The Center for Public Integrity

Background

Mozambique is a large country situated on the southeastern coast of Africa. To the north lie Tanzania and Malawi; Zambia lies to the northwest; Zimbabwe lies to the west; and Swaziland and South Africa lie to the south. Mozambique has a 1500 mile shoreline on the Indian Ocean.

This country of just under 20 million people is divided into 10 provinces. Maputo, the capital, lies on the southern coast. The majority of the population lives below the poverty level, and foreign aid comprises much of the country's budget.

A former colony of Portugal — which controlled of the country for nearly five centuries — Mozambique won independence in 1975, a decade after most other European colonies in Africa had gained autonomy. Portuguese is the official language.

From 1977 to 1992, nearly 1 million Mozambicans died from famine and fighting in conflicts between the ruling Front for the Liberation of Mozambique and the Mozambique National Resistance, a group of rebels funded by South Africa. Though a U.N.-negotiated ceasefire formally ended the fighting in 1992, the countryside remains riddled with landmines.

The face of HIV

AIDS is the leading cause of death for adult Mozambicans and fifth for children under 5. The country has the 10th-highest HIV rate in the world. The first case of AIDS in Mozambique was a Haitian doctor who was diagnosed in 1986 and died three days later.

According to the U.S. Centers for Disease Control and Prevention, the epidemic in Mozambique mainly strikes in areas where there is poverty and limited health care services and in corridors through which large numbers of people pass.

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.

Background

Located on the southwestern coast of Africa, Namibia borders four countries: Angola and Zambia to the north, Botswana to the east and South Africa to the southeast. Except for Angola, all are designated "focus countries" by PEPFAR, the President's Emergency Plan for AIDS Relief, the five-year, $15 billion U.S. initiative to combat AIDS abroad. Namibia was part of Germany's holdings in Africa until World War I, after which the League of Nations transferred control to South Africa. In 1990, after decades of war and international pressure, South Africa released its claim and Namibia attained independence.

The second most sparsely populated country in the world, Namibia is divided into 13 regions that are further divided into 102 constituencies. Windhoek is the capital.

Namibia's economy is very dependent on mining. Twenty percent of its gross domestic product comes from the extractive industries, including uranium and diamond mining. Subsistence farming accounts for the livelihoods of nearly half of Namibia's population.

While Namibia's gross national income per capita is several times that of sub-Saharan Africa's poorest countries, rampant unemployment means most of the population lives below the poverty level.

Like many southern African countries, Namibia has a diverse population. More than 87 percent is black African, with about half of the nation belonging to the Ovambo tribe. Whites and mixed-race groups each comprise about 6 percent of the population.

Afrikaans is the most widely used common language in Namibia, spoken by nearly all blacks and 60 percent of whites. English, the official language, is widely understood among the younger generation. But both languages are generally second tongues, reserved for the public sphere, while indigenous languages are spoken at home. About half of all Namibians speak Oshiwambo, the Ovambo tribe's language.

Clara Barton founded the American Red Cross (ARC) in 1881, out of a desire to offer neutral humanitarian care to Americans "in peace and in war, during times of disaster and national calamity," according to the organization's Web site. Over the years, it has extended its services at home and abroad.

The American Red Cross is one of 66 organizations that have directly received funding from the U.S. government to implement abstinence-until-marriage and fidelity programs overseas. Those are two components of a wider prevention plan implemented by the Bush administration to fight HIV/AIDS, called "ABC" — which is short for "Abstinence, Be faithful and correct and consistent use of Condoms." The $15 billion President's Emergency Plan for Aids Relief (PEPFAR) is a five-year program focusing in the 15 countries with some of the highest HIV prevalence rates in the world, the majority of which are located in Africa. Besides prevention, PEPFAR also includes funding for treatment and care programs.

Funded by a $7 million award since February 2004, ARC has worked in HIV prevention, implementing the "Together We Can" (TWC) program in partnership with national Red Cross societies and Ministries of Health in Guyana, Haiti and Tanzania.

