U. S. A GENCY FOR I NTERNATIONAL D EVELOPMENT APRIL/MAY 2000

THIS

ISSUE

1

HIV/AIDS undoing

decades of development

5

Grandmothers of

Mpondas

12

FY 2001 budgeto
FRONT ii

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT VOLUME 40, NO. 3 

April/May 2000

FRONT LINES

Administrator:

J. Brady Anderson

Assistant Administrator for

Legislative and 

Public Affairs:

Joseph R. Crapa

Chief of Multimedia

Communications:

Suzanne Chase

Editor:

Achsah Nesmith

Staff Assistant:

Mary Felder

Photo Librarian:

Pat Adams

Front Lines is published by the

Bureau for Legislative and Public

Affairs, U.S. Agency for

International Development.

Agency employees and others 

are encouraged to contribute 

stories, photos and ideas. 

Material should be submitted to

Editor, Front Lines, USAID,

Washington, D.C. 20523.

Phone (202) 712-4330 

Fax (202) 216-3035

www.info.usaid.gov

The Front Lines of a Long 

Twilight Struggle for Freedom

— John F. Kennedy

Cover: Noah Hendler’s photos capture

the strength and weariness of the

grandmothers struggling to care for the

children of Mpondas, Malawi, as the

HIV/AIDS pandemic strikes down

parents, destroys the economy and

undermines the traditional culture.

Page 5

News & Features

AIDS is leading cause of death in Africa 1

LIFE Initiative: turning point in U.S. government’s

global fight against AIDS 2

Preventing HIV transmission from mother to child 4

The grandmothers of Mpondas: 5

Malawi’s vice president: AIDS is taking away our future 5

AIDS is a story for the whole community 6

“Death used to mean an old person. Now it means someone

14 to 35 years old.” 6

Revival of AIDS prevention activities in Democratic Republic

of the Congo 8

New hope in Zimbabwe with voluntary counseling and testing for

HIV/AIDS 9

Deadly alliance – TB and HIV/AIDS in Africa 10

Frist legislation seeks more funds to fight AIDS 11

Congress gets President Clinton’s $22.75 billion FY 2001 international

affairs budget, USAID budget $7.5 billion 12

Where in the World?/Obituaries 13

Photo credits: Cover, Noah Hendler;

page 1, USAID/Uganda; pages 2-3,

AIDSCAP/Family Health International;

page 4, WHO/ J. Hernandez Claire;

pages 5-7, Noah Hendler; page 8, PSI;

page 10, WHO/H. Anenden; page 11,

Philip Birmingham Photography. 

printed on recycled paper

HIV/AIDS undoing decades of development
FRONT LINES / APRIL/MAY 2000 1

S

taggering as it is to contemplate, more than 50 million

people have been infected

with the human immunodeficiency

virus (HIV) worldwide. In 1999

alone, 2.6 million people died, and

33.6 million are now living with

HIV/AIDS. 

To grasp the true dimensions of

this tragedy, imagine a scenario in

which every child and adult in New

York City, Los Angeles, Chicago,

Houston, and in the 46 next largest

cities in the United States were

either dead or infected with a

deadly condition for which no cure

or vaccine existed. Such a catastrophe would still fall short of what

is happening in the AIDS pandemic

— by almost 8 million people.

AIDS destroys the human

immune system, making its victims

vulnerable to deadly opportunistic

infections like tuberculosis. It is

now the leading cause of death in

Africa — and the fourth leading

cause worldwide. Africa is the

hardest-hit continent in the world

by far — 60 percent of all men

living with HIV, 80 percent of all

women living with HIV, and 90

percent of all children living with

HIV are in Africa. 

The disease has gained a

foothold in Africa for several

reasons. Population movements

due to conflict, natural disasters,

and migrations across borders or

from rural to urban areas for

employment, all have contributed

to the increase of HIV/AIDS infection. In addition, as HIV spreads to

the general population, infections

among women of child-bearing age

have increased, along with the

threat of passing the infection to

their newborns and nursing infants. 

The spread of HIV/AIDS on the

continent is having major adverse

effects on current health infrastructures and society as a whole. Life

expectancy has plummeted, and

infant and child mortality rates are

doubling and tripling in some countries. Children who were among the

first generation to have access to

schooling have had to drop out to

earn a living and care for dying

parents. Millions of AIDS orphans

will lack food, health care and

nurture as families, villages and

societal systems are overwhelmed.

Many will become child laborers or

suffer sexual exploitation, without

the education and skills to improve

their lot as adults. 

Four decades of development

progress are being undone by AIDS,

which has become the single

greatest threat to the continent’s

future economic development.

Many African countries are beginning to experience declines in life

expectancy, child survival and

productivity as a result of HIV/AIDS.

Tragedy touching everyone in

Africa

The harsh statistics cannot fully

convey the human tragedy of AIDS

in countries struggling to provide

the most basic health care. AIDS

touched our own lives when my

wife, Betty, and I were in living in

Africa. A very valuable, loyal and

capable staff member and friend

who worked at the ambassador’s

residence in Dar es Salaam died of

AIDS while we were there, leaving

a wife and three children. 

That family’s tragedy is sadly

familiar to families all over Africa.

AIDS has touched the lives of

almost everyone on the continent,

taking the lives of young men and

women, in particular, when they

are most likely to have young children — and before they have had a

chance to fulfill their promise and

their dreams. They are struck down

during their most productive years,

and the hard-won education and

skills that might have benefited

their countries in such important

ways are lost with them. 

U.S. largest donor worldwide in

the fight against HIV/AIDS

The U.S. government is the

largest donor in the fight against

AIDS globally and is recognized as

a leader in technical expertise. For

over a decade, USAID has been a

leader in the fight against the AIDS

pandemic, assisting 46 developing

countries — 22 in Africa. As the

disease has spread over the past 10

years, USAID has responded by

providing over $1.2 billion in assistance, approximately 60 percent to

sub-Saharan Africa. 

For the past seven years,

USAID’s annual budget for AIDS

has remained at about $123

million. However, in FY 2000,

President Clinton’s LIFE Initiative

[see article, page 2] plus additional

increases from Congress raised our

budget for HIV/AIDS from $125

million to $200 million. About

$130 million is directed to Africa. 

Current programs reach less than

10 percent

With the FY 2001 increases in

HIV/AIDS funding President

Clinton has requested, we will be

able to scale up activities in prevention and care of patients, help

orphans and vulnerable children

and reduce mother-to-child transmission in 20 high-emphasis

AIDS is leading cause of death in Africa

By J. Brady Anderson

Billboards placed along Uganda’s roads were part of the campaign that helped

reduce the rate of increase in HIV infections in urban areas from 27 percent to 15

percent.

Four decades of development progress are being

undone by AIDS.... 
FRONT LINES / APRIL/MAY 2000 2

P

resident Clinton’s LIFE

Initiative (Leadership and

Investment in Fighting an

Epidemic, marks a significant

change in the U.S. government’s

— and USAID’s — approach to

the global fight against HIV/AIDS,

which previously concentrated on

prevention and research. 

