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The Role of the Community of Faith in HIV Prevention

Speakers: Bishop Charles E. Blake, Presiding Bishop, Church of God in Christ International; Chairman and Chief Executive Officer, Save Africa's Children, Kenneth Hackett, President, Children's Catholic Relief Services, and Jed Hoffman, Senior Director for Health and HIV/AIDS, World Vision
Presider: Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations
June 6, 2011
Council on Foreign Relations

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LAURIE GARRETT: Good afternoon everybody. I want to thank each and every one of you for joining us today; quite a turnout.

My name is Laurie Garrett. For those of you that have not previously had occasion to meet me or work with me here at the council, I'm a senior fellow here for Global Health. Also with us today is another of our senior fellows in Global Health, Yanzhong Huang, who focuses on global governance issues and national security.

We're at a crucial juncture in the AIDS pandemic that is reflected in activities underway this week here in New York as the United Nations convenes its only second ever General Assembly session dedicated to the pandemic. One could wonder why in 30 years only twice the General Assembly has seen fit to discuss the topic of the second largest pandemic in the history of humanity, but that's another matter for another day. (Laughter.)

We have a number of issues to discuss today. And I want to first say a few quick housekeeping issues and a few quick thank-yous. Many of you are here today because you're associated in some way with the council's Religion and Foreign Policy Initiative run by Irina Faskianos. And we want to thank Irina and you for joining us.

We are on the record today, which is unusual for the council. Those of you that have been regulars know most of our sessions run on Chatham House rules. Not so today. Remember that when you ask a question. You are on the record.

And there are a number of issues to consider today in terms of how we are going to go forward at this critical juncture in the pandemic. If we had been meeting just five years ago, we would have been having a discussion that fairly clearly separated what we called prevention from what we called treatment and from what we called care. They were in three separate boxes. They had three separate sets of technology, personnel, skillset, et cetera, fairly clearly defined, and each had its own controversies, its own unique political issues.

And, in the case of the United States and our foreign policy, we had one organization, called PEPFAR, the President's Emergency Plan for AIDS Relief, that oversaw all three of these boxes and how we spent. We're at a very different juncture today. The lines have become tremendously blurred between what is treatment and what is prevention, with some saying they are actually the same thing. We've had some major breakthrough studies in the last 12 to 18 months that have brought a new level of optimism to the whole battle against this disease.

The first I think that startled everybody was the microbicide study conducted in the KwaZulu-Natal part of South Africa which demonstrated upwards of 38 percent level of protection from vaginal microbicides when used even irregularly by women in an extremely high risk, high prevalence area. That offered the first real hope that was continued research and perfection, we could come up with a microbicide that women could use to protect themselves that was genuinely protective in excess of 50 percent.

We've seen some breakthroughs on the vaccine front with, for the first time, real demonstration of the ability to raise the most important marker, neutralizing antibodies, against HIV in both monkey studies and first tentative human trials, which is rejuvenating the whole vaccine research effort.

More recently, we saw very encouraging results in one trial of what's called PrEP, which is pre-exposure prophylaxis, giving the currently available anti-retroviral drugs to people who were HIV negative but either were partners with someone who was HIV positive or had a very active sex life or, you know, high risk as we say. In one study involving all gay men the results were very encouraging. In another study involving heterosexuals in Africa, it was quite the opposite -- very discouraging results, so much so that the study was shut down prematurely.

And then, finally, we've now had two very large studies that look at the relevance of being on antiretrovirals when infected to the ability or inability to transmit your infection to your partners. These have focused on sexual transmission. We've not yet seen anything like this used for IV drug users, but the results are extremely encouraging and, indeed, the latest trial conducted by the NIH here in the United States closed prematurely because it was thought to be unethical not to say this is the new standard, let's stop spread of this disease. In this case the key was to start treatment basically when you're diagnosed rather than waiting for this magical CD4-250 or CD4-300 level, meaning a certain level of deterioration of your immune system before you start taking drugs. And when combination drug therapy commenced at levels as high as 500 CD4, transmission to partners dropped by 96 percent. That's quite striking.

So here we go into this giant U.N. session. And the burden will be on all participants to answer a fundamental question: who's going to pay for all this and make it really work? Now, from the very beginning of PEPFAR, the answer to that -- who's going to really make it work on the part of the Bush administration was in large part roughly a third of the burden was the faith-based community. And many organizations became very active in various aspects of dealing with HIV/AIDS overseas that had not actually been in that space before PEPFAR emerged and the funding from PEPFAR was there. We are now enough years out from that first set of tentative steps into these waters or on the water, depending on how you look at it that we can now assess both how well have the faith-based efforts performed and as we go into this new space, this new dynamic where, as I said, the lines between prevention and treatment are blurred, what will be the appropriate role of the faith-based effort.

We have with us to answer these questions and for our general discussion three all stars for your consideration. Their biographies are available so I'm not going to go into details. What I would like to do is to ask Bishop Blake, Mr. Hackett and Mr. Hoffman to first answer one question briefly. What -- how do you perceive your organization's role in HIV prevention right now? And why don't I start with Bishop Blake.

BISHOP CHARLES BLAKE: I want to say that I'm very proud and honored to have the privilege of being on this panel today, Mr. Hoffman and Ms. Garrett and Mr. Ken Hackett, who is a very special person in my life. And I want to say to him, thanks so much for your help and collaboration during the early days, throughout the life of Save Africa's Children. I'm accompanied today by Mr. Reverend Eugene Rivers who is senior policy advisor for Save Africa's Children, and senior policy adviser for other assorted things in which I am involved, Mr. Paul Turner, who serves as president of Save Africa's Children.

I'd like to focus my attention today on the role of black churches in the AIDS crisis. And it is my view that the black church must function as did the Biblical character, Joseph, reach back to brothers and sisters in the homeland and help them -- for we could best help by advocating for economic development and by providing humanitarian assistance to those in our homeland who were and who are suffering.

In pursuit of this objective, I founded Save Africa's Children, the humanitarian organization, roughly 10 years ago. SAC has provided direct support and care to more than 400 orphan care programs impacting more than 200,000 orphans and vulnerable children affected by HIV/AIDS, poverty and war in 23 nations throughout sub-Saharan Africa and the Caribbean. SAC partners with individuals, churches, grassroots organizations, government and corporate sectors and endeavoring to build a dynamic, diverse movement to restore hope and a future to Africa's children.

Clinics sponsored by Save Africa's Children provide screening, testing services. And common conditions frequently diagnosed and treated are HIV/AIDS, malaria, upper respiratory tract infections, skin diseases, dental conditions, and eye and ear infections. Our volunteer doctors, dentists and nurses usually see more than 1,000 people in each medical clinic. And in the first quarter of this year, our clinic in Kenya alone has served 6,000 individuals through our volunteer counseling and testing services.

