WASHINGTON—In the cool of the rainy season in Malawi, a man mounts his bicycle "ambulance," fitted with a light trailer to deliver his neighbor, stricken with AIDS, to the nearest clinic for antiretroviral drugs.

Pedal push after pedal push, he is one member of an army of volunteers who are slashing AIDS-related deaths in rural Malawi, a country with one of the highest rates of HIV/AIDS in the world. In a sparsely populated area near the shores of Lake Malawi, 10 church members are charged with the care of 71 people living with AIDS—and drugs aren't the only thing they're offering.

"The church shared the Word of God with me and this has brought me great hope," said Joyce Banda, who is HIV positive and fell under the care of the church members. "I used to feel like I was just waiting around to die."

Banda's experience is at the heart of a debate in Washington about government money and religious charities. World Relief, which receives money from USAID, trained the church members who care for Banda, with the understanding that its work done with government funds won't involve any preaching.

Under the Bush administration, Christian organizations providing aid around the world with U.S. funds enjoyed a measure of freedom to keep their faith integrated with their services, but they are unsure now whether a new administration with new restrictions will alter their work in both body and soul. At the same time, debates over the role of evangelism in humanitarian work grow as the bigger tent "religious left" takes its seat at the table under a new administration.

The Obama doctrine, as pledged in a speech last July, is that organizations cannot use federal funds to "proselytize." In practice, this means that a Christian anti-addiction program could not say that faith in Jesus will enable a person to fight the despair that pushes people to heroin. Obama has also argued that faith-based groups should not "discriminate" in hiring against those who do not share their faith.

But so far the president has held off on changing policies that allow religion-based hiring, and his faith-based office has focused on a mostly domestic agenda of promoting responsible fatherhood, building interfaith dialogue, and reducing domestic poverty and unintended pregnancies. He has essentially left USAID alone, so far, and early in June has not yet nominated a new head for the agency.

"We just have to say this is not the Bush administration anymore. It's also not a fall off the cliff, where everything is turned back to the pre-Clinton years," said Stanley Carlson-Thies, who served in President Bush's faith-based office in 2001-2002. Carlson-Thies is now advising a subcommittee for Obama's faith-based advisory council. "Faith groups that care a lot about their faith should be quite wary—there might be changes down the road. They ought to read the fine print quite carefully. But we're not back in the '80s or '70s."

Back then, he explained, religious groups applying for government grants simply found their applications in the wastebasket. President Clinton, whose USAID administrator J. Brady Anderson was an evangelical Christian, helped change that by jump-starting the "charitable choice" policy in 1996, which prohibits discrimination against faith-based organizations for certain blocks of federal grants as long as they don't use the money to share their faith.

Seven of the top 10 recipients of USAID grants—according to numbers compiled by theBoston Globe through 2005—are Christian organizations. Catholic Relief Services, World Vision, Adventist Development and Relief Agency, Food for the Hungry, Samaritan's Purse, World Relief, and Opportunity International all claim Christianity as a centerpiece in their mission statements.

While USAID has strict rules about the sharing of faith, the line between what is acceptable and unacceptable can blur.

Currently, staff members are permitted to pray or worship after providing a meal, for example, as long as they indicate recipients don't have to pray in order to eat. Staff can talk about God's love as long as the conversation occurs outside the physical location or time where aid is delivered (the "or" is something that changed under Bush, allowing faith expressions and aid to occur in the same place). Organizations can have government-funded activities in church buildings. USAID's current guidelines read, "A religious organization need not purge, conceal or compromise its religious character."

This could change, especially depending on whom Obama chooses to head USAID. A new director can make subtle changes in the fine print—like encouraging AIDS prevention through "delayed sexual initiation and partner reduction" instead of "abstinence and faithfulness" programs, all aside from major changes like forbidding religion-based hiring.

