Cooperative for Assistance and Relief Everywhere Inc. (CARE)

Cooperative for Assistance and Relief Everywhere reaches over 7 million people in 40 countries with their HIV/AIDS programs

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Cooperative for Assistance and Relief Everywhere Inc. (CARE) debuted in the international humanitarian arena in 1945 to aid survivors of World War II. Over two decades, more than 100 million food parcels, the legendary "CARE packages," were delivered in Europe.

In 1966, CARE started phasing out the food packages as the core of its mission while moving on to other projects. Health, children and poverty are now at the center of its work. But the organization also focuses on education, combating HIV/AIDS and emergency disaster relief. Across the board, CARE strives to give poor women resources because, the organization's literature says, "women have the power to help whole families and entire communities escape poverty."

Among the world's largest private international humanitarian organizations, CARE spent more than $514 million in 2005 on its programs around the world. Its tax returns filed with the Internal Revenue Service between the 2000 and 2004 tax years show that, historically, CARE has obtained the bulk of its funds from governmental agencies such as the U.S. Agency for International Development (USAID). For example, 70 percent of its funds in 2003 and 57 percent for fiscal 2004 (the most recent fiscal-year records available) came from the government.

Care for HIV/AIDS

The relief group started addressing HIV/AIDS in 1987 in Thailand. Today, CARE has more than 150 programs tackling the causes and consequences of the virus in nearly 40 countries and reaching more than 7 million people, according to agency spokeswoman Alina Labrada.

The announcement of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative launched in 2003 to fight HIV/AIDS abroad, again infused CARE programs with federal funds.

Though the organization has noted PEPFAR's "unprecedented investment and long-term commitment by the U.S. government to the fight against HIV and AIDS," CARE has offered constructive criticism of the initiative. Most recently, during a congressional hearing in September 2006, Dr. Helene Gayle, CARE's president and chief executive officer, raised issues encountered by CARE staffers in the field while implementing PEPFAR's prevention programs. She called for a more balanced and flexible approach to HIV prevention policy.

PEPFAR's prevention strategy is known as the "ABC" approach: "Abstinence" from sex until marriage, "Being faithful" to one sexual partner and correctly and consistently using "Condoms." However, promotion of condoms solely as a prevention strategy is restricted to high-risk populations such as sex workers.

"By requiring that condom outreach, distribution, and marketing programs be focused only on 'high risk' groups, PEPFAR ignores the sound public-health premise that 'integrated' means integrating A, B and C," Gayle said at the hearing. "Those who are sexually active should all be considered at high risk of infection."

CARE officials also say that PEPFAR is not effectively addressing gender inequity in sub-Saharan Africa with its prevention programs.

"In CARE's experience, many women and girls are unable to choose to remain abstinent due to the high prevalence of rape and gender-based violence in far too many countries," Gayle testified, adding, "It is clear that we must do more to change men's behavior."

CARE's secular stand has drawn criticism from powerful figures in the religious right, and funding was cut off this year for the CORE Initiative, which CARE spearheads.

The CORE Initiative is a consortium of five organizations known as the Communities Responding to the HIV/AIDS Epidemic. The program, which predates PEPFAR, was awarded almost $20 million for a five-year grant in January 2003 to strengthen the capacity of community and faith-based groups in Africa, Asia, Europe, Latin America and the Caribbean.

In a letter addressed to President George W. Bush in May 2005, Sen. Rick Santorum, R-Pa., accused CARE and other agencies of having a "solid record of anti-abstinence, pro-prostitution, and anti-American activities."

When asked by the Center, current CARE officials offered no response to the allegations, but said they can only "imagine why" aid to the CORE Initiative was cut off and redirected to faith-based organizations.

But after she left her post as director for the CORE Initiative in July 2006, Kristin Kalla told The Boston Globe: "There was a lot of resentment, a lot of pressure, from the religious right feeling that they supported Bush, especially for the second term, and they wanted to get paid their dues, they wanted a piece of the pie in terms of foreign assistance."

The CORE Initiative grant was "centrally awarded," which means the funds were administered directly out of USAID's headquarters in Washington, D.C. Under this system, CORE Initiative awarded small and large grants for HIV prevention efforts that included abstinence, fidelity and condoms programs, as well as for activities to reduce the stigma related to the disease.

The grants were also directed for the care and support of people living with HIV/AIDS and to orphans and vulnerable children. The cap for each small grant was $5,000; grants for larger-scale projects ranged from $5,000 to $250,000 a year, according to the project's proposal.

But the system was changed in 2006, and the CORE Initiative is now only eligible to receive funding from U.S. government missions abroad for specific projects.

Gayle, CARE's president and CEO, said the agency has received about $10 million annually from PEPFAR to roll out activities to fight HIV/AIDS in 11 of the program's 15 focus countries and in a number of other nations.

CARE is also part of the Hope for African Children Initiative (HACI), a pan-African effort created to tackle the challenges affecting millions of African children who have been orphaned due to AIDS or whose parents suffer the disease or are dying from AIDS-related illnesses.

In Mozambique, for example, HACI provides technical and financial assistance to 14 nongovernmental organizations — faith- and community-based groups that provide care and support, programs on education, health, microfinancing, food and nutrition. HACI also provides counseling and psychological support to children and families dealing with HIV/AIDS. HACI is currently active in nine countries, among them Cameroon, Ethiopia, Ghana, Senegal and Uganda.

Other CARE programs targeting AIDS include Local Links, an initiative to help orphans and vulnerable children in Kibera, the largest informal settlement in Kenya and the third largest in Africa. CARE operates in five of Kibera's 13 villages. By 2008, the organization expects to have benefited 20,000 people in Kibera affected by HIV/AIDS, including orphans, vulnerable children, their families and caregivers.

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