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. RH Reality Check 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 RH Reality Check.

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 RH Reality Check with details about the church's stance on faith-based AIDS work under PEPFAR, but had not done so as of press time.