JHPIEGO (its name is not an acronym), a nonprofit health organization affiliated with The Johns Hopkins University, works worldwide to "train trainers" — whether they are hospital employees or African village laymen.

JHPIEGO draws on resources from Johns Hopkins' schools of Public Health, Medicine and Nursing, but doesn't offer medical treatment or family services. The organization trains people overseas to do that instead, and mainly uses local medical practitioners and trainers to run its programs.

"Our focus is on establishing the system," said Sam Dowding, acting director of JHPIEGO's Center of Excellence on HIV/AIDS. "We work in institutions where we train the trainers, so in 5 years, 10 years, it continues to be self-sustained."

The organization's funding largely comes from the federal government, which has backed the organization since its first day in operation.

In 2005, the Presidents Emergency Plan for AIDS Relief, a five-year, $15 billion initiative to fight AIDS abroad, granted the organization $8.2 million for its efforts in Côte d'Ivoire, Ethiopia, Mozambique, South Africa, Tanzania and Zambia. The funding accounted for more than a fifth of JHPIEGO's $37.5 million program expenditures and built on its work in more than 90 countries worldwide.

But at least one of JHPIEGO's programs has been debated in international circles and was not supported by PEPFAR.

Working history with U.S. government

For more than 30 years, JHPIEGO has been working with the U.S. Agency for International Development to improve health care services for women and families in developing countries.

It was founded in 1973 to implement a five-year USAID grant to train obstetricians and gynecologists. After the grant's extension, JHPIEGO expanded its global presence through partnerships with USAID, then with private foundations and other international health organizations.

Although its name suggests a scholarly focus, the Academy for Educational Development's reach extends far beyond the classroom. AED is organized into 27 "centers of excellence" and has programs in 167 countries, making it one of the world's largest nonprofits addressing human and social development.

AED has forged partnerships with governments, companies and communities around the world, but perhaps none has been more crucial than its relationship with the U.S. government. In fiscal 2004, AED's federal, state and local grants, combined with its program-related revenues (including government contracts) amounted to nearly 80 percent of the organization's quarter-billion-dollar budget.

Government support is vital to the academy's HIV/AIDS efforts. According to Michael Kaplan, vice president and deputy director of AED's Center on AIDS and Community Health, the U.S. government historically has been AED's largest funder for its HIV/AIDS efforts. In 1987, for example, AED was awarded one of the U.S. Agency for International Development's first global HIV/AIDS relief contracts.

AED's work has carried over into participating in the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative to fight AIDS in 15 focus countries (Vietnam, as well as 14 in Africa and the Caribbean) and more than 100 other nations. Through PEPFAR, AED was allocated $11 million in 2005 for its programs in Botswana, Haiti, Kenya, Namibia, Nigeria, South Africa, Tanzania, Vietnam and Zambia.

Background and PEPFAR programs

AED was founded in 1961 as an initiative to study the higher education system in Kansas. Over the next 40 years the organization expanded domestically and internationally to help build local sustainability. AED now also focuses on environment and energy policy, health, youth initiatives, leadership and democracy and HIV/AIDS relief.

Cooperative for Assistance and Relief Everywhere Inc. (CARE) debuted in the international humanitarian arena in 1945 to aid survivors of World War II. Over two decades, more than 100 million food parcels, the legendary "CARE packages," were delivered in Europe.

In 1966, CARE started phasing out the food packages as the core of its mission while moving on to other projects. Health, children and poverty are now at the center of its work. But the organization also focuses on education, combating HIV/AIDS and emergency disaster relief. Across the board, CARE strives to give poor women resources because, the organization's literature says, "women have the power to help whole families and entire communities escape poverty."

Among the world's largest private international humanitarian organizations, CARE spent more than $514 million in 2005 on its programs around the world. Its tax returns filed with the Internal Revenue Service between the 2000 and 2004 tax years show that, historically, CARE has obtained the bulk of its funds from governmental agencies such as the U.S. Agency for International Development (USAID). For example, 70 percent of its funds in 2003 and 57 percent for fiscal 2004 (the most recent fiscal-year records available) came from the government.

Care for HIV/AIDS

The relief group started addressing HIV/AIDS in 1987 in Thailand. Today, CARE has more than 150 programs tackling the causes and consequences of the virus in nearly 40 countries and reaching more than 7 million people, according to agency spokeswoman Alina Labrada.

