Geoff Foster Accepts ICMDA Dignity & Right to Health Award

Dr Geoff Foster, a paediatrician in Zimbabwe, was selected from a number of other highly regarded and most worthy nominations for the 2008 award. The award is made annually to persons for excellence, outstanding leadership and compassion in responding to the HIV/AIDS epidemic. Dr Foster has graciously accepted the award on behalf of all those with whom he works

A full profile of Dr Foster can be downloaded at www.icmda.net , and further details are available at www.icmdahivinitiative.org

Zimbabwe Cholera Appeal
At the same time, as Zimbabwe faces a new epidemic of cholera, ICMDA has launched an appeal to get medical supplies to doctors from the Christian Medical Fellowship of Zimbabwe who are responding to the epidemic.

World AIDS Day 2008

This year is the 20th World AIDS Day - and as such is a time to give us pause for thought. At one level it seem like we are loosing the war - HIV infections are increasing, with no sign globally of a slow down, deaths from AIDS related illnesses remain alarmingly high, and so many of the world's poorest people have no access to treatment, care or education on how to avoid infection.

But we have also seen in the last five years one of the biggest mobilisations of resources in human history to reverse this trend, an have seen some countries where rates of new infection are in decline, numbers on treatment climb rapidly, and mortality rates drop dramatically. So, in the midst of gloom there are an increasing number of pockets of light.

But we are now in the early stages of what will probably prove to be a major and possibly prolonged global recession - so the worry inevitably is, can this response even be sustained, let alone scaled up so that the few good news stories become many? That may be the biggest cause for concern in the next two to five years. And even if we can keep the scale up of AIDS related funding, what will happen to other areas of development funding to aid poverty reduction and improvement of basic medical and educational services? Services that are going to be essential in seeing the up-scaling of AIDS funding actually having an impact on the ground.

How can equity and justice be maintained in the midst of economic turmoil? - that will be the key question in the coming year - and the answers we find and put in to practice could be the difference between life and death for millions.

The Churches have a role to play here - speaking up for justice and equity for the poor communities where they are based and minister, mobilising resources independently of governments and major donors, setting up models of best practice in care, treatment and prevention through church hospitals, local clinics, church schools, community projects and the like. Church leaders are speaking out this year in an increasingly high profile manner - but more needs to be done. Churches are being encouraged to see HIV as a spiritual and practical challenge that we are called to respond to by God. But more can be done to empower and envision churches. Leadership is the key, and the principle theme for this year's World AIDS Day.

So let this 20th Anniversary World AIDS Day be the point where we stop, reflect on what we have learned from the past, then put all our energies in to finding a result for the future.

Winner of the ICMDA Dignity & Right to Health Award 2008

It is with great pleasure and a deep sense of privilege that the ICMDA HIV Initiative Interviewing/Selection panel announce the winner of the 2008 Dignity and Rights to Health Award.

Dr Geoff Foster, a Paediatrician in Zimbabwe, was selected from a number of other highly regarded and most worthy nominations. The award is made annually to persons for excellence, outstanding leadership and compassion in responding to the HIV/AIDS epidemic.

We share with you the profile of Dr Foster:

1.Significant Impact locally, regionally and internationally.
Geoff recognized in 1987 that HIV was a devastating exploding epidemic when he saw, within a few weeks, many infants dying of AIDS at the Mutare government hospital . He began a crusade which continues through today to alert the world through publications, speaking, and demonstrating personal concern as a pediatrician in Zimbabwe. In my opinion none else has been more effective in bringing to the world’s attention the plight of children affected by HIV/AIDS and break the silence and hopelessness of Pediatric AIDS.

Below are a sample of his contributions:


A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa (2000)
by Geoff Foster and John Williamson

Where the heart is: Meeting the psychosocial needs of young children in the context of HIV/AIDS (2006)
by Linda Richter, Geoff Foster and Lorraine Sherr
Also see: Bernard van Leer Foundation

Under the radar: Community safety nets for children affected by HIV/AIDS in poor households in sub-Saharan Africa (2005)
by Geoff Foster

Where the heart is: Meeting the psychosocial needs of young children in the context of HIV/AIDS (2006)
by Linda Richter, Geoff Foster and Lorraine Sherr
Also see: Bernard van Leer Foundation


2.Empowers others
Geoff created an NGO called FACT-now completely led by Nationals-he remains on the board-to be a channel for resources and to advocate within Zimbabwe for HIV in children and in their mothers. He has also worked extensively with community based groups particularly those within the faith communities to bring care and prevention to the village level.

In particular he has worked with the CBO/NGO ‘Farming God's Way’ to bring agricultural enterprises appropriate for orphans and the poor/vulnerable to enable survival in the critical condition that Zimbabwe finds itself today.

The church is the avenue that Dr. Foster sees as the primary strategy of delivering prevention and care to children in Africa-he has shown it can be done in the midst of complete government failure and actual policies that promote HIV spread and human degradation.

As noted above, Geoff with FACT, work primarily at the community level to bring programs for HIV prevention--and population survival in the absence of government/international programs.



