I used to write grants for the medical and public health schools of a medical research university, and I often helped public health researchers write grants for HIV/AIDS programs in Africa.  Time and again, they scoffed at faith-based groups in Africa who preached abstinence and fidelity.  They never said quite why they didn’t approve of these methods, but you got the feeling that they thought preaching morals was imperialistic and, well, moralizing.  Instead, they wanted AIDS education and AIDS medication (both good things, but not enough by themselves).  In other words, they didn’t want to step on their own pluralistic toes by suggesting that something was fundamentally flawed in African culture and in the worldviews of certain peoples, so they dared not suggest these good people change their view of right sexuality.  A new report on all this is discussed at great length at First Things.

Katherine Marshall and Lucy Keough, lead authors of the report, are clearly uncomfortable with approaches to HIV prevention that emphasize sexual responsibility, behavior change, and morally based messages. They praise the work and compassion of faith communities in treating and caring for people ­living with AIDS and their families, yet harshly ­criticize the messages of faith communities for increasing the stigma of AIDS. Their discomfort with attempts to change sexual behavior is evident early in the report, when, for example, they muse: “Should the focus be on changing the behaviors that contribute to HIV/AIDS? (Is that possible? Desirable? How? With what assurance?)”

Education and medicine bring change, but the gospel brings the most fundamental change in all of history.  That’s why it works in the fight against AIDS/HIV.

Who said it? Pat Robertson? Fred Phelps? No, it was Matt Foreman, outgoing director of the National Gay and Lesbian Task Force, in a ”State of the Movement” address he delivered on Feb. 8.

Today, right now, more than 45 percent of African-American gay and bi men in key urban areas are infected with HIV, with a 33 percent increase in new diagnoses among our brothers under age 30 over the past six years. Today, right now, African Americans are nearly 10 times more likely than white people to be diagnosed with AIDS.

The response - internal to our community and external - is appallingly racist. Internally, when these numbers come out, the “established” gay community seems to have a collective shrug as if this isn’t our problem. Folks, with 70 percent of the people in this country living with HIV being gay or bi, we cannot deny that HIV is a gay disease. We have to own that and face up to that.

Foreman is not the first gay activist to buck the politics of AIDS in order to focus attention on the highest number of victims.  A little over a year ago, the Los Angeles-based Gay and Lesbian Center launched a provocative AIDS awareness campaign with the slogan, “HIV is a Gay Disease.  Own it.  End it.”

The campaign drew cat-calls with many critics saying such frank talk would ratchet up anti-gay bigotry. Others were more measured, such as one columnist who wrote, “Time will tell whether the in-your-face approach to shaking everyone out of complacency translates to a resurgence of bigotry and stigmatism - and whether the number of lives of young L.A. men saved outweighs that.”

With Foreman’s statement, it appears some gay activists are now ready to admit that suppressing the epidemiological facts about AIDS is no longer worth the high cost in lives.

In his State of the Union address this week, President Bush repeated a request he made in May to double funding for global AIDS work. The President’s Emergency Plan for AIDS Relief (PEPFAR), enacted in 2003, is now treating 1.4 million people in 15 focus countries around the world.

While no one argues over whether PEPFAR funding should be renewed, some say doubling the funds may not be sufficient. While Democrats wish to triple the funding to $50 billion, David Bryden, spokesman for the Global AIDS Alliance, said the figure should be closer to $59 billion.

Other issues also cause controversy among PEPFAR recipients and members of Congress such as requirements to allocate one-third of prevention money to abstinence programs. Other provisions block funds from groups that perform abortions and that aid prostitution. Outside of Democrats’ opposition to these provisions, others worry that the focus on AIDS could drain resources for other health care needs.

World Vision, a Christian relief and development organization, receives more than $150 million from PEPFAR grants now implemented in 14 countries. Director of corporate communications Dean R. Owen told WoW the organization focuses on caring for vulnerable children and especially those who have lost parents to AIDS.

Owen agreed that $30 billion does not meet global resource requirements that would ensure universal access to treatment, care and prevention by 2010: “Regrettably, the President’s request . . . is a doubling of the original bill in 2003, but not of current appropriations.”

He also explained that when PEPFAR was initiated, “prevention measures were narrowly focused,” and AIDS treatment did not focus on wide dissemination of drugs. The requirements helped distribute treatment effectively and support behavior change programs. This is necessary to accomplish World Vision’s goals of slowing the progression of the disease and also preventing its transmission, “something that will only be achieved in the foreseeable future through behavior change.”

Has Bill Gates poured $8.5 billion into programs that are doing just as much harm as good? LA Times questions whether the money Gates has devoted to global health causes is well-spent.

Critics say that Gates is funding much-needed vaccines and AIDS pills, but diverting attention from the true killers: poverty, ignorance, hunger, and poor hygiene. Patients may receive free AIDS pills from the Global Fund to Fight Aids, Tuberculosis, and Malaria, but the patients vomit them up because they are starving. Mothers may owe their lives to the pills, but their infants are dying in filthy hospitals for lack of a $35 oxygen tube.

LA Times poses three concerns. First, the Global Fund has diverted staff from basic health care, replacing well-trained clinicians with inferior staff. In Rwanda, for instance, the Global Fund pays its nurses $175 to $200 a month, while other nurses earn $50 to $100 a month. A Lesotho government official said the problem could be solved by taking a fraction of Global Fund’s funding to fund pay raises for other government health pay professionals.

Second, the focus on a few high-profile diseases has diverted attention from nutrition and transportation. The clinics are there, but some patients have to walk nine hours to reach them. One nurse told Times that four out of her five patients ate fewer than three meals a day, and most of them were dying of hunger as well as AIDS.

Finally, programs actually tell caregivers to ignore the possibility of other diseases. During vaccination drives, program directors tell caregivers that addressing other health concerns slows the vaccination lines.

Global Fund director Michel Kazatchkine said the Global Fund “cannot resolve all the problems of all the people.” The Global Fund has given 1% of its funds to helping local health systems, but it adds that its task is treating AIDS, TB, and malaria, not propping up local health systems. To take over would weaken African countries that need to learn to support themselves.

Hillary Clinton took to the pulpit again yesterday, this time at Rick Warren’s Saddleback Church in SoCal. The Democratic presidential hopeful spoke at Warren’s Global Summit on AIDS and the Church, the same conference her top rival Barack Obama appeared at last year. During her speech, which outlined her plans to combat the AIDS epidemic worldwide, Clinton quoted what she said was her favorite verse: “For as the body without the spirit is dead, so faith without works is dead also” (James 2:26). In using the verse to comment on the necessity of faith in charity efforts, Clinton said, “I have concluded that works without faith cannot be sustained.”

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