Religious groups
get larger chunk of U.S. AIDS money

President Bush's $15 billion effort to fight AIDS has handed out nearly one quarter of its grants to religious groups, and officials are aggressively pursuing new church partners that often emphasize disease prevention through abstinence and fidelity over condom use. Award recipients include a Christian relief organization famous for its televised appeals to feed hungry children, a well-known 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. The Bush administration provided more than 560 million condoms abroad last year, compared with some 350 million in 2001.

Secular organizations in Africa are raising concerns that new money to groups without AIDS experience may dilute the impact of Bush's historic three-year-old 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."

The Administration is beginning a broad effort to attract newcomers and distribute money for AIDS prevention and care beyond the large nonprofit groups that traditionally have led the fight.

The New Partners Initiative reserves $200 million through the 2008 budget year for community and church groups with little or no background in government grants. Some may have health operations in Africa but no experience in HIV work. Others may be homegrown groups in Africa that have not previously sought U.S. support.

"The notion that, because people have always received aid money, they'll get money needs to end," deputy U.S. global AIDS coordinator Mark Dybul said. "The only way to have sustainable programs is to have programs that are wholly owned in terms of management personnel at the local level."

Large nonprofit groups involved in health and development projects typically enlist local religious groups because of their deep community ties.

The goal now is to penetrate hard-to-reach corners of the target countries--13 in Africa as well as Haiti and Vietnam--and bring aboard community and faith groups that previously lacked expertise to win grants, Dybul said.

Religious organizations last year accounted for more than 23% of all groups that got AIDS grants, according to the State Department. Some 80% 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 ask viewers to support Third World children.

* 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 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 patients.

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. 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 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."

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 Reverend 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."

Secular activists say it is not realistic to expect all teenagers to abstain from sex and that teenagers also should be taught how to protect themselves.

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, a New Jersey Republican, 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.

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, contending that several large grant recipients were pro-prostitution, pro-abortion, or not committed enough to Bush's abstinence priorities.

The letters followed a briefing last year by Focus on the Family, run by Christian commentator and Bush ally 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 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, a California Democrat.

USAID has declined to renew funding for two major AIDS-fighting consortiums, CORE and IMPACT, headed by organizations the conservatives targeted. Those two groups fund hundreds of community and religious-based organizations.

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.

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, an Oklahoma Republican, last year complained about renewing $14 million to Population Services International, a leading nonprofit condom distributor. The group's bingo-style games that teach Guatemalan prostitutes about safer sex misused funds "to exploit victims of the sex trade," Coburn said. Sen. Larry Craig, an Idaho Republican, 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. (AP)