Winner of the 2012 Dignity & Right to Health Award

This World AIDS Day We are delighted to announce that the joint winners of the 2012 Dignity and Right to Health Award is held jointly by Dr Saira Paulose of SHALOM Delhi and Drs Isac and Vijila David of Prem Jyoti Community Hosptial, Jharkhand, India.

The "Dignity and Right to Health Award" is an international award established to address health and development issues including HIV. The "Dignity and Right to Health Award" is an activity of the International Christian Medical and Dental Association (ICMDA) Leadership in Christian Health and Development Initiative.

The nominations this year were:

1. Beacon of Hope Kenya  - www.beaconafrica.org

2. Dr. Pratibha Esther Singh of India - http://bchtezpur.hpage.in/

3. Dr. Saira Paulose of India  - http://shalomdelhi.org/

4. Drs. Isac & Vijila David of India - Prem Jyoti Community Hospital

Each represents an example of compassionate and innovative outreach to marginalised communities, and it has been a great challenge to choose between them.


Drs Isac & Vijila David have clearly demonstrated visionary and innovative leadership from the time they graduated as Family Physicians by stepping out in faith to take on a very difficult, yet rewarding role among a diminishing people group called Maltos in a very remote and neglected area in Jharkhand, India. On their exploration within the context of their call and vocation over fifteen years ago, they found the need to step in to change the course of life for these people.

Dr. Saira Paulose leads the SHALOM Delhi HIV/AIDS Unit of the Emmanuel Hospital Association of India. Dr. Saira through her quiet leadership has knit together a team which has significantly impacted many HIV-affected individuals and families, both directly, and also indirectly through training of other organizations for home based care, and other HIV-related interventions (including clinical care).

The majority of SHALOM's Home Based Care program beneficiaries are of migrant origin (neighboring States) and live in poverty stricken communities in North West Delhi, SHALOM's area of focus. Stigma and discrimination are still a very live issue, as attested to by case stories that continue to emerge from SHALOM's work.

Further details of these inspiring lives can be shared by visiting
www.icmdahivinitiative.org

Global Fund - 10 Years of Impact

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 Good video to illustrate what the Global Fund has achieved in one decade - and the enormous amount still to be done!

Eurozone Crisis setting back global health advances

Today is the 10^th anniversary of the founding of the Global Fund for HIV, TB and Malaria.  This was an initiative promoted by then UN General Secretary Kofi Annan in 2002 to put significant funding into fighting the three biggest communicable diseases afflicting the developing world.

Sadly, it is a tenth anniversary with quite a shadow cast over it. After nearly a decade funding a steady increase in provision of treatment, care and prevention initiatives in all three diseases, the Global Fund had received pledges and projected contributions of $11.7 billion in 2010 for the time period 2011-13, but subsequently several donors (mainly form the EU, and in particular the Eurozone) have reneged on their pledges or delayed in coughing up the promised cash as the wrestle with their own economic crises. The Fund is still disbursing some $10 billion of previously approved grants between 2011 and 2013, but no new grants will be made until 2014 unless some or all the previously promised funding arrives.  This means that in the Democratic Republic of the Congo for instance, 28,000 people with HIV who were meant to start life-saving treatment by 2014 may now be unable to. 

The irony of this is that the British Government had found the Global Fund to be one of the most effective, transparent and accountable mechanisms for funding effective treatment and prevention that was saving lives on a major scale. So much so it had agreed to double its funding last year (although the UK has also drastically cut back its bilateral funding for HIV & AIDS at the same time) In fact, the Global Fund is being widely recognised as one of the most effective mechanisms for delivering the Millennium Development Goals (certainly with respect to the fourth goal, which was to reduce the spread of these three diseases, and to see number of infected and dying decrease significantly by 2015).