Orphans and vulnerable children face tremendous not just physical, but also mental and emotional stress and it is especially important that those most impacted be diagnosed and treated. Frequently we have mental health practitioners on our teams from the U.S., but we also partner with the Chicago School of Professional Psychology to train orphan care providers, teachers and other adults, most if not all of whom are indigenous who care for children so that they too can deal with children who are coping with emotional trauma and distress.

Many areas of Africa face shortages of clean water and food. SAC provides wells where they are needed and when it is possible for us to do so. And we also partner with the U.S. Feed the Future Initiative so that African NGOs can be assisted in growing food for sustenance and income. And we also provide direct grants for the purchase of food supplies.

The HIV/AIDS epidemic continues to be the greatest threat to social and economic development in sub-Saharan Africa. An estimated 33.3 million people are living with AIDS or HIV globally; 68 percent of them live in sub-Saharan Africa which is the epicenter of the epidemic. One of the epidemic's distinct social impacts is the growing number of children orphaned by AIDS.

Despite progress in reducing the rate of infection and improvement in the treatment of HIV, the number of AIDS orphans, the overwhelming majority of whom live in sub-Saharan Africa, is still growing. And according to a recent U.N. AIDS report, despite modest decline in HIV adult prevalence worldwide and increasing access to treatment, the total number of children age 0 to 17 years who have lost parents due to HIV has not yet declined.

Indeed, it has further increased from 14.6 million in 2005 to 16.6 million in 2009. Almost 90 percent of these children live in sub-Saharan Africa and more than 10 percent of all children age zero to 17 have lost one to two parents due to HIV/AIDS in Zimbabwe, 16 percent in Lesotho, 13 percent in Botswana, and Swaziland 12 percent. For more than two-third of the world population with HIV reside in sub-Saharan Africa and nearly three-quarters of AIDS related deaths occur in Africa. In 2009, 16.6 million children in sub-Saharan Africa had lost both -- at least lost either one or both parents to AIDS. And young women and girls continue to be disproportionately affected by HIV in sub-Saharan Africa throughout the region, about 60 percent of all AIDS infection.

So, today, there is a strategic opportunity for the black church community to intensify its efforts to address the AIDS orphan care crisis on the continent. And the black church is well positioned to mobilize financial and institutional resources for the U.S. black church community for historically black institution as well as black celebrities, intellectuals, to support grassroots African and faith-based initiatives that serve orphans and vulnerable children in Africa and in the diaspora.

Also we can support comprehensive grassroots programs in Africa focused on strengthening families and communities that are locally designed and managed and are transparent and fully accountable. Also we can cultivate partnerships with governments and donors to leverage finances and human resources to serve the needs of children. In addition to this, we can raise awareness about the plight of children in sub-Saharan Africa through church-based educational initiatives using existing church structures and multi-media educational tools.

And, finally, we can cultivate a U.S.-based advocacy network among black churches that represents the interests of vulnerable children of African descent and addresses the development policy concerns that affect them. So through initiatives such as these, black churches in the U.S., linking up with black churches in Africa and other NGOs can play a significant role in reducing the impact of an AIDS crisis in Africa.

Thank you very much.

GARRETT: Jed Hoffman, perhaps you can tell us what World Vision is we're thinking about right now regarding its role in HIV prevention.

JED HOFFMAN: Sure. I would say we have five major focuses in responding to your question that -- first and foremost, World Vision sees its role as advocating for full funding and implementing and implementation mechanisms and program focus that prioritize clinical outcomes.

Secondly, we see our role as mobilizing, educating and animating faith leaders in the United States and in countries around the world and in our domestic constituencies and congregations to focus on the problems of AIDS, most particularly to focus their compassion, on the people who suffer from this disease and to educate themselves about the solutions and what they can do to address it. In the field we see our role as mobilizing and empowering faith and local communities to assume healthy behaviors, both risk avoidance and risk reduction behaviors, to demand world-class healthcare wherever they are and to assume key tasks related to delivery of this care.

We also see our role as to produce evidence-based innovations and care delivery systems that reduce cost and increase local self-reliance. And, finally, as a child focused agency, we have a special mission in regards to vertical transmission. We have recently signed a memo of understanding with the Elizabeth Glaser Pediatric AIDS Foundation and we are pledging ourselves to eliminate vertical transmission where we work in Africa and in other parts of the world. So I'll stop there.

GARRETT: Thank you. And Ken Hackett, can you give us a similar sense of things from the point of view of Catholic Relief Services?

KENNETH HACKETT: Thank you. I will try. And let me give you the platform from which we're moving at this point in time. Over the last five years we have been able to mobilize $500 million for antiretroviral therapy, most of it from the PEPFAR initiative. And that has been distributed through a network of Catholic, non-Catholic and governmental partners in 11 countries round the world.

In that particular program, as we stand right now, there are 210,000 people enrolled in therapy who, as you all know, are alive because they're enrolled in a therapy and they would not be. In addition, there's another 400,000-plus people who are in some stage of care in those 10 countries. And in addition to that, we have programs like Jed's at World Vision and like Bishop's for orphans which is an immense problem. And right now we are engaged in support to efforts to care for orphans, and the number we're talking about as of this month is about 650,000, none of them in orphanages that I know of, all of them cared for in the community, in the extended family and the support group that falls around them. So that's the base for our service activities.

Now, where we are at this moment is in the transition, so the message has come down from on high, the track one funding for PEPFAR has to be changed. Track one funding was centralized funding to a series of organizations. I think it was four -- Jed, you'd be more correct -- ourselves, Harvard, Columbia and Elizabeth Glaser -- to put together the therapy outreach for the antiretrovirals. That is coming to an end and the expectation is that we will hand it over within the next 12 months to local partners, local partners meaning our local church partners, local partners possibly networks of churches, local partners possibly ministries of health. And so it is envisioned, in our opinion somewhat naively -- I'm on the record, right -- (scattered laughter) -- that this is all going to happen in 12 months.

Happily -- and Jed was part of this when he was with the Catholic Relief Services -- we have been able to do one very successful transition in South Africa. So the program that we have been supporting for antiretroviral therapies in South Africa for five years was handed over to the Catholic Church's health capacity. And we subcontract from them, not to them. They run the show. The transition is taking place in Kenya, Tanzania, Zambia, Rwanda, Uganda, Ethiopia, to some extent in Haiti -- although in our Haiti program everybody understands that things are just so unsettled that we're not going to be able to pass it over to anybody -- and lastly, in Guyana. So that's the program for antiretrovirals.