Together for a decade

Just two months before ordering the invasion of Iraq, President Bush in his 2003 State of the Union address asked Congress to appropriate $15 billion for care, treatment and prevention of HIV/AIDS in developing countries. The subsequent President's Emergency Plan for AIDS Relief (PEPFAR) served to burnish his "compassionate conservative" credentials even as he took the nation into war.

Congress authorized the money to be spent over five years primarily in 15 "focus countries," although more than 100 other countries receive smaller amounts. The major goals were to treat those infected with HIV/AIDS, care for those dying of or orphaned by AIDS and prevent the spread of the disease.And it has enabled his administration to funnel tens of millions of dollars to Christian faith-based organizations that support his ideology and form his political base.

"This was an unprecedented moment in history," said Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a Washington-based AIDS advocacy group, and a former official with the U.S. Agency for International Development (USAID). "We've never had this opportunity before. We are the first generation in 100,000 years to have such an opportunity to face a global scourge and defeat it.

"We have the information technology, the communication technology, the transportation technology, the developmental and health systems technology, the biological technology, the global wealth and the moral compass to face this pandemic and change the course, change the reality faster than ever before. There's never been a time when we had all these technologies" to work with.

Dr. Mark Dybul, ambassador for the Office of the Global AIDS Coordinator, refused repeated requests for an interview about the PEPFAR program and its restrictions. But Zeitz was not so reluctant to make an assessment.Despite some successes, PEPFAR has not worked out the way it was envisioned.

The major U.S. government program engaged in the worldwide war on the HIV/AIDS epidemic requires those in the field to tell at-risk communities that latex condoms aren't very reliable in preventing transmission of the disease, and instead to emphasize abstinence and fidelity programs.

But several key government agencies and the condom industry disagree with that approach, saying the message is wrong. They maintain that condoms are a vital weapon in fighting the spread of the disease and that they are more effective than the government program acknowledges.

The report, summarizing a workshop in 2000 co-sponsored by the U.S. Agency for International Development (USAID), the Federal Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, found that condoms are "essentially impermeable to particles the size of [sexually transmitted disease] pathogens."

In 2004, the Joint United Nations Program on HIV/AIDS (UNAIDS), the World Health Organization and the United Nations Population Fund released a joint position statement supporting the availability of condoms universally, not only to the parts of the population that are at high risk for contracting HIV, as the President's Emergency Plan for AIDS Relief (PEPFAR) provides, but also to the general population.

Despite those findings, the $15 billion PEPFAR program has been saying that condoms are only 80 to 90 percent effective. The study cited by PEPFAR giving this low range of effectiveness was not exclusively a latex condom study and could have included natural membrane or lambskin condoms which are not recommended by the CDC for disease prevention.

According to the CDC, "only latex or polyurethane condoms provide a highly effective mechanical barrier." USAID refused to comment on this issue but did confirm that it distributes only 100 percent natural latex condoms.

Background

One of only two West Africa "focus countries" under the President's Emergency Plan for AIDS Relief (PEPFAR), Nigeria borders Benin, Niger, Chad and Cameroon and has a coast on the Gulf of Guinea.

Nigeria is the most populous country in Africa, comprising one-sixth of the continent's population, and ninth in the world. In its 36 states, Nigeria has more than 250 ethnic groups. Since 1991, the capital has been Abuja. Previously it was Lagos, which remains the country's largest city.

Nigeria declared its independence from Great Britain in 1960. For decades, Nigeria was controlled by a series of dictators, except for the period from 1979 to 1983 that was known as the second republic. In 1999, Olusegun Obasanjo became the first democratically elected president in decades. He remains in office to this day.

Nigeria has the largest Muslim population of any PEPFAR focus country: about 66 million people, or 50 percent of its population. Twelve of Nigeria's states follow Sharia, or Islamic, law.

