The Sen. Paul Simon Water for the Poor Act of 2005 requires the Sec. of State, in consultation with USAID and other U.S. Gov¿t. agencies, to develop and implement a strategy to increase affordable and equitable access to safe drinking water and sanitation within the context of sound water resources management in developing countries. This report represents one point in an evolving process to strengthen the U.S.¿s response to these issues. Contents: Intro.; The Challenge; U.S. Strategy; U.S. Support for Water and Sanitation in FY 2009: Bilateral Assist.; Support to Multilateral Development Banks and International Org.; Activities and Results: Evidence of Aid Effectiveness; U.S. Gov¿t. Assistance in FY 2009; Country Reports. Illustrations