The program for orphans, which the bishop so rightly characterized, this is a problem that's going to be with us as an international community for another generation or two. And, therefore, we must think about innovative ways of dealing with this amazing number of young -- what do you call them -- households led by young people. How you do transfer the mores in society and the cultural patterns and the farming patterns and the management of money patterns? So there's all kinds of issues like that.

So for our strategic view, we're going to be for the next 10 years focusing on this issue as it takes its form, not just with young people who are pre-teens, teens, but then young adults and what kind of attitudes have they developed.

Now, all of this presumes that we spend a little time on Capitol Hill. And we are doing that, although we find with the new Congress that there is often a degree of ignorance about what the issues are, what the solutions are and what can actually be done. And so we find that we have to spend a large amount of time doing basic rudimentary education about some of these issues because they just don't know. So that's the challenge ahead of us I would say right now.

GARRETT: OK. So you're all facing pretty grandiose scales of programs and challenges. Underlying all of them is one common challenge, which is stigma -- stigma associated with the disease and stigma associated with people thought to be likely to become infected.

I saw that just last week Archbishop Desmond Tutu had a striking editorial in which he said that Africa was taking, quote, "a step backwards on human rights" because several countries, notably Uganda and Malawi and Kenya have begun to blame homosexuals for their epidemics and for other root issues in their societies, have passed or attempted to pass very egregious legislation that would not only outlaw homosexuality but result in prison terms for people that fail to turn in homosexuals to authorities. And the most extreme of which, in Uganda, did not actually come to a floor for a vote before the Uganda Parliament took a recess but may come up in the next session. And that would actually have a death penalty clause related to homosexuality.

When you look at all the issues of stigma, whether it's being an orphan child labeled as an AIDS kid or it's being a David Kato, assassinated in Uganda for being a homosexual, what's the role of faith-based organizations in confronting the larger questions of stigma?

BLAKE: In my experience in Africa and related to and associated with a number of children leaders and pastors, literally across the continent of Africa, I can say that I have not once found among any of the church communities that I have dealt with that kind of vindictive, hostile attitude toward those who are afflicted with AIDS, who might assume to have been from the homosexual community.

I found that most of the churches that I've dealt with are compassionate communities that express love and redemption and salvation and assistance also to those who are affected and impacted by the pandemic. I have not seen on their part any aggressive effort to influence or impact these kind of vindictive efforts that governments or individuals or groups might assert.

And so I think that they do, of course, have a great opportunity to expand and to share with others the spirit that has characterized the efforts that I've seen. And then, of course, I think that, of course, the government of the United States and other NGOs that minister to the continent of Africa can approach the governments of those nations and indicate that that is certainly not the spirit and the attitude and the behavior that we can condone or support or cooperate with.

HACKETT: Well, I would kind of agree with Bishop Blake. You don't find the same vitriol within the local churches that you see written up in the Economist. It just isn't there at that level.

But I think on the question of stigma, you have to deal with it at different levels. You have to deal with it in the family. Start right there. I mean, how do you get your husband to admit that he needs to go for treatment, so that communication element right there in the family. And, as you said quite rightly, the whole question of in a community -- if you're seen going to the AIDS clinic, maybe you're going to be cut of the group, and there's where churches I feel can play an enormous role and individuals as pastors getting up and talking to the community about the respect for the dignity of the individuals, even when they are suffering with a disease.

And then, of course, there's the whole question in Africa and elsewhere about the situation of young girls, the situation meaning that men hit on young girls and they are exceptionally vulnerable. And it is the community that can become a protective element for young women and girls when there is no -- when the parents have died. So, that is also another element that has to be dealt with.

HOFFMAN: Just to pick up on Ken's last point, my eldest daughter is in the Peace Corps in West Africa in Benin and she's teaching school in a village in the far north. And one of her biggest struggles is precisely the pressure that the male members of the community place on these young schoolgirls. And, in fact, a Peace Corps volunteer was actually murdered in Benin a couple of years ago for reporting this to the Peace Corps office. But just to rewind a bit, trying to answer your question, perhaps I can share with you some of the things that World Vision is actually doing in the field to address stigma in these developed intervention models that we utilize.

For example, something called the Community Care Coalitions, and this is something that CRS also does where we work together in many places, particularly in Zambia where these local community groups are part of a project that we're both implementing which mobilizes and strengthens community-based care and support for orphans, children living with HIV and other vulnerable children in their households. To give you an idea of the scale of this, in fiscal year 2009, which goes to almost the end of 2010, over 73,000 volunteer home visitors provided care to 1.2 million orphans and vulnerable children and 84,000 chronically ill adults, including ART support, income generation activities, and so forth.

Addressing the faith communities themselves, there's an intervention model that we use called Channels of Hope which mobilizes and equips churches and other faith communities to respond to the needs of people affected by HIV and AIDS in positive and powerful ways, reducing stigma and discrimination while improving access to HIV and AIDS services. Again, in the same time period, to give you an idea of the scope of these activities, over 2,000 workshops reached more than 43,000 people, including almost 15,000 faith leaders from 3,500 congregations. So we're in the weeds with the faith communities and the faith leaders on these subjects.

And then we have another model, the values-based life skill training which provides training information and materials to enable girls, boys and youth from ages 5 to 24 to develop knowledge, attitude, skills to make healthy life choices and avoid acquiring HIV. Again, to give you an idea of the scope during the same time period, 600,000 children received these skills training, and almost 60,000 were trained as peer educators and facilitators.

There's also a model called Community Conversation which engages the communities and their leaders to affect change in social norms that adversely affect health and well-being of orphans and vulnerable children, people living with AIDS, gender and other harmful traditional practices.

There's another intervention model called Timed and Targeted Counseling which provides health messages to improve health seeking behaviors and access to services at specific points in -- key points in time and specifically targeted to vulnerable members of the community.

Community PMTCT, interventions that specifically target linking the clinical services to the community. As many of you probably know, one of the big problems in vertical transmission is losing these children to follow-up. It's very difficult to track and to manage children. They tend to disappear once they leave the clinic with their mothers. And so, this is what World Vision does is help the facility track these kids so that they come back and they're properly cared for.

And, also at Pediatric AIDS there are similar programs that, again, as I said before, our role is to help link the communities to these services and step down many of the services or the tasks related to these services to the community which both empowers the community but -- and at the same time reduces patient cost and makes these delivery systems more sustainable.

GARRETT: We're going to open it in a moment to the full group here but before I do, I want to ask Ken a question. now, I know most of you think I'm going to ask him about last week's Vatican summit on condoms and maybe some of you want to ask him that but I have a more pressing problem in my mind right now.

