Keeping Faith with HIV & AIDS

Religious, secular, governmental and international bodies came together at Lambeth Palace this week to discuss the impact and relevance of faith based responses to HIV and AIDS.
In the face of an ongoing financial meltdown in the West, and collapsing economies in many developing nations, the sustained global effort to tackle the HIV pandemic has recently looked in doubt. This is ironic, because for the first time since AIDS was recognised in the early eighties, there is good news.

The global effort to turn back the pandemic is working. New infection rates are down, more people than ever are on treatment, and as a result the death rate from AIDS related causes is decreasing.

It was with this in mind that the question: ‘Why does faith have a role in the response to his pandemic?’ was tackled. If Richard Dawkins in his latest book is to be believed, religion in any form should play no role in public life and civil society.

However, the reality is that most of the world’s poor have a religious outlook on life, and for them the spiritual dimension is as real and relevant as economic targets and indicators are to the World Bank. The spiritual dimension lies at the heart of all faith based responses to HIV, and it is one of the distinctive approaches we can bring.

A report launched at last Monday’s conference called for the global community to recognise and support the role of faith based groups and communities in their response to HIV. Faith based organisations can often access groups inaccessible to other organisations, and can affect change in attitudes and behaviour by reference to scriptures and theology – routes not open to secular bodies.

But it is a hard message to get across. Most aid agencies, major donors, governments and UN institutions come from a largely secular, Western mindset, in which faith is relegated to the private sphere. While that perspective is slowly changing, it is also true that some religious leaders and groups hold strongly conservative opinions that put them in diametric opposition to the views of the wider international community.

And while some of this is down to shaky theology and can and should be challenged, and some is down to a misunderstanding and confusion over the use of language (which also can and should be overcome), sometimes it is because there are fundamentally different values between the religious and secular worldviews. There are times when we have to agree to disagree and go our separate ways. But there are times when we can and should work together for the greater good.

Research suggests that while faith based responses and health interventions are not necessarily better or worse than more secular ones, they are often more valued and appreciated by people in developing nations. Often, the key difference is that the spiritual needs of the individual or community is being addressed. This is the other ‘added value’ that we can bring.
But also, as HIV starts to slip off the global agenda and as funding for treatment, care, support and prevention faces cuts, it is vital that those at the coalface get support. Many faith communities are dealing with HIV and AIDS on a day-to-day basis. The Christian church in particular has, in all its varied forms, a presence in so many of the communities affected by HIV and AIDS in Africa in particular, often dealing with the reality of its own congregations and leaders living with HIV and AIDS.

If the global community begins to forget the struggles faced by these communities, then the wider, global church cannot and must not.

Is Treatment Becoming the New Prevention Fad for HIV & AIDS?

Two new studies (one in Kenya and Uganda, the other in Botswana) were published this weeksuggesting that administering HIV antiretroviral (ARV) drugs to the general population could reduce the risks of HIV transmission by 60-70%.

In May we reported on a study that showed this worked for reducing infection rates between sero-dsicordant couples (i.e. where one is HIV+ and the other is uninfected). These newer studies however, suggest that making ARVs available to the general population in communities where there is a high incidence of HIV infection could dramatically reduce the rate of infection overall.

There are big questions about the reality of turning this into a realistic and ethical prevention strategy. Firstly, it does not always work – an earlier study (FEM-PrEP) using the same drug as the Botswanan study (Truvada) showed no impact. The reasons for that disparity are unclear, but may have to do withadherence – i.e. the benefits disappear if the drugs are not taken consistently.

Secondly, there is the cost – ARVs are still not cheap, and making them available to uninfected people when the majority of those with an AIDS diagnosis worldwide cannot get access to them raises real questions about affordability and the ethics of how aid money is distributed. In other words, given limited funding, do you invest in helping those who are already ill, or in stopping some of those who might get ill from becoming infected?

Thirdly, is it ethical to make available drugs (with all their side effects) to otherwise healthy people? Especially if, in doing so there is a risk that we could undermine other proven strategies such as partner reduction (so called ‘zero grazing’), abstinence and condom usage?

Using HIV antiretroviral therapy as a prevention strategy is rapidly gaining a body of supporting evidence. This is good news, as the argument for getting more people on to ARVs worldwide is boosted – it not only saves the lives of the infected, but reduces the rate of new infections. This gives added weight to efforts to get 15 million people living with AIDS on to ARV by 2015.

At the same time, if this happens at the cost of the massive gains in more comprehensive prevention strategies, we could find ourselves back peddling on the progress made in prevention initiatives over the last two decades. These initiatives have shown that not only behaviour change and treatment are important, but community engagement and awareness, government commitment and a partnership with civil society, including the churches, is vital.

Let us hope that the global community proceeds wisely with its growing tool box to tackle the HIV & AIDS pandemic, and does not forget the hard learned lessons of the last three decades.

this post originally appeared on the blog of the Christian Medical Fellowship UK

A surprisingly upbeat end to the UN high level meeting on AIDS promises renewed global action

UN meetings and political declarations are often perceived as wordy and irrelevant. But every now and again these high level meetings do come up with statements that shape the actions of governments and aid agencies for years to come. The Millennium Summit of 2000 was one of these occasions, when the Millennium Development Goals were agreed. The UN General Assembly Special Session (UNGASS) High Level Session Declaration of Commitment on HIV and AIDS last week may well be another.

