President George W. Bush was awarded
the first-ever medal of P.E.A.C.E. for his work on HIV/AIDS. Pastor
Rick Warren of the Saddleback Church presented the medal as part of
his Saddleback Civil Forum on Global Health.

The event featured video tributes
to President elect Barack Obama, UN General Secretary Ban Ki Moon, musician
and activist Bono, and other mainstream, secular figures in the global
fight against AIDS.

This is the first-ever P.E.A.C.E.
medal, awarded for excellence in combating what Warren calls the Five
Giants: spiritual emptiness, self-serving leadership, extreme poverty,
pandemic disease, and illiteracy.

The ceremony is part of Warren’s
ongoing bid for bipartisan political credibility on the national and
international stage. Senators Obama and John McCain appeared at another
prominent “civil forum” hosted by Warren during the presidential
campaign.

The ceremony itself had a decidedly
secular flavor, but the sponsor is a mega-chuch with outsized missionary
aspirations. The “P” in “P.E.A.C.E.” originally
stood for “plant or place a church in every town.” The P was
later reassigned to “Promote reconciliation.” The old acronym
made more sense. Rick Warren’s goal is to set his churches up around
the world and make each church a source of food, medicine, and education.

Obama did not attend the awards ceremony,
but he pre-recorded a video address which was shown at the event.  It is a coup for Warren that the President Elect chose to release his
address to the nation on the event of the 20th annual World AIDS Day at
the Saddleback Civil Forum.

In his speech, Obama stressed the importance of partnership between
government, non-governmental organizations, and faith-based
organizations.

“NGOs and faith-based institutions are marshaling the best of the human
spirit to help those affected. And world governments are coming
together to address the humanitarian crisis the pandemic has left in
its wake,” Obama said.

For all the mutual good will on display,
Warren’s agenda may well clash with Obama’s plans to reshape American
AIDS policy.

As a presidential candidate, Obama
laid out a detailed strategy for combating HIV and AIDS in the US and
abroad: Barack
Obama and Joe Biden: Fighting HIV/AIDS Worldwide.

Obama is committed to reauthorizing
the President’s Emergency Plan for AIDS Relief while eliminating the
ideologically-motivated provisos about how recipients can spend the
money.

Currently, the recipient nations
must pledge to spend at least fifty percent of funds allocated to fight
the sexual transmission of HIV on promoting abstinence until marriage
and marital fidelity, unless they justify why they are promoting condom use.

“The reauthorized PEPFAR bill maintains
an onerous reporting requirement that signals to countries that abstinence-until-marriage
should be the dominant prevention paradigm,” explains
William Smith, Vice President for Public Policy at the Sexuality Information
and Education Council of the United States (SEICUS). Smith explained
that recipient nations must file a report to Congress unless they spend
50% of their sexual transmission prevention budget to promote abstinence
and marital fidelity. Countries that
receive funding are desperate for resources and loathe to do anything
the might jeopardize their funding.

Smith hopes that President
Obama will encourage recipients to tailor their PEPFAR programming to
local needs and “not
some silly formula written and forced into law by right wing zealots
in Congress.”

It will take time
to see changes, even with strong leadership from
Obama.

“Even with the
best of education, it will likely take several years to get countries
to the point where their own plans mirror the demands of their epidemics
instead of the Bush Administration’s policy preferences,” Smith said.

Obama is a staunch supporter
of comprehensive age-appropriate sex education as a cornerstone of AIDS
prevention. In his AIDS position paper he pledges “to ensure that
best practices – not ideology – to drive funding for HIV/AIDS programs.”

A president, Obama will have the
power to make several key executive decisions that will further his
AIDS agenda. Rewire attempted to contact several key health advisers
on Obama’s transition team, but we had not received a response as
of press time.

President Obama could start by revoking
the so-called global gag rule, a rule that prevents international development
projects funded through USAID from giving comprehensive family planning
advice, including abortion referrals.