We thank the ICMDA HIV Initiative standing committee for its dedication to the cause of holding so prominently before us all the in the ICMDA the reality of HIV/AIDS and its effects in our world.

Dignity & Right to Health Award: 2008 NomineesPart 2

Today we present the remaining two nominees for the ICMDA Dignity & Right to Health Awards 2008.

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Dr Peter Okaalet, Kenya

Impact at local and wider level
Peter acknowledges that his role in his immediate family is irreplaceable, where he sees he has a key role as a mentor and a model. He sees his relationship between he and his wife is his basis for leadership in the church. Peter joined MAP in 1996. He addresses issues of HIV, AIDS and poverty. His mission is to provide total health through the work of MAP international in east Africa, west Africa, Asia and Central America.

He teaches at the Haggai Institute in Nairobi, Singapore and Hawaii.


Empowers others in integrated community responses
As well as the above Peter is involved with MAP in active training of community health workers, training of pastors, and in the development of HIV curricula for theological colleges. In Kenya nd in six other countries. MAP trains community health workers who are at the interface between community and hospital – some of these workers are employed and others are volunteers. Map Partners with the Kenyan government in responses to HIV. Peter sees that Christians often fill the gaps that are not currently addressed by government.


Facilitates church integration and participation in best practice models of care
By participating in meetings with groups such as Micah network, Peter is able to disseminate within the MAP network, and more widely information on best practice models. Peter shared that churches are facilitated when they know where gapes in services are present, we know what we do and we know what others do.


Demonstrates excellence in full community involvement and empowerment of People Living With HIV and AIDS (PLWHA)
Peter has always worked closely with PLWHA, with TASO in Uganda before his work with MAP in Kenya. Peter commented that “the wearer of the shoe knows where it pinches most” Peter sees not only do PLWHA have an important role in storytelling, and also they have an important role directing and reflecting on strategy. MAP has a policy that strongly supports employment of PLWHA.

Facilitates and advocates for gender equality in community participation and response to the epidemic
Map is intentional in including boys, girls, men and women in all that they do. In a patriarchal culture, Peter shares that men do take time to understand the role of women. Theologically we know it is not good for man to be alone. MAP has a gender aware employment policy. Peter acknowledges that sixty per cent of those who are HIV infected in Africa are women.


Links well with government and other actors in a comprehensive approach to the epidemic
MAP is the chief facilitator for FBOs within government negotiations on HIV and AIDS. MAP has fulfilled this role for many years. MAP is represented on many agency boards that deal with HIV. The Kenyan Muslim community has adapted the MAP model.


Models creative and compassionate responses that inspire many to similarly enhance the dignity and human rights of people infected and affected by the epidemic.
MAP International staff belong to many churches. MAP International materials have been translated form English into Swahili, French, Portugese, Hausa and Amharic.


Does justice, loves kindness and walks humbly with God
Peter referred this answer to the MAP mission statement. MAP’s guiding principles, vision and mission are steeped in scripture. MAP’s motto is “Health and Hope for a Hurting World”.
See http://www.map.org/site/PageServer?pagename=who_Main


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Dr Gisela Schneider, Germany


Impact at local and wider level
Programmes developed during the nineties in Gambia had a measurable impact in reducing stigma, increasing Christian engagement in a predominantly Muslim country, improved quality and length of life before the absence of ARVs, and emerging signs of an impact in HIV prevention. Programme was well integrated into the Gambian Government’s HIV services.


Empowers others in integrated community responses
Gisela’s work has been focused on developing community based responses that are integrated with government, church, hospital, training institutions, etc. Has an emphasis on building capacity by getting all stakeholders (e.g. churches, hospitals, families) to work to their strengths in addressing HIV.


Facilitates church integration and participation in best practice models of care
Strong emphasis on church involvement and empowerment - helping churches to identify the contribution that they can make to a coordinated response to HIV & AIDS, encouraging integrations of both churches and FBOs with Government health programmes


Demonstrates excellence in full community involvement and empowerment of People Living With HIV and AIDS (PLWHA)
Strong emphasis on developing local ownership and leadership, and it is very often PWLHA and their families that have been at the forefront of this.


Works, facilitates and advocates for gender equality in community participation and response to the epidemic
Gisela works very closely with women on the ground, and has being doing work in DRC in particular on helping churches to self identify gender roles and issues in general relation to health and to HIV in particular


Links well with government and other actors in a comprehensive approach to the epidemic
This programme encourages integration of church and FBO services with wider government and civil society health systems and social engagement.



Models creative and compassionate responses that inspire many to similarly enhance the dignity and human rights of people infected and affected by the epidemic.
The initial programme that ran for over a decade in Gambia was handed over to in other local leadership in 2004, and immediately there was interest in training people in the lessons learnt from Uganda. This led to another two year project that is now locally led, and the new, wider ministry of extending this training to other nations and contexts.


Does justice, loves kindness and walks humbly with God
Strong theological root to this work – it’s main emphasis is on living out the gospel in who you are, then in what you do, and finally in what you say. It is based on a theology of salt and light, engaging even with corrupt systems to model God’s Kingdom in practice. This is what Gisela has imparted to her staff, her partners on the ground, church leaders and FBOs. It is about doing what you do the best you can to serve God where and when you are faithfully.