In 2004 we had a meeting here looking at the status of PEPFAR at that moment which was still early days of PEPFAR and a lot of mistakes were being made and a lot of money was rushing out the door very rapidly. And one of Ken's colleagues, who's here, and he became fairly choked up, quite emotional, talking about the moral dilemma the Catholic Relief Services felt that they were rapidly enrolling patients in the antiretroviral -- or individuals in antiretroviral therapy programs without having any guarantee that two years down the road they would have the money to keep them in. And every day, those same individuals were coming forward and saying, well, what about my brother, my three lovers, my wife, my children, I want them all on the drugs too. And for CRS, this was creating this extraordinary burden of the expectation out there versus the lack of any guarantee that you would have the money to keep them on.

Now, you gave the staggering figure of -- what was it -- 210,000 people on antiretrovirals under your program. And at the same time, you said that PEPFAR is easing you out of the driver's seat. So how do you see this looking forward, the ability of CRS to continue to provide that treatment service, even to perhaps expand it and your relationship with the U.S. government?

HACKETT: For the last year we have slowed down new enrollment because the budgets have been cut. So, in order to -- our adherence rate is pretty high so people stay in the program once they're enrolled. And if you've got a fixed budget, you've got to provide a certain amount of services within that fixed budget. Happily, the cost of drugs have gone down markedly and we have been able to make some movement forward but that's the first instance. We haven't been able to enroll as aggressively because of tight budgets.

The second challenge is that our board in helping us through this decision basically said, we will set aside X million dollars for the eventuality of there being a rupture in the fund pipeline. We've had to use that reserve now at least on two occasions where we had to underwrite the cost of the PEPFAR program from private donations because the money wasn't flowing fast enough.

GARRETT: Wait. Let me just make this clear. So even out here in New York you're shutting down parochial schools and cutting back on health services. St. Vincent's hospital is no longer a reality. St. Luke's, Roosevelt, et cetera. Even so, you have to say to your parishioners, we guaranteed these 210,000 people would stay on treatment so this money and support is going overseas.

HACKETT: You could put it that way. (Laughter.) I mean, basically we have worked hard to create a pool of funds that would allow us to keep those patients on treatment. And I know this is a painful dilemma for the other lodge agencies. Harvard -- I think Jimmy, maybe you can speak to this -- Harvard debated very seriously about getting involved in this program. And the reason is because the president's office said basically, what about after year five, what responsibility is there and where are we going to get the funds? So this is a real challenge and we're putting a lot of energy, as I say, on Capitol Hill but also recognizing that these people are alive because of this therapy and we brought it to them and we've got an obligation, moral and ethical to stay with them to the extent we can.

GARRETT: OK. Protocol at the council is, if you wish to ask a question, you raise the card. I will try to see them in the sequence in which they're raised and give you an opportunity to ask a question in the order that I see your cards get turned. And I may not be able to read all the cards but I've got them.

All right. So I think we -- the first one I saw pop up was Jeffrey. Please identify yourself and if you have a question, make it a question, not a speech. And if there's any particular individual on our panel you'd like to direct it to, please do so.

QUESTIONER: Thank you, Laurie. Let me make a brief observation regarding the remarks with which you opened our discussion. In one sense, it is not so remarkable the General Assembly is only discussing the special session AIDS for the second time but that for a health related issue, it's popped up at this supremely political body at all rather than being relegated to the World Health Organization, WHO like most others are. I mean, it's a sign it has political traction I would think.

The question that I would like to pose is the kind of resources that NGOs of faith are able to raise among their faithful here in the U.S. And in this regard, what is the experience of a different kind of Protestant bottom-up ecclesiastical organization in getting a message out across church communities and the Catholic more top-down turning to the faithful and asking them to cough up something. Can you raise money at the parish or congregation level for a kind of contribution, matching contribution to what you get from government agencies? So -- I think of my own parish, where I don't recall ever having been asked for a second collection for AIDS programs of Catholic Relief Services or anybody. What's the experience of this with local folks at the congregation level and in getting the bishops willing -- in the Catholic case -- to demand that the parishes try to do something?

BLAKE: For the Save Africa's Children organization, we are totally supported primarily by congregations and by members of congregations. Relatively young organization, relatively small and we have a lot of priorities that have to do with establishing relationships with our brothers and sisters in Africa and congregations in Africa.

And so we are organizing and structuring -- Mr. Paul Turner, our president, is doing a great job in terms of establishing relationships with government entities and the U.N. and others, you know, in soliciting support from those organizations. But, for us, totally our life has been celebrities and wealthy individuals who have made donations and they are primarily members of the local congregations with whom we deal.

HACKETT: Good question and good observation sitting here in the Archdiocese of New York.

QUESTIONER: (Off mic.)

HACKETT: Oh, well, that's even worse. (Laughs.) It is possible. But let me look at your question in a different way. First of all, there is a network around the world and particularly in the poorer countries of Catholic and other Christian health facilities. That is enormous. In some African countries, you could suggest with great credibility that 50 (percent) to 70 percent of healthcare facilities are Catholic or other Christian.

GARRETT: (Also ?) you could say 100 percent.

HACKETT: The ones that are working, yes. So, it's enormous. So that's a resource right there and that was recognized within the early founding fathers of PEPFAR and I think that's why we were encouraged to be engaged. I find here in the United States that people will be generous in their support if they are asked and we are doing as much as we can right now through the Catholic bishops, but also through other networks of Catholic groups to try to raise the visibility on this particular issue. So I don't think we will match government funding, but we have seen over the last eight or nine years a significant increase from the Catholic faithful.

HOFFMAN: In terms of World Vision, a real rough thumbnail calculation is probably in the last five years or so, probably about $100 million worth of private moneys were going into HIV programs. Now, many probably know that a good part of World Vision's -- first of all, World Vision is primarily privately funded. The grants portion is probably around 15 (percent), 20 percent which is sort of small compared to some others. And that much of our private funding comes through sponsorship, child sponsorship.

Now, this gives the organization a certain amount of leeway since we're implementing integrated projects at these area development programs for 10 to 15 years in large groups of villages and families, sometimes up to 100,000 people are grouped in individual (ADPs ?). Only a portion of those resources that are from the sponsored child actually are going to provide something to the child. More is directed to help the community. Obviously in those communities where HIV is a huge problem, it's there.