AIDS activists say the gag rule has had
a chilling effect on HIV prevention programs, even though the gag order
doesn’t cover PEPFAR money. Many prevention projects receive funds
from both sources.

Even without a change in the law,
Obama could instruct the Office of Global AIDS Coordinator to re-write the
guidelines for recipients of PEPFAR funds encouraging applicants interpret
them more loosely when drawing up their budgets–in effect sending
the signal that science-based AIDS prevention will not jeopardize funding.

Obama could also ask USAID to revoke
its 2004 policy directive requiring foreign NGOs effectively take a
loyalty oath to oppose prostitution. The current rules require that
receive U.S. global aids funding to have a specific policy against prostitution
and sex trafficking.

Hillary Clinton’s appointment as
Secretary of State has been hailed as a potential boon to global public
health. USAID is a State Department agency, so Clinton might have considerable
influence when it comes to drafting new policy directives about who
is eligible for AIDS funding.

USAID also has a policy against funding
for overseas projects involving needle exchanges, which have been shown
to reduce the spread of HIV. Obama’s AIDS plan explicitly supports
needle exchanges as one facet of a comprehensive strategy to prevent
AIDS infections. Sen. Clinton belatedly embraced federal funding for
domestic needle exchanges during the primary campaign, having previously
rejected the idea.

Obama and Clinton could also work
together to restore funding for the UN Family Planning Agency’s (UNFPA)
work to promote voluntary family planning and HIV prevention in 150
countries. The US is virtually alone in not participating in this effort.
Obama could instruct the State Department to review the law to determine
whether a contribution might be possible as early as 2009.

The US does not currently contribute
to UNFPA because George W. Bush’s Secretary
of State told Congress
that the so-called Kemp-Kasten amendment prohibits it. The amendment
forbids the US to spend money on coercive family planning programs.
The UNFPA operates in China, which has coercive family planning policies.
This, according to the Bush administration was enough to outlaw funding
for the UNFPA, even though the UNFPA explicitly rejects all forms of
coerced family planning and there is no evidence that the organization
has coerced anyone.

Sources within the Clinton camp declined
to comment on the specifics of Clinton’s plans for AIDS policy as
secretary of state.

The recently re-authorized PEPFAR
bill contains a number of provisions that hamper the AIDS agenda that
Obama has laid out.

In order to change the law, Obama
will need congressional allies. Rep. Diana Degette (D-CO) has pledged
to work with Obama to implement a comprehensive AIDS strategy at home
and abroad.

“Rep. DeGette supports using a
science-based approach to fighting the epidemic both domestically and
internationally, rather than relying on abstinence-only education, which
has done little to further prevent the spread of HIV/AIDS worldwide,”
DeGett spokesman Chris Arend told Rewire.

Obama has also sought the support
of religious social conservatives in congress for his AIDS agenda. In
2006, he and Sen. Sam Brownback (R-KS) set an example by getting AIDS
tests at Warren’s church in Orange County, CA.

Obama is a proponent of faith-based interventions both at home and
abroad. During the presidential campaign he pledged to set aside half a
billion dollars for faith-based social programs.

“The challenges we face today, from putting people back to work to
improving our schools, from saving our planet to combating HIV/AIDS to
ending genocide, are simply too big for government to solve alone. We
need all hands on deck,” Obama told a crowd in Zanesville, Ohio in July.

Analysts saw Obama’s promises of faith-based aid as an attempt to woo
religious voters and build goodwill with religious organizations that
would be eligible for federal funds in these public/private
partnerships.

Rick Warren is clearly positioning
himself as the powerbroker who can muster support from the religious
right for AIDS initiatives in the developing world. Obama will need
bipartisan allies in the fight to reform AIDS policy. The question is
what concessions Warren will ask in return.

A spokesman for Saddleback Church
promised to get back to Rewire with details about the church’s
stance on faith-based AIDS work under PEPFAR, but had not done so as
of press time.