We shall be announcing the winner in time for World AIDS Day, but all five nominees are people who have made a significant impact in their nation and the wider world in establishing and developing effective responses to HIV & AIDS from within their faith communities.

Dignity & Right to Health Award: 2008 Nominees Part 1

We, the ICMDA HIV Initiative team, have received five nominations for the Dignity and Right to Health Award 2008. The following five individuals were nominated -


Rev Gideon Byamugisha – Uganda

Dr Mukwege – DRCongo

Dr Geoff Foster - Zimbabwe

Dr Peter Okaalet – Kenya

Dr Gisela Schnieder – Germany



All nominees are acknowledged as demonstrating excellence and authenticity in keeping with Micah 6:8. They are excellent role models for us all.

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Rev. Canon Gideon Byamugisha, Kampala, Uganda

Canon Gideon Byamugisha is an ordained priest in the Church of Uganda.
In 1992, he became the first African religious leader to openly declare his HIV-positive status. He has since devoted his life to an AIDS ministry which has taken him to over 40 countries in sub-Saharan Africa and many other parts of the world.


Work
Gideon is driven by a passion for the dignity and rights of all people, especially those marginalised, stigmatised and discriminated against because of their HIV-positive status. He has played leading roles in the Church of Uganda's AIDS program, the Uganda AIDS Commission, World Vision International, the Ecumenical Advocacy Alliance, special conferences of the United Nations, and in founding the African Network of Religious Leaders living with or Affected by HIV and AIDS.

Impact
Gideon has successfully challenged AIDS-related stigma, denial and discrimination within and outside the church. He has corrected wrong and misleading information about HIV and AIDS, and provided accurate and relevant information in a clear, easily understandable manner. He has spread awareness of the multi-sectoral dimensions of the AIDS pandemic, especially the ways in which people's choices are influenced by poverty, gender discrimination, cultural practices and sexual violence. He argues that HIV and AIDS are both preventable and manageable.

He calls upon people to spread hope about HIV through peer education, counselling, home-based care, practical help and prayer, pointing to an array of outstanding work with which people can engage.

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Denis Mukwege, Bukavu, DRC

Dr Denis Mukwege is a gynaecologist, who is working in Bukavu, South Kivu, Eastern Congo. He trained in France but went back to DRC many years ago to serve at a mission hospital in a rural area of South Kivu. 10 years ago he had to flee this region and his hospital was burnt down in the war. Dr Mukwege did not return to France but started a new hospital in Bukavu. He opened a maternity unit, but his first operation was not a caesarean section, but a woman who was destroyed by war – raped by soldiers and with large injuries to her genital organs. Dr Mukwege saved her life and restored her dignity once again.

Since that day he has not stopped fighting for the survival of women in the community. He developed an excellent centre for women who were raped, 3600 women are treated at this centre per year. He trained young doctors in this type of surgery and care and developed a psycho- social support network for the women who often could not return home into their villages because of war. He never was afraid to operate on women whether they are living with HIV or not. His work and testimony reaches far not only South Kivu, but all of DRC and on a global level.

He did not only assist women but he started to advocate for the right of the women and families in the villages of South Kivu whose life is at risk because of external forces who exploit the land for coltan, gold and other minerals. Dr Mukwege speaks up and he says: “We do not want money we need peace in our country”.

Impact at local and wider level
At local level Dr Mukwege has made a huge impact on the lives of women who are raped or are suffering from VVF, many of whom are HIV positive. In addition he has worked as an advocate for peace in DRC on an international level and has spoken for the many women whose life stories are too sad to tell.

Empowers others in integrated community response In post war Congo, it is not easy to do community work. But Dr Mukwege started a psycho-social service for the women at Panzi hospital. With mobile teams he now reaches rural areas with services for women. In addition as the head of the ECC (Eglise du Christ du Congo) medical work, he mobilises churches and communities to get involved in the healing ministry of the church. He is head of a health zone in Bukavu and coordinates the church health services in 22 health zones throughout South Kivu.

Facilitates Church integration and participation
Dr Mukwege is an elder in the church (CEPAC) in Bukavu. He is very much aware of the importance of the integration and participation of the church in the healing ministry and recently started a new approach of envisioning the church to participate in this ministry.

Empowerment of PLWHA
Dr Mukwege does not only work with PLWHA but he works with all women who are sexually assaulted, many of whom are HIV positive. They are actively involved in the care and recovery process and many of his counsellors and workers are women who have recovered from such trauma.

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Dr Geoff Foster, Zimbabwe.

Significant Impact locally, regionally and internationally.
Geoff recognized in 1987 that HIV was a devastating exploding epidemic when he saw, within a few weeks, many infants dying of AIDS at the Mutare government hospital . He began a crusade which continues through today to alert the world through publications, speaking, and demonstrating personal concern as a paediatrician in Zimbabwe. In my opinion noone else has been more effective in bringing to the world’s attention the plight of children affected by HIV/AIDS and break the silence and hopelessness of Paediatric AIDS.

