World Vision International

The organization is known for providing access to clean water, food and education for sponsored children, and more recently has tackled natural disaster and HIV/AIDS relief

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Measuring the success of World Vision's efforts might require little more than turning on a TV. The Christian relief organization has capitalized on direct funding appeals since 1950, most notably commercials featuring hungry children in impoverished countries that encourage child sponsorship.

The result? Almost $650 million in annual direct giving in fiscal 2005, supplying the bulk of World Vision's $900 million revenue that year.

World Vision has spread its wealth over nearly 100 countries in which its 22,000 employees work to improve the lives of Third World children and families. The organization is known for providing access to clean water, food and education for sponsored children, and more recently has tackled natural disaster and HIV/AIDS relief.

Child and family sponsors, whom World Vision calls "stewards of God's resources," are the nonprofit's primary funders, but a fair share of the budget is also supported by the U.S. government.

In fiscal 2005, World Vision received more than $240 million in federal funding, continuing a 30-year financial relationship. Although direct sponsorship can be used to provide "spiritual nurture" and all employees must assent to a statement of Christian faith, World Vision said its government funds are not used for religious purposes.

In HIV/AIDS relief specifically, World Vision's prevention, care and advocacy work has been largely financed through U.S. Agency for International Development (USAID) grants.

Its work has carried over into the President's Emergency Fund for AIDS Relief (PEPFAR), the Bush administration's five-year, $15 billion initiative to fight HIV/AIDS in the world. Through PEPFAR, World Vision administered more than $11.7 million for programs in Haiti, Kenya, Mozambique, Tanzania, Uganda and Zambia in 2005.

Its 2005 funding ranked World Vision as PEPFAR's second most highly funded faith-based organization, a controversial designation. PEPFAR critics say President Bush has favored faith-based groups — or "armies of compassion," as he has called them — especially because PEPFAR emphasizes sexual abstinence until marriage as "the best and only certain way" of preventing the spread of the disease.

HIV/AIDS work and PEPFAR programs

In 2003, World Vision sponsored a 15-city tour across the United States for evangelical leaders. It was intended to drum up support for HIV/AIDS relief in American communities where Richard Stearns, president of World Vision, has said many evangelical Christian circles have attached a stigma of immoral fault on infected individuals.

The stigma has discouraged Christians from donating to relief efforts, Stearns said while on tour. In response, World Vision has been working since 1990 in challenging Christians to be "good Samaritans on the Jericho road of AIDS," largely by stressing the millions of children orphaned by HIV/AIDS — a number the United Nations has predicted could reach 25 million by 2010.

"World Vision chose to take a stand because the pandemic is growing and has the potential to undermine the long-term development work in poor communities where our organization has been active for decades," World Vision officials told the Center for Public Integrity in an e-mail message.

The organization ramped up its efforts in 2000 with the Hope Initiative, a strategy that mainly sought donations to care for orphans and vulnerable children, help communities care for and treat those infected by HIV/AIDS, and target children with prevention messages. The initiative also included forming "community care coalitions" to provide home aid, getting churches to talk about the epidemic and reduce stigmas, and, among other outreach activities, partnering with government health agencies to gear up programs to prevent mother-to-child disease transmissions.

World Vision built on its Hope model when PEPFAR came into being, particularly in sub-Saharan Africa. There, the organization has been helping communities support 370,000 orphans and vulnerable children and is aiming to bring that number up to 2 million over the next five years.

In Zambia, for example, World Vision received PEPFAR funding to lead a six-year program that in fiscal 2005 was allocated $8.6 million, its largest grant that year. The initiative includes five other large organizations and is targeted towards scaling up efforts, especially in caring for orphans and vulnerable children.

Documents from the U.S. State Department's Office of the Global AIDS Coordinator (OGAC) obtained by the Center for Public Integrity through a Freedom of Information Act request indicate that in 2005, the program aimed to provide care and support for 307,000 children and their families and fund up to 300 local faith- and community-based organizations to provide care based on individual community needs.

