W. Bush announced PEPFAR. PEPFAR supports a wide
1). The 108th and 110th Congresses enacted two pieces of
range of HIV/AIDS prevention, treatment, and care
legislation that have shaped U.S. responses to these
activities and is the largest commitment by any nation to
diseases: the “Leadership Act” of 2003, P.L. 108-25, and
combat a single disease. Later that year, Congress enacted
the “Lantos-Hyde Act” of 2008, P.L. 110-293. Among
the United States Leadership Against HIV/AIDS,
other things, these acts authorized appropriations for the
Tuberculosis, and Malaria Act of 2003, P.L. 108-25, which
President’s Emergency Plan for AIDS Relief (PEPFAR), a
authorized $15 billion to be spent from FY2004 to FY2008
government-wide initiative to combat global HIV/AIDS.
on bilateral and multilateral HIV/AIDS, TB, and malaria
programs. The Leadership Act (and the legislation that it
In 2013, when authorizations in the Lantos-Hyde Act were
amends) is the primary vehicle through which U.S. global
set to expire, congressional commitment to fighting
assistance for fighting these diseases is authorized. The act
HIV/AIDS remained strong, but concerns about recovering
included language to instruct how the funds should be
from the Great Recession had depressed support for
spent, list program goals and targets, and establish the
enacting legislation that authorized the provision of billions
Coordinator of the United States Government Activities to
of dollars over several years. Ultimately, the 113th Congress
Combat HIV/AIDS Globally (known as the Global AIDS
enacted P.L. 113-56, the “Stewardship Act” of 2013, which
Coordinator) at the Department of State. The Office of the
did not authorize a particular amount, but permitted further
Global AIDS Coordinator (OGAC) distributes the majority
appropriations, extended programs, and enhanced oversight.
of the funds it receives from Congress for global HIV/AIDS
Many of these provisions were set to expire at the end of
programs to U.S. federal agencies and departments and
FY2018 (Table 2).
multilateral groups like the Global Fund to Fight AIDS,
Tuberculosis and Malaria (Global Fund).
On November 13, 2018, the House passed H.R. 6651, the
PEPFAR Extension Act of 2018. The bill was agreed to in
The Lantos-Hyde Act. In 2008, Congress enacted the Tom
the Senate and presented to the President on November 30,
Lantos and Henry J. Hyde United States Global Leadership
2018. The President signed the bill into law on December
Against HIV/AIDS, Tuberculosis, and Malaria
11, 2018. Among other things, the PEPFAR Extension Act
Reauthorization Act of 2008, P.L. 110-293, which amended
the Leadership Act to authorize the appropriation of $48
required the Inspectors General of the Department of
billion for global HIV/AIDS, TB, and malaria efforts from
State, Broadcasting Board of Governors, HHS, and
FY2009 to FY2013. The Lantos-Hyde Act mostly amends
USAID to jointly coordinate annual plans for oversight
the Leadership Act, although it also amends some other
activities through 2023;
acts, such as the Foreign Assistance Act of 1961, and
required the Global AIDS Coordinator to publish
includes some stand-alone authorities. The Leadership Act
annually reports on HIV/AIDS spending by the U.S.
and the Lantos-Hyde Act (primarily through amendments to
government, the Global Fund, and governments in
the Leadership Act) created frameworks for how the funds
partner countries through 2024;
should be spent, established program goals and targets, and
established offices for coordinating government-wide
limited U.S. Global Fund contributions to 33% of all
responses, among other things.
contributions received and permit withholding portions of
those contributions through 2023;
PEPFAR Stewardship Act. In 2013, Congress enacted
required that more than half of U.S. international
P.L. 113-56, the PEPFAR Stewardship and Oversight Act
HIV/AIDS appropriations be used for treatment of
of 2013. Unlike its predecessors, this act did not authorize a
HIV/AIDS and other associated opportunistic infections,
particular total amount for global HIV/AIDS, TB, and
as well as nutritional support and medical care for people
malaria programs. It primarily focused on enhancing
living with HIV/AIDS through 2023; and
oversight for related programs; preserving requirements to
apportion 10% of HIV/AIDS funds for orphans and
required that at least 10% of funds be used on care and
vulnerable children (OVC); mandating that more than half
support for orphans and vulnerable children until 2023.
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.