The announcement of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion initiative launched in 2003 to fight HIV/AIDS abroad, again infused CARE programs with federal funds.

When George W. Bush proposed his five-year, $15 billion initiative to "turn the tide against AIDS" in the developing world in 2003, he said the availability of low-cost drugs to fight the disease "places a tremendous possibility within our grasp."

Bush told Americans in his State of the Union address that the per-patient cost of antiretroviral drugs (ARVs), which improve the health and extend the lives of people who have HIV/AIDS, had dropped "from $12,000 a year to under $300 a year."

That significant decrease was a result of the competition from generic drug manufacturers. Yet Bush's initiative, the President's Emergency Plan for AIDS Relief (PEPFAR), funded by Congress a few months after that speech, has been slow to embrace funding cheaper generic ARVs.

ARV treatment is a major focus of PEPFAR and similar international programs. In addition to providing the drugs, it typically includes things such as HIV testing, counseling, monitoring for side-effects, lab tests and hospitalization.

Estimates released by PEPFAR reveal that in 2004 and 2005, its first two fully funded years, the plan allocated only about 5 percent of its overall ARV drug budget — less than $15 million — for generic drugs. A key reason for that lies in PEPFAR's own rules: only ARVs approved by the U.S. Food and Drug Administration (or given tentative FDA approval through an expedited review process set up in May 2004) can be procured with the program's funds.

While the president's AIDS initiative was still on the drawing board, that proposed stipulation drew fire from some, including Rep. Henry Waxman of California.

Background

Once referred to as the "Pearl of Africa" by Winston Churchill, Uganda lies in East Africa, bordered by Rwanda, the Democratic Republic of the Congo, Sudan, Tanzania and Kenya. The landlocked country is divided into 78 districts that are spread across four administrative regions — Northern, Eastern, Central and Western. The capital is Kampala.

There are myriad ethnic groups in Uganda, none of which is large enough to constitute a majority. Dozens of languages are spoken. While the official languages are Swahili and English, Swahili is not widely spoken.

The country gained independence from the United Kingdom in 1962. In 1971, Idi Amin took over in a military coup and ruled the country for the rest of the decade. Under his reign, nearly 300,000 Ugandans lost their lives and the economy plummeted when Amin forcibly removed minority Indian entrepreneurs from the country.

Amin was overthrown in 1979 by Tanzanian forces and Ugandan rebels. Milton Obote, who had preceded Amin as president, took over and ruled until 1985, when he was overthrown and replaced by a general who ruled for six months. The general was overthrown by the current president, Yoweri Museveni, who has been in power since 1986.

The face of HIV

According to the U.S. State Department's Office of the U.S. Global AIDS Coordinator, the infection rate is 10.7 percent in urban populations and 6.4 percent in rural areas.

In 2006, the government banned HIV-positive recruits from joining the military, a move it called a "humanitarian" measure. The defense force has suffered from losing soldiers to AIDS.

Management Sciences for Health (MSH), a private nonprofit organization that works to strengthen health systems worldwide, was founded in 1971 by Dr. Ronald O'Connor, who wanted to provide technical assistance in public health management to the developing world.

MSH is based in Cambridge, Mass., and receives the vast majority of its funding from the federal government — $155,826,790 for fiscal 2005. MSH is involved in multiple health policy and service areas, including leadership development, financial management, pharmaceutical procurement and inventory management.

Partly as a result of its international work in treatment and supply chain management, MSH is one of the largest recipients of President's Emergency Plan for AIDS Relief (PEPFAR) grants over the last three years, receiving more than $44 million in fiscal 2005 alone. MSH has been receiving funding from the U.S. Agency for International Development (USAID) for 35 years, said Dr. Malcolm Bryant, MSH's director for the Center of Health Outcomes.

MSH programs

In September 2005, the Partnership for Supply Chain Management (PSCM), a nonprofit group created by John Snow Inc. and Management Sciences for Health, was awarded a USAID contract that totals up to $7 billion. The contract was for providing pharmaceuticals and related supplies in PEPFAR countries. MSH and JSI are joined by 15 subcontractors, which include universities, defense companies and international health organizations.

