New groups are springing up to win a piece of President Bush’s $15 billion AIDS program, with traditional players and religious groups joining forces to improve their chances in a competition that already has targeted nearly a quarter of its grants for faith-based organizations.
The administration is putting out a call for new community and church groups to get involved in HIV prevention and care in 15 target countries, most in sub-Saharan Africa. It is reserving $200 million specifically for groups with little or no government grant experience.
Groups that have deep local ties in the countries and focus on abstinence and fidelity — instead of just condoms — are faring well.
“The notion that because people have always received aid money that they’ll get money needs to end,” Deputy Global AIDS coordinator Mark Dybul said in a recent interview with The Associated Press.
“The only way to have sustainable programs is to have programs that are wholly owned in terms of management personnel at the local level.”
Those on the ground in Africa say Bush’s 3-year-old effort is reshaping prevention efforts.
“You have community organizations, some that have operated for decades, asking for money and you have lots of new organizations popping up,” said Sarah Lucas, a development assistance expert who recently toured four countries on the U.S. target list for HIV/AIDS grants.
Award recipients so far include a Christian relief organization famous for its televised appeals to feed hungry children, a well-known Roman Catholic charity and a group run by the son of evangelist Billy Graham, according to the State Department.
The outreach to nontraditional AIDS players comes in the midst of a debate over how best to prevent the spread of HIV. The debate has activated groups on both ends of the political spectrum and created a vast competition for money.
Conservative Christian allies of the president are pressing the U.S. foreign aid agency to give fewer dollars to groups that distribute condoms or work with prostitutes.
Concerns over inexperienced groups
Secular organizations in Africa are raising concerns that new money to groups without AIDS experience may dilute the impact of Bush’s program.
“We clearly recognize that it is very important to work with faith-based organizations,” said Dan Mullins, deputy regional director for southern and western Africa for CARE, one of the best-known humanitarian organizations.
“But at the same time we don’t want to fall into the trap of assuming faith-based groups are good at everything,” he added.
Religious organizations last year accounted for more than 23 percent of all groups that got HIV/AIDS grants, according to State Department estimates. Some 80 percent of all secular and religious grant recipients were based in the countries where the aid is targeted.
Among those winning grants were:
- Samaritan’s Purse, which is run by Graham’s son, Franklin. It says its mission is “meeting critical needs of victims of war, poverty, famine, disease and natural disaster while sharing the Good News of Jesus Christ.”
- World Vision. The 56-year-old Christian organization is known for its TV appeals — some with celebrities such as game show host Alex Trebek — that asked people to support a Third World child.
- Catholic Relief Services. It was awarded $6.2 million to teach abstinence and fidelity in three countries; $335 million in a consortium providing antiretroviral treatment; and $9 million to help orphans and children affected by HIV/AIDs. The group offers “complete and correct information about condoms” but will not promote, purchase or distribute them, said Carl Stecker, senior program director for HIV/AIDS.
- HOPE. The global relief organization founded by the International Churches of Christ recently brought comedian Chris Rock to South Africa for an AIDS prevention event. AIDS grants support HOPE in several countries.
- World Relief, founded by the National Association of Evangelicals. It won $9.7 million for abstinence work in four countries.
Most of the money in Bush’s initiative goes to treatment programs, earning the administration praise for delivering lifesaving drugs and care to millions of HIV-infected patients.
Administration's ‘ABC’ strategy
For prevention, Bush embraces the “ABC” strategy: abstinence before marriage, being faithful to one partner and condoms targeted for high-risk activity. The Republican-led Congress mandated that one-third of prevention money be reserved for abstinence and fidelity.
The U.S. government provided more than 560 million condoms abroad last year, compared with some 350 million in 2001.
Condom promotion to anyone must include abstinence and fidelity messages, U.S. guidelines say, but those preaching abstinence do not have to provide condom education.
The abstinence emphasis, say some longtime AIDS volunteers, has led to a confusing message and added to the stigma of condom use in parts of Africa. Village volunteers in Swaziland maintain a supply of free condoms but say they have few takers.
