Features

Putting money where his mouth isn't

International | WASHINGTON: Does the president's preference for faith-based solutions to the AIDS crisis matter when the dollars are doled out?

Issue: "Spain waves white flag," March 27, 2004

Randall Tobias wakes up in the morning with 8,000 people on his mind. That's how many people on any given day will die of AIDS. "It's like discovering that 20 fully loaded 747s had crashed and everyone on board had died," he says.

Marshaling a plain-spoken command of facts is one reason President Bush eight months ago picked Mr. Tobias, the former CEO of drug maker Eli Lilly, to head his Emergency Plan for AIDS Relief.

With announcements of first-round funding under the multibillion-dollar plan, AIDS caregivers are sizing up not only the nation's first AIDS czar, but also whether he and the president can walk their radical talk when it comes to battling AIDS.

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But faith-based groups are worried enough about how the emergency plan is unfurling that a number of well-known evangelical personalities-including James Dobson and Chuck Colson-made a trip to the White House. In a closed-door session last month they told Mr. Tobias and top Bush officials they saw "a growing pattern of bias" against evangelical relief groups in the bid for AIDS money. Most thought they would never have to have that confrontation with the Bush White House.

Despite what some called a "heated" but helpful discussion that also included Samaritan's Purse founder Franklin Graham, Salvation Army national commander Todd Bassett, and Campus Crusade representative Bailey Marks Jr., subsequent funding announcements under the AIDS plan have done little to cheer them.

Total funding for faith-based groups from the first allotment of $350 million is still unknown, as Mr. Tobias's office combs through winners awarded through multiple departments. But total initial funding to abstinence-related programs just topped $5 million-still well below what the congressional appropriation requires by law. Under that schedule, groups teaching abstinence before marriage and faithfulness to one partner should receive $320 million by the end of this year.

For Mr. Tobias, managing what the president calls "a work of mercy" while straddling the competing concerns of religious groups and the medical establishment-both claiming territorial rights when it comes to AIDS prevention-will demand all his managerial skills. In five years at Eli Lilly, Mr. Tobias quintupled market value of the manufacturer to $75 billion. The soft-spoken Indiana native, at 61, abandoned retirement, persuaded, he says, by the president's "deep personal commitment" to an ambitious plan both men expect will reverse the medical crisis gutting the populations of Africa and the Caribbean.

"I'd really like for people to judge me a year from now on what I have done, rather than being apprehensive about what I'm going to do," Mr. Tobias said when asked about the February meeting. "I would be the first to say that we do not yet have answers to every question."

The Bush goals are lofty: to treat 2 million people with HIV/AIDS; prevent AIDS in another 7 million people; and care for 10 million additional overseas victims, particularly orphans and other youth. The price tag, not surprisingly, is high-$15 billion over five years.

Early on, President Bush pledged to move away from condom publicity and sex-awareness campaigns, the zeitgeist of AIDS activists and the healthcare industry. He promised to embrace solutions that address the deeper cause of AIDS: promiscuous sexual behavior. That emphasis sells with his conservative base, but more importantly, according to Mr. Tobias, "It's simply what works."

"There's no evidence in generalized populations that a broad-based use of condoms as the backbone of prevention efforts has worked," Mr. Tobias said in a March 10 interview in his suite at the State Department, dotted with cardboard boxes as the AIDS czar awaited new office space five blocks from the White House. "I've come to believe, not just intuitively or by guessing about it, but based on a lot of data that we've been able to collect, that abstinence is the best approach."

But instead of making faith-based groups a bigger part of the solution, the recent grant announcements appear to cast them as footnotes.

Growing acceptance of behavior change as a way to prevent AIDS can be traced back to Uganda, the first African country to reverse its AIDS epidemic using its nationwide "ABC" campaign. The elemental formula teaches abstinence before marriage, being faithful in marriage, and targeting condom use to select groups like prostitutes. With that, plus a bullhorn in the streets, literally, Ugandan President Yoweri Museveni worked with government health officials and church leaders to educate Ugandans on AIDS-fighting. The results: HIV prevalence rates nationwide dropped from over 30 percent a decade ago to around 6 percent.

The formula is a natural for faith-based groups because it squares with their beliefs. It also gained an important ally in the medical community last year, when Harvard senior research scientist Edward Green published a book titled Rethinking AIDS Prevention, a tacit endorsement of ABC programs.

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