Now, I think that -- to take up Ken's point and to give you an example, we had a church come to us a couple of weeks ago and not in the area of HIV, but in the area of malaria -- World Vision has a capital campaign going on now that focuses on different sectors and malaria is one of them. And this church was pledging $1 million for a certain area in northern Malawi, but they wanted -- they had been supporting the Presbyterian hospital there for years and they wanted this donation to be coordinated with and reinforce the clinical activities in the area of malaria in the hospital. And so you find this sort of connection where you have the faith-based resources that are going in, both institutionally and individually for decades and they're meeting up with and combining with specific pledges, either for a sponsored child or for a specific sector like HIV or malaria.

GARRETT: Timothy Thomas.

QUESTIONER: Thanks, Laurie, and great gathering. Thanks for inviting us. I'm Tim Thomas from the Maternal Health Task Force at EngenderHealth. Just one interjection and one question. The Uganda death penalty for homosexuals is not unusual. Homosexuality is criminalized across the world, most notably Jamaica, most of the Arab speaking world, anyplace that's governed by any sort of fundamentalist government. So singling out Uganda is good for us to all look at how the codification of a criminal law -- criminality for homosexuality is happening in one state, but it is by no means unusual.

Secondly, I'm struck by what Mr. Hackett said about your role as a political educator in Washington. And I see this very much in my work in maternal health in the developing world that we are sought as experts to instruct new politicians on the five major causes of maternal mortality and morbidity. But we are not service providers. We are educators so we are advocates. We are a collection of researchers and that's our job. You are service providers. And I wonder, do you have thoughts about how we could -- how you can disaggregate political education, especially among donor governments so that it's handled by groups that are adept and committed to doing that as opposed to adding that burden to the good service providers like you.

HACKETT: We feel very comfortable talking about what's going on in Malawi, in Haiti, in Kenya, in specific ministries of health. That's our world. Why not convey that to our congressional leaders in a way that hopefully they can understand when you put actually the face of those people in front of them, we're just finding -- that's a gift we have to give.

QUESTIONER: A follow-up, Laurie, if I may. Are you funded to do it?

HACKETT: No. We have an office of three, four people in Washington. We fund it out of our general revenues. We don't spend that much on it, but we use the occasion of knowing about what's going on around the world and making that available to congressional and administrative people.

GARRETT: Is it Reverend or Father Tischovsky (ph)? Reverend.

QUESTIONER: Irreverend.

GARRETT: Irreverend. (Laughter.)

QUESTIONER: I wanted to thank the presenters very much for lucid and important presentations. I want to ask a question about the inter-faith dimension. The communities of faith in most parts of the world, many parts of the world are pluralistic and what is the interfaith dimension of the challenges that you've commented on? The program is called Communities of Faith, so when you go into Africa, say, as an example, there's certainly a very strong presence of Muslims and Muslim communities, as well as a strong presence of Christian communities. How does that impact, influence, challenge the work that you're doing?

HOFFMAN: Could I respond to that? Of course, with HIV, oftentimes the prevalence and the problem in the Muslim communities is less acute than in the other faith communities. I'll give you an example not from HIV but from another disease response, the polio response which we're working on with CRS and ADRA, the Adventists, and others.

In the case of Uttar Pradesh in India, which is primarily a Muslim area of India, where the program is working with local imams to discuss issues around resistance to vaccination because the popular wisdom in these communities is that polio vaccination is a plot, a Hindu plot to sterilize Muslim children. And the -- when we first started working on this -- and I know CRS is working there so is ADRA and so is World Vision, the rejection or the resistance was massive.

Now, with -- and I've sat on the ground with groups of local imams talking about this and the work they do in demystifying this activity. So it does happen. In the case of HIV, it's a little bit more complex. And I don't -- maybe Ken or the bishop have some specific examples.

GARRETT: Let me narrow it down a little bit, the question, if I may -- lean in if you don't mind. Do either of you have anything going on on the ground in Africa where you're directly coordinating your effort with another denomination, another religious affiliation?

MR. : We work with a number of -- particularly in Tanzania where 40 percent of the population is Muslim. And by the way, Save Africa's Children is -- although we're faith-based, we really are a secular service delivery organization, so we do not discriminate on the basis of religion, although that is something we have to remind some of our faith-based partners in-country that -- who tend to be not only tribalistic sometimes, but also in terms of faith. They like to kind of garnish those resources for their particular community. And we have to say, you know, that is not our values, our values are that we meet the need wherever it is and that's regardless of faith. So while we don't -- so the dimensions that you talk about is that. That trying to translate that sense of pluralism to the field has been a challenge, but it's been a challenge that we've met.

HACKETT: I can give you an example from Nigeria, and I'm cautious about examples from Nigeria because they oftentimes blow up in your face. But in fact, the Archbishop John Onaiyekan of Abuja and the imam whose name I forget have come together in a very public partnership to work on health programs: malaria, to some extent AIDS, in both treatment and the care of orphans and vulnerable children. And then it has gone even further. You've all heard about the trouble in the north, which has gone on for decades, but of late, the burning of churches and mosques. And what they're trying to do is to use the collaboration around health program to go into other efforts to foster a more peaceful dialogue among people.

GARRETT: Babatunde.

QUESTIONER: Thank you very much, Laurie. And let me, first of all, apologize for coming late. My name is Babatunde Osotimehin. I'm a Nigerian, so it's just appropriate that I'm speaking after Kenneth. I'm the current executive director of UNFPA and in my last life I was minister of health in Nigeria. And I think -- I don't have a question, but I think I could make some contributions to these conversations, which I believe would illuminate it further.

I want to start from where Kenneth stopped and talk to the issues of the interfaith collaboration on the ground to Nigeria. (Inaudible) -- the sultan of Sokoto, who is the supreme Muslim leader in Nigeria, actually under our leadership provided on-the-ground support for -- started with HIV, and then we went on to polio. And today, Nigeria, even though is one of the four under the leadership of the interfaith organization in Nigeria, reduced the burden of polio by 90 percent. And this is something that the WHO has documented. In fact, at the last World Health assembly, Bill Gates actually had to congratulate the organization that was responsible for this on the ground, in Nigeria.

So there are very positive things that interfaith could accomplish on the ground. Now -- and furthermore, that interfaith coalition was responsible for assuring that we started and we are in the process of distributing 62 million bed nets in Nigeria to communities that otherwise would never have been able to access this facility. So we have a good collaboration on the ground. And indeed, I remember President Obama, visiting Africa for the first time, actually citing that collaboration as a good example.

Now, the point I wanted to actually -- a point I came into this conversation, and I felt I should -- I should make an intervention -- was the point where I listened to Kenneth talking about -- and I think there are other issues around the table, where people were asking about sustainability of treatment of HIV. That is a big issue. And I want to turn it on its head and to say that maybe those of us who are mobilizing resources from developed countries and trying to assist developing countries should also do something a little different, which is set aside some part of the money for advocacy to governments on the ground in Africa, and after to put domestic resources to this.