The LIFE Initiative will support

USAID’s longstanding prevention

efforts while expanding activities

aimed at providing care to persons

with HIV infection. Congress

provided $100 million in the F Y

2000 budget to fund the initiative at

President Clinton’s request, of

which USAID received $55 million. 

One of the most successful

AIDS care organizations in Africa

has been supported through a partnership with USAID. The AIDS

Support Organization (TASO) is a

non-governmental organization in

Uganda, providing services

including counseling, basic

medical care and family planning

services, as well as food supplements, skills training, support

programs and assistance to AIDS

orphans. Under the LIFE Initiative

care and treatment services will be

provided to HIV-infected persons

in 13 targeted countries — India

and the 12 most severely affected

countries in sub-Saharan Africa.

The LIFE Initiative also seeks

to reduce by 25 percent the current

rate of 5.8 million new HIV infections each year in the 13 target

countries. Programs in target countries will be complemented by

regional activities in western and

southern African countries, which

have the highest number of new

infections, the potential for greatest

impact and active U.S. government

presence. 

USAID will take the lead in

implementing the initiative, collaborating with the Department of

Health and Human Services and

LIFE Initiative: a significant turning point in 

U.S. government’s global fight against AIDS 

countries. This additional funding

will enable USAID to expand

these programs beyond the 10

percent of vulnerable persons who

are presently covered. 

Finally, USAID aims to help

build critical health and educational infrastructure in these

countries so that African and Asian

institutions and community organizations can better take the lead in

responding to the epidemic in their

countries. This is a time of special

opportunity when we can galvanize all kinds of groups to work

with governments all over the

world to accelerate the fight

against HIV/AIDS. 

Over the next five years,

USAID will seek to significantly

decrease the incidence of HIV in

target groups — including children

and young people 15- to 24-yearsold — and increase support to

households caring for children and

others affected by AIDS. We will

work closely with the United

Nations, other bilateral donors and

the governments of affected countries to achieve that vital goal.

Models for success: Uganda and

Senegal

Models for success already

exist. With USAID support,

Uganda reduced the prevalence of

HIV in urban areas from 27

percent to 15 percent during the

last decade — reversing the

growth of the epidemic. Senegal

was able to hold its HIV prevalence rate to less than 2 percent,

even as rates in surrounding countries continued to escalate. The

Uganda and Senegal models prove

that the battle can be won — and

challenge us to achieve comparable success in other countries in

the developing world that are

struggling to combat AIDS. ■

By David Stanton

A counselor teaches young Thai women about HIV/AIDS prevention in the factory

where they work. Reaching people in workplaces, schools, and religious and

Much can be done to improve the quality and community meeting places helps Thailand reduce new HIV infections. 

duration of life for people living with HIV/AIDS

and their families.

Africa is the hardest-hit continent in the

world by far . . . .
FRONT LINES / APRIL/MAY 2000 3

the Department of Defense.

Interventions will be grounded in

goals and objectives consistent with

those established by the international community in collaboration

with the Joint United Nations

Program on AIDS (UNAIDS). 

The initiative addresses four key

elements critical to fighting the

AIDS pandemic:

Primary prevention

Prevention activities are aimed

at slowing — and ultimately

reversing — rising HIV rates in

developing countries, where 90

percent of new infections are

known to result from either sexual

transmission (80 percent) or

mother-to-child transmission (10

percent). Another 5 percent result

from contaminated blood transfusions and infected needles.

Activities include voluntary counseling and HIV testing, prevention

of mother-to-child transmission,

treatment of other sexually transmitted diseases, social marketing of

barrier methods to prevent transmission, behavior change interventions,

and blood safety, targeting both

civilian and military populations. 

Improving community and homebased care and treatment

Currently in sub-Saharan Africa

and India, care and treatment for

HIV-infected persons and support

to their families are minimal. Less

than 5 percent of people in these

countries know their HIV status,

and health care providers lack

resources to diagnose and treat HIV

and the associated opportunistic

infections. Under these conditions,

use of the expensive “state-of-theart” anti-retroviral treatment regimens that require careful

monitoring is a long way off. But

even in the absence of anti-retroviral drugs, much can be done to

improve the quality and duration of

life for people living with

HIV/AIDS and their families. 

The leading killer of AIDS

patients in the developing world is

tuberculosis (TB). Using directly

observed therapy regimens

(DOTS), TB can be cured in HIVinfected persons, increasing both

the quality and duration of a

person’s life. Ideally, inpatient care

would be complemented by

community outpatient treatment,

combined with psychosocial

support services utilizing a wide

range of community workers,

including traditional healers. The

LIFE Initiative will support basic

medical, home and communitybased care to greatly expand the

availability of these services.

Activities to assist children

affected by AIDS

Before the end of this year,

nearly 24 million children are

expected to have lost one or both

parents in 19 of the African countries where the HIV/AIDS

epidemic is full-blown. By the end

of the next decade, this number is

expected to increase to more than

40 million children. Despite the

magnitude of this crisis, services in

developing countries for children

orphaned by AIDS are extremely

limited or non-existent. The LIFE

Initiative will support USAID in

undertaking activities to assist children affected by AIDS and their

families, primarily through Title II,

Food for Peace programs. 

Strengthening the capacity of

target countries to fight HIV/AIDS 

Within the target countries,

greater political commitment is critical. The LIFE Initiative will

emphasize developing the capacities of governments, the private

sector, non-governmental organizations and research institutions to

implement effective interventions.

The initiative will not support all

elements in every country, but tailor

programs to each country’s needs

and seek to complement existing

efforts. UNAIDS estimates that

more than $1 billion per year is

currently needed for prevention of

HIV/AIDS in sub-Saharan Africa

alone. The LIFE Initiative will

contribute significantly toward this

goal, as well as to the global partnership necessary to bring effective

programs to adequate scale. U.S.

partners involved in LIFE will

collaborate with UNAIDS and

other international and local agencies to leverage additional host

country, multilateral, bilateral, and

private resources. ■

— Stanton is an epidemiologist in the

Global Bureau’s Public Health and

Nutrition Division. 

Taking HIV prevention information to the people at risk, this counselor talks to truck drivers in Tanzania. 

The LIFE Initiative will support USAID’s longstanding prevention efforts while expanding

activities aimed at providing care to persons with

HIV infection.
FRONT LINES / APRIL/MAY 2000 4

Nine out of 10 HIV-infected

babies are born in Africa.

This is due to high fertility

rates combined with high HIV

infection rates. In some urban

centers in Southern Africa, it is not

uncommon to find HIV infection

rates as high as 20 percent to 30

percent among pregnant women

tested anonymously in antenatal

clinics (serving newborns and their

mothers). AIDS has already

doubled infant mortality in the

most severely affected countries

and threatens to reverse years of

progress in child survival. 

A groundbreaking, multisite

study of services aimed at

preventing the transmission of the

HIV/AIDS virus from mother to

child is being conducted in Kenya

and Zambia by the Horizons

Project (implemented by the

Population Council and five other

organizations, funded under a fiveyear cooperative agreement with

USAID). The study assesses the

acceptability, operational concerns,

cost and impact on mother-to-child

HIV transmission, child morbidity

and mortality of a package of

services offered in antenatal clinics. 

