I’m in a session about sustainable approaches to PEPFAR.

Shephard Smith, who does faith-based work on HIV/AIDS, is one of the speakers. The chair of the meeting introducing him notes that in the 1980s, it was very unusual to find evangelical Christians working on HIV/AIDS and that Smith was one of the first such activists. Smith cautions that "PEPFAR may be doing some harm that we don’t understand" because in paying doctors in the developing world for specializing in HIV, other medical specialties may be neglected. He also cautions developing countries against relying for aid on a country that might have "some fiscal issues of its own" at some point. He calls for "local solutions." Finally, he applauds the integration of the faith community in the HIV/AIDS services community.

The next speaker is a pastor who emphasizes the role of the faith community in the fight against HIV. He says that churches are already integrated into communities, that churches are sustainable, and are "always there." (He also hails President Bush as a "hero." Make of that what you will.)

I haven’t interjected any opinion in my reporting from UNGASS so far, but now I can’t resist. The speaker is concluding his remarks with a lengthy story about a prize-fighter who won against seemingly insurmountable odds. I can’t believe he is spending people’s time on this!

For the record, there has been no discussion of the actual weaknesses and controversies in PEPFAR — lack of integration of contraceptive services, the anti-prostitution pledge, and the abstinence-only approach.

I typed too soon!  A speaker from the floor is now decrying the PEPFAR’s excessive bureaucracy, saying that it is a hurdle for community-based organizations in accessing PEPFAR funds. He also raises the question of the rights of sex workers, intravenous drug users and men who have sex with men in truly effective prevention methods.

A panelist respondes that the perception of excessive bureaucracy comes from the "clash of cultures" and that Africa’s "oral tradition" means that Africans are not used to needing to document financial transactions in writing. He says that that’s part of becoming a developed country. "Accept it as a good thing, even though it’s very painful," he says.

A USAID panelist gives another prospective on the bureaucracy.  He acknowledges that it’s frustrating, but also admits that USAID has in the past preferred contracting with larger NGOs than smaller community-based organizations because they are less work to implement and require less oversight. He says that now, 70-80% of PEPFAR partners are locally-based.

He also says that PEPFAR offers grantees the flexibility to promote and educate about condoms in a variety of different ways, so long as they are not providing misinformation. He says that PEPFAR has been decried by the left (for including abstinence) and the right (for talking about and distributing condoms) but he says both sides are wrong. He claims that PEPFAR emphasizes a comprehensive approach.  He says he has seen real progress on "the culture wars" in the past two to three years. "People in Africa see that condoms won’t solve this problem alone," he says. He claims that behavior change — delay of sexual debut and reduction in number of sexual partners — is an integral part of prevention strategy. 

A participant from the floor asked about the prospects for the PEPFAR bill currently in the Senate.  The USAID panelist thinks the bill has a strong chance of being passed.  "They’re going to argue about a few little things back on forth…but most people on both sides of the aisle have already agreed." 

I’m heading upstairs to the press conference on marginalized communities.