A little over a year ago, President Bush announced an ambitious plan to triple funding for AIDS prevention and treatment efforts, to $15 billion. On December 1, World AIDS Day, a coalition of religious leaders called on the administration to keep its promises and appropriate the money.

Anne Peterson is a former missionary doctor to Zimbabwe and Zaire who was appointed by the Bush administration as head of global health for the Agency for International Development (USAID). She spoke with Timothy C. Morgan, CT's deputy managing editor, about what she believes are the key ways to push the administration's AIDS policy forward.

What is the best way to spend money fighting the AIDS pandemic?

It's going to be a matter of keeping the balance. How do we begin to do treatment, deal with all of the difficult systems issues, make treatment available fairly—while still not losing the key prevention messages, as well as the orphan care and dying-patient care?

If we ever want to be able to address all of the treatment needs for people living with HIV and AIDS, then we have to work desperately hard on prevention. We have to make sure there are the fewest number of people getting HIV/AIDS so that we can manage to do that scope of treatment. So we need to do both, and we need to do them carefully and effectively and fully.

The promise that I can make is that whatever Congress chooses to appropriate, we will work very, very hard to make sure it is very well used.

The other bottom line is, whether it's AIDS or whether it's child health or tuberculosis, or infectious disease, or agriculture, the scope of the need out there is way more than the available resources. So there isn't a single area of international endeavor that couldn't use more funds.

Is condom use effective against HIV?

Condoms clearly can reduce transmission of HIV/AIDS sexually. The question is how correctly and consistently they are used, and by whom and where. We have evidence that shows that if couples—in which one is HIV-positive and the other is negative—use the condoms correctly every single time, they get a lot of protection. This is especially true for married couples. Evidence from Thailand and Cambodia shows that 100 percent condom use in brothels, together with reducing the number of partners, made a huge difference for an entire country.

Are condoms perfect? No. Are they 100 percent effective? No. Do people always use them correctly and consistently? No. But there is a role. This can be an effective tool in specific situations. So for high-risk populations, for encounters with a nonregular partner, they are a good idea; they are better than nothing—as long as you make clear that they have to be used consistently and correctly.

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Now the flip side. When I was in Kenya in the '80s there was the question, "Why do the Americans keep bringing condoms to us? This doesn't fit with our culture." In a generalized epidemic, 50 to 69 percent of new infections are in youth. For most of that population, abstinence—delaying sexual activity—is a fully appropriate message. So is "zero grazing," the emphasis on remaining sexually faithful in ongoing relationships.

Such messages reduce the number of partners, thus reducing exposure to the disease. We have seen in places like Uganda, and now starting in Kenya, that people will respond to such messages. In a generalized epidemic, this is the strategy I would recommend most strongly.

Why does prevention work? Is it an issue of morality, or fear of disease?

It depends on where the person is coming from. In Zimbabwe I worked with a Scripture Union program that talked about abstinence as God's law, though we also talked about it as a public health issue—that God asks you to respect and care for your body, so you shouldn't expose yourself to disease. That worked there. But the USAID programs we support in Zambia come at it as merely the right way to live, also noting that it will protect you from disease. So there, it's a combination without a specific spiritual mandate. Still, it has been very effective.

Why do scholars and researchers object to abstinence and fidelity as a primary way to stop HIV/AIDS?

The public health community for a very long time did not believe that you could get youth to abstain or to wait. Because they did not believe it was possible to do it, they saw it as a philosophical or religious push.

What changed is that both in the U.S. and internationally, we're seeing data that people will change their behavior. They will choose to abstain or wait or stay faithful within marriage. And that does make a difference in disease transmission.

Some prominent Christian leaders such as Bruce Wilkinson, Rick Warren, Franklin Graham, Rich Stearns from World Vision, and Clive Calver from World Relief have recently seized on this issue. What do you see as their role in addressing the HIV/AIDS problem?

I think there's a huge role, because this is an issue that fits with the Christian message. And the prevention of AIDS fits with the righteous living and moral standpoint [of Christianity]. But equally important is the church's role in giving a message of forgiveness, of compassion, of caring for the sick, of caring for the widows and orphans; there's almost no part of the AIDS epidemic where the faith orientation doesn't have a very, very strong message. I think there is an absolutely huge role, and I am thrilled to see this outpouring of interest.

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Related Elsewhere:

Also posted today is a Charles Colson column on evangelical work fighting AIDS and international slavery.

Other CT AIDS coverage includes:

Beyond Condoms | To alleviate AIDS, we must sharpen our moral vision. (June 10, 2003)
A Strategy for Progress | Unless prevention of HIV/AIDS becomes a clear priority, things are only going to get worse. (May 2, 2003)
Civics for Gay Activists | We may see more die from HIV/AIDS because gay activists are intolerant. (April 10, 2003)
ABC vs. HIV | Christians back abstinence-fidelity plan against deadly virus. (March 10, 2003)
Jerry Thacker: Politics Muddies Fight Against AIDS | The politics of homosexuality has made it easier to battle the disease in foreign countries than domestically, says a former nominee to the Presidential Advisory Council on HIV and AIDS. (Feb. 07, 2003)
Killing a Pandemic | The church may be best equipped to deal HIV/AIDS a crippling blow.
AIDS 'Apathy' Campaign Debuts | Yet Christian leaders say stigma, not neglect, is the bigger problem. (Aug. 28, 2002)
Bono Tells Christians: Don't Neglect Africa | He urges evangelicals to take a lead in fighting AIDS and poverty. (April 19, 2001)
U.S. Blacks Preach Abstinence Gospel | Mission workers testify that Christ helps control sexual urges. (March 27, 2002)
Health Workers Urge Indian Churches to Join Campaign Against AIDS | The Christian Medical Association of India fights the social stigma that accompanies the disease. (Nov. 21, 2001)
Mercy Impaired | Let's shock the world by reversing our apathy toward African sufferers. (September 27, 2001)
Indian Church Steps Up Education Programs To Deal With Threat Of AIDS | Ten percent of those living with AIDS live in India. (August 17, 2001)
Kenyan President Suggests Hanging for 'Knowingly' Infecting Others with AIDS | Church organizations criticize use of capital punishment as solution to epidemic. (July 19, 2001)
Dying Alone | Baptist women seek out and care for ashamed, abandoned AIDS patients. (June 15, 2001)
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Few to Receive Generic AIDS Medicines | Pharmaceutical companies drop suit against South Africa, but problems remain. (May 18, 2001)
Zambia's Churches Win Fight Against Anti-AIDS Ads | Church leaders are concerned that condom promotion encourages promiscuity. (Jan. 12, 2001)
Mandela, De Klerk, and Tutu Join to Fight AIDS | South Africa's men of peace call for end of silence and stigmatization. (Dec. 14, 2000)
Pastors as Grave Diggers | Christians hope to break the silence and overcome Asia's prejudice against people with AIDS. (July 28, 2000)
Speaking with Action Against AIDS | A report from the Thirteenth International AIDS Conference. (July 19, 2000)
'Have We Become Too Busy With Death?' | As 4,900 people die each day from AIDS, African Christians are faced with the question. (Feb. 4, 2000)
'Sexual Revolution' Speeds Spread of HIV Among Africans | An interview with World Relief's Debbie Dortzbach. (Feb. 4, 2000)
Books & Culture Corner: An Open Letter to the U. S. Black Religious, Intellectual, and Political Leadership Regarding AIDS and the Sexual Holocaust in Africa (Jan. 24, 2000)

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