The Center for Public Integrity

Although its name suggests a scholarly focus, the Academy for Educational Development's reach extends far beyond the classroom. AED is organized into 27 "centers of excellence" and has programs in 167 countries, making it one of the world's largest nonprofits addressing human and social development.

AED has forged partnerships with governments, companies and communities around the world, but perhaps none has been more crucial than its relationship with the U.S. government. In fiscal 2004, AED's federal, state and local grants, combined with its program-related revenues (including government contracts) amounted to nearly 80 percent of the organization's quarter-billion-dollar budget.

Government support is vital to the academy's HIV/AIDS efforts. According to Michael Kaplan, vice president and deputy director of AED's Center on AIDS and Community Health, the U.S. government historically has been AED's largest funder for its HIV/AIDS efforts. In 1987, for example, AED was awarded one of the U.S. Agency for International Development's first global HIV/AIDS relief contracts.

AED's work has carried over into participating in the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative to fight AIDS in 15 focus countries (Vietnam, as well as 14 in Africa and the Caribbean) and more than 100 other nations. Through PEPFAR, AED was allocated $11 million in 2005 for its programs in Botswana, Haiti, Kenya, Namibia, Nigeria, South Africa, Tanzania, Vietnam and Zambia.

Background and PEPFAR programs

AED was founded in 1961 as an initiative to study the higher education system in Kansas. Over the next 40 years the organization expanded domestically and internationally to help build local sustainability. AED now also focuses on environment and energy policy, health, youth initiatives, leadership and democracy and HIV/AIDS relief.

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.

In 1975, a family planning research program opened its doors in North Carolina, funded by a grant from the U.S. Agency for International Development (USAID). Its study narrowly focused on contraceptives and fertility, but within a decade, the nonprofit had expanded its mission beyond research, reproductive health and the borders of the United States. In 1986, it started addressing a pandemic that was jolting the world: HIV/AIDS.

Thirty years later, the once-small outfit is a giant in federally funded HIV/AIDS work. Family Health International (FHI) ranks as one of the U.S. government's top contractors through the President's Emergency Plan for AIDS Relief (PEPFAR), the five-year, $15 billion initiative to fight HIV/AIDS in 15 "focus countries" (12 in Africa, plus Guyana, Haiti and Vietnam) and more than 100 other countries worldwide.

In fiscal 2005, FHI was granted more than $100 million through PEPFAR, eclipsing most competitors' contracts by $20 million or more. It has responded to PEPFAR's emphasis on improving indigenous relief efforts by building many of the emergency fund's largest networks of overseas and grass-roots partnerships. In nearly every PEPFAR focus country, FHI has worked with hundreds of governments, community organizations, faith-based groups, medical centers and schools.

Background

Botswana lies in a region of Africa heavily burdened by HIV. It is among six countries in southern Africa that are the President's Emergency Plan for AIDS Relief (PEPFAR) "focus countries" (others include South Africa to the south and Namibia to the north and west). Along the Zambezi River to the north, it shares a border of only a few hundred yards with Zambia, another focus country. Zimbabwe, which is not a PEPFAR focus country, borders Botswana to the northeast.

Diamond, copper and nickel mining and beef exports are the country's main industries, though efforts are being made to diversify and expand the economy. Botswana supplies beef to the European Union, and its diamonds are shipped around the world.

A former British protectorate, the country gained its independence in 1966. Since then, it has experienced the most rapid growth in per capita income in the world. Unlike most African nations, Botswana has experienced almost continuous peace since its independence, which is key to implementing HIV/AIDS programs, according to Mary Kay Larson, deputy director of BOTUSA, a collaboration between the Botswana government and the U.S. Centers for Disease Control and Prevention (CDC).

"If you don't have security, you can't do much" Larson said. "Peace and stability are major, major factors of success."

The face of HIV

Almost all of Botswana's 1.7 million people are affected by HIV in some way. They are themselves infected, caring for someone who is or paying their last respects to AIDS victims. "People are always attending funerals," said Larson. In 2005 alone, about 18,000 people died from AIDS-related illnesses in the country.

While still in medical school at Harvard University in 1987, Drs. Paul Farmer and Jim Yong Kim helped found Partners in Health (PIH) with real estate developer Thomas J. White, friend Todd McCormack, and current organization head Ophelia Dahl.

Kim and Farmer are well-known names in public health: They were independently awarded MacArthur Foundation Fellowships, nicknamed "genius grants." Kim recently returned to PIH after a stint as the director of the World Health Organization's HIV/AIDS Division.

PIH is based in Boston and has sister organizations in Haiti, Latin America, Russia and Africa. In addition to running programs, its Boston headquarters also raises money to support programs around the world. The organization has maintained longstanding alliances with Harvard Medical School and Brigham and Women's Hospital, one of the university's teaching hospitals.

Zanmi Lasante (Creole for "Partners in Health"), PIH's sister organization in Haiti, partners with other nongovernmental organizations (NGOs) and the Haitian Ministry of Health. Zanmi Lasante is the only provider of comprehensive primary health care for the Haiti's Central Plateau, an impoverished and largely rural state located a few hours from the capital city of Port-au-Prince.

According to Ted Constan, PIH vice president for program management, focusing on HIV and other infectious diseases such as tuberculosis, is the organization's way of addressing public health care for the poor.

"Health is just health, and then infectious disease is just our way into that fight," said Constan. "We will ride that battle horse into the fight against poverty, but our goal is poverty reduction and to bring communities out of despair into what we often call a virtuous social cycle where they can lift themselves up and take care of themselves."