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Putting money where his mouth isn't

"Putting money where his mouth isn't" Continued...

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

USAID officials encouraged CrossRoads to submit an initial proposal late last year. Officials told Mr. Kavgian that a review panel would request a detailed proposal if it cleared. But CrossRoads never heard back from anyone at USAID. "We weren't given any critical feedback on what we did wrong," Mr. Kavgian said.

None of the groups WORLD spoke to that were turned down could learn why. USAID won't discuss the rejections because they are "procurement sensitive." Disclosing names of reviewers and the review panel process, said spokesman José Fuentes, might lead to potential contractors exerting "undue influence" on them.

That's OK for a few faith-based operators. World Vision spokesman Dean Owen said he believed the government's process "is fair and that there was no discrimination against faith-based organizations" even after officials rejected his organization's bid to carry out not only abstinence training but also medical treatment. "We do not know the reasons why World Vision was not awarded any of those grants; we understand fully that the process is very competitive and that there are many qualified organizations submitting applications," Mr. Owen said in a written statement.

Others worry not only about losing out on the ground floor of a new AIDS funding regime. They also worry that future AIDS victims won't benefit from what works. "The issue is whether or not behavior change-abstinence and faithfulness-is going to be allowed an honest shot," said Ken Isaacs, program director for Samaritan's Purse. "At the very least, there ought to be sunshine on how these decisions are made."

Meanwhile, big-ticket health groups who thrive on government grants are discovering that they have a stake in the new AIDS regime without trying. Nearly half of this year's "new" funding goes to existing programs. In fact, groups that support status-quo AIDS remedies-promoting condoms and other contraceptives, sexual awareness training, and expensive drug treatments-are enjoying more federal dollars under the Bush administration than they did under President Clinton.

Family Health International (FHI), a North Carolina-based conglomerate, tests and supplies condoms for the U.S. government in AIDS-stricken countries, in addition to providing anti-retroviral therapy, contraceptives, and sex-education training. Federal revenue to FHI rose 30 percent from 2002 to 2003, from $97 million to $126 million. FHI expenditures, nearly all from Washington, at the end of the Clinton era totaled $66 million; now they are more than double, at $137 million.

If FHI operatives provide a snapshot of where Bush AIDS dollars will flow, then leaders of faith-based organizations have reason to worry. Officer and board member Willard Cates, FHI's main point of contact with federal agencies, is a former CDC officer who once co-authored a study depicting childbirth as more dangerous to a woman's health than legalized abortion. In medical journals he argued for Medicaid funding of abortion and against waiting periods and parental notification procedures on abortion. Regarding promotion of condoms overseas, he has said: "We should push them."

Another FHI officer, David A. Grimes, is a leading proponent for emergency contraceptive Plan B, the morning-after pill, arguing for its availability over the counter, "sitting on the shelf with aspirin and acetaminophen." FHI documents list as board adviser Xiao Bilian, a Chinese government family-planning specialist who has pushed widespread use of a Chinese version of RU 486 among Chinese women.

Groups like FHI until now had little interest in faith-based policies. But with funding priorities beginning to tilt that way under Mr. Bush, they are at least learning the lingo. FHI produced (with federal funding) a 38-page booklet titled "HIV/AIDS Prevention, Care and Support Across Faith-Based Communities." Its website now promotes "ethics training" under HIV/AIDS headings.

Such groups "are seething with resentment," according to a U.S. health official who asked not to be identified. "They don't want to do ABC, but it is the trend. They exist, particularly the for-profits, to make money. I am concerned when I see their funding going up in spite of what we know works."

Evolving to meet Bush funding priorities "is happening everywhere, with every major organization," according to Debbie Dortzbach, AIDS coordinator for World Relief. "It appeared all at once that international organizations began to see and promote the value of faith-based initiatives." Now overseas health providers want in on it, she said, "because we have been working steadily and doggedly at the community level, helping churches realize they are at the front of the pack in terms of prevention and AIDS care."

Successful faith-based caregivers like World Relief, Dr. Green said, "have been doing ABC from the beginning and often without getting a dime of government funding.... My argument is since they know how to do it and want to do it, doesn't it make sense to let them do it?" That's the question faith-based leaders are asking the White House.

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