Now, the MDGs and the Global Fund are not without their critics, and others have seen corruption and inefficiency or skewed priorities where some have seen transparency and effective resource allocation. TB HIV and malaria are not the only major health problems facing developing countries. Other illnesses, particularly non-communicable disease such as diabetes and cancer, as well as less fatal but no less debilitating parasitical diseases are major but still largely neglected issues.  And by focussing so much money and energy into a few illnesses, wider health issues were in danger of being neglected.  We have not been above agreeing with these reservations in this blog. However, there can be no major doubt that the funding crisis facing the Global Fund will mean millions will not get on to treatment programmes, and that this will inevitably cost lives.

Other recent research has shown that in all areas, funding for health related development is in decline, despite clear evidence that it works.  The problem is that so many donor nations are in severe economic decline, and that other issues such as climate change, food and water security and sustainable economic development have become more fashionable.  In this instance at least it is the fickleness of donors and the public of wealthy nations that looks set to wreck progress on the health of the poor rather than feckless developing countries frittering away aid.  The Coalition Government here in the UK, much to its credit, has been one of the few to buck this trend, but even it is facing an increasingly hostile climate of public and press opinion against its policy on overseas aid, and increasing political opposition from within the governing Tory party itself.

But the evidence is there to see. Maternal and infant mortality are reducing, the rates of HIV infection and AIDS related deaths are going down dramatically, and similar stories can be told around so many global health issues.  And in many of these it is national initiatives resourced by the Global Fund that have plaid a significant role.

We may need to rethink how we fund and support the development of health systems in the developing world in the long term, but we cannot just sit back now and watch a decade of progress collapse.  It is a mark of our humanity what we do with our resources when time gets tough. If we forget our neighbour in need when times get tough, what does that say of us?

The Winner of the 2011 Dignity and Right to Health Award

It is the great privilege and pleasure of the ICMDA HIV Initiative to announce that Dr. Olive Frost is the most worthy winner of the International Christian Medical and Dental Association (ICMDA) HIV Initiative Dignity and Right to Health Award for 2011.

The Award is given to individuals for excellence, outstanding leadership and compassion in responding to the HIV/AIDS epidemic.

We acknowledge the excellent and faithful work of the other 2011 nominees - Dr. Saira Paulouse in Delhi, and also the comprehensive and continual growth of the ministry of Andi and Sheeba Eicher from Thane - Mumbai and their organization which is called Jeevan Sahara Kendra. Both ministries and their programs are exemplary.To read more of their work click on 2011 DRH Nominees

The story of Dr Olive Frost is quite unique. Olive, a retired obstetrician and gynaecologist from North Wales is now well into her seventies and has for many years been working quietly as "a humble plodder" in her own words, in several countries in Central Asia where humanitarian work is important, and where there is an emerging just and compassionate response to those who struggle with the disease caused by HIV. She has sown many seeds and though small, there is an emerging growth of many new programs. These programs are often led by women in situations where there have been many difficulties. Yet through a powerful commitment to stand with the stigmatized and discriminated, the power of humanitarian responses are being demonstrated in an important way in several countries including Kyrgyzstan, Tajikistan and Ukraine.

Olive has worked for nearly twelve years across several Central Asian republics. In that time she has worked on the challenges and issues of women and teenagers' health, sexual health and HIV prevention training in various community groups.  In all of these countries there are now autonomous non-government organisations (NGOs) working with the wider community, and two of the first leaders have gone on to form NGOs of their own. Olive has always take a supportive role, and has contributed to the development of independent movements and organizations that are carrying on the work.

The community groups in all  settings have been at the heart of Olive's work since she began, and continue to be the main route through which wider prevention and care and support is offered to the wider national communities.

In the context of Central Asia Olive has focused on inspiring and encouraging a response from community organisations. This has included involvement and leadership of a task group aimed at equipping and informing community leaders on HIV AIDS since 2006. In particular this has led to seminars and conferences held within Central Asia for leaders and workers to be informed regarding HIV and  AIDS and envisioned as to involvement and a response. Olive has taken a lead in arranging and teaching at these.