This research is examining

several interventions, including

voluntary HIV counseling and

testing and provision of anti-retroviral drugs and breast milk

substitutes to HIV-infected

mothers. The study is a major

component of an international

effort led by UNICEF and the

United Nations Program on

HIV/AIDS (UNAIDS) to produce

critically needed information for

making informed choices and

developing best practices for the

prevention of mother-to-child transmission. 

Milestones to date include

development of a research protocol

in collaboration with local partners,

needs assessments in clinics and

communities as well as development of a monitoring and

evaluation plan measuring utilization of services and impact. The

first report on the study will be

issued by the end of this year. 

In Kenya, Horizons is collaborating with the Network of AIDS

Researchers in East and Southern

Africa (NARESA), which will

implement the study in cooperation

with the Ministry of Health,

UNICEF/Kenya and the World

Health Organization. In Zambia,

Horizons is collaborating with the

Mother-to-Child-Transmission

Working Group, appointed by the

Central Board of Health. The

package of services, including

equipment, supplies and educational materials, will soon be

available at sites in both countries. 

Working with these partners,

Horizons has also developed a

training curriculum, which, for the

first time, addresses the roles of

clinics and communities in

preventing mother-to-child transmission. The curriculum targets

health workers and supervisors,

community leaders, people-livingwith-HIV/AIDS groups and

government program managers.

The course covers a wide spectrum

of mother-to-child transmission

concerns including prevention,

integration of transmission interventions in maternal and child

health settings, counseling and

community mobilization, and assistance to HIV-infected mothers in

making choices about safe ways to

feed their infants. 

Because of the critical need for

this type of training, the project has

received numerous requests for the

curriculum from institutions

throughout sub-Saharan Africa. So

far, staff have been trained in the

new curriculum at three pilot sites

in Kenya and six pilot sites in

Zambia. ■

—Dr. Rutenberg is research director of

the Horizons Project. 

Preventing HIV transmission from mother to child

By Naomi Rutenberg, Ph.D.

Preventing transmission of the HIV/AIDS virus from mother to child is critical in

Africa, where nine out of 10 babies with the virus are born. 

AIDS has already doubled infant mortality in the

most severely affected countries and threatens to

reverse years of progress in child survival. 
FRONT LINES / APRIL/MAY 2000 5

On March 24, Vice President

Justin Malewezi of Malawi

appealed to donor countries

for additional help in fighting

HIV/AIDS. “Our war chest against

AIDS is empty. We are a nation in

grief as AIDS is devastating our

economy and the fabric of our

society,” he said, adding that AIDS

is “taking away our future.”

AIDS has left thousands of

orphans, he said, and caused

increased poverty in a country

where 60 percent of the people were

already living below the poverty line

set by the U.N. Development

Program. 

Health and Population Minister

Aleke Banda said AIDS has reached

crisis proportions in Malawi. The

official death toll is over 265,000,

and 14 percent of Malawi’s 11

million people are living with the

HIV virus, with the adult infection

rate at 26 percent in urban areas. 

In the 23 countries included in

USAID’s 1997 study, “Children on

the Brink,” the number of children

who will lose one or both parents as

a result of the HIV/AIDS pandemic

will reach 24.7 million this year and

increase to over 41 million in the

year 2010. Most of the countries in

that study are in Africa, where the

epidemic began early and is now

severe. In all 23 countries studied,

AIDS-related mortality is expected

to eliminate the gains made in child

survival over the past 20 years. 

USAID’s Displaced Children

and Orphans Fund develops and

supports programs that strengthen

the capacity of families and communities to provide care, protection

and support for displaced children

and orphans. The fund supports

Save the Children’s COPE Program

in Malawi, which has become a

model for community-based support

and protection programs for vulnerable children, especially children

orphaned or otherwise affected by

HIV/AIDS. 

Writer Craig Cohen and

photographer Noah Hendler visited

the cluster of villages in Mpondas,

Malawi, in 1997 to document the

social ramifications of HIV-AIDS in

a project co-funded by Save the

Children’s COPE Program and

Duke University’s Hart Fellows

Program. The Hart Fellows

Program places recent college graduates in one-year fellowships with

international humanitarian organizations. Cohen and Hendler worked

with translator Daud Maulidi to

interview and photograph government officials, hospital workers,

traditional authorities and community members affected by the

disease. Much of their work focused

on grandmothers caring for

orphans, one of the most vulnerable

and visible populations affected by

the virus. 

The National AIDS Control

Program estimated earlier that this

year 300,000 of Malawi’s children

will have lost one or both parents —

more than twice the number in

1995. During their initial visit to

Mpondas and in their subsequent

visits, Cohen and Hendler have

found that grandmothers are often

unable to find work to provide for

their orphaned grandchildren, many

of whom lack the money to pay for

their clothes or school fees. In addition, children and adolescents often

have the increased responsibility of

caring for their younger siblings

and their grandparents. 

The stories of the people whose

words and pictures appear here illuminate the tragedy that has befallen

the children and grandmothers of

Mpondas. The following are

excerpts from a book that Cohen

and Hendler are currently working

on about the life of one African

community in a time of AIDS. The

tragedy that has befallen Mpondas

is now spreading to other areas of

Africa as well, and will strike far

greater numbers of people in South

Asia and Southeast Asia in the

decades to come. 

Note: Cohen and Hendler did

not ask the people in these

photographs if they were HIV-positive, and it should not be assumed

that any of them are HIV-positive or

have AIDS. ■

The grandmothers of Mpondas 

Malawi’s vice president: AIDS is taking away our future

In Malawi, where the economy is being devastated by HIV/AIDS, grandmothers struggle to care for the children. 
FRONT LINES / APRIL/MAY 2000 6

T

here are some things which

should be talked about and

some things which shouldn’t.

There are different types of stories

for families, stories for governments, stories which involve one

individual, and stories which

involve the whole community.

AIDS is a story for the whole

community.”

—Emily Chipeta, headwoman of

Chipeta village. Her father and

grandfather were the traditional

leaders of her village. 

“I’m afraid of becoming sick more

than I’m afraid of anything else. My

grandmother has never talked to me

about AIDS. I’ve just heard about it.

I’m afraid of AIDS.

“At first I was afraid of the

hippos, but now I’m not afraid. The

hippos are the main problem of

living here. Sometimes we doze off

and while we’re sleeping, the

hippos come and eat our crops. We

throw stones and bang pots and

don’t sleep most of the night to

make sure they stay away. We can’t

be afraid of the hippos — if we

were, we’d have nothing to eat.

“Most of the time, Grandma sits

alone by the fire while my brothers

and sisters and I sleep. Grandma

isn’t afraid of the hippos....The

worst is when a hippo has a baby to

protect — then it’s terrible because

it thinks you want to take its child. I

don’t think my grandmother is

afraid of anything.”

— Shaibu Msosa, 11, grandson of

Margaret Zaizi.

—Margaret Zaizi says of the seven

grandchildren she cares for,

“Shaibu’s father died three

years ago from coughing, and I’ve

been taking care of Shaibu and his

brothers and sisters ever since.

