12 2 STA T . 2 9 2 0PUBLIC LA W 110 – 29 3—J UL Y 30 , 200 8inare a sofh i g h HIVp re v a l en c e m a yb ev u lnerable t o the d isease or its socioeconomic effects .‘ ‘ (38)L ac k of health capacity , including insufficient per - sonnel and inade q uate infrastructure, in sub- S aharan A frica and other regions of the w orld is a critical barrier that limits the effectiveness of efforts to combat HIV / AI D S, tuberculosis, and malaria, and to achieve other global health goals. ‘‘(3 9 ) O n M arch 3 0 , 2 00 7 , the Institute of Medicine of the N ational Academies released a report entitled ‘ PE P F A R Implementation
Progress and Promise ’ , which found that budget allocations setting percentage levels for spending on prevention, care, and treatment and for certain subsets of activi- ties within the prevention category — ‘‘(A) have ‘adversely affected implementation of the U .S. G lobal AIDS Initiative’
‘‘( B ) have inhibited comprehensive, integrated, evidence based approaches; ‘‘( C ) ‘have been counterproductive’; ‘‘(D) ‘may have been helpful initially in ensuring a balance of attention to activities within the 4 categories of prevention, treatment, care, and orphans and vulnerable children’; ‘‘(E) ‘have also limited PEPFAR’s ability to tailor its activities in each country to the local epidemic and to coordinate with the level of activities in the countries’ national plans’; and ‘‘(F) should be removed by Congress and replaced with more appropriate mechanisms that— ‘‘(i) ‘ensure accountability for results from Country T eams to the U.S. Global AIDS Coordinator and to Congress’; and ‘‘(ii) ‘ensure that spending is directly linked to and commensurate with necessary efforts to achieve both country and overall performance targets for prevention, treatment, care, and orphans and vulner- able children’. ‘‘(40) The United States Government has endorsed the prin- ciples of harmoni z ation in coordinating efforts to combat HIV/ AIDS commonly referred to as the ‘Three Ones’, which includes— ‘‘(A) 1 agreed HIV/AIDS action framework that pro- vides the basis for coordination of the work of all partners; ‘‘(B) 1 national HIV/AIDS coordinating authority, with a broadbased multisectoral mandate; and ‘‘(C) 1 agreed HIV/AIDS country-level monitoring and evaluating system. ‘‘(41) In the Abu j a Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, of April 2 6– 27, 2001 (referred to in this Act as the ‘Abuja Declaration’), the Heads of State and Government of the Organization of African Unity (OAU)— ‘‘(A) declared that they would ‘place the fight against HIV/AIDS at the forefront and as the highest priority issue in our respective national development plans’; ‘‘(B) committed ‘TO TA K E PERSONAL RESPONSI- BILIT Y AND PROVIDE LEADERSHIP for the activities of the National AIDS Commissions/Councils’;
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