In her work in Central Asia and beyond through the impact of her wide travel and teaching connected to maternal and child health Olive has been seen to empower PLWHA. As an older female doctor Olive has been well respected within Central Asia and has been able to advocate gender equality in response to the epidemic.           

  

Olive has sought to involve other key players in Central Asia including ACET as well as other local NGOs. We can be greatly encouraged by this important and inspirational work!

We are most grateful to Dr James Tomlinson for this nomination.

We congratulate Dr. Olive Frost and salute her for the commitment and devotion she demonstrates in and through all that which she has done and continues to do for the plight of those living with HIV & AIDS. The worldwide family of the ICMDA joins in congratulating her, giving praise and thanks to God for such models as this which bring transforming HOPE and LIGHT into otherwise desperate situations.

Each year the ICMDA HIV Initiative Committee calls for nominations for this Award. Nominees are sought who live a life which 'does justice, loves kindness and walks humbly with God' (Micah 6:8).

Previous winners are: Dr Biangtung Langkham (2006 - India) , Prof Ruth Nduati ( 2007 - Kenya) and Dr Geoff Foster (2008 - Zimbabwe), Dr Stephen Watiti (2009, Uganda) and the joint winners of 2010 Dr Gisella Schneider (Germany) and Dr Joseph Kwong Leung Yu (Taiwan).

Faith Healing and it's impact on AIDS

At the start of 2012, it is worth stopping to reflect where we got to in 2011.

 

First the good news – new HIV infections are down, deaths are down, and the number of people on antiretroviral treatment is up.  The UN High Level Meeting on AIDS in New York last June committed the world to getting 15 million onto antiretrovirals by 2015, and to zero new infections, zero deaths and zero AIDS related stigma by 2020.  Hilary Clinton at a recent speech committed the US to work towards an AIDS free generation, with the recent research findings that antiretrovirals are a key element in reducing new infections forming one of the planks in that commitment. 

In October a UK Consortium meeting at Lambeth Palace reiterated the important role of faith based responses to HIV.  In short, it has been a year where the science, the statistics and even the political will seem to have been blowing the right way for once.

However, that is not the complete story.  For on the downside, funding is rapidly disappearing, making the likelihood that these high level targets will be met less and less likely (especially around access to treatment). There are also worrying signs that faith is not always good news in the fight against AIDS.

These two stories should come as no surprise – the economic downturn has hit the whole aid industry hard, and is going to make sustaining major drives to increase accedes to treatment, care and prevention politically more and more difficult.

And that faith is not always good news is not news for many who feel that religious people and institutions have been discriminating against people with HIV for years, perpetuating stigma.  This situation has changed a lot, and continues to change, but we know that many people of faith still find it hard to deal positively with HIV.  But it is a more specific issue that is of current concern.

Recent news stories have highlighted the role of religious healers (particularly from African Pentecostal and Charismatic Christian traditions) who have been encouraging people with HIV to stop treatment because they claim that God had healed them of HIV.  Many of these people had subsequently grown very ill, and some have died.  That this happens in many developing countries has been documented for some time. But there is now growing evidence that it is a problem here in the UK as well, where the fastest growing churches are African led and Pentecostal in flavour.

Whether because they are charlatans out for  money or (as I suspect in the majority of cases) well meaning but misguided, pastors and religious leaders in many traditions are claiming that God has healed a person, and then getting them to ritually dispose of their medication as a sign of their belief in their healing.  The consequences are a serious threat to the well being and even the life of the individual, and a potential threat to public health.

Stopping ARVs can lead to a rapid rebound in viral load, threatening a collapse in the immune system, but also rendering the individual much more infectious to sexual partners as well as to their unborn and newborn children. Furthermore sudden cessation of treatment can lead to viral drug resistance, limiting future treatment options for the individual and anyone they may subsequently infect.