Below are a sample of his contributions:

• A review of current literature on the impact of HIV/AIDS on children in sub-Saharan Africa (2000) by Geoff Foster and John Williamson
• Where the heart is: Meeting the psychosocial needs of young children in the context of HIV/AIDS (2006) by Linda Richter, Geoff Foster and Lorraine Sherr Also see: Bernard van Leer Foundation
• Under the radar: Community safety nets for children affected by HIV/ AIDS in poor households in sub-Saharan Africa (2005) by Geoff Foster
• Where the heart is: Meeting the psychosocial needs of young children in the context of HIV/AIDS (2006) by Linda Richter, Geoff Foster and Lorraine Sherr Also see: Bernard van Leer Foundation

Empowers others
Geoff created an NGO called FACT-now completely led by Nationals-he remains on the board-to be a channel for resources and to advocate within Zimbabwe for HIV in children and in their mothers. He has also worked extensively with community based groups particularly those within the faith communities to bring care and prevention to the village level.

In particular he has worked with the CBO/NGO ‘Farming GOD’s Way’ to bring agricultural enterprises appropriate for orphans and the poor/ vulnerable to enable survival in the critical condition that Zimbabwe finds itself today.

Facilitates Church integration and participation
The church is the avenue that Dr. Foster sees as the primary strategy of delivering prevention and care to children in Africa-he has shown it can be done in the midst of complete government failure and actual policies that promote HIV spread and human degradation.

As noted above, Geoff with FACT, work primarily at the community level to bring programs for HIV prevention--and population survival in the absence of government/international programs.

A Creed for the AIDS Pandemic

The Christian HIV/AIDS Alliance have launched a “Creed for the AIDS Pandemic” designed to be read out in churches, on either Sunday nearest to World AIDS Day, December 1st. The aim is to help churches to remember the 2.1 million people who died from AIDS related illnesses last year alone, and to express support for those involved in the response to HIV and AIDS throughout the world.

CHAA member, the Salvation Army UK Territory, plan to launch the Creed in their churches for World AIDS Day 2008; Tearfund have written their own version inspired by CHAA’s Creed; Alpha International, Holy Trinity Brompton, and St Philip and St James Church, Bath, also both plan to use the Creed. Copies of the Creed were also distributed to Anglican Diocesan World Mission Officers and Mission agencies attending the recent Anglican, “Partners in Mission World Mission” conference.

CHAA developed the Creed as a step towards their vision to see a mobilised UK Christian Community responding to the Global pandemic.

The short Creed affirms Christian belief in God’s love to reach out to those infected and affected by HIV and AIDS whilst firmly rejecting the idea of the AIDS pandemic being God’s judgement on sinful behaviour. Its emphasis is firmly on the church being an agent of change, putting the responsibility on church members to reach out as Christ’s’ disciples to comfort the broken hearted, help the oppressed, care for orphans and widows and minister to the sick. The Creed is in bookmark format, designed to be signed and dated and kept as a reminder by church members as a commitment to be involved with the worldwide pandemic.

AIDS activist, Rev Alan Bain, Vice Chair of CHAA, and Vicar of St Philip and St James Church, Bath, said, “ At the World AIDS conference in Mexico City this year UN Secretary – General, Ban Ki Moon pointed out that an even greater effort is now required if the world is to meet the Millennium Development Goal of halting and reversing the spread of HIV by 2015. CHAA’s new Creed provides a reminder and an opportunity for churches to commit themselves to solidarity with the overseas church who have fought the pandemic for over 25 years, often in situations of abject poverty and deprivation.”

Chair of CHAA, Ken Pearson said, “The Creed for the AIDS pandemic is not new. It is being lived out every day by millions of Christians living with and caring for those affected by the pandemic. My prayer is that the Creed will reawaken the UK Church to our responsibility to share with them in their need.”

The full text of The Creed is as follows:

1. We believe that God loves the world and the proof of that love is the Lord Jesus Christ’s death on the Cross.

2. We believe that through the reconciling power of the Cross, God’s love seeks to embrace all people regardless of creed, colour, gender or sexual orientation and that the AIDS pandemic is not God’s judgement on sinful behaviour.

3. We believe that God has called the Church to be the agent of His love in this broken world.

4. We believe that Christ’s love compels us that we should no longer live for ourselves but for Him and that the Gospel calls us to care for our brothers and sisters in Christ and share in their sufferings and to do good to all people.

5. We believe that as stewards of the talents we have been given, we have a responsibility to use them to help all those affected by the AIDS pandemic.

6. We believe that, as Christ’s disciples, we are called to comfort the broken-hearted, help the oppressed, care for orphans and widows and minister to the sick.

7. Therefore, as God’s people, we covenant together to pray regularly, give generously, fight stigma, encourage one another, and share in fellowship with those affected by the pandemic.