We moved across the river to this

garden because in the village

there is nothing to eat. Their

mother stayed behind to take care

of the house.” The children see

their mother every few days and

the grandmother returns to the

This traditional healer carries herbs and a bundle of sticks (center front of

picture) to use in treating patients, but has no medicine that can cure HIV/AIDS.

The grandmothers of Mpondas: 

AIDS is a story for the whole community 

Mr. Maluwa, one of 10 AIDS

counselors working at Mangochi

District Hospital:

“I’m a counselor, I’m not there to

judge. I just listen to what the patient

knows about AIDS, and if it’s not

enough information, then I educate

him. The aim of counseling is for the

patient to know about the disease so

he will change his behavior and for

him to stay positive with his problem.

It’s a very difficult thing when a patient

is first diagnosed as being HIV-positive. I sit next to him, try to create a

friendly environment, hold his hand. At

first, denial is often there and it seems

a patient will never accept his

problem. He will say, ‘My uncle has

bewitched me,’ or claim that it’s just

TB. Many who are terminally ill return

home and don’t say what they have,

even to their husbands or wives.” With

the consent of the patient, he tries to

arrange for home-based care that

involves the spouse and the village

headman.

Domonic Misomali, district social

welfare officer in Mangochi, five miles

from Mpondas:

“We’ve had orphans ever since

God has created people. As a consequence of AIDS, though, a lot of old

people, particularly grandmothers, are

becoming responsible for orphans to a

much greater extent than in the past.

Some refuse to care, but most say,

‘What else can I do?’ They’re not as

capable, and, as a result, we’re losing

a lot of kids. 

“Death used to mean an old

person. Now it means someone 14 to

35 years old. It’s different because

young people are dying, the really

productive members. We’re losing the

people who could be assisting in the

development of our country. The

graveyard is changing, too. It used to

be a bushy-type of place, overgrown,

not as open. Now, with a funeral

almost every day.... 

“People know about AIDS. Even if

you go to the most remote village, they

will know information about AIDS. Yet

even now you could go to a funeral of

a person who has had full-blown AIDS

and people will deny it. People know

this disease is different from others,

and I think we will get to the point that

we’ll admit people are dying of AIDS.

But that is in the long term, it is for the

young people. It is a long way before

the community as a whole gets there.

This reluctance to talk about AIDS

makes it more widespread. People

aren’t getting the true information

about AIDS. If people don’t know, they

won’t take any precautions.”

Mr. Maluwa believes the silence

hampers efforts at AIDS care but

says, “People now understand there

is a problem because there are so

many orphans in the villages. The

community knows about this problem,

and because of it, some of our cultural

beliefs are changing.”

“Death used to mean an old person. Now it means someone 14 to 35 years old.”

“
FRONT LINES / APRIL/MAY 2000 7

village often — mostly for

funerals. “It’s important to go so

that people will mourn you when

you die....Some weeks, I go to

funerals five days in a row.

“The only time I sleep is during

the day for a few hours, so I’m

always tired. I bang pots the whole

night to keep the hippos away.”

“My grandmother is the head of

our household, but if she’s away,

then I’m the head. She goes away a

lot — mostly for funeral ceremonies

in the village. I take care of my

brothers and sisters when my grandmother isn’t here. I’m stronger than

other children because I’m a child

and I’m also an adult.”

— Silenga Martin, 11 years old,

cared for by her grandmother,

Patuma Liwande.

“Every week we have four or

five funerals. In the past, people

weren’t dying like this and grandmothers didn’t have to work so

hard. When my daughter died, I was

forced to become strong. There was

no one else to take care of her child.

So many people are dying in our

community, we remain poor.”

— Ndulaga Sampson, grandmother

caring for six orphans in

Mpondas.

— Emma M’bwana has cared for

her eight grandchildren since her

daughters died from “general body

pains and leg swelling.” She says,

“When my two daughters

became sick, each of their husbands

left them for me to take care of and

never came back. Their husbands

weren’t from Mpondas — like

many men here, they were just

doing business, buying and selling

fish. They said they would come

back to help, so I was surprised

when they didn’t. Now, I never

think of them.”

Her son helped her when her

daughters were sick. “I never asked

him for assistance — he did it on

his own. Even now he supports me

sometimes if I’m having troubles.

You know, people have different

hearts. Some people have good

hearts, some people have bad hearts.

My husband had a good heart....I

think my son has a good heart. I

can’t judge all men badly. For my

grandchildren, I teach them to have

good hearts.”

M’bwana builds houses to

support her grandchildren. Her sister

from Zimbabwe taught her how,

digging out the foundation, mixing

soil with water and molding the mud

into the foundation and building up

the walls. When the mud dries, she

smooths the walls with water by

hand, which takes all day for the

inside and another day to do the

outside. She has to hire men to put

bamboo and grass on the roof. “A

big house might take me three

weeks, but a small house could take

under a week. If it doesn’t leak, you

could live there your whole life. I

don’t like building houses, but

because of the problems I’m in now

with my grandchildren, with no

support from their fathers, I need the

money.”

She built her own house and

says, “I’ll teach my grandchildren

when they grow older. I’ll teach

anyone who’s willing to learn. It’s

so much more difficult to raise

grandchildren than to raise children,

especially because my husband is

no longer alive to earn money. I had

never thought that when I became

old I would have to work this hard.”

— Rosa Adams, 36, helps her

mother, Mbesyaga Bula, care for the

12 children of her two dead sisters. 

“We remain poor because everything here is done by ladies — we

have no husbands, no fathers. In our

community, a man has special

responsibilities, like providing food

for the family. We’ve had to do

both men’s and women’s work.”

—When Atima Lunde’s sister and

her sister’s husband died, she

adopted her sister’s three children

and her own husband fled, not

wanting the additional responsibility.

“I told my husband I couldn’t

leave my sister’s children to die and

he didn’t understand this.” She has

been the sole support of her own

three children as well as her sister’s

three and she says she is not looking

to remarry. “I’m capable of doing

men’s work. I built this fence, I

work these fields. When my

husband returned, I told him to go

away. I no longer trust in men, only

in my children.”

—Manesi John has been caring

for her daughter’s three children

since her daughter died.

“According to our culture, yes,

I am supposed to care for these

children. But her husband has

never sent assistance and has never

even come to visit his children.

This is not our culture. This

depends on the father’s heart. Men

didn’t used to behave like this.”

—Kaesim Chipakas is a traditional

healer.

“Mostly, I treat people who have

been bewitched. I hammer bundles

of small sticks and herbs into the

corners of my patients’ homes. To

protect my patients, I put medicine

into their blood by making small

cuts with a razor blade. I always use

different razor blades for each

person. I have heard about AIDS—

that there is no medication for it,

and I believe that. I have tried to

treat people with AIDS, but they

didn’t get cured. Patients never tell

me they have AIDS. I know only if

I give them treatment and it doesn’t

work....I can treat a bewitched

person, but not someone with AIDS.

I tell patients to look for healers

who can cure the disease, even

though I don’t know any....I have

fear to the future, whether AIDS

will ever have a medication,

because many people are dying.” ■

In the villages of Mpondas, in southeastern Malawi, there are funerals almost

every day.