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PEPFAR Stewardship and Oversight Act: Expiring Authorities
Table 1. Appropriations for Global HIV/AIDS Programs: FY2001 Enacted-FY2019 Enacted
(current U.S. $ bil ions)
Bush Administration
Obama Administration
Trump Administration
FY01-FY08
FY01-FY08
FY09-FY16
FY09-FY16
FY17
FY18
FY18
FY19
Enacted Total
Average
Enacted Total
Average
Enacted
Request
Enacted
Enacted
State HIV/AIDS
8,663.6
1,083.0
31,185.2
3,898.2
4,228.5
3,850.0
4,320.0
4,370.0
Global Fund
2,858.4
357.3
9,376.1
1,172.0
1,321.4
1,125.0
1,350.0
1,350.0
USAID HIV/AIDS
2,412.7
301.6
2,459.6
307.4
323.0
0.0
330.0
330.0
CDC HIV/AIDS
918.4
114.8
891.4
111.4
125.5
69.5
128.4
128.4
NIH HIV/AIDS
1,935.2
241.9
3,085.1
385.6
422.8
a
a
a
DOD HIV/AIDS
42.1
5.3
53.2
6.6
0.0
0.0
0.0
8.0
DOL HIV/AIDS
30.3
3.8
0.0
0.0
0.0
0.0
0.0
0.0
Total HIV/AIDS
16,860.9
2,107.6
47,050.6
5,881.3
6,421.2
a
a
a
Source: Created by CRS from appropriations legislation and correspondence with CDC and USAID legislative affairs offices.
Abbreviations: U.S. Department of State (State), U.S. Agency for International Development (USAID), U.S. Centers for Disease Control and Prevention
(CDC), U.S. Department of Defense (DOD), National Institutes of Health (NIH), tuberculosis (TB), HIV/AIDS, TB, and malaria (HTAM), not specified (n/s)
Notes: Congress appropriated funds to the Department of Defense for global HIV/AIDS activities from FY2001 through FY2015. After FY2015, al support for
DOD HIV/AIDS activities were provided through appropriations to the State Department.
a. NIH international HIV/AIDS Research is funded through the Office of AIDS Research. Congressional budget justifications typical y include annual funding
levels, but not requested funding levels. CRS did not aggregate the total since FY2018-requested and FY2019-enacted levels are not yet available.
Table 2. Authorities in the PEPFAR Stewardship Act Set to Expire in 2018 or 2019
Date of
Section and Title
Summary of Language
Expiration
Sec. 2 Inspector General
Directs the Inspectors General of the Department of State and Broadcasting Board of Governors,
September
Oversight amends 101(f)(1) of
the Department of Health and Human Services (HHS), and the U.S. Agency for International
30, 2018
the Leadership Act
Development (USAID) to jointly develop annually coordinated plans for overseeing global HIV/AIDS,
TB, and malaria programs.
Sec. 3(a) Annual Study
Directs the Global AIDS Coordinator to annually complete a study of treatment providers, including September
amends Sec. 101(g) of the
a description of the per-patient cost of providing treatment and care for people with HIV/AIDS,
30, 2019
Leadership Act
human and fiscal resource requirements for HIV/AIDS programs, and spending by the Global Fund
to Fight AIDS, Tuberculosis, and Malaria (Global Fund) and by partner countries.
Sec. 4(a)(1)(A) Limitation
Prohibits U.S. contributions to the Global Fund from exceeding 33% of all funds donated to the
September
amends Sec. 202(d)(4)(A)(i) of
Fund.
30, 2018
the Leadership Act
Sec. 4(a)(1)(C)(vi) amends Sec. Requires the Department of State to withhold contributions to the Fund commensurate to the
September
202(d)(4)(A)(i ) of the Leadership amount the Fund provided to a country that the President has determined repeatedly provided
30, 2018
Act
support for acts of international terrorism.
Sec. 4(b) Withholding Funds Permits any amounts withheld from the Global Fund to be used for bilateral HIV/AIDS, TB, and
September
amends Sec. 202(d)(4)(A)(iv)
malaria programs.
30, 2018
Sec. 4(b)(1)(A) amends Sec.
Authorizes withholding 20% of Global Fund contributions until the Secretary of State certifies that
September
202(d)(5) of the Leadership Act
certain reporting and evaluation requirements are met.
30, 2018
Sec. 6(a)(1) Orphans and
Requires that at least 10% of funds appropriated for bilateral HIV/AIDS programs be expended for
September
Vulnerable Children amends
programs targeting orphans and vulnerable children affected by HIV/AIDS.
30, 2018
Sec. 403(b) of the Leadership Act
Sec. 6(b)(1) Allocation of
Requires that more than half of funds appropriated for bilateral HIV/AIDS programs be expended on September
Funding amends Sec. 403(c) of
the provision of treatment, care and nutritional support for people living with HIV/AIDS.
30, 2018
the Leadership Act
Source: Created by CRS from P.L. 113-56, the PEPFAR Stewardship and Oversight Act of 2013.
Tiaji Salaam-Blyther, tsalaam@crs.loc.gov, 7-7677
IF10797
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