The Center for Public Integrity

Independent media, open communication and community empowerment are what the nonprofit Internews Network strives to create — largely with the help of the U.S. government.

Since the early 1990s, Internews has been working to develop autonomous media outlets and fair media laws in more than 70 countries. In 23 countries the organization now has offices, most run by journalists native to the region in which they are working. The organization has given training to tens of thousands of journalists on issues such as diverse news coverage, media production techniques and the importance of government accountability.

Though Internews is an organization that promotes an independent press, its own autonomy is an issue it "wrestles with all the time," said Annette Makino, the organization's senior vice president for communications. The vast majority of Internews' efforts are bankrolled by the U.S. Agency for International Development and other federal sources.

Internews' donors over the years have included foundations, individual contributors, corporations, nongovernmental organizations and foreign governments. However, all but $1.6 million of the $26.7 million in revenue it reported in 2004 came from the federal government.

The group's ties to Washington are more than financial. On its board of directors — consisting mainly of journalists, media analysts and philanthropists — sits U.S. Rep. Jim Leach, R-Iowa, whose 30-year run in Congress will end in January, and Lorne Craner, formerly a high-ranking State Department official under George W. Bush.

Although Internews has a working history with the U.S. government, it seems an unlikely candidate for funding from the President's Emergency fund for AIDS Relief, 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.

Background

Located in the northern part of the South American continent on the Atlantic Ocean, Guyana — an Amerindian word meaning "land of many waters" — is bordered by Brazil to the south and southwest, Suriname to the east and Venezuela to the west. Though located in South America, Guyana is considered, both culturally and economically, to be a Caribbean country. It is a member of the Caribbean Community and Common Market, or CARICOM.

Guyana gained independence from Great Britain in 1966 and became a cooperative republic in 1970. It is the only country in South America where English is the official language.

Guyana, which is divided into 10 administrative regions, is the third smallest independent country in South America after Suriname and Uruguay. The capital is Georgetown, which lies on the coast.

Guyana is a religiously and ethnically diverse country. The largest ethnic group in Guyana is East Indian, or Indo-Guyanese — descendants of East Indian indentured servants brought to Guyana in the early 19th century — followed by Afro-Guyanese, or Guyanese of African descent. Both groups live primarily along the coast. Guyana's rural interior is populated by several groups of Amerindians, comprising about 7 percent of the population. The predominant religions are Christianity, Hinduism and Islam.

Although Guyana is a very poor country, it ranks higher on the U.N. Human Development Index — 103 out of 177 — than any other of the "focus countries" receiving funds from the President's Emergency Plan for AIDS Relief (PEPFAR), the five-year, $15 billion U.S. initiative to combat AIDS abroad.

The face of HIV

The first case of AIDS in Guyana was diagnosed in 1987. That same year, the HIV infection rate was 1.3 per 100,000 inhabitants. By 2003, that number had ballooned to 56.2 cases per 100,000 inhabitants.

Background

Thailand lies between the Andaman Sea and the Gulf of Thailand just south of Myanmar and Laos and north/northwest of Cambodia. Since unified as the kingdom of Siam in the mid-14th century, Thailand remains the only Southeast Asian country never ruled by a European power. After a bloodless revolution in 1932, Thailand became a constitutional monarchy guided by a written constitution that outlines the monarch's responsibilities and duties. In September 2006, a military coup removed Prime Minister Thaksin Shinawatra and his government from power. Thailand is currently being ruled by an interim government, which has promised to deliver a new constitution by October 2007.

The economy is heavily driven by tourism, with the services industry accounting for 46 percent of Thailand's gross domestic product. Although most visitors come to see the natural beauty of the fertile lands and beaches, a small portion visit Thailand as "sex tourists" who frequent the brothels in Bangkok, Chiang Mai and other major cities. Said Sudarat Sereewat, director of the Coalition to Fight Against Child Exploitation: "A lot of people want to come for the weather, the culture, the cheap prices. ... But the big problem is that there are many factors that made Thailand a paradise for these sex tourists: weak law enforcement, technology and things like that."

The face of HIV

The sex industry played a major role in the spread of the HIV/AIDS epidemic in Thailand, which recorded its first case of AIDS in 1984. Men who have sex with men (MSM), sex workers and intravenous drug users fueled the epidemic, which peaked at 143,000 new cases in 1991. In 1988 the government spent only the equivalent of $180,000 on prevention because of a belief that it was a foreigner's disease. In 1991, Anand Panyarachun became prime minister and made AIDS prevention and control a national priority. Thailand spent $44 million in 1993 on efforts to curb the spread.

Food for the Hungry is an Arizona-based Christian relief organization that implements development, health and food programs in more than 45 developing countries, including remote areas of Afghanistan, Sudan, Ethiopia and Bolivia. The organization was founded in 1971 when Dr. Larry Ward made a $1,000 donation to Haitian victims of disaster. "They die one at a time; we can help them one at a time," was his philosophy.