There is plenty of evidence that faith has a part in the healing process.  We know that a sugar pill can have similar efficacy in stopping pain as an analgesic, if the patient believes it is a real pain killer.  The trust and faith that a patient places in a doctor, nurse or care team can have a big impact on their subsequent recovery. And it is true that people often cope better with debilitating conditions when they have been prayed for, or had other interventions that appear to have no basis in science, but in which the individual has faith. 

If, like me, your world view accepts a God who intervenes in the physical world to effect cures, the fact that prayer can affect health comes as no surprise.  But even if you only accept this as a pscyho-neuroimmunological response, it is still not to be discounted.  There is a mounting body of research on the impact that religious belief and practice (especially within a wider faith community) can have in have in preventing illness and promoting recovery, whether or not you accept the existence of miracles.

But to take the leap of taking someone off of medication with no medical verification is highly suspect.  Such an approach works on an assumption that God does not work through medical interventions and that only miraculous healings are valid.  This is, needless to say a position that is not taken by Christians, Muslims, Jews or other major faith groups, who have for centuries held that medicine is not only valid in treating illness, but that the skills and learning that facilitate it are a gift from God.

In short, this practice is based on a misunderstanding of both science and orthodox theology.  Not all Pentecostal and African lead churches follow this practice – the majority would always encourage people to take prescribed medication and only come off it on the advice of their doctor.  However, there are undoubtedly some churches that do encourage people to stop treatment in an unplanned and inappropriate manner. This is not unique to this particular Christian tradition either - there are anecdotal reports of Muslim faith leaders and traditional religious healers who are also encouraging treatment cessation, although the evidence of the scale of this in any religious community in the UK or elsewhere is still very sketchy. 

These practices are not something that can be challenged by just presenting the science behind ARVs and the evidence of their efficacy. The world view of these faith leaders does not give primacy to scientific evidence per se. Instead we need to start with challenging these religious leaders to rethink their theology from within their own faith and using their own scriptures, and this can only be done by other leaders from within their tradition.  If they can be encouraged by their peers to see that science and medicine are also God given, only then can we hope to persuade them that the science is worth looking at and to be trusted. 

At the same time, we need to help the health professions to understand the world view, belief systems and values of patients coming from a variety of faith backgrounds. Assuming that your patient shares with you the same understanding and values about health, illness, aetiology, medicine, drugs, compliance, etc. is dangerous. We need to help train health professionals to bridge this gap in understanding, and to get allies within the faith traditions to work alongside them to communicate with patients.

But above all, we must challenge these healers.  Some of them could be allies in our response to HIV, but at the moment are working against us.  But just condemning them will drive them further underground – instead we (faith leaders, faith based organisations, secular NGOs, governments) all  need to work together to tackle this head on.

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

ICMDA HIV INITIATIVE 2010 DIGNITY AND RIGHT TO HEALTH AWARDS - more details of the joints winners

The joint winners of the 2010 Dignity and Right to Health award are Dr Gisela Schneider from Germany and Dr Joseph, Kwong Jeung Yu from Taiwan.

Dr Gisela Schneider  has worked for many years in West Africa, East Africa and now more recently in Europe. Working in multiple settings she has been and continues to be a strong advocate and role model for many through her excellence in several fields of the HIV challenge, including clinical work, community engagement and mobilisation, and teaching. Dr Schneider is an exceptional person who has demonstrated an incarnational ministry in Gambia and Uganda and now continues to seek to bring Christian healing and compassion to people in many other countries through the work of Difaem, the German Medical Missionary Association. Gisela continues as a great role
model for all. Her work in the many fields of HIV medicine and community responses has been of the highest calibre.