World Vision and other faith-based groups' efforts with children haven't gone unnoticed. In the 2006 annual report of the Joint United Nations Program on HIV/AIDS, faith-based organizations and churches were cited as being "among the first to deliver treatment, care and support to people living with HIV and dying of AIDS, and to address the needs of orphaned children."

But the State Department documents also detail PEPFAR's abstinence advocacy programs, which one high-ranking U.N. official has called a "dogma-driven policy that is fundamentally flawed."

AB vs. C debate

In 2003, Congress authorized PEPFAR and its multifaceted prevention, care and treatment structure. In doing so, it also endorsed the so-called ABC approach to prevention, through "Abstinence," "Be Faithful" to one partner and the correct and consistent use of Condoms.

Under the ABC strategy, one-third of all PEPFAR funding for prevention programs and two-thirds of sexual transmission prevention funding must be spent on programs that encourage the "A" and "B" components. The spending requirements, in turn, have trickled down into efforts implemented by contractors, especially faith-based organizations such as World Vision.

PEPFAR especially emphasizes youth abstinence programs, backed by the statistic that half of new infections afflict the 15- to 24-year-old age group.

Critics inside and outside the government argue that the policy distorts the emphasis on prevention techniques in favor of AB, curbs condom distribution and ironically leaves those not in at-risk populations at greater risk of contracting the virus. Some critics also associate the policy with the faith-based "armies of compassion" that they say Bush has favored.

Abstinence education is dominant in World Vision's ARK program, which is fully funded by PEPFAR. ARK aims to use peer leadership and small group support to encourage abstinence and monogamy. Ten- to 14-year-olds receive education on the importance of future faithfulness in a marriage, while those ages 15 to 24 receive general AB messages.

And according to Dr. Elie Nicolas, World Vision's manager of Health and HIV in Haiti, young people who aren't married but are sexually active are encouraged to practice "secondary abstinence," or to become abstinent again.

The Zambia program also has a large AB component, one that in 2005 aimed to train 30 faith-based organizations to run abstinence-only programs, set up youth sport camps that would also train abstinence peer educators and train advisers to promote abstinence and faithfulness in girls' "coming of age" ceremonies, according to government documents. All in all, 23,400 youth were to be reached with abstinence and faithfulness messages.

World Vision's prevention efforts are geared overwhelmingly toward AB education, but the organization said that through ARK and other efforts, it also conducts prevention lessons for youth and others who are already sexually active, including referrals to where they can get condoms.

In an e-mail to the Center for Public Integrity, World Vision officials stated their official condom policy: "While World Vision emphasizes abstinence and fidelity within marriage, World Vision recognizes that not all people can or will choose to be abstinent, and that even within marriages one or both spouses may be HIV-positive … and therefore recommends the consistent and correct use of condoms for harm reduction."

Condom promotion has also been controversial, but for a different assortment of critics. Condom policies have caused a rift among Christians supporting HIV/AIDS work. James Dobson, the leader of the evangelical Christian group Focus on the Family, has charged a global relief effort to which the U.S. contributes with promoting "legalized prostitution and all kinds of wickedness around the world" and specifically said PEPFAR's "terrible" condom programs are "immoral as well as ineffective."

Much to the dismay of Dobson and other conservative Christians, World Vision is reported as promoting condoms for sex workers. The Vietnam Investment Review wrote in April 2005 that World Vision Vietnam finalized PEPFAR plans for a roughly $65,000 prevention program. Part of the program would offer condoms to high-risk individuals such as drug users and sex workers in Vietnam, a continuation of World Vision's efforts there.

But despite the ideological gaps that surround PEPFAR, World Vision said other organizations see it as a "bridge builder" between religious and secular groups fighting HIV/AIDS — and that's all in the name of "Christ-like living and caring actions."