“I’m afraid of becoming sick more than I’m afraid

of anything else.” 
FRONT LINES / APRIL/MAY 2000 8

USAID’s mission to Zaire was

supporting the largest

HIV/AIDS prevention project

in Africa when civil unrest forced

the suspension of all projects and

evacuation of USAID personnel in

September 1991. Ultimately, the

mission itself was closed and did not

reopen until 1997, after Zaire’s

name had been changed to the

Democratic Republic of the Congo

(DRC). 

Upon its departure, USAID allocated an additional quantity of

condoms to the project contractor,

Population Services International

(PSI) and, in collaboration with its

local non-governmental organization, the Association de Santé

Familiale (ASF), PSI carried on

reduced activities, relying on its own

funds and limited assistance from

local sources. This situation

continued until August 1998, when

USAID renewed funding to PSI for

the original project. 

Intervention to prevent

HIV/AIDS is vital to the future

well-being of the entire population.

Surveys completed by the project in

1999 found that half the young

people are sexually active by age 17

and 30 percent of these report

having two or more partners. More

than 60 percent of the young people

reported they never use condoms. 

The project, now called

AIDSMark, targets vulnerable

youth, commercial sex workers and

people living with HIV/AIDS, using

a multifaceted approach to behavior

modification that includes peer

education, mass-media information

dissemination and social marketing

of PRUDENCE brand condoms. A

peer education program targets

commercial sex workers in

Kinshasa. It attempts to reach their

clients as well, but that is proving

more difficult. Through mass-media

broadcasts of care and treatment

messages, the project also seeks to

change the overwhelmingly negative

view of people living with

HIV/AIDS and erroneous information about HIV/AIDS. The surveys

indicated that over 60 percent of the

people living in Kinshasa believe

HIV/AIDS can be propagated by

witchcraft. 

HIV/AIDS awareness activities

are being implemented through a

collaborative effort by partner nongovernmental organizations and

community-based organizations,

such as churches, the network of

people living with HIV/AIDS and

neighborhood youth groups, all in

cooperation with the Congo’s

National HIV/AIDS Prevention

Program. 

All activities are monitored for

impact and degree of behavior

modification. It was envisioned that

8 million PRUDENCE condoms

would be marketed to the general

population during the first two years

of the project. After only twelve

months, 9 million condoms have

been distributed. 

Music, theater, quiz shows

The September 1999 African

AIDS Conference in Lusaka

focused on the decreasing age of

those newly infected with the

HIV/AIDS virus and the need to

devise viable strategies to reach the

vulnerable age group of youth

between 15 and 25 years old. ASF

uses music, theater, quiz shows and

witnessing by people living with

HIV/AIDS to propagate messages

on sexual responsibility dealing with

abstinence, fidelity and condoms,

focusing on secondary schools and

neighborhood out-of-school youth

discussion groups. Up to 200,000

students are currently participating

in the high school program, which

organizes monthly activities in each

school produced by a student

committee and led by ASF-trained

peer educators. The Coffee Club

program reaches 42,000 youth who

have dropped out of school for

economic reasons. 

The project’s Knowledge,

Attitudes and Practices Survey and

the Consumer Intercept Survey indicate that a vast majority of people in

Kinshasa have heard project

messages on radio and television.

These results indicate that continued

support of this program is helping to

make the general population aware

of its sexual responsibilities and is

giving hope to an entire generation

whose future is in doubt. ■

— Schulman is program officer at USAID’s

mission to the Democratic Republic of the

Congo. Loftin is PSI’s representative in the

DRC.

Revival of AIDS prevention activities in 

Democratic Republic of the Congo

By John Loftin and Janet Shulman

Street theater, such as this in India, is proving useful in getting the message out

about HIV/AIDS prevention and testing. Strategies USAID helped develop in

then-Zaire became models for the global prevention effort. Music, drama and

quiz shows are part of USAID’s prevention efforts since returning to the now

Democratic Republic of the Congo in 1998. 
FRONT LINES / APRIL/MAY 2000 9

Z

imbabwe has the highest 

HIV prevalence of any 

country in the world. Every

week in 1998, an estimated 2,000

adults were infected with the AIDS

virus and about 1,200 people,

including children, died from

AIDS-related causes. An alarming

25 percent of sexually active adults

in Zimbabwe are HIV-positive.

In an effort to respond to this

dire situation, an innovative and

urgently needed social marketing

program, the New Start Voluntary

HIV Counseling and Testing

Network, aims to motivate

healthier sexual behavior and

prevent the spread of AIDS. This

national, voluntary HIV counseling

and testing network was launched

in the spring of 1999 through

collaborative efforts of the

Zimbabwean Ministry of Health

and Child Welfare’s National

AIDS Coordination Program,

Population Services International

(PSI) and USAID/Zimbabwe.

The New Start program is an

effective, cost-efficient variation of

successful HIV counseling and

testing programs conducted on a

limited scale in several countries.

Focusing on the individual, the

program encourages customized

risk-reduction strategies to motivate

behavior change. 

Research has shown that people

who test negative for HIV are

more likely to change their

behavior to maintain that negative

status when effective counseling is

coupled to test results. Those who

receive counseling when they test

positive are more likely to be motivated to protect themselves and

others from HIV and to seek

medical attention for early symptoms of AIDS-related illnesses.

Offered at affordable prices,

New Start services are targeted to

specific groups, including young

couples, adolescents, commercial

sex workers, transport industry

workers and other “mobile” populations. The network integrates

voluntary counseling and testing

services into existing health service

delivery institutions, such as public

clinics and hospitals, non-governmental organizations and private

health facilities. Establishing the

centers at institutions that already

provide health-related services

helps reduce the stigma of seeking

an HIV test. 

Counseling sessions covering

risk reduction are tailored to each

individual. New Start staff are

trained in standard protocols and

procedures to provide on-site,

state-of-the-art rapid HIV testing

and confidential counseling both

before and after testing. When

appropriate, referrals are made to

community support groups.

The New Start project is

funded through AIDSMark,

USAID’s five-year program being

implemented by PSI that uses

social marketing to combat the

spread of HIV/AIDS and other

sexually transmitted infections in

developing countries. USAID’s

mission in Zimbabwe and the

National AIDS Coordination

Program collaborate closely with

PSI in planning, implementing and

managing New Start. Project activities are enhanced by the efforts of

AIDSMark partner Family Health

International (FHI), which assists

in project evaluation and provides

technical expertise on counseling

and procedures.

Social marketing, the promotion

and distribution of needed health

products and services to lowerincome people through local

commercial and non-governmental

organization infrastructures,

strengthens the voluntary counseling and testing model and results

in a dynamic program that works to

destigmatize HIV testing and

encourages people to communicate

about HIV/AIDS. Strategic

marketing of counseling and testing

services is key to promoting New

Start. Messages on radio and television and print mass-media

advertising are based on consumer

research that pinpoints motivations

for and barriers to the use of counseling and testing services. New

Start also spreads the word about

voluntary counseling and testing

services and the benefits of

knowing one’s HIV status through a

strategy that includes drama groups

in each community hosting a New

Start center. Communications

campaigns focus on motivating

sustained behavior change. ■

— Dr. Richter is deputy director of

research for Population Services

International, Washington; Dr. Ncube is

project manager, AIDSMark; Dr. Sangiwa

is technical adviser, AIDSMark.