Dr. Joseph, Kwong-Leung Yu has done excellent work in both his home country of Taiwan and also for many years in the nation of Malawi. He energetically worked at setting up a model of how to eliminate discrimination and stigmatization of HIV/AIDS in the public domain. He actively participated with PLWHA groups to encourage and ensure the enhancement of public awareness. Dr Yu is an exceptional person whose ministry is growing.  He now represents Kingdom values in many other countries as well as continuing to serve the people of Malawi as Director of the Rainbow clinic. He has established and strengthened a comprehensive multi-level program in an area of great need in Northern Malawi working closely with government and local church communities. A journal article on the challenges facing Malawi prisoners spoke to us of a Christian man with a great heart to better the lives of those who are marginalised and rejected by many.

It is a great honour and priviledge for the ICMDA to recognise and acknowledge the exceptionally inspiring service and witness of Drs Schneider and Yu to the glory of God the Father, Son and Holy Spirit.

We pray for God's presence to be ever with them both.

Previous Award winners

2006 - Dr Biangtung Langkham (India), 2007 - Prof Ruth Nduati (Kenya), 2008 - Dr Geoff Faster (Zimbabwe) and 2009 - Dr Stephen Watiti (Uganda).

Joint Winners of 2010 Dignity & Right to Health Award #WAD

After much discussion and prayerful reflection, the 2010 Dignity and Right to Health award of the ICMDA HIV Initiative is to be jointly awarded to Dr. Joseph, Kwong-Leung Yu of Taiwan who has worked for many years in Malawi and Dr. Gisela Schneider of Germany who has worked for twenty years in the Gambia and many years in Uganda.


Dr Gisela Schneider - Gisela has worked for many years in West Africa, East Africa and now more recently in Europe. She has worked in multiple settings and has been and continues as a strong advocate and role model for many with her excellence in several fields of the HIV challenge including clinical work, community engagement and mobilisation and teaching. Dr Schneider is an exceptional woman who has demonstrated an incarnational ministry in Gambia and Uganda and now continues to seek to bring Christian healing and compassion to people in many other countries through the work of Difaem, the German Medical Missionary Association. Gisela continues as a great role model for all. Her work in the many fields of HIV medicine and community responses has been of the highest calibre.

Dr. Joseph, Kwong-Leung Yu has done excellent work in both his home country of Taiwan and also for many years in the nation of Malawi. He strongly tried to set up an example of how to eliminate the discrimination and stigmatization of HIV/AIDS in the public. He actively participated with PLWHA groups to encourage and ensure the enhancement of public awareness. Dr Yu is an exceptional man who ministry is growing and he now represents Kingdom values in many other countries as well as continuing to serve the
people of Malawi. He has established and strengthened a comprehensive multi-level program in an area of great need in Northern Malawi working closely with government and local church communities. A journal article on the challenges facing Malawi prisoners spoke to me of a Christian man with a great heart to better the lives of those who are marginalised and rejected by many.

It is a great honour to have both Dr Yu and Dr Schneider join the ranks of earlier nominees and winners of the Dignity and Right to Health award of the ICMDA HIV Initiative.

Three nominated for the 2010 Dignity and Right to Health Award

Given to individuals and organisations for excellence, outstanding leadership and compassion in responding to the HIV/AIDS epidemic, the ICMDA HIV Initiative Dignity & Right to Health Award this year has three nominees:

1. Dr Gisela Schneider – nominated by Dr Vicky Lavy. Gisela has worked for many years in West Africa, East Africa and now more recently in Europe. She has worked in multiple settings and has been and continues as a strong advocate and role model for many with her excellence in several fields including clinical work and teaching.

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.

2. Dr. Joseph, Kwong-Leung YU – nominated by Dr. Herng-Der Chern, M.D, Ph.D. This nominee has done excellent work in both his home country of Taiwan and also for many years in the nation of Malawi. "Dr. Yu has been working in Malawi for 5 years. He strongly tried to set up an example of how to eliminate the discrimination and stigmatization of HIV/AIDS in the public. He actively participated the need group with the enhancement of public awareness."

3. Dr .Geoff Foster (Zimbabwe) nominated by Dr S. W. Hynd – Geoff, a paediatrician, has an outstanding record as a clinician, researcher, writer and advocate for the rights of orphans in Zimbabwe and beyond.