It is also unsustainable to expect that ODA and aid money would treat people for life for HIV. It's not going to happen. And there are reasons why it won't happen. Number one, because those drugs and the treatment continue for life. Most of the people we are treating are in their 30s and their 40s. And if you continue to treat them and you have the compliance which we talked about, they're going to live to 70. Now, that's one.

Two, we're not treating everybody that requires treatment now. So there's a demand, and that demand will continue to grow because new infections keep coming up every day.

Number three, as they take drugs, whether they are compliant or not, we are going to begin to see that they will need second-line and third-line drugs, which are infinitely more expensive. And so even from the pot which you're getting now, you would not be able to sustain that. But I think that the most important is that we should take an advocacy beats to our work and give the real numbers to governments on the ground to say we will start, we will catalyze the process of putting these in place in our hospitals, in our clinics, in our counseling centers, but you must sustain this.

GARRETT: Well, congratulations I guess is the right thing to say for your new position. Taking over UNFPA is always -- talk about sustainability. I mean, one burp from the United States Congress and there goes all family planning money again. And by the way, they're burping really loudly right now.

Our time is almost up. We always end on time here. And so I just want to make sure that a couple of people get last chance. We have time for one really burning comment. Which one of you has a burning comment, Rick?

QUESTIONER: (Off mic) -- previous remarks here. I'm Father Rick Ryscavage of Fairfield University. I -- it's inconceivable to me that PEPFAR is going to be fully funded in the scale it has been in the past. And I know PEPFAR is putting a lot of attention and energy into public-private partnerships and I'm wondering if any of the faith-based groups have actually been successful with any partnerships with corporate America, in terms of raising funds for projects in Africa and other places.

GARRETT: By the way, you can take your time answering it because I goofed and we're going till 2:30. (Laughter.)

HOFFMAN: The project that we mentioned in Zambia was the initial -- one of the initial PEPFAR programs, Orphans and Vulnerable Children. It also was treatment support and a lot of other things. That -- the actual U.S. government PEPFAR funding was a little bit under $60 million. The total booked value of that project after five years was almost $200 million and the balance was made up with private corporate support. Now, a lot of it was in GIK, in gifts in kind that had to do with bicycles to transport community care workers. There was a care kit that the community health workers carry with them that have certain components in them and so forth. But there was also financial resources.

So that's an example, but it's not -- it's not a panacea, just like, you know, Ken mentioned before, healthy skepticism about this idea that local governments are going to assume the responsibility of providing treatment and care to these folks. It's probably not going to happen and I don't think the corporate world is going to step forward and fill the gap either, in my personal opinion.

GARRETT: I could see our conversation evolving towards more and more concern about sustainability and about identifying alternative sources of ongoing funding for this effort we call tackling HIV/AIDS. And with that in mind, I wanted to ask our wonderful guest from Oslo, Sigrun Mogedal. You are next.

QUESTIONER: Thank you very much. I used to be the Norway's ambassador for HIV and global health initiatives, but I have just retired, so I am helping as a special advisor for HIV -- (inaudible) -- in UNAIDS. What I wanted to comment on is in relation to sustainability, but also matching sustainable resources with policies, national policies that actually help to prevent infections.

Listening in to the conversation about the compassion and the care that the churches stand for -- and coming from the negotiations in the U.N. headquarter over here, where also we see church and faith communities in a political role, but not necessarily a political role that talks about the same that we talk about here, but somehow do not face up to what do countries need to do in order to stop HIV transmission, in terms of policies, legislation. And it's a lot of difficulty -- we know -- in how to handle that.

One of the answers you have mentioned, responsible behavior and knowledge, but there is also a lot of things going on in countries that actually keep this pandemic going. We've also touched on that, but I think somewhere there is a disconnect between the discussion around more resources and a very honest discussion about what can be in the national responsibility to have policies that stop transmissions and be accountable to that.

And how can churches actually go into that dilemma, where there are different opinions, where we do have the moral mandate, but also in the public world one has to make policies that actually do give -- so that's what's my sort of challenge to the church leaders. How can we actually translate some of this compassion and the reality check that you have with a voice at the political level when we're debating, so it doesn't stop responsible action when it comes to national ownership.

In terms of the sustainable finance, I think the only deal we can make, because donors start to get also weary and there is a reason why one shifts from one to the other and talk about national ownership -- I think if one could make a compact between countries that do everything possible to stop HIV and provide access to people, then it's easier to get governments to make a deal which is a predictable long-term deal and not just year-by-year or organization-by-organization.

So I think there are possibilities here, but we'll need to somehow create a compact between those interests. And I'm just wondering how can churches be advocates for both, not just for more resources. Thank you.

GARRETT: Let me take your first question and focus it for each of you to address because I think it's a -- it flows a little bit like the flipside of Mr. Thomas' question. He asked you, you know, how does the church play a role on the donor side, how do you advocate inside government? Sigrun's asking you how do the churches -- and it follows a little bit from your comments as well -- how do the churches, religious forces influence the host governments so that the real issues at the core of the thread of HIV get addressed. And I think how -- both Ken and Jed, you both mentioned the treatment of women and girls and attitudes towards women and girls, some of which are enshrined in law in these countries. And -- so let's see if we can get our hands around this issue to some degree.

MR. HACKETT ?: I think this would be wonderful for you to start and to talk about the role of churches in influencing government.

MR. OSOTIMEHIN: That's fairly straightforward for me. Under President Obasanjo, he instituted an interfaith platform. And they met like a monthly basis, addressing national issues. And it was that platform that we used to address the issues of HIV. And we got them to accept that prevention is the way forward and that they must be standing there talking about prevention, not from a moral perspective because that one will not go far, but actually being realistic about what needs to be done on the ground. And so we got them to push understandably the issue of abstinence. But then, for the first time, they allowed us to talk about choosing condoms in discordant couples. And that, in fact, was like five, six years ago.

So in a sense, that worked, but we -- I then was managing the HIV program in Nigeria and I did it for eight years before I became minister of health. We gave them information and material to passage all the way down to the smallest units as either imams or Christian clerics. And we identified one week in a month where they would go to the pulpit and speak about HIV. I think that really worked effectively in terms of bringing that.

Now, the last thing we did with them was to speak to them about the status of women. That is something which is ongoing, something that we have to address because we know that the gender power relationship between men and women in our society actually fuels the transmission of HIV.