The face of HIV

Nigeria has the third-highest number of people living with HIV/AIDS in the world, behind India and South Africa. The first case of AIDS in Nigeria was diagnosed in 1986. HIV rates tend to be higher in urban areas than rural areas, but more research needs to be done to understand the variations found within the country.

About a third of Nigeria's 36 states have HIV infection rates of over 5 percent. Estimates place 60 percent of new infections in the age group of 15 to 25.

The government program is funded entirely with public money. It has nothing to do with national security. And it appears to spotlight the Bush administration's "compassionate conservative" profile.

It would seem, in other words, to be just the kind of program officials would gladly share with journalists.

But it took about two dozen Freedom of Information Act requests; lawsuits against the State Department, Department of Health and Human Services and U.S. Agency for International Development (USAID); and a yearlong investigation by the International Consortium of Investigative Journalists (ICIJ) to get access to information about the President's Emergency Plan for AIDS Relief (PEPFAR), President Bush's five-year, $15 billion initiative to fight AIDS abroad. PEPFAR is managed through the newly created Office of the Global AIDS Coordinator (OGAC) at the State Department.

During the investigation, reporters encountered PEPFAR officials who couldn't answer basic questions about the program they oversee, recipients of PEPFAR money who were reluctant to criticize their donor out of fear of losing funding and Freedom of Information Act requests that were stalled for months.

In general, U.S. government officials in the field overseas were more knowledgeable and readily available to answer questions than Washington bureaucrats and press officers. Requests for interviews and information from OGAC's Washington office were often ignored; dozens of phone calls and emails were never returned.

About a dozen ICIJ reporters and researchers, working from Uganda, Kenya, South Africa, Ethiopia, Nigeria, Haiti, Thailand and India, investigated the impact of the U.S. government's HIV policies and programs. Additional reporting was done in Washington by ICIJ staff.

WolfBlock Government Relations touts the success of its employees "in this specialized field of Pennsylvania politics" on its Web site. It's not surprising the firm knows how to get results for its clients from the state government: of the six lobbyists with online profiles, five worked as staffers in the state legislature or the governor's office. The sixth member is a former legislator.

Through its six-month investigation of state legislators-turned-lobbyists, the Center for Public Integrity found not only ex-lawmakers cashing in on legislative experience, but government staffers who also moved into private advocacy positions.

Former Michigan Republican House speaker and current lobbyist Rick Johnson told the Center that ex-legislative staffers are probably more powerful and more plentiful in the state lobbying corps than former legislators.

"It's a big deal in term-limited states," Johnson said, because "the staff can be really more influential ... Legislators have a short time to learn, then they're gone. The staffers stick around a while. People say there should be a two-year ban for legislators before they go into lobbying — if you're going to do it for legislators, you should do it for staff."

While a few states prohibit legislative staffers from immediately returning to lobby the statehouse, most do not.

One staffer-turned-lobbyist is David K. Shapiro, who served as budget director of the Massachusetts House Ways and Means Committee and policy advisor to the committee's Democratic chairman, Tom Finneran, who would later serve as speaker. He now represents more than 20 clients, and his bio notes that he "was responsible for drafting and defending the state's $17 billion program budget and acted as chief negotiator on programs and fiscal policies with more than 130 state agencies."

Shapiro's firm, Holland & Knight, operates in several states and employs many former government staffers.

“My little cat … I’m going crazy without you …. You have repeatedly betrayed me, I think …. Little cat, when are you coming? ... I love you, little cat.” On Jan. 4, 2001, Dusanka Pesic Jeknic, representative of the Montenegrin trade mission in Milan, Italy, was speaking on the phone at her home in the southwest of the city. Milo Djukanovic, at that time president of Montenegro, was calling from the capital Podgorica. Billions of people around the world had just hailed the New Millennium. Dusanka, nicknamed “Duska,” the beautiful 41-year-old widow of the late foreign minister of Montenegro, was alone, far from her country. And she spoke out freely about everything: love, tobacco, and crime.