Interviewing processes are continuing. The award winner will be announced prior to World AIDS Day, December 1 2010.

The 2009 winner Dr Stephen Watiti, Of Uganda, continues his important clinical work with the Mildmay group in Kampala, and his important work in media and in advocacy for the rights of HIV infected and effected people.

What is Distinctive about Faith Based Healthcare & Advocacy?

The following is just a brief summary of some discussions held in London yesterday by the Faith Working Group.

It was noted that working with the UK's Department for International Development (DFID) presented some singular challenges for Faith Based Organisations (FBOs) and Faith Communities (FCs), and in particular getting them to understand the distinctives within faith based responses to health needs such as HIV.


Two members of the group highlighted how internationally, through President Obama, WHO, the Partnership Unit of UNAIDS and others, faith has become a key issue in international health and development circles, but this has had relatively limited traction in the UK.  The difficulty is not just one of evidence of a tangible difference made by FBOs, it is also one of world view and culture – most donors are driven by managerial, input/output approaches to health and development, whilst most FCs and FBOs come from a different world view, that is usually more relational, community, behaviour/lifestyle and values oriented. As a consequence most FBOs either buy into the donors world view for the sake of funding (and run the risk of losing their distinctive faith dimension in the process, becoming indistinguishable from secular development agencies) or they bypass donors and strategic bodies, operating independently, but keeping their faith based distinctives.

If we are going to engage with DFID (which seems to be where the FWG could make a singular contribution - there already being much work on engagement between faith and other bodies being done elsewhere), then we need to enter into a dialogue with them, and explore with them the specific dimensions that faith brings to the table that are distinctive, both in approach, practice and impact.

In light of the Pope’s recent visit to the UK, and his speeches that challenged the churches in the UK to be more engaged with society, and challenging society to allow space for faith and belief in the public square, alongside the positive speech from David Cameron (and other voices within the coalition, such as Baroness Warsi) it would suggest that, in the UK at least now is the time to make such an engagement.

World AIDS Conference – Vienna
Those who had been in Vienna in August reported back.  Some encouraging advocacy with Pharma – encouraging more of the big drug companies to sign up to the Patent Pool, and some good networking opportunities.  The big issue seemed to be the increasing emphasis, from USAID and the Obama administration on health systems strengthening rather than AIDS as a unique focus, and how this was feeding through into wider strategy and funding priorities from other major donors.

The Ecumenical Pre-Conference was really multi-faith, only one day, and as a result far too broad, large and brief to be of much value.  African voices were not much heard (the focus seemed to be more on intravenous drug users , commercial sex workers and men who have sex with men), and there was an overall feeling that the whole conference is now so large that it is of very limited value for the vast majority of participants.
Question marks were being raised about the value of the 2012 Washington D.C Conference, although there were plans to restore the faith based pre-conference to three days. See earlier posts reporting back from various other faith groups at the Vienna Conference for some wider perspective

Faith Based Advocacy
In a wide ranging discussion on the theme, several key points were raised.

Faith leaders have a huge impact on behaviour, and FCs on the whole put an emphasis on ‘orthopraxis’ (right behaviour) as much as they do on ‘orthodoxy’ (right beliefs).  As a consequence, being able to talke to faith leaders in their own terms and own language to help them see the value they can bring to tackling HIV by promoting behaviour change can be highly effective and reaching a whole community.  And often those communities are ones that secular groups find it hard to access – e.g. Muslim women in rural areas.
Advocacy to governments and international bodies can only come from our engagement on the ground – seeing the issues ‘at the coal face’, and so being able to present real cases and real solutions gives us a very strong voice. But advocacy that just changes policy and not behaviour of individuals or practices within a community is of very limited value.

