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.