The Christian HIV/AIDS Alliance is a network of 19 Christian agencies and churches praying and working together to serve and empower those affected by HIV and AIDS. Copies of the “Creed for the AIDS Pandemic” are available to order or by download on the CHAA website, www.chaa.info

HIV Call to Action from Evangelical leaders worldwide

I have just read the HIV Call to Action adopted the World Evangelical Alliance General Assembly on October 29 in Thailand. This was drafted after their consultation with the Micah Network for Integral Mission. It also feeds in to the joint global campaign both networks are running around the Millennium Development Goals - the Micah Challenge.

I think it speaks eloquently of both God's heart and our responsibility as we are faced with the local and the global challenges that HIV & AIDS present to the world.

While we have not always acknowledged it, we recognise today that the Body of Christ, His Church, is living with HIV. With brokenness we admit that as Evangelical Christians we have allowed stigmatisation and discrimination to characterise our relationships with people living with HIV. We repent of these sinful attitudes and commit to ensuring that they are changed. We will follow Jesus’ example and identify with those who are affected (Matthew 9:12-13) as we intercede fervently for one another (Romans 8:26).

We recognize that as the current generation of young people in our churches enters adulthood and becomes sexually active we have not always provided a clear, biblical framework of human sexuality and life skills for their guidance and nurture. We are cognizant that we have been insensitive to the inability of women, children and the most marginalised to exercise real choices and that in many areas of the world marriage and gender-based violence are risk factors for HIV transmission. We apologise for this failure and resolve to model and teach the essential value of human sexuality within the bounds of God-honouring lifestyles. We also commit ourselves to listen with understanding to our children, youth, women, and the most marginalised – especially people living with HIV – so that we can work together for a healthy and safe future which will enable all people to live in the abundant life Jesus promised (John 10:10).

The HIV pandemic has reminded us that the health of all communities is connected to the health of the most vulnerable and marginalised in our societies. We commit as leaders to equip ourselves and our congregations to follow the footsteps of Jesus. Since ours is the ministry of reconciliation (2 Corinthians 5:18-19) we will seek to live out incarnational faith working in partnership with the most marginalised and vulnerable to HIV infection.

As a community of Evangelical Christians we believe that all people regardless of belief, identity, gender, ethnicity or health are created in the image of God (Genesis 1:27). Hence it is an essential element of our identity that we bear witness to the love of God for all people in word and deed, in private and in public. We therefore resolve to strengthen our theological reflection and practical action in our advocacy, respect for life and justice with dignity for all people. We realize that this resolution will profoundly challenge us as we deeply long to be a holy people who please God (1 Peter 1:15-16; Matthew 5:8). We reaffirm that we all live in and by the grace of God (Ephesians 2:8-9; Romans 5:1-2) and agapé love (1 Corinthians 13:1-8).

We commit to working in HIV prevention in partnership with others to halt and reverse the spread of HIV. In so doing we understand that there are many social drivers that contribute to HIV transmission and that no one group or organisation can do everything. We will therefore work alongside other sectors of society so that all people will know how to protect themselves from infection and have access to the services needed to do so.

We commit to playing our part in caring relationships – individually and corporately – working to mitigate the impact of HIV on individuals, families and communities and advocating for comprehensive HIV services in prevention, treatment, care and support. We will work towards universal access for these services for people living with HIV so that they become less vulnerable and are enabled to be meaningful contributors within the Church and society.

We commit to develop a comprehensive HIV strategy in collaboration with our member-networks, people living with HIV and other partners.

As a community of Evangelical Christians expressed globally, nationally and locally we will foster connections between parts of the Body of Christ. We will strive for practical solidarity and sacrificial giving among Christians – person-to-person, congregation-to-congregation, denomination-to- denomination, and country-to-country – in order that Jesus may be lifted up, the Father glorified and men and women brought into His saving grace through the life revolutionising power of the Gospel we preach (Romans 3:23-24; 6:23; Ephesians 5:8; Colossians 1:13).

An evening with Ugandan Canon Gideon Byamugisha

Humble, yet courageous, Gideon was the first churchman to publicly declare his HIV+ status. Canon Gideon now has a worldwide ministry in drawing attention to the plight of AIDS sufferers and the work being done in their midst to bring them hope. Canon Gideon's ''Ambassadors of Life'' evening will inspire and challenge you with his unique blend of humour and pathos. Hear about innovative new strategies

Canon Gideon was a keynote speaker at the ICMDA world congress in Sydney 2006, and again at the ICMDA Eurasia Regional Conference in Schladming Austria in September 2008. He is supported through HealthServe Australia in the ICMDA HIV Initiative project. The Kilimanjaro Rehabilitation project will also be featured - where of those adults admitted with neurological problems such as stroke, over 20% are HIV positive.

Meet Canon Gideon in

· Brisbane Wednesday Nov 5

· Sydney Saturday Nov 8

· Adelaide Tuesday Nov 11

· Melbourne Saturday Nov 15

HealthServe Australia is collaborating with SIMAid in these dinners. More details of the dinners will be available later but put it in your diary NOW. For more details visit the CMDFA website

Day 2 – Part 1:Utilising Resources

Day two focussed primarily on the issues of treatment and care, and responding to stigma. It has been especial privilege to have contributors from Kazakhstan, Ukraine, Belarus, Uganda and India, and the differences and commonalities between the experiences in these different nations in different regions of the world has been eye opening.