Since then, Food for the Hungry has grown financially and has burnished its connections in Washington, D.C. Today the group is one of the leading organizations tapped by the federal government for food distribution programs abroad and its president, Benjamin K. Homan, was appointed to chair U.S. Agency for International Development's (USAID) Advisory Committee on Voluntary Foreign Aid. In June 2006, President Bush appointed Homan to a commission that will make recommendations to the government on ways to make foreign aid more effective. The group's government funding jumped from $17 million in 2003 to $28 million in 2005.

According to Food for the Hungry, more than 88 percent of its total income — including donations from individuals, churches and foundations — goes to field programs. The U.S. volunteers who join the group's "Hunger Corps" to work in developing countries raise money for their salaries and expenses among relatives and friends.

Until recently, Food for the Hungry's HIV prevention and care activities were smaller side projects to its core food distribution and development programs. But this changed in 2005 when the group was awarded an $8.3 million grant through the President's Emergency Plan for AIDS Relief to expand its prevention programs in Ethiopia, Nigeria, Mozambique and Haiti. PEPFAR is Bush's five-year, $15 billion initiative to fight AIDS in 15 developing countries with some of the highest HIV prevalence rates in the world.

Background

Landlocked in the Horn of Africa, Ethiopia is the continent's oldest independent country. Apart from a five-year invasion by Italy, from 1936 to 1941, it has never been colonized. Its ancient monarchy was toppled in 1974 by a Marxist junta that established a socialist state in 1975. Drought, famine, political instability and bloody coups dominated the 1970s and '80s; the Derg regime was overthrown in 1991 by a coalition of rebel forces, the Ethiopian People's Revolutionary Democratic Front. In some rural areas of Ethiopia, obsolete Soviet tanks still lie at the side of the roads and are silent reminders of the confrontations that tore the country apart for two decades.

Ethiopia gave itself a constitution in 1994, and the next year it held the first multiparty elections. Eritrea to the north gained independence from Ethiopia through a referendum in 1993, but border disputes escalated into a full-blown war in 1998 and caused the loss of tens of thousands of lives. A fragile truce was reached in 2000, but final border demarcation is still on hold because Ethiopia objected to the findings of an international commission in 2002.

Ethiopia is one of the poorest countries in Africa and in the world, with an adult literacy rate of about 43 percent. Only 28 percent of pregnant women receive prenatal care, according to the 2005 Ethiopia Demographic and Health Survey, and more than 15 percent of children are expected to die before the age of 5.

Originally published in the Fall 2006 issue of Ms. magazine.

Beatrice Were is a small woman with delicate features, but don't let that fool you. The Ugandan mother of three has a large presence when it comes to HIV/AIDS, the cause to which she's devoted herself since 1993.

Were, who began her AIDS work as a Red Cross volunteer and now works with ActionAid International, is highly critical of current U.S.-funded AIDS-prevention programs. Those prevention programs aren't just inadequate—they're actually harming women, she says.

"Treatment [for HIV/AIDS must be] complemented by an effective prevention program," says Were. "[But] five years from now we'll need more money [for treatment] because we're bound to have more people who will need [it]."

Her conviction is held by many AIDS workers and experts in countries that receive assistance through PEPFAR, which began distributing funding in February 2004. Although Were praises PEPFAR-funded programs that treat those with AIDS—which involves about half of all PEPFAR funding—she believes the sexual-prevention arm, which strongly favors abstinence and fidelity over other methods, seriously shortchanges the needs of women.

"The gender dimensions of the epidemic are completely ignored," says Were. "We know very well that women don't [always] have control [over sexual decisions]. There is rape in marriage. [There is] the fact that many women can't make a decision on whether to have protected sex or not, even whether to have sex or not, because it's their husbands [who] make the decision."

In Uganda, she says, polygamy and promiscuity among men is both significant and socially acceptable. "This [PEPFAR] approach places a huge burden on a woman to abstain and, when she's married, be faithful," she says. "Personally, I did all of that, but I still got infected, too. It just doesn't work."

Background

Once referred to as the "Pearl of Africa" by Winston Churchill, Uganda lies in East Africa, bordered by Rwanda, the Democratic Republic of the Congo, Sudan, Tanzania and Kenya. The landlocked country is divided into 78 districts that are spread across four administrative regions — Northern, Eastern, Central and Western. The capital is Kampala.

There are myriad ethnic groups in Uganda, none of which is large enough to constitute a majority. Dozens of languages are spoken. While the official languages are Swahili and English, Swahili is not widely spoken.

The country gained independence from the United Kingdom in 1962. In 1971, Idi Amin took over in a military coup and ruled the country for the rest of the decade. Under his reign, nearly 300,000 Ugandans lost their lives and the economy plummeted when Amin forcibly removed minority Indian entrepreneurs from the country.