GARRETT: Let me refocus this again because I think that Sigrun Mogedal has raised a very, very critical question. And with us is Jimmy Kolker from UNICEF. UNICEF, if you haven't seen it, just released, on Friday, I believe, this really massive report, the first one with incidence data, annual incidence data on adolescents and young adults and HIV, very disturbing information in here. As we speak of successes, we also have to recognize, we have groups that are very hard to reach.

Now, one of the problems everybody knows, teenagers don't like to hear messages from the pulpit that tell them they're nasty, they're evil, they're awful. The teenager walks out of the church. What's -- how do you create a set of messaging and influence governments in these countries in ways that actually can save the lives of these 14 and 15-year-olds that are at such high risk, especially the girls, who, as Jed pointed out, are at risk from basically predatory older men?

HACKETT: I would just suggest that what was done in Nigeria is really the leading edge. You don't find church leaders everywhere across the continent of Africa or the Caribbean taking such a bold position, but it may be a paradigm for others and an encouragement. And I know within the Catholic Church, many of the Nigerian bishops are moving around Africa talking to their brothers about what they could do in Ghana, what they could do in Sierra Leone, in Niger. And so there's hope there.

But a bishop is not trained to talk about AIDS or extractive industries or mining or -- that's not what they go to school for. And so they feel kind of nervous. And so it is the material that can be helpful to give them the comfort that they're not going to look like a fool when they enter the minister of health's office. They want to be able to have a dialogue at an intellectual level that makes sense.

BLAKE: I don't have much to add except to say that churches are so significantly grassroots organizations. They are in the communities. A significant percentage of the population of every nation participates in the life of the churches and I think that any kind of way that we can influence governments to understand that churches should not be avoided as vehicles of communication and healing for those communities, because they are so deeply involved, and I've not found, across the continent of Africa that that is realized by political leaders. And I think we need to focus on that.

HOFFMAN: A couple of things. First of all, there're some interesting initiatives going on right now that are developing compendiums of sermons that -- or homilies adaptable to different congregations and faith traditions to -- around how to message from the pulpit these issues and oftentimes issues that, as Ken says, pastors are not comfortable or feel ill prepared to speak to. But -- and so there's a number of these going on. One of the -- I know World Vision is involved and working on this -- so is IMA, World Health. And so this is one initiative. But there's also this issue of subsidiarity that -- and I believe that all of us, all the faith-based organizations, even though it's a principle of Catholic social teaching, I believe, that we all ascribed to the principle of subsidiarity. I know that Rich's new book, "Hole in the Gospel" borrows a lot from Catholic social teaching. Rich Stearns, the president of World Vision.

But I think the engagement we have with the structured local expressions of faith organizations in the countries, whether it's the Christian Association of Zambia or the Christian Health Association of Kenya and so forth, all of these -- they're typically ecumenical. They're not Protestant and Catholic. They tend to combine the two. And even in areas where there are other faith traditions, they're also involved. And these are the vehicles that influence local policymakers.

And to the extent to which we can influence them, support them, get them involved, increase their expertise and their exposure to these complex issues, we can influence local policy. But to go in as World Vision or CRS and try to influence local decision makers, local politicians and so forth, it's a little bit not our thing. We tend to work with the local organizations to increase the capacity, local capacity; they advocate to formulate policies -- tends to be better received and more effective in the long run.

GARRETT: Let me throw it to you another way. When we had Desmond Tutu here at the council as a speaker, he became quite emotional talking about the raft of rapes being committed across his own country and other countries in the region by man who believe that by having sex with a virgin, they transferred the spirit that was making them ill from their body to the body of the virgin. There's two very horrible values there. One is the rape itself, but the other is the assumption that that female is so worthless that it's OK for you to give your lethal disease to this other human being and they must absorb it.

Cannot the churches address this? Cannot and should not the churches be talking about these values.

BLAKE: Laurie, just on this issue, number one, there has been a discussion in South Africa on the issue of rape and one of the things that's missing from this entire conversation is the fact that this is a very racialized discourse. Now, no one has sort of talked about the whale in the tub of the political discussion around blacks and sex, which is complicated when folks from the north or the west get into the political conversation. And what has been under-appreciated intellectually is how racialized this is. So when my comrade from World Vision says, "I'm not touching that," translation from a white NGO -- I'm not going into Africa to tell no black dudes about what their sexual behavior should be like.

Now, what should be known on the ground, we initially got involved, in 1998, as a result of Michael Orrin (ph), one of Ken Hackett's friends, who told a group of us the bishop had sent to Africa to sort of look at this business: Look, there is a sexual holocaust. There's an issue of behavior. There's the issue of rape. And the black Church has raised it because we challenge the black political leadership and the churches on the issue of black men raping black women, all right? So it wasn't going to be a neo-colonial thing. It wasn't going to be white people trying to tell black people. It wasn't that game. And we've directly challenged them.

So there has been a conversation and a discourse that the Western media never picked up. The only stories that get told are about black people trying to kill gay men. So that when I read the New York Times, no one reports about the thousands of Pentecostal churches on the ground who challenge the political leadership precisely because of their conservative convictions. See, the conservative thing plays two ways and being good high liberals, we only get one side of it, right? The good side of the conservative thing is that you're actually dumb enough to believe what you -- dumb enough to have convictions, so you will challenge.

So let me just say this, Laurie. One of the things that needs to be done by the intelligentsia is that we actually need to go on the ground and see the work that's being done, so that if you go to the Kibera slum in Nairobi, they challenge the man. Now, this gets picked -- the Times won't run that story. It will only be the Nairobi story about the courts and the fact that, you know, blacks in Africa are pathologically homophobic. I mean, that's sort of the line. But there's a much more complicated, much more nuanced story that needs to be on the table because we're only getting one side of it.

GARRETT: OK. Now, we're moving somewhere. (Laughter.) We have about 15 minutes and what I want to do is try and give as many of you an opportunity to make your comments or ask your questions as possible. So let me just first go through the list in the order I saw the cards turn, of five people, and let's see where we are when we get through that. Coming up next, Chung Ok Lee, then Thomas Utep (ph), then Azza Karam, Father James Dugan (sp), and then Gabriel Salguero. So -- oh, OK, then you'll be after Gabriel. Let's just go --

QUESTIONER: Yeah. Chung Ok Lee, executive director of U.N. affairs and interreligious affairs, Won Buddhism International. My question is that how can we really talk about the root causes of the problem than just dealing with the symptoms. As Laurie mentioned, I think a big issue in Africa, as I heard your presentation about the pressure on girls and women, is really about the gender inequality, discrimination against the women and girls, especially the young adults who are so vulnerable. They don't know how to say no. These are really related with the values, related with local cultures and traditions. And my question is how can you really -- just that, go back to the root cause of this problem. Politically maybe we -- (inaudible) -- let them doing what they are doing because of this value.