Those present from British NGOs and faith organisations had feared yet another fudge, but instead we got a commitment to getting 15 million people on HIV antiretroviral treatment by 2015. Granted, the commitment was only to ‘work towards’ that target, and there was no detail on how it would be funded or sustained. However a target has been publicly agreed, one to which governments and the UN can and should be held accountable.

There were other positives, in particular a lot of discussion and acknowledgement of the importance of faith based responses (even if they get little mention in the declaration text). There was also recognition that thirty years of responding to HIV means the global community has learnt a lot about how to deal with a major international health issue – learning that needs to be shared and used in other health issues.

But the big surprise was saved for the Secretary General, Ban Ki Moon who announced that the high level targets were to be what is becoming known as the ‘Three Zeroes’ – zero new infections, zero AIDS related deaths and zero stigma by 2020. These may be impossible targets to achieve, but as the saying goes, ‘aim for the stars and you may reach the moon’. And more significantly, it is the first target to be publicly announced by the UN that takes any of the Millennium Development Goals past 2015.

Of course, the devil will be in the detail of how these targets get turned into actions, but they do give us some specifics with which to hold our own governments and global bodies accountable.

an earlier version of this post originally appeared on the Blog of the UK Christian Medical Fellowship - www.cmfblog.org.uk

HIV & AIDS treatment as the new Prevention Tool: new findings should be treated with caution

News broke in the morning of Friday 13th May 2011 of the results of a ten year study by the United States National Institutes for Health (NIH) into the impact of early antiretroviral treatment (ART) for people living with HIV infection on reducing their risk of transmitting the virus to their sexual partners. Setting up two groups of 800-900 serodiscordant couples (i.e. where one was HIV+ and the other was not) from different countries around the world, one group was treated with ART while still healthy, with high CD4 white cell counts and no clinical symptoms, while the other group were treated according to current clinical guidelines. Both groups were given advice on safer sex to reduce risks of infecting the HIV negative partner.
Six years into the study it was stopped because the results were so dramatic. The chances of HIV transmission amongst those on early ART were 96% less than amongst the control group.

The results were so startling that it led Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) to say “This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option.”

It is heartening news when any study shows that a single intervention can have such a significant impact on something as life threatening as the transmission of the Human Immunodeficiency Virus, and we should be cheered to see a long held maxim – that HIV treatment is a key prevention tool – at last have some strong evidence to back it up.

However, we should perhaps treat these results with some caution. As the NIH points out, after six years a total of 39 cases of HIV infection were found among the previously uninfected partners of HIV positive study subjects. Of those, 28 were linked through genetic analysis to the HIV-infected partner as the source of infection. Seven infections were not linked to the HIV-infected partner, and four infections are still undergoing analysis. So in at least seven cases, HIV was acquired from another source – probably another sexual partner, or through IV drug use.

In other words, for a small minority of at least seven people in this study, the fact that their partner was or was not on ART had nothing to do with their acquisition of HIV infection – it was their own personal behaviour that was the risk factor. And this illustrates the danger of jumping onto a single intervention.  It is widely recognised that faithfully married wives are often most at risk of HIV infection in many parts of Africa and Asia, because their husbands are sleeping around – it is their husband’s behaviour that puts them at risk, not their own.  Intermittent use of condoms only with ‘non-regular’ sex partners is another route by which HIV gets transmitted, particularly in parts of southern Africa, where it is not uncommon for men and women to have more than one regular sexual partner who would be considered ‘safe’ enough not to warrant condom use – ART would make only a marginal impact in such a situation.

In short, the danger is that in focusing on one bit of genuinely good news, we can forget that HIV prevention is about multiple interventions – human behaviour is not so easily put in boxes, especially when it comes to sex. Focusing on condoms or male circumcision or delayed sexual debut alone does not make for an effective HIV prevention strategy, as countless years of research as shown. They all play a part, for sure, but investment in strategies to encourage behaviour changes – especially to encourage sexual abstinence outside of and mutual fidelity within a lifelong relationship – effective treatment and care, strategies to combat stigma and fear, and to equip and mobilise communities to respond together, are all needed. The twofold danger with the reaction to this finding could be a myopic focus by funders on ART as the main prevention tool, or of people on ART believing that they are not an infection risk and behaving in a manner that would put themselves and others at risk.

And there is a third danger. This study was stopped after six years – so we do not know of the long term consequences of early ART. What of the impact on viral resistance and the limitations this will bring to later treatment option? Will more resistant viral strains be transmitted by those on early ART? And will the funding be sustainable to keep people on ART for the rest of their lives.

Christian responses to HIV continue to emphasise a wide ranging, socially responsible and sustainable response to HIV and AIDS, recognising that our behaviour and choices as individuals, societies and as a global community have an impact on one another. We should greet the news that there is a new tool in the prevention arsenal as a positive development, but not take our eye off the ball with the other interventions and our own long term commitment to tackle this awful pandemic.

This post originally appeared on the official blog of the UK Christian Medical Fellowship