Not All FBOs on “Obama’s Evangelical Gravy Train”

by | Jul 9, 2014 | IHP Editorials

On July 8, 2014 The Nation published an article criticizing the Obama administration for its continued funding of programs run by conservative Christian religious groups (Obama’s Evangelical Gravy Train, The Nation). A number of the faith-based programs named in the article have received funding from the President’s Emergency Plan for AIDS Relief (PEPFAR). The article provides a service in highlighting tensions between the religious beliefs of these organizations and sound public health science and policy.

What it fails to do, however, is to show that many faith-based organizations are carrying out work in alignment with sound public health science and policy. And such organizations do indeed exist. The Interfaith Health Program (IHP) at the Rollins School of Public Health at Emory University receives funding from PEPFAR to build the capacity of precisely these kinds of faith-based partners and to build the evidence base for effective, responsible, sustainable HIV treatment, prevention, and support programs being carried out by the faith-based sector.  Such faith-based programs play a crucial role in responding to HIV because they have deep roots in local communities and in country-level health systems. In Kenya, for example, almost 30% of all HIV services are provided by the faith-based sector and in high HIV incidence areas such as Nairobi and Mombasa, almost 60% of medications used to treat HIV infection are provided by faith-based organizations (FBOs).

In 2012, IHP worked with PEPFAR to convene a consultation of leaders from faith-based organizations and health systems from eastern Africa. Program participants, leaders of FBOs from Kenya, Rwanda, Tanzania, and Uganda, developed a set of key recommendations. Among them:

  1. Marginalized, hard-to-reach, and most at risk populations (including men who have sex with men, commercial sex workers, and people who inject drugs) should be included in program design, implementation, monitoring, and evaluation.
  2. Maximize the existing organizational infrastructure of faith-based health systems to reach communities impacted by HIV, including vulnerable, hard-to-reach, and most at risk populations.
  3. FBOs that actively use religion to promote stigma and shame should be held accountable by FBOs endeavoring to offer strong HIV prevention, treatment, and support service.

The Nation article references both the report of the 2012 consultation and the third recommendation listed here but it does not note that leaders of FBOs from eastern Africa developed these recommendations. This distinction is important because it demonstrates that PEPFAR’s key faith-based partners are providing effective HIV services for diverse communities and combatting stigma in their local communities. Conference participants included representatives from organizations such as:

  • INERELA+, a network of religious leaders living with or affected by HIV/AIDS that has advocated forcefully for HIV programs in support of women, men who have sex with men, and anyone facing stigma or discrimination on the basis of their HIV status;
  • The Muslim Education and Welfare Association of Mombasa which works to provide clean syringes to injection drug users and provides comprehensive drug treatment programs;
  • Nyumbani, an independent Roman Catholic organization that provides comprehensive primary care services every day to over 6,000 children and adolescents living with or affected by HIV
  • The Ecumenical HIV/AIDS Initiative in Africa, a program of the World Council of Churches working to build partnerships among Christian organizations, governments, and civil society organizations built on compassion, social justice, and sound policy.

The representatives from these organizations and scores of others not named were calling themselves to accountability at the 2012 consultation and they were urging PEPFAR to help them build their capacity to implement programs built on the recommendations listed above.

In response to this call, PEPFAR has funded IHP to undertake a number of initiatives. From 2012-2014, IHP has been asked to develop:

  • a report describing effective work with men who have sex with men, commercial sex workers, and people who inject drugs being carried out by FBOs
  • a capacity-building initiative to build collaboration among FBOs, civil society organizations, and HIV clinical programs at the local level
  • a mentorship initiative that builds the capacity of smaller faith-based health systems by partnering them with established, model systems
  • a program to support HIV-positive adolescents in they grow into adulthood by addressing their needs in relation to sexual health and reproductive health, educational attainment, and economic empowerment
  • a report describing the ways in which FBOs effectively address the social drivers of HIV risk and disease progression

In 2015, IHP will be expanding some of these initiatives into new PEPFAR priority countries and implementing new programs, including:

  • a model practices framework to identify the essential elements required for FBOs to work effectively with people who inject drugs, commercial sex workers, and men who have sex with men so that those elements can be replicated by other FBOs
  • the creation of the Interfaith Centre on Social Justice on HIV to provide a platform for religious perspectives in support of social justice for all people

In short, PEPFAR is working to build partnerships with the faith-based sector in support of sound public health policy and science.  The article in The Nation raised a number of important issues that should be addressed. But in failing to describe the ongoing efforts from PEPFAR to work with faith-based partners very different from those profiled, the article only presented one side of the story.