New hope in Zimbabwe with voluntary counseling

and testing for HIV/AIDS 

By Drs. Gloria Sangiwa, Buhle Ncube and Kerry Richter

Zimbabwe has the highest HIV prevalence of any

country in the world. 

Post-test Club in Uganda performs to encourage others to get HIV testing and

counseling, which is slowing the spread of infection there. Voluntary testing and

counseling are giving new hope in Zimbabwe, as well. 
FRONT LINES / APRIL/MAY 2000 10

By Dr. Connie Davis

Deadly alliance – TB and HIV/AIDS in Africa

T

uberculosis (TB) and

HIV/AIDS have forged a

deadly alliance in Africa that is

fueling epidemics of both diseases

and creating a host of obstacles to TB

control programs throughout the

continent. 

Real progress in controlling TB

and HIV can be made only through a

dual strategy that targets both

epidemics. 

The Joint United Nations

Program on HIV/AIDS (UNAIDS)

and the World Health Program

(WHO) estimate that 23.3 million

Africans are infected with HIV or

have full-blown AIDS. Africa has

the highest per capita incidence of

TB in the world — 259 cases per

100,000 persons — and TB is the

most common opportunistic infection associated with AIDS on the

continent. 

Because HIV suppresses the

immune system, people who carry

the TB microbe and are infected with

HIV are 30 to 50 times more likely

to develop active tuberculosis than

TB carriers who are free of HIV.

Since TB is transmitted through the

air, adequate and complete treatment

of infectious cases is the best means

of prevention. However, TB

programs in developing countries

that were beginning to control their

TB rates are now being inundated by

new cases of TB — fueled by the

AIDS epidemic. 

Eighty percent of the TB cases in

the world are concentrated in just 22

countries, and eight of those countries are in Africa: Nigeria, South

Africa, Ethiopia, the Democratic

Republic of the Congo, Tanzania,

Kenya, Uganda and Zimbabwe.

Many other African countries have

very high incidences of TB rates. 

TB is the leading killer of AIDS

patients in the developing world and

is spreading worldwide at an

alarming rate. Although there is still

no cure for AIDS, there are treatment

advances that can improve the quality

and duration of life. TB can be cured

in HIV-infected persons by using one

of those advances, Directly Observed

Treatment Short Course (DOTS)

regimens. The DOTS regimens have

proven their ability to work, even in

resource-poor African countries.

DOTS involves giving the standardized anti-TB drugs and observing

that the patient takes them daily or

three times a week (depending on the

type of case and regimen). Despite

these encouraging results, only 15

out of 47 African countries have fully

implemented the DOTS strategy.

Research also indicates that another

treatment advance, preventative

isoniazid treatment, administered

over a six-month period can stop

latent TB from developing into the

active form in people with

HIV/AIDS. 

Community-based care project

People infected with HIV or who

have full-blown AIDS need services

close by. The international health

community has developed projects to

assess the feasibility, acceptability

and cost-effectiveness of communitybased TB care. USAID, UNAIDS,

the International Union Against

Tuberculosis and Lung Disease, the

Royal Netherlands Tuberculosis

Association and the federal Centers

for Disease Control and Prevention

in Atlanta are collaborating with the

World Health Organization on a

project that offers treatment supervision within the community as an

alternative to the standard treatment

supervision provided by regular

health facilities. 

The project has eight components

in five countries (Botswana, Kenya,

Malawi, South Africa, Uganda and

Zambia) testing different community

mechanisms to deliver TB care.

These include using community

health workers, traditional healers

and “guardians” — designated

people who take responsibility in the

community and are trained to administer the medication. TB treatment

delivered by community workers

consistently shows higher cure rates

and treatment completion rates

compared to treatment delivered by

health facilities. 

LIFE Initiative increases role of

USAID missions

The $100 million increase in FY

2000 U.S. support for sub-Saharan

African countries and India — part

of the five-year Leadership and

Investment in Fighting an Epidemic

(LIFE) Initiative — represents an

important opportunity for USAID

missions to address the deadly

alliance of TB and HIV/AIDS.

Working with national TB programs

in target countries they can:

■ determine the status of the twin

epidemics and ensure that

addressing the TB-HIV/AIDS link

is part of the policy agendas of host

governments, non-governmental

organizations and USAID partners; 

■ assess whether DOTS therapy is

offered only in pilot projects or is

available nationally; 

■ identify areas of strength in which

to assist national TB programs in

expanding DOTS coverage or

strengthening program components; and,

■ help national TB programs establish more effective links to

international HIV/AIDS programs

and work with both to develop a

care and support component that

includes community-based treatment and prevention. ■

— Dr. Davis is an infectious disease adviser

for the Africa Bureau. 

TB can be cured in HIV-infected persons, improving the quality and duration of

life. Voluntary testing and counseling are key elements in fighting the

epidemics of TB and HIV/AIDS in Africa. 
FRONT LINES / APRIL/MAY 2000 11

My first experience with the

silent apocalypse of AIDS

in Africa was during a

medical mission into a war zone

known more for its calculated

starvation and loud and violent

death from above than for staggering under the burden of

disease. 

In January of 1998, I flew to

the town of Lui in southern

Sudan, where I helped open a

clinic and perform surgery by

flashlight on everything from

hernias to legs maimed by land

mines. Upon arrival at the rudimentary hospital I was given only

two tips intended to save my life:

First, I had less than 90 seconds to

get into the bomb shelters once

we heard the drone of the engines

of the government’s bomber. (That

hospital has since been bombed

four times by the government.)

Second, a stern warning to

“double up” on latex gloves while

working with wounded patients

because of the chance of

contracting HIV. Both made a

deep impression and have guided

me as Chairman of the Senate

Foreign Relations’ Subcommittee

on African Affairs.

The cost in human life and

productivity, as well as the potential societal and economic

disruptions from AIDS assure us

of one distinct possibility: All

goals of the United States in

Africa – goals we share with

Africa — will be seriously

compromised, if not completely

undermined, by AIDS. Growing

trade, better education and health,

stronger democracies, efforts

toward peace — all will be undermined by a disease that is

positioned to sap life from the

most promising and productive

generations. That is to say, in very

short order, AIDS will become the

single greatest policy challenge

for the United States in Africa,

and for Africans themselves, of

course, driving all other policy

considerations. It has the same

potential in other parts of the

world – it is not solely an African

disease.

Two characteristics of this

pandemic which distinguish it

from the other great killers on the

continent have shaped the Senate’s

recent initiative to support the

efforts to combat HIV/AIDS

worldwide.

The first is the fact that AIDS

affects the younger members of a

community in their most productive years. It contorts and

eventually turns on its head the

already strained economic equation by effectively reversing the

proportion of dependents to

productive members of a family.

In short, it has struck at the heart

of the extended families, changing

the breadwinners into burdens.

That is to say nothing of the grief,

personal loss and often shame

associated with death from AIDS. 