GARRETT: Well, Bishop Blake, I bet you didn't know you were coming today to talk about women's rights.

BLAKE: I don't mind. (Laughter.)

Well, again, you're talking about how do you impact a culture from the outside. And that is a very difficult thing to do. However, I am not as ready to assume that there is negligence and absence from a dialogue in this area in every sector of the continent of Africa. I believe that churches that I'm aware of, and there are some huge, very active, very vitally involved productive, hard working churches on the continent of Africa. And you can't really talk about Christian doctrine without talking about sexual behavior. And again, I know the statistics may contradict it, but I'm thinking that the sectors where the church is active and involved are sectors where this dialogue is taking place and where sexual behavior is spoken of as an aspect of the moral life that is expected of individuals who are involved in the life of churches.

And I think that churches should continue to share that with their constituents and with their communities and aggressively pursue that. That's all I can say. I'm not familiar with or aware of those other sectors where, for instance, it is believed and assumed that if a man can have sex with a virgin, he can pass on to her the disease and the demon that causes it. The people that I deal with are not preaching such foolishness. And I think that we need to continue that within our churches and within the communities where they are located.

QUESTIONER: Yes, I wanted just to address it more concisely. It is not about influencing culture or value there. It's about addressing women's issue as a human right issue. It's very fundamental issue for girls' rights and the women's right equally with the men, hopefully.

HACKETT: I think we're not reflecting adequately the breadth and the scope of the many, many programs initiated by churches in Uganda or in Zambia or in Malawi, in South Africa to engage young people in a whole breadth of activities where they feel supportive of each other and protective of each other -- men, boys, and young girls, and young women. We're just not giving an adequate explanation. But there's a lot going on. And I have to give some credit to the PEPFAR initiative.

Ten years ago, at a forum here, at least the Catholic group would be not allowed to talk about abstinence. Well, it was a very difficult battle, but some very good things happened that were funded by the PEPFAR initiative on abstinence. And they had impacts beyond the initial thing that was funded. You created youth groups in high schools and secondary schools and parishes. So more needs to be done, but we're not giving the full breadth of what is being done.

HOFFMAN: Could I just add to that that we are living in a time of tremendous change, from my point of view, at the community level. And I think a lot of it again has to do with this concerted focus of resources and energy and expertise and mobilization around HIV that has really transformed. There are changes happening -- profound changes happening in the communities. And I think we have reason to be hopeful that the generation of young people who are coming up will have created a -- will create a different kind of society. Of course, it's really frustrating to see that we have all the tools in our hands to do so much more and yet oftentimes politics and, you know, scrapping about what separates us rather than what unites us seems to drain away our energy and the resources seem to be drained away by donor architecture that makes collaboration and harmonization so much more difficult than it has to be.

Anyway, I think that you need -- I think that there's a lot of positive things that are happening right now, at least from my point of view, after going to these communities for so many years. I can see massive change happening.

GARRETT: Thomas Utep.

QUESTIONER: Thank you. My question is going to be very brief, I hope, and is directed specifically to Bishop Blake. During your talk, you mentioned evangelization and I'm wondering if both here in -- particularly in California, among your church community, your donor community, and in the host countries I think you address this among the local grassroots churches, is there a perception that this is a tool of proselytization or conversion among the people who are being served? And if so, how do you counter that, because obviously I don't think that that's what you're trying to do. But that's my question.

BLAKE: No, sir, the answer to that question is no. I'm not aware of where I referred to the matter of evangelization in my talk. If I did so, that certainly was not the focus of my sharing. The focus of this context, the focus of Save Africa's Children is extending every kind of assistance that we can extend to our brothers and sisters to advance the needs and the cause of serving the orphans and benefiting them and providing food sustenance, medical care, and guidance for them, using indigenous organizations on the continent of Africa.

And so, no, this is not a means of evangelization or extending the gospel of the church. It certainly is a means of expressing what the church is and who the church is in terms of its focus and its purpose to assist those who need help.

GARRETT: Azza Karam.

QUESTIONER: Thank you, Laurie, and I'm begging Dr. Osotimehin's permission to be able to speak as a staff of UNFPA. I deal with the cultural work of the organization, and therefore the discussions that have come about the way that people think and believe and behave being so fundamental to the changes that are ultimately required in order to see a difference in the HIV/AIDS work are very pertinent.

But we are also -- and Thomas is a member of this -- we're also working together as about 10 U.N. agencies on something called the Inter-Agency Task Force for Faith-Based Organizations and Outreach within the U.N. system, which has produced some very interesting observations as we go along, trying to assess how many different U.N. agencies are working with the faith communities. And the question that Laurie asked at the beginning, a very pointed question about stigma, I think lingers a little bit because one of the things that we've come across, which I'd like to be able to ask specifically to Kenneth and Jed is a sort of a disconnect between the rationale and the areas of emphasis that are seen as important by the faith-based sector in their interventions on HIV and the non-faith-based, for lack of a better word, interventions of the international development sector around HIV.

There isn't always a congruence, and I think Reverend Chung Lee underlined this notion of women's rights as human rights, as Dr. Osotimehin also said. Where do we often become very selective about which aspects of women's rights we will indeed talk about and which aspects we remain silent on? And I think one of the things that confronts us in the international development world is that the backing or the support that is often required from the faith-based communities sometimes can fall through the cracks of that -- the religious dogma and where there are some aspects where we will not be able to find the loud voices or voices as loud as we would like to hear from the religious discourses. So where can we work better to make sure there is more -- less dissonance?

QUESTIONER: (Off mic.) (Laughter.)

HACKETT: With the Catholics, you can't work on abortion, so take that one off the table. And then you can go from there and trying to find a common place for behavior change and things like that. But I don't think there's any good dialogue going on. I mean, these two organizations here are $2 billion a year. We don't talk that much with your group of U.N. faith-based organizations. So maybe there's a dialogue going on, but I don't think it's with the organizations that work on the ground. We should maybe pursue that a little bit.

GARRETT: That's a great way to end -- with dialogue. Let me thank everybody who participated today. I think this was a wonderful discussion. And of course, our panel members -- Bishop Blake, Mr. Hackett, and Mr. Hoffman. Two quick things -- and apologies to those of you whose questions we couldn't jam into the discussion. Everybody just got too motivated. Dan -- where's Dan? Daniel Barker, some of you have already had some interactions with him. He works with us here at the council. We have an update list that's put out by the Global Health Program that updates you on things going on in the global health world and also on activities here. If you would like to be added to that list and are not on it at this time, please give Dan one of your business cards.

And overall, again, let's give a strong hand of applause to our panel members. Thank you.

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