Amin was overthrown in 1979 by Tanzanian forces and Ugandan rebels. Milton Obote, who had preceded Amin as president, took over and ruled until 1985, when he was overthrown and replaced by a general who ruled for six months. The general was overthrown by the current president, Yoweri Museveni, who has been in power since 1986.

The face of HIV

According to the U.S. State Department's Office of the U.S. Global AIDS Coordinator, the infection rate is 10.7 percent in urban populations and 6.4 percent in rural areas.

In 2006, the government banned HIV-positive recruits from joining the military, a move it called a "humanitarian" measure. The defense force has suffered from losing soldiers to AIDS.

Management Sciences for Health (MSH), a private nonprofit organization that works to strengthen health systems worldwide, was founded in 1971 by Dr. Ronald O'Connor, who wanted to provide technical assistance in public health management to the developing world.

MSH is based in Cambridge, Mass., and receives the vast majority of its funding from the federal government — $155,826,790 for fiscal 2005. MSH is involved in multiple health policy and service areas, including leadership development, financial management, pharmaceutical procurement and inventory management.

Partly as a result of its international work in treatment and supply chain management, MSH is one of the largest recipients of President's Emergency Plan for AIDS Relief (PEPFAR) grants over the last three years, receiving more than $44 million in fiscal 2005 alone. MSH has been receiving funding from the U.S. Agency for International Development (USAID) for 35 years, said Dr. Malcolm Bryant, MSH's director for the Center of Health Outcomes.

MSH programs

In September 2005, the Partnership for Supply Chain Management (PSCM), a nonprofit group created by John Snow Inc. and Management Sciences for Health, was awarded a USAID contract that totals up to $7 billion. The contract was for providing pharmaceuticals and related supplies in PEPFAR countries. MSH and JSI are joined by 15 subcontractors, which include universities, defense companies and international health organizations.

MSH's role in PSCM is multifaceted. It assists in the coordination of country support for HIV/AIDS commodity policy; provides training, guidance, management and technical expertise as well as quality insurance.

MSH has previous experience in supply chain systems and has a program called Rational Pharmaceutical Management Plus Cooperative Agreement, which predates PEPFAR. The program aims to improve access to drugs, vaccines, supplies and equipment. 

Background

The Indian subcontinent is bordered on the west and south by the Indian Ocean and the Arabian Sea, on the east by the Bay of Bengal, and on the north by Pakistan, Nepal, China and Bangladesh. Just over 1 million square miles are home to 1.1 billion people — one-sixth of the world's population, with more than 60 percent living in rural areas.

Once a colony of the British Empire, the country gained independence in 1947. Now a federal union, the Republic of India has 28 states and seven union territories that are self-governing and a prime minister who is the elected head of the country.

The country is characterized by its diversity in language, culture, landscape and heritage. Fertile lands and river valleys support agriculture, which employs about 60 percent of the labor force.

The face of HIV

Migrant laborers and truck drivers, who spend days to months on the road, are among the most vulnerable groups for HIV/AIDS infection. According to the National AIDS Control Organization (NACO), India's central HIV/AIDS agency, there have been 124,995 officially reported cases of AIDS from 1986 to August 2006, though that number may be grossly underestimated because many people do not report their cases. Of those who have reported being infected, 58 percent live in rural areas and about 39 percent are women.

Just over half of all reported cases of HIV/AIDS are in two southern states: 52,036 in Tamil Nadu and 15,099 in Andhra Pradesh. In fact, those two states, along with the southern state of Karnataka and the western state of Maharashtra, which together make up 30 percent of India's population, account for about 75 percent of HIV cases.

Migrant workers and truck drivers who reside in southern India and engage in sex with commercial sex workers or with other men account for the high prevalence rate there.

Background

Bordered by China to the north, Laos and Cambodia to the west and the South China Sea to the east, Vietnam lies in a culturally diverse and politically volatile region of the world. After being ruled by Chinese dynasties, Vietnam achieved independence in the 10th century. In the mid-19th century France colonized Vietnam and remained in power until World War II, when Japan occupied Vietnam. After that war, France unsuccessfully attempted to regain control during an eight-year war that ended in 1954 when Vietnam was temporarily split in two by the Geneva Accords, which called for national elections in 1956 to unify the country.

But the elections didn't happen, and instead, Vietnam was entrenched for two decades in a civil war, with the U.S. sending combat support for South Vietnam. Millions of Vietnamese died in the conflict which ended in 1973 when U.S. troops withdrew. In 1975, the North captured Saigon — renaming it Ho Chi Minh City — and extended the communist regime to the South. In the mid-1980s the Communist Party started to ease its control over the economic market and slowly adopted capitalist practices. Since then, the Vietnamese economy has grown robustly, and political repression has declined.

Vietnam had no formal diplomatic ties with the United States until 1995, when it opened an embassy in Washington. Over the past decade, diplomatic relations between the two nations have developed rapidly.

The country is one of the few remaining with a Communist government and despite its political gains over the past decades, maintains a highly centralized one-party system.