“This drive for abstinence is putting a lot of pressure on girls to get married earlier,” said Dr. Abeja Apunyo, the Uganda representative for Pathfinder International, a reproductive health nonprofit group based in Massachusetts.
“For years now we have been trying to tell our daughters that they should finish their education and train in a profession before they get married. Otherwise they have few options if they find themselves separated from their husbands for some reason,” Apunyo said.
An AIDS program pastor in Uganda explained his abstinence teaching to unmarried young people.
“Why give an alternative and have them take a risk?” asked the Rev. Sam Lawrence Ruteikara of the Anglican Church of Uganda, a U.S. grant recipient. “This person doesn’t have a sexual partner, so why should I report too much, saying that in case you get a sexual partner, please use a condom. I am saying, please don’t get a sexual partner — don’t get involved because it is risky.”
U.S.-backed programs have spread abstinence and faithfulness education to more than 13 million people in Uganda, according to the State Department. Officials promote the nation as an “ABC” model, with its HIV infection rate down by more than half in a decade.
Rep. Chris Smith, R-N.J., said that on a tour of Uganda in January he saw pro-abstinence rallies and skits praising Bush, and U.S.-supported groups conducting house-to-house testing, care and counseling.
“The good news about the faith-based groups is not only the passion they bring to the work, but it is the moral authority and the extended numbers of volunteers they can mobilize to get the word out,” Smith said.
Accusations of a distortion campaign
But Smith believes the administration is wrongly supporting some nonprofit groups. He and several other congressional conservatives wrote to Bush and the U.S. Agency for International Development, or USAID, contending that several large grant recipients were pro-prostitution, pro-abortion and not committed enough to abstinence priorities.
The letters followed a briefing last year by Focus on the Family, run by Christian commentator James Dobson. The group’s sexual health analyst, Linda Klepacki, said even some religious groups emphasize condoms over abstinence.
“We have to be careful that the president’s original intent is being followed where A and B (abstinence and faithfulness) are the emphasized areas of the ABC methodology,” she said.
Six congressional Democrats, in a letter last week to Secretary of State Condoleezza Rice, accused the conservatives of a distortion campaign that undermines a balanced approach to fighting AIDS.
“Their attack is based on a narrow, ideological viewpoint that condemns condoms and frames any attempt to reach out to high-risk populations as an endorsement of behaviors that these critics oppose,” said Rep. Henry Waxman, D-Calif.
USAID has declined to renew funding for two major AIDS-fighting consortiums, CORE and IMPACT, headed by organizations the conservatives targeted.
CORE, whose lead partner is CARE, is losing its central source of money, meaning its work survives only if it can win grants from individual USAID missions in target countries.
Political motivation denied
Family Health International, the lead organization of IMPACT, brought hundreds of local and religious groups into its $441 million project, but was told the administration wants new partners, said Sheila Mitchell, senior vice president of FHI’s Institute for HIV/AIDS.
Dybul said the changes are in keeping with the shift to local groups. Any suggestion of political motivation is “inaccurate and offensive to people doing this work,” he said. Millions of grant dollars still go to the groups that were criticized.
One grant was delayed when Sen. Tom Coburn, R-Okla., complained last year about renewing $14 million to Population Services International, a leading nonprofit condom distributor.
The group’s bingo-style games that teach Guatemalan prostitutes about safe sex misused funds “to exploit victims of the sex trade,” Coburn said. But Sen. Larry Craig, R-Idaho, then wrote to praise PSI’s work as “provably effective and efficient.”
USAID divided the grant; condom distribution was separated into the smaller part so that religious groups could apply for the other part. PSI eventually won the larger grant. The second is outstanding.
Although administration critics frequently cite PSI as a group that fell from favor under the new initiative, “we have not been eviscerated,” said Stewart Parkinson, a senior program analyst.
The group lost U.S. grants in Uganda and Tanzania but retained others. And Parkinson said he had no indication of political motivation.