The second is that the estimated number of orphans caused

by AIDS in Africa already

exceeds 10 million, and is

expected to approach 40 million

in coming years. Many of those

children will themselves be HIVpositive. The prospect of 40

million children without hope,

health and often without any

support whatsoever is as

dangerous as it is tragic. These

children are susceptible to

substance abuse, prostitution,

banditry — even child soldiery.

Their plight will be an economic

strain on weakening or completely

broken economies, and an

extremely volatile element in

strained societies.

With the unanimous support of

my colleagues on the Senate

Foreign Relations Committee, I

successfully passed a proposal

which includes, among other critical provisions, support for

USAID’s and the World Bank’s

programs for combating AIDS. It

would also fund critical research

into the ultimate weapon in the

fight against disease: a vaccine.

The legislation focuses on both

prevention and an eventual cure.

It authorizes funding of up to

$460 million next year alone –

nearly double the President’s

request. Its prospects for

becoming law are good.

Congress and the

Administration must be mindful

that the United States can be a

great force for good in Africa and

the world. However, our job is to

determine how best to use our

limited resources to maximize

their potential for good on the

African continent. These are life

and death decisions which cannot

be addressed simply by allocating

more funds. How we direct or

allocate those resources will

significantly impact the situation.

Issues involving life and death

decisions are extremely difficult.

Now, those decisions affect the

future of an entire continent. ■

Frist legislation seeks more funds to fight AIDS

Experience in Sudan clinic brought home HIV/AIDS threat 

By Senator Bill Frist (R-Tenn.)

Sen. Frist’s proposed legislation

focuses on both prevention of AIDS and

an eventual cure.

“...AIDS will become the single greatest policy

challenge for the United States in Africa, and for

Africans themselves...driving all other policy

considerations. ”
FRONT LINES / APRIL/MAY 2000 12

USAID’s budget justification

(formerly called the congressional presentation),

requesting $7.5 billion for agencymanaged programs, was sent to

Congress in March. The agency’s

budget is part of the International

Affairs (Function 150) account, for

which President Clinton submitted

the Fiscal Year (FY) 2001 federal

budget request on Feb. 7. 

The international affairs budget

for FY 2001 represents an increase

of about $2 billion over the FY 2000

appropriation enacted last fall. This

is apart from the FY 2000 supplemental funding for the Wye Accord

($1.825 billion), which Congress has

approved, and pending supplemental

requests for Plan Colombia ($818

million), Kosovo and Southeastern

Europe ($251 million) and debt

restructuring ($210 million). 

Testifying before the Senate

Foreign Relations Committee Feb.

10 and before the House

International Relations Committee

on March 15 in support of the

agency’s programs and budget

request, Administrator J. Brady

Anderson said, “USAID’s work in

development assistance takes time. It

is an incremental process that pays

off for America and for the world.

Foreign assistance is a national security priority. USAID is a smart

investment and one of the most

effective tools the U.S. government

has in building the foundations for

trade and markets, and the spread of

democratic ideas.”

Highlights of the agency’s priorities in this year’s budget include:

■ For HIV/AIDS programs, $259

million from all sources (Child

Survival and Disease Programs

Fund, Economic Support Fund,

(continued on back cover)

Congress gets President Clinton’s $22.75 billion FY 2001

international affairs budget, USAID budget $7.5 billion

By Bette Cook

USAID Budget ($000)

FY 1998 FY 1999 FY 2000 FY 2001 

Appropriation Appropriation Appropriation Request

Foreign Operations Subcommittee

Child Survival and Disease Programs Fund 1 650,000 700,000 724,866 659,250

Less transfer to UNICEF -100,000 -105,000 -110,000 —

Subtotal – Child Survival and Disease 550,000 595,000 614,866 659,250

Development Assistance 1 1,210,634 1,225,000 1,210,334 948,822

Less transfers to InterAmerican Foundation/

African Development Foundation . -36,000 -31,000 -19,326 —

Subtotal – Development Assistance 1,174,634 1,194,000 1,191,008 948,822

Development Fund for Africa [445,143] [452,487] [448,830] 532,928

Subtotal Sustainable Development 1,724,634 1,789,000 1,805,874 2,141,000

International Disaster Assistance 190,298 388,000 202,014 220,000

Development Credit Programs [by transfer] — — — [15,000]

Development Credit Authority [7,500] — [3,000] —

Other Credit Programs-subsidy costs 4,500 3,000 3,000 —

USAID Operating Expenses 2 478,858 502,792 518,960 520,000

Development Credit Programs – — — — 8,000

Admin. Expenses

Other Credit Programs-Admin. Expenses 6,553 5,446 5,490 —

Kosovo/S.E.Europe Initiative Supplemental — — 22,000 —

request for USAID Operating Expenses

Inspector General Operating Expenses 29,047 27,117 24,950 27,000

Foreign Service Disability & [44,208] [44,552] [43,837] [44,489]

Retirement [mandatory] 

Economic Support Fund & International 2,419,928 2,594,100 2,792,187 2,313,000

Fund for Ireland 

Central America/Caribbean Disaster — 613,500 — —

Recovery Fund 

Assistance to the Independent States 1 770,798 847,000 835,812 830,000

Support for East European and 

the Baltics,SEED

(Support for East European 485,276 550,000 532,970 610,000

Democracy Act) 1

Kosovo/Southeast Europe Initiative-suppl. — — 195,000 —

request-SEED

Plan Colombia request-USAID- — — [127,500] [90,000]

managed portion 3

Foreign Operations Subtotal 6,109,892 7,319,955 6,938,257 6,669,000

Agriculture Subcommittee

P.L. 480 Food For Peace Title II 837,000 986,200 800,000 837,000

P.L. 480 Food For Peace Title III 30,000 25,000 — —

USAID Total: 6,976,892 8,331,155 7,738,257 7,506,000

1 To be consistent with the FY 2001 request, the FY 1998 through FY 2000 levels exclude congressionally mandated Development

Assistance transfers to the African Development Foundation and the Inter-American Foundation and congressionally mandated Child

Survival and Disease transfers to UNICEF, but include funds ultimately transferred from SEED and FREEDOM Support Act funds to

other agencies.

2 FY 1998 through FY 2000 levels include congressionally authorized transfers to Operating Expenses from other USAID program

accounts but exclude local currency trust funds and prior year funds. 