Treatment & Care in Resource Limited Situations

Dr Gisela Schneider spoke with great passion n the challenges of effectively treating people with late stage HIV infection. Quoting Colossian 3:17, she reminded us that caring for those living with HIV & AIDS is an act of worship to God.

The biggest challenge is that for all the work we have done in scaling up access to antiretroviral treatment [ART], the reality is that for every two people newly accessing ART, five are infected with HIV. We are not even running to stand still – and unless we scale up access to treatment dramatically over what has already been achieved, and start seriously investing in effective prevention, we are never going to get universal access. And it must be a combined strategy of treatment and prevention.

The reality is that effective treatment is not just about rolling out antiretroviral [ARV] drugs. Early diagnosis is key – so early testing is essential, which requires good voluntary testing and counselling. Good nutritional support is essential if ARVs are to be effective, along with effective diagnosis and treatment of opportunistic infections. We must have good palliative care, not just in terminal illness, but in controlling symptoms of opportunistic infections and managing the side effects of ART. Good psychosocial support is vital – community support, counselling and other forms of support to help the individual and their family deal with the pressures that are on them. You need well trained staff and volunteers to provide all of this support, as well as to deliver and monitor ART itself. Well trained clinical officers and nurses can deliver the majority of the care and treatment, you do not need lots of doctors, and this leads to a significant increase in capacity within health systems.

Once you have all of this, you are ready to start administering ARVs. First line treatment in most of Africa is usually with Nucleoside and Non-Nucleoside Reverse Transcriptase Inhibitors (in West Africa, where HIV2 is predominant, Protease Inhibitors are first line treatments). In Eastern Europe and Central Asia there was some debate over the best first line treatment.

In Africa the usual criteria to start ART was a CD4 count below 300 and a presenting Stage III AIDS defining illness. However, in practice, anyone with a presenting illness would go on to treatment, regardless of CD4 count.

While many thought ART would not work with poor, uneducated rural Africans, the evidence suggests that ART has reduced HIV related mortality by as much as 95% in rural Uganda, and other evidence suggests that compliance amongst Africans is significantly greater than among North Americans (85-99% in Africa versus 57-75% in the USA). Treatment support is vital – volunteer support in the form of treatment advocates are vital in reinforcing the message that compliance is like a marriage – you and your drugs are together for life!

Multi Drug Resistant TB (and more recently Extremely Drug Resistant TB) have become major problems for people living with HIV. But evidence suggests that much HIV infection is also being missed because people with TB are not being tested for HIV – the reality is that the two infections go hand in glove, especially in Africa and Asia.

Good monitoring and evaluation of treatment is essential – particularly early recognition of treatment failure. However, the big struggle is to get second line therapies – as most global funding is only for first line therapy. First line treatments can be as cheap as $92 per annum, but second line treatments are coming in at $600-1,200 per annum. There simply is not the funding for this, and it is becoming a major concern as more people are either being infected by resistant strains of HIV or are developing resistance after many years on ART.

The biggest future challenge is to start seeing people living with HIV and AIDS as part of the solution rather than the problem. They are the most effective educators, advocates and supporters and counsellors for the newly diagnosed. They are actors not passive recipients. The other major challenge is to start engaging heterosexual men in tackling the causes of gender based violence and the empowerment of women – if we are going to turn back the feminisation of the epidemic, we need the men to be part of the solution, not the problem. This is a key role that the churches can take on – re-educating men in their attitudes to sexuality and relationship with women from a truly Biblical basis.

Day 1 – setting the scene

Today's meetings were focussing on the big picture issues – global lessons learned (the very hardest of ways) over the last thirty years, especially in Africa.

Lessons Learnt from Africa

Revd. Cannon Gideon Byamugisha was the opening speaker – sharing some of those hard learned lessons – the most of basic of which is that care, treatment and prevention all fit together and cannot be tackled separately. Furthermore, each compliments the other. Gideon's approach has been christened SAVE – Safe Practices (this includes the sometimes derided ABC [Abstain, Be faithful, use Condoms], clean needle exchanges, prevention of mother to child transmission, etc, etc); Access to treatment (Universal Access for all by 2010); Voluntary, routine and stigma free counselling and testing; Empowerment of people and communities at risk of or living with HIV & AIDS.

Faith Communities and Global Responses

Joy Backory of UNAIDS gave an overview of the big picture from the UN standpoint, highlighting the importance of the 2001 UN Declaration of Commitment and the 2006 UN Political Declaration as commitment we as civil society groups can use to hold our governments to account for their actions to respond to HIV & AIDS – these are agreements that all UN member states have signed up to (see here for a report on the 2008 evaluation meeting on the progress towards achieving these declarations and commitments).

Key ways in which the faith communities and faith based organisations can have an impact is in breaking the silence on HIV & AIDS, speaking out against stigma and discrimination. We also have a key role in mobilising communities to respond – from primary health care to community education and support mechanisms for those affected.

