News from the Field on “ABC” and AIDS Prevention

 

USAID Adopts “ABC” as Official AIDS Prevention Policy

The U.S. Agency for International Development (USAID) has adopted as official policy an “ABC” strategy of AIDS prevention. In a December 30, 2002, action cable to all USAID missions, Administrator Andrew Natsios instructed, “Where there are generalized epidemics, a fully balanced approach to the ABCs - abstinence, being faithful, and condoms - should be implemented.” He argued, “Empirical evidence shows that successful programs support a strong emphasis on campaigns that promote abstinence, faithfulness and reduction of the number of partners.”

Concerning partnerships, the new policy states that “Faith-based and community organizations should be engaged in USAID's fight against HIV/AIDS.”

This policy builds on a September 17, 2002, "ABC" Experts Technical Meeting convened by USAID, where leading AIDS prevention experts examined the experience of Uganda and elsewhere in reducing or maintaining low levels of HIV prevalence. The article by Dr. Dorothy Brewster-Lee in this issue of The CCIH Forum is based on her plenary presentation on a faith-based perspective. Other papers presented  at  the  workshop  can  be  accessed  on  the  Internet at <www.synergyaids.com/show.asp?id=3750&type=18>.

The ABC strategy is controversial in AIDS expert circles. Many western AIDS experts doubt the efficacy of A and B approaches to behavioral change and focus instead on promoting condoms and other medical/technological approaches. The Uganda success has put these people on the defensive, however. Others, including some religious groups, are cautious or opposed to condoms, believing they promote irresponsible or sinful behavior. Despite the debate, there is a growing consensus that all tools - A, B and C - should be used in a comprehensive, balanced program for the highest impact on reducing the spread of HIV.

The Agency has also developed new indicators for monitoring and evaluating of HIV-prevention programs consistent with an ABC framework, to include median age of sexual debut, percentage of people reporting multiple partners, and condom use with non-regular partners.

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Christian AIDS Specialists Wanting to Be Heard

Christians working on AIDS are seeking to share their experiences at the International Conference on AIDS and STIs in Africa (ICASA) September 21-26, 2003 in Nairobi. Christians are finding a receptive attitude by the organizers of ICASA. Stung by the anti-religion tendencies of the International HIV/AIDS Conference in Barcelona last July, Christians are already gearing up for a significant presence at the next international conference scheduled for Thailand in July 2004. A major challenge for churches and Christian agencies is to learn to do a better job of monitoring and evaluating their efforts so they can document their achievements following scientific principles.  

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United States Announces Big Increase in AIDS Funding

U.S. President Bush surprised and pleased AIDS activists, by announcing in his 2003 State of the Union address, a five-year commitment of $15 billion to fight AIDS internationally, nearly tripling of current levels. His announcement marks a significant shift in US funding for international AIDS programs, for the first time embracing treatment with anti-retroviral (ARV) drugs as a viable and legitimate goal, as well as, apparently, the use of generic drugs.

Officials said that half the funding would be for drugs, about 15% for care, and one-third for prevention, which would include education, behavioral modification, treatment of sexually transmitted diseases, abstinence programs, mother-to-child transmission prevention, and condom distribution.

What brought about this major commitment to increase funding? Administration officials said the AIDS crisis had become a major cause for evangelical Christians, many of whom are affiliated with missions in Africa. Bush has close ties with these groups. Also, AIDS activists have campaigned relentlessly for increased funding. AIDS specialists suggest that the new interest in ARV treatment came as the Administration saw mounting evidence that AIDS treatment can work in Africa. And Uganda’s success in reducing HIV prevalence provided evidence that prevention can make a real impact.

While pleased by the expanded funding, many are troubled by Bush's decision to largely bypass the multilateral Global Fund, instead earmarking 90% of new funding for bilateral aid agreements with 14 African and Caribbean countries. Also, some fear that this increase in AIDS funding will come at the expense of child survival or other priority development accounts.

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New Center for Faith-Based and Community Initiatives at USAID

On December 12, 2002, U.S. President George W. Bush signed an executive order to establish at USAID a Center for Faith-Based and Community Initiatives. The purpose is to facilitate the development of innovative pilot projects and the expansion of partnerships between the U.S. Government and faith-based and other community organizations to combat poverty and facilitate delivery of services to the poor. USAID Administrator Andrew Natsios commented that “USAID's long-standing successful partnerships with private voluntary organizations, including faith-based organizations, have been highly effective and efficient in implementing USAID programs around the world, which non-government organizations are uniquely qualified to pursue. These partnerships help USAID maximize its resources. USAID's work with private voluntary partners accounted for 35% of USAID's development assistance programs from 1995 to 2000."

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Donors Actively Seeking Partnerships with Faith-Based Groups

CCIH and other faith-based leaders are observing a sudden increase of interest by donors and major global institutions in partnering with faith-based organizations (FBO). President Bush wants to involve FBOs in the major funding increase for AIDS he announced recently. USAID just signed an agreement for a $50 million project with a consortium including the World Council of Churches to make small AIDS grants to faith-based and community-based organizations working on the frontlines. The Global Fund leadership very much wants to support the scaling up of FBO programs, and it has recently signed an agreement with the Lutheran World Vision, by working closely with the Global Fund-related Country Coordinating Mechanisms, has been included in approved projects that could bring it as much as $10 million in 13 countries.

The World Bank is wondering whether FBOs can become greater recipients of its funding in countries with loans or grants under their Multi-Country AIDS Program. Even UN agencies, which have been slow to reach out to FBOs, are seeing the need to work with religious communities to fight AIDS. Good intentions do not translate quickly and easily into funding, however, and many FBO leaders remain impatient and skeptical, waiting to see the money.

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Documenting the Contribution of Churches to AIDS Control

There is growing interest by both faith-based organizations and global institutions to research and document more extensively the impact that religious organizations have on AIDS. A recent study by Dr. Jeremy Liebowitz, entitled The Impact of Faith-Based Organizations on HIV/AIDS Prevention and Mitigation in Africa can be accessed at www.und.ac.za/und/heard/publications/FBOs%20paper_Dec02.pdf

UNAIDS has sought FBO advice on indicators for evaluating programs. USAID is funding research to understand better the respective contributions of “A,” “B” and “C” in AIDS prevention, as well as the role that FBOs have played in behavioral change. Several donors are interested in a CCIH initiative to improve monitoring and evaluation of small projects implemented by churches. CCIH is planning to inventory Christian medical and health institutions and resources in developing countries. Christian Health Associations in Africa, along with others, are gathering information on AIDS programs of churches. Look for much more information to become available in the coming months and years.

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Examples of Christian Projects Including Abstinence and Fidelity

CCIH is compiling descriptions of good Christian projects addressing AIDS, malaria, and TB. See Compendium: Church & Christian NGO projects on the website, www.ccih.org. The following projects address abstinence and/or fidelity:

Ø      Anti-STDs/AIDS Youth International (ASAYI)

Ø      Family Impact Building Families

Ø      Fellowship of Christian Students Aid for AIDS

Ø      Metropolitan Edu-Aids Project

Ø      Mobilizing for Life

Ø      Tshepong Counseling Network

Ø      The ECWA AIDS Ministry (TEAM)

Ø      Organization of African Instituted Churches (OAIC)

Ø      Undergirding Abstinence within a Sexuality Education Program