"There has been no pressure on World Vision to stifle our religious values and motivation," Richard Stearns, president of World Vision U.S., told me by email. "However, we have always understood that government monies cannot be used for religious purposes." George Washington University constitutional law professor Chip Lupu, during an April discussion of the issue, said, "'Don't ask don't tell' to a slight degree is probably going to work out OK."

President Obama faces pressure from some quarters to take a hard line against Christian nonprofits. "The abuses in the last administration are obvious," said Barry Lynn, executive director of Americans United for Separation of Church and State. "The deep politicization of the [faith-based] office is abundantly clear. This was driven more by politics than a passion for the poor." Americans United lobbied to prevent stimulus funds from going to the Compassion Capital Fund, a program the Bush administration created to fund many faith-based organizations.

This year's stimulus legislation did provide funds for grants to nonprofits, which could include faith-based ones, just under a different name than President Bush's fund. Lynn said it was discouraging that Obama didn't immediately reverse Bush administration policy in this area, as he did in others: "I don't expect that this is going to happen quickly. I wish it had. I was very disappointed at the time and I expressed that to the administration"—but he's still "guardedly optimistic."

Stearns counters that faith-based groups have 40 years of legal and constitutional protections, referring to the Civil Rights Act of 1964, which permits religion-based hiring for faith-based groups.

Christian organizations also battle within their walls to avoid politicization. Catholic Relief Services initially didn't apply for government funds to work in Iraq when the United States invaded in 2003 because staff didn't want to be perceived to be part of the "war effort." But aside from foreign policy debates, certain organizations do feel more welcomed under certain presidents. Organizations like Sojourners have hailed the new administration and are moving forward with ambitious agendas.

That group kicked off its first Obama-era gathering of the self-described "religious left" in April at the "Mobilization to End Poverty," a coalition of groups (including World Vision) that called on government to increase spending on the poor. Organizers said the event showed the power shift from conservative religious groups to liberal religious groups.

Tom Getman, former executive director of international relations at World Vision, sees his former organization becoming like Sojourners in that it will be "not so defined in terms of evangelicalism." It would be more appropriate, he said, to call the organization "faith-based" instead of "Christian."

Getman, in comments at Georgetown University, said that it might not be bad for World Vision to lose Christian distinctives: "That's the worry of the board of directors and some of the senior leadership. Some of them will approach me and say, 'Tom, we can't give an inch on this or we'll go the way of Yale University and the YMCA!' The more I see of Yale and the YMCA, the more I think that wouldn't be a bad thing!"

World Vision's president Stearns is adamant that the organization is indeed Christian and that part of its work is bringing the gospel through word and deed—poverty, he said, is both "material and spiritual." World Vision requires its U.S. employees to sign either the organization's faith statement or the Apostle's Creed. But overseas, almost 20 percent of World Vision's staff is Muslim, according to Getman; they must simply subscribe to the mission of the organization.

Andrew Natsios, who served as vice president of World Vision from 1993 to 1998 and as the head of USAID from 2001 to 2006, said because World Vision's structure is diffuse it is a "larger tent" than church-based organizations.

"World Vision Australia is very secularized, much more so than the U.S. World Vision offices in Latin America are into liberation theology," he said at the lunch with Getman. "They evolve."

While at the organization, Natsios said he pushed to allow employees to sign the Apostles Creed instead of the "more fundamentalist statement" that emphasized aspects like the inerrancy of Scripture. He said that the new inclusiveness had grown the organization's Catholic donor base.

For organizations like World Vision that aren't tied to one denomination, internal questions over Christian identity can't help but persist—but changes in government restrictions on faith-based organizations would force a decision between their work being simply humanitarian or definitively Christian.

Some in the Christian nonprofit world have abstained from government funds to avoid secularizing pressures. Richard Land, president of the Southern Baptist Convention's Ethics & Religious Liberty Commission, encouraged Southern Baptist organizations to refuse government dollars. World Vision's board permits up to 35 percent of the organization's revenue to come from the government.

"If forced to choose between preserving our faith values and forgoing government funds, we would have to walk away from the funding," Stearns insisted. "Our mission and motivation are not for sale."