3 Plan Colombia request presented parenthetically because it is requested by the Department of State; the amount shown is the

USAID-managed portion.
FRONT LINES / APRIL/MAY 2000 13

Angola Luanda

Director Keith Simmons

Benin Cotonou

Director Thomas E. Park

Democratic Republic of the Congo

Kinshasa

Director Janet Schulman (Acting)

Eritrea Asmara

Director William J. Garvelink

Ethiopia Addis Ababa

Director Douglas Sheldon

Dep. Director David Eckerson

Ghana Accra

Director Frank J. Young

Dep. Director Jay Knott

Guinea Conakry

Director Harry Birnholz 

Guinea-Bissau Bissau

Director Donald Clark (Acting)

Kenya Nairobi

Director Jonathan Conly

Liberia Monrovia

Director Rudolph Thomas

Madagascar Antananarivo

Director Karen M. Poe 

Malawi Lilongwe

Director Kiertisak Toh

Mali Bamako

Director James Hradsky

Dep. Director Paul Tuebner

Mozambique Maputo

Director Cynthia Rozell

Dep. Director David Hess

Namibia Windhoek

Director Carole Scherrer-Palma

Nigeria Lagos

Director Thomas Hobgood

Rwanda Kigali

Director Richard Goldman

Senegal Dakar

Director Donald Clark

Dep. Director Allan E. Reed

South Africa Pretoria

Director William Stacey Rhodes

Dep. Director Eilene B. Oldwine

Tanzania Dar es Salaam

Director Lucretia Taylor

The Sudan Khartoum

Sudan Field Office Coordinator

Larry Meserve 

(Headquartered in Nairobi, Kenya)

Uganda Kampala

Director Dawn Liberi

Dep. Director Patrick Fleuret

Zambia Lusaka

Director Walter North

Zimbabwe Harare

Director Rose Marie Depp

Regional Economic Development

Services Offices

East & Southern Africa

(REDSO/ESA)

Kenya Nairobi

Director Donald R. Mackenzie

Dep. Director Steven G. Wisecarver

Regional Center for Southern

Africa (RCSA)

Botswana Gaborone

Director Edward J. Spriggs

Dep. Director Anthony Vance

Bangladesh Dhaka

Director Gordon H. West

Dep. Director Anne Aarnes

Cambodia Phnom Penh

Director Willard J. Pearson,Jr.

India New Delhi

Director Linda E. Morse

Dep. Director James Bever 

Indonesia Jakarta

Director Terry (Desaix) Myers

Dep. Director Sharon Lee Cromer

Nepal Kathmandu

Director Joanne Hale

The Philippines Manila

Director Patricia Buckles

Dep. Director (Vacant)

Sri Lanka Colombo

Director Lisa Chiles

USAID Offices

Mongolia Ulaanbaatar

Director Edward W. Birgells

Egypt Cairo

Director Richard M. Brown

Dep. Director Toni ChristiansenWagner 

Jordan Amman

Director Lewis W. Lucke 

Morocco Rabat

Director James Bednar 

West Bank/Gaza

Director Larry Garber

Dep. Director William P. Hammink

USAID Offices

Lebanon Beirut

Director James (Spike) Stephenson

Bosnia Sarajevo

Director Craig Buck

Albania Tirana

Director Howard Sumka

Bulgaria Sofia

Director John Grant

Croatia Zagreb

Director Charles R. Aanenson

Caucasus Tbilisi

Director Michael Farbman

Dep. Director P.E. Balakrishnan

Kosovo Pristina

Director Craig Buck

Lithuania Vilnius

Director (Vacant)

Macedonia Skopje

Director Stephen Haynes

Poland Warsaw

Director William M. Frej

Romania Bucharest

Director Denny Robertson

Serbia (Belgrade) Federal 

Republic of Yugoslavia

Director Richard J. Hough

Slovakia Bratislava

Director Paula Goddard

Regional Services Center

(RSC/E&E)

Budapest Hungary

Director Patricia Lerner

Russia Moscow

Director Carol Peasley

Dep. Director Mark Ward

Ukraine Kiev

Director Christopher Crowley

Dep. Director Richard Goughnour

Regional Mission for the Caucasus

Armenia Yerevan

Director Diana Tsitsos 

Dep. Director Jatinder Cheema

Regional Mission for Central Asia

Republic

Kazakhstan Almaty

Director Glen Anders

Dep. Director Vicki Moore

Bolivia La Paz

Director Liliana Ayalde 

Dep. Director Wayne Nilsestuen

Brazil Brasilia

Director Janice Weber

Colombia Bogota

Robinson, Natasha 

Wilson, Ernest 

Atherton, Joan 

Austin, Paul 

Bowen, Patricia 

Braxton, Annette 

Broadnax, Tanya 

Allaire MacDonald, Julie

Bambara, Alicia 

Crawford, A. Lindsey 

Foltz, Jennifer

Promoted

Latin America

and the Caribbean

Europe and Eurasia

Near East

Asia

WHERE

In The 

World

Are

USAID

Employees?

Moved On

R. James Falconer Jr., 55, died

Jan. 28 of an abdominal hemorrhage at his home in Arlington, Va.

Falconer joined USAID in 1987

and was a personnel officer in the

Foreign Service Personnel Division

before joining the Bureau for

Humanitarian Response, where he

served as an administrative officer

until his death. Falconer was in the

first group of Peace Corps volunteers sent to Guyana in 1965 and

was a special assistant to the Peace

Corps director and other officials

until the late 1970s. 

Ralph Dean Fry, 87, died Jan.

3 at Newton Memorial Hospital in

Winfied, Kan. Fry joined USAID’s

predecessor agency in 1953 as a

Foreign Service officer. He worked

in Tripoli, Libya, as a drilling

superintendent and supervised the

teaching of Libyans in water exploration, development and

purification. Fry also served in

Egypt, Laos and Vietnam. In

Egypt, he headed a drilling operation that uncovered water 3,000

feet beneath the Sahara Desert. Fry

retired from USAID in 1975.

Obituaries
(continued from page 12)

FREEDOM Support Act fund, and

P.L. 480 resources), up from $200

million in FY 2000. USAID joins

other agencies in supporting

President Clinton’s new

Leadership and Investment in

Fighting the Epidemic (LIFE)

Initiative first funded in FY 2000. 

■ A population program funding

level of $542 million from all

accounts, bringing agency

funding for this activity back to

the FY 1995 funding level.

■ Support for two new presidential

environmental initiatives –

Clean Energy for the 21st

Century ($30 million, part of a

$100 million interagency

program) and Tropical Forest

and Biodiversity ($33 million).

The latter initiative is part of the

new “Greening the Globe”

initiative President Clinton

announced in the FY 2001

budget. 

■ An increase of $18 million in

Disaster Assistance funds, for a

total request of $220 million.

■ A separate Development Fund

for Africa, totaling $533 million,

is requested, compared to $449

million in Development

Assistance budgeted for Africa

in FY 2000. This excludes funds

budgeted for Africa in the Child

Survival and Disease Programs

Fund.

■ An increase in funding to

$136.5 million to support

Indonesia’s economic and

democratic transition.

■ An increase in funding to $96

million from all sources

(Development Assistance, Child

Survival and Disease Programs

Fund, Economic Support Funds

and recoveries) for Nigeria,

which is undergoing a profound

transformation to democracy.

■ A two-year $1.3 billion request,

in addition to the $300 million

for current programs, for Plan

Colombia, a comprehensive

counter-narcotics strategy for

Colombia and other Andean

countries. USAID will administer a portion of these funds

(see estimates in chart). ■

— Cook is a legislative program specialist

in the Bureau for Legislative and Public

Affairs.

Congress gets USAID budget: $7.5 billion

“USAID is a smart investment and one of the most

effective tools the U.S. government has in building

the foundations for trade and markets, and the

spread of democratic ideas.” 

–Administrator J. Brady Anderson