UNAIDS is now establishing an ongoing working group on joint working with faith communities and FBOs, and developing an engagement strategy for use by all international bodies. The Global Fund for instance still has difficulties engaging with faith communities, and vice versa, as the large scale project funding is often at an operational level removed from the activities of all but the largest FBOs. However, in some countries faith communities are engaged with country coordinating mechanisms (CCMs) that act as conduits for Global Fund grants, and these good examples need replicating.

The key message is that the international response to HIV & AIDS needs faith communities, but we need to be willing and able to engage with the wider, global response

The Church in the Central Asian Republics: Challenges to an effective response

In the afternoon, we looked at the challenges for the churches in Central Asia in responding to the emerging pandemic there. In most countries of the region, the pandemic is mostly amongst intravenous drug users (IVDUs) and commercial sex workers (CSWs). Exact figures are hard to come by, as reporting is not well developed in some of the republics, and figures for Turkmenistan in particular are impossible to find. What figures there are almost certainly underreporting the scale of the problem. But roughly speaking Kazakhstan has a 3% HIV incidence amongst IVDUs, in Kyrgyzstan the incidence is only 0.8% among IVDUs, but soars to 5% of the prison population, many of whom are IVDUs. In Uzbekistan 30% of IVDUs are HIV+, while in Tajikistan it is 24% amongst IVDUs and 17% amongst CSWs. Government responses vary, but as HIV is an emergent problem and still confined to these 'at risk groups' it is not a major public health priority.

The churches are engaging with HIV in most countries of the region, but only in small pockets. Overall most churches do not see it as a spiritual or pastoral issue, and see it primarily linked to sin and worldliness, therefore not a legitimate issue for the churches to engage with. There is little or no worked out theology of AIDS or social engagement, and there are few resources available for churches on HIV & AIDS in Russian or other local languages.

Many churches have difficulties in working together – there is much distrust between churches and denominations. Furthermore, unless the pastor catches the vision, there is little chance of much being achieved as the work is very much led by pastors and members of the congregations (especially younger people) are not listened to or given room to develop their own ministries. In addition, the churches are mostly marginal or even persecuted, and thus not looked upon by government or wider society as a resource; if they reach out to affected people and communities they can face further hardships themselves.

However, the churches are often the only communities able to respond and help those affected. Churches are engaging with people living with HIV & AIDS because they are coming to the churches for help, having nowhere else to turn.

What can be done? Training of pastors in issues around sexuality, death, HIV & AIDS, drug use, stigma etc need to be part of seminary courses, and post graduate training is also needed for those already leading churches. Seeing people living with HIV as a resource, especially as educators (not just to peers, but to other church leaders and their congregations) will be key – especially to combating stigma and giving the pastors and their churches a vision to reach out to those affected. There are already national networks linking pastors and FBOs together, and these meet regularly across the region – at these meetings HIV is coming to the fore as a major issue. But it will take time for this to translate to a real transformation in the churches on the ground.

HIV Prevention in a Post-Christendom Culture

If the Central Asian Republics are post communist/post Muslim states, the problems of Western Europe are summarised in their being 'Post Christendom' – not post-Christian, but reacting against model of institutional Catholic and Protestant religion that has had long standing state approval. Richard Carston of ACET Ireland highlighted the challenge of engaging the church in prevention when it wants to keep its head down because society in Ireland now want to define itself as not being anything to do with traditional faith (especially, though not exclusively, Roman Catholicism). So the challenge is to couch prevention language that promotes Biblical values in language not associated with traditional religion. So the traditional answer to the question 'When will I lose my virginity' would have been 'only once you are married', whereas the approach ACET would take is to reframe the question – 'with whom will I enter a one-flesh relationship.'

The challenge is to tackle an increasingly heterosexual epidemic by mainstreaming the work, and standing alongside secular groups.

Aid to the poor falling behind

As we start on Sunday to look at how we respond to HIV & AIDS as Christian health professionals in Eurasia, it is sobering to stop and note that efforts to tackle poverty (one of the main drivers and symptoms of the AIDS Pandemic) and improve access to healthcare (one of the main weapons in the war against HIV & AIDS) are falling woefully behind. As this article highlights, though there are some areas of progress, in reality the rich nations are maybe $30 billion behind target.

I remember the heady days of July 2005, the Gleneagles G8 Summit in Scotland, the 'Make Poverty History' campaign, and a real sense that change was in the air. This report is merely the latest set of figures that shows the rich are still not living up to our obligations and commitments to the poor. We are not going to make the 2010 universal access targets for HIV & AIDS treatment, care and prevention either, for similar reasons.

One of the challenges we face is not just to ask how best we can provide treatment, care and prevention, it is also to ask how we challenge the social and political systems that lock people out of these resources.

AIDS Slang

Interesting Blog post - slang/colloquial terms for HIV, AIDS and related matters (mostly from Africa)

Five days to go

Five days before the ICMDA Europe/Eurasia Regional Conference in Schladming, Austria. Just trying to sort out visas, ensure all the literature and resources arrive on schedule, and just generally get everything organised that has not already been put in place.