However, many FCs, FBOs and religious leaders are anxious about advocacy because it can seem political and confrontational, and in some cases, e.g. where a certain FC is a marginalised or persecuted minority, it could rightly be perceived as dangerous.  However, there are ways of addressing these concerns and going back into tradition, scripture and the spiritual dimension to address advocacy needs.

One story was recounted of getting a group of Ethiopian church leaders together to start to self identify needs in their communities and what they could do to address them.  Without prompting they identified female genital mutilation (FGM) as not only a problem to be addressed, but one that they as male church leaders had overlooked. This led to a spontaneous act of public repentance, a lengthy prayer meeting followed be discussions on actions that could be taken to change attitudes to FGM, and subsequently they have been active in working to end the practice in their communities ever since.  They could see the need, could see from scripture that this was one they needed to address and there was a leading of the Holy Spirit to change.  This is not the sort of advocacy a secular group would have felt comfortable or able to facilitate, but it was one that a Christian organisation was able to.

AHPN shared how they were now working with Christian and Muslim leaders of the African Diaspora in the UK to address HIV and other health issues amongst the African expatriate communities of Britain, and were already seeing the huge influence of these leaders in changing behaviour and attitudes.

It was agreed that these discussions were opening up some of the areas where the British faith communities and FBOs should start a dialogue with DFID and the British Government.

Religious activists leave AIDS conference worried about funding but committed to continue efforts

In the last of our items feeding back on the 18th International AIDS Conference, we present the feedback from Ecumenical Advocacy Alliance, who were the official coordinators of the Faith Based Responses to HIV & AIDS represented at the conference.

While faith based organisations (FBOs) and faith community responses to the pandemic seem to have been well represented, well listened to and more integrated into the main programme at this conference than in previous years, there has been a real sense that the tide has turned in turns of international funding commitments, and that we will be ploughing on with our work, doing more with fewer resources than before.

There are also cries for more coordinated responses from faith communities at future conferences and summits on HIV & AIDS so that we can bring our voice ever more clearly to the public debate on AIDS strategy.

So - doing more with less and making ourselves heard better seem to be the main challenges coming from the EAA - from CHAA a recognition that the Western, secular discourse on AIDS is missing the realities on the ground that faith based responses deal with day-to-day, and from ICMDA a question mark over the current, highly individualistic and Western emphasis on a rights based approach to care and prevention.

As Bishop Yvette Flunder, senior pastor of the City of Refuge United Church of Christ in San Francisco said "this work is not for wimps”!

Report on XVIIIth International AIDS Conference #AIDS2010

The XVIIIth International AIDS conference in Vienna, Austria told a story of measured progress in responses to the challenges of the epidemic. There were encouraging news on the development of microbicides, early signs of lives saved by the PMTCT programs and better more informed science that indicated that there may be further major steps available.

The conference was titled “Rights Here, Rights Now”. Obviously there was a major emphasis on a human rights response to the epidemic. Yet there was correspondingly much less on the importance of partnerships. The role of faith based organisations was little voiced, even though in many countries they provide approximately half of the health services.

A human rights framework has been helpful in many areas in acting as an umbrella that has allowed many groups to move forward. Yet it now seems to have over extended its clam for adherence. While there was discussion of the risk of ideologically driven responses to the disease, there was little recognition of the limitations of the ideology of human rights. An ideology is a set of aims and ideas that directs one's goals, expectations, and actions.

Human rights affirms an individualistic response to treatment options. The individual is assumed to have agency. And while this may well resonate in international conference settings, it often is little understood in rural village settings, where the individual has little power to bring about needed change, and where the power of fear greatly overwhelms externally derived science and knowledge.

For those who hold to a Christian ideology that has made enormous contributions to the provision of health services throughout the world, our response to an exclusively human rights approach needs to be carefully considered. A human rights approach, in one form seems to affirm that a commercial sex worker can only best become a human rights empowered sex worker. There is a deficiency in vision, a restriction a limitation to a human rights ideologically driven approach to disease. Christianity offers so much more.

