Over the last week, the American people and financial markets around the world watched as Congress debated an eye-popping $700 billion dollar economic rescue for the American economy.  Lost amidst the media's coverage of the rescue plan was another Congressional decision -- to punt to the next President and new Congress tough decisions on funding for most FY 2009 government programs, including foreign assistance. 

As World Watch Institute's latest magazine issue "Population Forum" illustrates, concerted foreign assistance that emphasizes international family planning programs is going to be required to address the nexus of population issues that have emerged -- environmental degradation, climate change, as well as poverty, security and the health of women and children.  However, having worked in Togo, West Africa, an area of the world where hundreds of thousands of women already fail to have their family planning needs met, I'm left to wonder: if the next Administration turns away from our obligations overseas, will foreign assistance and developing world women be the first casualties of the economic downturn?

This morning I attended an extraordinary presentation at the Woodrow Wilson International Center for Scholars by Thomas Friedman about his new book, Hot, Flat and Crowded.  As you might suspect from the catchy title, the book focuses on how "global warming, the stunning rise of middle classes all over the world, and rapid population growth have converged in a way that could make our planet dangerously unstable." [See p. 5 @
http://www.thomaslfriedman.com/bookshelf/hot-flat-and-crowded]

In recent months, Friedman's been joined in bringing attention to the role of population growth in such critical issues as poverty, climate change, hunger, and security by the Secretary General of the U.N., the director of the CIA, former President Bill Clinton, the leaders of the G-8, Secretary of Defense Robert Gates, and the United States Senate.

The fact that the President matters is nowhere more obvious in the policymaking arena, in two ways -- either through promulgation of policy directives himself or in interpreting and enforcing the laws passed by Congress.

The HLF3 reviewed progress implementing the 2005 Paris Declaration on Aid Effectiveness and addressed emerging issues. The Paris Declaration is supposed to increase the impact of aid on reducing poverty and inequality, increasing economic growth, building capacity of aid recipient countries, and accelerating achievement of the Millennium Development Goals (MDGs). The Declaration outlined a framework for improving aid effectiveness through a set of principles: (1) Promoting country ownership of development; (2) Donor alignment with aid recipient priorities; (3) Donor harmonization with one another; (4) Managing for results; and (5) Mutual accountability for development outcomes.

Does HIV/AIDS still require an exceptional response? That question framed the interactive discussion hosted by the Caucus for Evidence-Based Prevention at the International AIDS Conference.    

Mitchell Warren (AVAC) launched the dialogue by quoting Richard Horton (The Lancet): "In 2031 will there still be UNAIDS?  Will we still need UNAIDS?  What would you do as the new Executive Director of UNAIDS?"

In the session "Women's Rights Equals Women's Lives," at the International AIDS Conference, advocates and researchers came together to discuss the twin pandemics of gender-based violence (GBV) and HIV.  Researchers Charlotte Watts from the London School of Hygiene and Claudia Garcia-Marcos of the World Health Organization, noted that while the body of evidence on direct biologic linkages between HIV and GBV is limited, the evidence we do have demonstrates an extremely strong correlation between the two.  Not only does the evidence tell us that women who experience gender-based violence are more likely to be at risk for transmission of HIV, but we also know that many of the risk factors for gender based violence are the same as those for HIV -- including gender inequities, poverty, lack of financial independence and lack of education.

While the risk of HIV from gender-based violence is often limited to a discussion of the risk of rape as a transmission factor, Watts stressed that there are many forms of gender based violence beyond rape, including perpetration by an intimate partner (spouse, boyfriend, etc.) rather than a stranger.

"We need to be clear that this is the best researched disease in history. We know what to do to prevent HIV infection, but we're not drawing a straight line between what we know and what we do," stated Elizabeth Pisani, author of The Wisdom of Whores: Bureaucrats, Brothels, and the Business of AIDS.

This session, sponsored by the Caucus for Evidence-Based Prevention, was a frank discussion among advocates, framed around Pisani's idea of the "sacred cows of HIV" (an analogy taken from drivers in India swerving to avoid cows in the road). What are the "sacred cows" standing in the way of progress in the fight against AIDS?

Attending Craig Lasher's presentation on modernizing U.S. Foreign Aid was yet another thought provoking PAI brown bag, adding to the cornucopia of great opportunities us interns have experienced during our short duration here. I want to revisit a topic that undermines the efforts Craig spoke of about modernizing foreign assistance, that Carlos Indacochea, a recent addition to PAI's research department, so eloquently brought to our attention. One of how to convince the American populous that foreign assistance should regain comprehensive support among both policy makers and those who elect them.

Within the next few weeks, the President will sign the Tom Lantos and Henry J Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 into law.  This reauthorization will extend the President's Emergency Plan for AIDS Relief (PEPFAR) for another five years and provide unprecedented levels of funding to fight the global AIDS pandemic.

Unfortunately, the passage of the Reauthorization Act is bittersweet as it not only fails to address the ideological policies of the 2003 Global AIDS Leadership Act, but in many cases has even expanded their impact. One of these ideological policies is the so-called "conscience clause," which allows organizations who have a moral or religious objection to opt-out of providing services to which they may object. In the 2003 Act, the clause was limited to objections over HIV prevention or treatment programs, thereby allowing faith-based and other organizations to promote the A(abstinence) and B (be-faithful) of ABC, without fear of retribution or loss of funds for not providing the comprehensive information needed to prevent sexual transmission of HIV.

The Caucus for Evidence-Based Prevention--composed of  more than 50 nongovernmental organizations and their international partners meeting throughout the conference--is eager to learn from new prevention research, incorporating a breadth of biomedical, behavioral, and social interventions. The caucus was created for the specific purpose of promoting HIV prevention supported by sound science at the International AIDS Conference.

We also know that over the next 20 years certain pressures – population, resource, energy, climate, economic, and environmental – could combine with rapid cultural, social, and technological change to produce new sources of deprivation, rage, and instability. We face now, and will inevitably face in the future, rising powers discontented with the international status quo, possessing new wealth and ambition, and seeking new and more powerful weapons. But, overall, looking ahead, I believe the most persistent and potentially dangerous threats will come less from emerging ambitious states, than from failing ones that cannot meet the basic needs – much less the aspirations – of their people.