As ever, the logistical challenges of a conference can easily get in the way of the central priority - how are we supporting these doctors and others to give the very best care in often less than ideal circumstances to people living with HIV and AIDS? My main prayer is that we achieve that aim at least at this conference.

Following 2006’s Sydney HIV preconference, a Worldwide ICMDA HIV/ AIDS initiative/ network has been established [www.icmdahivinitiative.org]. As there is significant variation in the nature of the epidemics from region to region it was recognised early on that it was important for this network to become regionally focused in the same way in which ICMDA is developing regionally.

The HIV pre-conference in Austria 2008 is an opportunity to start a regional focus in Europe, Central Asia and the Middle East – areas currently not well represented, but where the HIV pandemic is accelerating at its fastest. In many nations in the region keep their HIV pandemic hidden, and remain in denial reminiscent of many Africa nations in the early to mid 1990s. It is also a region where the churches are often marginalised or even persecuted, and overt Christian responses are not always possible. The need to empower, equip and network those Christians who are responding to the pandemic is vital.


The main aims of the HIV & AIDS pre conference stream are:

1. Establishing regional links, especially in unknown places this far, i.e. Middle East, Eastern Europe. Find out what people are doing.

2. In a lot of places, it’s likely that people will be working in isolation – the pre conference will therefore aim at encouragement and empowerment, learning from each other, creating a space for people just to network.

3. Sharing skills and best-practice knowledge. Cautiously, aware of cultural / practice differences.

4. Creating a virtual network for Christian ministries, mission agencies, churches and health professionals responding to HIV and AIDS in the region.

We are hoping that around thirty five to forty delegates/speakers from the region will be attending (final figures are just coming through). Medical practitioners and students will get some subsidy from ICMDA, we will look to support others attending by other means. Target group for the conference will be Christian health professionals, mission agencies, indigenous ministries and Churches responding to the pandemic in their own nations or across part or all of the Eurasia region.

We will be posting updates on to this site regularly over the next week.

The Welcome Return of the "AIDS Heretics"

Interesting review in Spiked this week, looking at Elizabeth Pisani's "The Wisdom of Whores" and James Chin's "The AIDS Pandemic: The Collision of Epidemiology with Political Correctness" two of the current generation of "AIDS Heretics". While the earlier generation of "heretics" questioned the science of HIV (and have now largely been discredited, although sadly not in South Africa), this new generation are attacking the accepted wisdom on HIV prevention.

One of the big challenges is that most HIV epidemics do seem to be confined to certain "risk groups" - i.e. gay and bisexual men, commercial sex workers, intravenous drug users, etc, etc. It is more generalised only in parts of the world (mostly Southern and Eastern Africa) where networks of stable, multiple sexual partnerships exist.

The problem with saying any of this is that it immediately becomes ammunition for those who would stigmatise and marginalise these groups even further than they already are - and cuts against a common belief that women are not promiscuous in the same way (or to a similar degree) that men are. It also puts in to question a lot of the HIV prevention strategies that have gone on for decades, and the way that funding is allocated by donors and international agencies. And there is undoubted resistance to such a challenge to the current orthodoxy, as I have catalogued elsewhere.

The reality is that we should welcome these "heretics" for making us think again about how we are undertaking prevention work. The great challenge before us is how we effectively slow and halt the spread of the pandemic, especially in high incidence countries. Asking these questions and looking again at what actually works is vital to the future effectiveness of any prevention strategies. We do not have to agree with all that the new "heretics" say or prescribe, but we can value the hard re-look at the facts that their diagnoses force upon us.

Welcome

This blog will attempt to cover some of the issues in the HIV and AIDS arena that the members of the International Christian Medical and Dental Association are dealing with around the world - partcualrly looking at the engagement of faith, medicine and HIV/AIDS.

In the short term this will include a detailed report (at least day-to-day) from the Eurasia Regional HIV Pre-conference at the ICMDA Conference in Schladming, Austria this September (2008).

The aim of the HIV pre conference stream is to bring together Christians working in HIV & AIDS care, prevention and treatment across the region in order to learn from one another, explore new models of practice, look at how we influence our own churches and faith-communities to respond positively, and to strengthen networks of professionals working in the field

The ICMDA HIV Initiative grew out of the ICMDA International AIDS Preconference at Meroo, New South Wales in July 2006. It is a linked activity of the International Christian Medical and Dental Association. We are motivated by a belief in a loving God who cares about all the world's people regardless of health status, race, creed, colour or financial or social standing. We continue to encourage all Christian health workers, services, institutions, local congregations and communities to engage holistically in HIV and AIDS advocacy, education, prevention, care and treatment. We support the call for universal access to prevention and treatment as part of a right to health and dignity for all. To these ends, and other commitments highlighted in the Meroo Statement


The ICMDA HIV Initiative is involved in:

• An annual Dignity & Right to Health Award that recognises Christian health professionals making a significant impact in care and treatment of people and communities affected by HIV

• Running conferences and events within and outside ICMDA Programmes that seek to encourage, equip and empower Christian health workers involved in responding to HIV & AIDS.