Michael Burke

ICMDA HIV Initiative

Collision of Worlds at Vienna’s World AIDS Conference

Rev Alan Bain of the Christian HIV/AIDS Alliance: writes a blog post from his time at the recent World AIDS Conference in Vienna.

Commenting on the cultural programme and the emphasis of the conference, Rev. Bain says

the schizophrenic attitude to the disease here in the West, where our loss of long dead pop stars and the almost glamorous dimension of AIDS now takes higher priority than 40 million infected people living with HIV throughout the world.

The big challenge for Christian responses to AIDS was given by UNAIDS’s Deputy Executive Director, Ms Jan Beagle who cautioned for faith groups to stay engaged.

“You are the advocates and practitioners. You have the networks on the ground and you can energise social movements... the poor still die while the rich live. Global AIDS is at tipping point. Although we have seen a 17% drop in AIDS infections worldwide we still reach only a fraction of those infected. For every one treated a further 5 are infected and still, 5,500 people die of AIDS each day.” The real barriers, she said, are not technical or medical but political and cultural. “We need political courage to break the trajectory of AIDS.” she concluded.

Read the full post at www.chaa.info

‘Back the banker’s tax’: International Aids Conference | The Robin Hood Tax

‘Back the banker’s tax’: International Aids Conference | The Robin Hood Tax

With reference to our earlier post about the Financial Transaction Tax campaign At the World AIDS Conference on 23 July 2010 the UN Special Envoy for Innovative Finance called on world leaders to ‘back the banker’s tax’ – referring to the IMF’s recommendation to create new taxes on banks – and to ‘fill the gap ‘, referring to the 70% gap in people accessing lifesaving HIV antiretroviral medicines.

Given the scale of the funding gap, and the scale by which several European nations and the USA bailed out banks during the crisis of 2008, it would seem both an effective and just measure. However, there seems to be a reluctance in several major powers to move forward on this issue, so now is a good time to engage with the Robin Hood Tax campaign where you live and change the minds of governments the world over.

HIV Initiative at ICMDA World Congress

This July the ICMDA HIV Initiative had the privilege to present a seminar at the ICMDA World Congress in Punta del Este, Uruguay. Winners of the 2006 and 2009 ‘Dignity and Right to Health Awards’ Drs Biangtung Langkham & Stephen Waititi. Both spoke eloquently of their long experiences in tackling HIV in (respectively) India and Uganda.

The issue of harm minimisation as opposed to harm elimination was discussed at some length – in particular the issue of whether Christian organisations should be involved in distributing condoms to commercial sex workers – on the one hand this seems to condone behaviour that is not just dangerous but morally wrong, but on the other hand, as we know that they will be plying their trade whatever we say, we should at least seek to minimise their risks, and in so doing earn their trust and the right to help them find other ways of earning a living. The issue extends to clean needle exchanges for IV drug users, and working with other individuals and groups who engage in high risk behaviours.

We hope to bring further news and reports from the World AIDS Conference and other international news in the coming months

Boston Globe Examines How PEPFAR Budget Pressures Are Affecting AIDS Clinics In Africa - Kaiser Global Health

Boston Globe Examines How PEPFAR Budget Pressures Are Affecting AIDS Clinics In Africa - Kaiser Global Health

Depressing news that the Obama administration's downward pressure on PEPFAR funding is now impacting patient treatment programmes amongst the poorest communities.

We stated back in February last year that we would wait and see if Obama would match Bush's impact on HIV & AIDS care - the jury is still out, but the verdict is looking less favourable just over one year into his presidency.

Robin Hood Tax

Excellent video explaining the basic idea behind a miniscule tax on bank transactions that could have a huge global impact, including increased access to treatment and care for people living with HIV & AIDS in the developing World

See http://robinhoodtax.org.uk/ for more information - and if you are outside the UK, news will be coming out in the coming days and weeks of campaigns in Europe and the US