MSH's role in PSCM is multifaceted. It assists in the coordination of country support for HIV/AIDS commodity policy; provides training, guidance, management and technical expertise as well as quality insurance.

MSH has previous experience in supply chain systems and has a program called Rational Pharmaceutical Management Plus Cooperative Agreement, which predates PEPFAR. The program aims to improve access to drugs, vaccines, supplies and equipment. 

Background

The Indian subcontinent is bordered on the west and south by the Indian Ocean and the Arabian Sea, on the east by the Bay of Bengal, and on the north by Pakistan, Nepal, China and Bangladesh. Just over 1 million square miles are home to 1.1 billion people — one-sixth of the world's population, with more than 60 percent living in rural areas.

Once a colony of the British Empire, the country gained independence in 1947. Now a federal union, the Republic of India has 28 states and seven union territories that are self-governing and a prime minister who is the elected head of the country.

The country is characterized by its diversity in language, culture, landscape and heritage. Fertile lands and river valleys support agriculture, which employs about 60 percent of the labor force.

The face of HIV

Migrant laborers and truck drivers, who spend days to months on the road, are among the most vulnerable groups for HIV/AIDS infection. According to the National AIDS Control Organization (NACO), India's central HIV/AIDS agency, there have been 124,995 officially reported cases of AIDS from 1986 to August 2006, though that number may be grossly underestimated because many people do not report their cases. Of those who have reported being infected, 58 percent live in rural areas and about 39 percent are women.

Just over half of all reported cases of HIV/AIDS are in two southern states: 52,036 in Tamil Nadu and 15,099 in Andhra Pradesh. In fact, those two states, along with the southern state of Karnataka and the western state of Maharashtra, which together make up 30 percent of India's population, account for about 75 percent of HIV cases.

Migrant workers and truck drivers who reside in southern India and engage in sex with commercial sex workers or with other men account for the high prevalence rate there.

Background

Bordered by China to the north, Laos and Cambodia to the west and the South China Sea to the east, Vietnam lies in a culturally diverse and politically volatile region of the world. After being ruled by Chinese dynasties, Vietnam achieved independence in the 10th century. In the mid-19th century France colonized Vietnam and remained in power until World War II, when Japan occupied Vietnam. After that war, France unsuccessfully attempted to regain control during an eight-year war that ended in 1954 when Vietnam was temporarily split in two by the Geneva Accords, which called for national elections in 1956 to unify the country.

But the elections didn't happen, and instead, Vietnam was entrenched for two decades in a civil war, with the U.S. sending combat support for South Vietnam. Millions of Vietnamese died in the conflict which ended in 1973 when U.S. troops withdrew. In 1975, the North captured Saigon — renaming it Ho Chi Minh City — and extended the communist regime to the South. In the mid-1980s the Communist Party started to ease its control over the economic market and slowly adopted capitalist practices. Since then, the Vietnamese economy has grown robustly, and political repression has declined.

Vietnam had no formal diplomatic ties with the United States until 1995, when it opened an embassy in Washington. Over the past decade, diplomatic relations between the two nations have developed rapidly.

The country is one of the few remaining with a Communist government and despite its political gains over the past decades, maintains a highly centralized one-party system.

In the aftermath of World War I, British activist Eglantyne Jebb, determined to aid the young survivors in neighboring war-torn Vienna, Austria, founded the Save the Children Fund in England in 1919.

The new organization immediately began pressing for the safeguards of children to be internationally recognized. In 1923, Jebb wrote the Children's Charter, which eventually served as the foundation for an international treaty called the United Nations Convention on the Rights of the Child in 1989. It has been ratified by all but two countries, the United States and Somalia.

The British Save the Children initiative was mimicked in 1932 by American philanthropists to aid children suffering the consequences of the Great Depression. John Voris established Save the Children U.S. in New York.

World War II further spread the work of Save the Children overseas to aid youngsters in England, France, Germany, Italy, Austria and Finland.

In the 1980s, a new crisis emerged that gradually started to affect millions of children around the world. This time, it was not a world war or a stock market crash, but HIV, the virus that causes AIDS.

Besides responding to emergencies and developing a variety of education, health and entrepreneurship programs, Save the Children entered the AIDS battle overseas to promote the care and support of those affected and to address prevention, particularly among high-risk youth.