Issue Contents  Faith based approaches Overview Responding to HIV Religious Health Organisations How health organisations can respond Entry points Where to start? Respecting beliefs Difficult issues Talking about sex Working with young people Letter Resources

Faith-based organisations exist in almost every community and play an important role in the emotional, social and spiritual aspects of many people's lives. In many communities, faith-based workers have become active in HIV care and prevention projects, as they have faced the challenges of:

	increasing numbers of people living with or affected by HIV, who are seeking counselling and support
	increasing numbers of children needing support as they care for parents or siblings with HIV
	increasing numbers of children orphaned by HIV
	increasing numbers of deaths among younger members of faith communities.

As many faith-based organisations consider and develop their responses to the HIV epidemic they face the need to tackle stigma and discrimination towards people with HIV, including discrimination by people working in faith-based organisations, and the need to develop responses that are sensitive to religious beliefs and writings. It may be especially difficult for faith-based organisations to have discussions about:

	sexual behaviour, sexuality and sexually transmitted infections
	preventing the spread of HIV, especially the issue of condom use
	working with marginalised groups, e. g. sex workers, street youth, intravenous drug users, men who have sex with men.

People may be motivated to respond to the HIV epidemic in a number of ways. Some people experience the loss of a friend or loved one from HIV/AIDS or may find out that they are themselves HIV-positive (see page 2). This kind of experience can encourage people to advocate within their faith-based organisation for a response to HIV, either at a local or national level. Some religious health institutions may advocate for a response by approaching religious leaders or by forming networks of similar organisation to broaden and strengthen their response (see page 3). This newsletter looks at different entry points for HIV/AIDS projects (page 4), as well as practical approaches to dealing with particularly difficult issues, such as talking about sex and working with young people (pages 6 and 7).

In this Issue   Responding to HIV Page 2 How health organisations can respond Page 3  Where to start? Page 4 Respecting beliefs Page 5 Talking about sex Page 6 Working with young people Page 7 Letters and resources Page 8

Responding to HIV

Why have some faith-based organisations responded more quickly to HIV/AIDS than others? 
 

The HIV epidemic has been particularly severe in sub-Saharan Africa, where the latest UNAIDS report estimates there are 24.5 million people living with HIV. In this region religious beliefs are particularly strong and these affect how people see themselves, how they think, how they act and how they view disease.  Some people believe that too few faith-based organisations have developed positive responses to HIV/AIDS. Statements by prominent religious leaders have led to discrimination, stigma and guilt. In other cases, religious groups have failed to respond strongly to the epidemic. A recent report of the World Council of Churches concluded that the response of Christian Churches and other religions has been inadequate. According to Rev Gideon Byamugisha, a priest in the Church of Uganda: 'It is not so much that the church has refused concerning AIDS... rather that it has failed.'

What factors have been important in prompting organisations and individuals to become Involved HIV/AIDS programmes?

1. Personal experience

Direct personal contact with the human consequences of HIV, e.g. finding out that you or a friend are HIV positive or having a with member of your faith community become sick and die of the disease.

1. The Reverend Gideon Byamugisha was ordained a priest in the Church of I Uganda in 1992. Three years later he became the first practising priest in Africa to declare publicly that he was living with HIV. ‘My own experience of coming out openly has been mostly very positive. When I joined Namirembe Diocese I told my bishop, the Rt Rev Samuel Ssekkadde, about my HIV status. He and his wife were incredibly supportive and understanding and even offered us the use of the house where we now live. He said, “Gideon, don’t worry. I’m going to pray for you. And you have a special mission here.” So I left my teaching job at the theological college and came to Namirembe Diocese to strengthen the AIDS programme here. All the support the care and acceptance that Pamela and I have received here from the bishop, his wife, the clergy and the Christians of this diocese has helped us to live positively and to dedicate our lives to the fight against HIV.' Adapted from Open Secret People facing up to HIV and AIDS in Uganda. [See Resources page 8)

 

2. Internal advocacy

Those religious organisations that have become involved with issues relating to HIV/AIDS have often had within them members who have lobbied and advocated for greater involvement on HIV/AIDS.

2. In September 2000, after attending the Xlllth World AIDS Conference in Durban, South Africa, staff at St John’s Cathedral HIV Education and Information Centre, in Hong Kong, shared the video by the African Regional Forum of Religious Health Organisations in Reproductive Health with the Chinese clergy. The clergy in Hong Kong are still uncomfortable about HIV/AIDS issues and sex and sexuality issues in general. This may be because the number of people with HIV in Hong Kong is quite small. It is unlikely that clergy will have had the opportunity to meet people with HIV/AIDS and it is hard to change their attitude. I believe that will take time and effort, but at least we are sowing the seed. Elijah Fung, StJohn’s Cathedral HIV Education and Information Centre, Hong Kong, E-mail: sjhivctr@asiaonfine.net

3. Responses from church leaders 

Church leaders who acknowledge the challenge of HIV/AIDS and do not condemn those affected by it, but offer support and understanding, can motivate others within religious groups to respond positively to those affected by HIV/AIDS. 

3. 'In an ideal world we have hoped that everyone would be responsible about sex...that everyone would behave as we would have hoped they would do. Unfortunately, in the real world that is not the case and it is to fly in the face of ghastly fates to pretend otherwise. So we are going to have to teach people so-called safer sex, we are going to have to speak about condoms and seek to make it possible for people to have access to reproductive sexual health.'  Archbishop Emeritus Desmond Tutu. video address to Breaking the Silence. Religious Health Organisations Speak Out on HIV/AIDS symposium, South Africa. July 2000.

 

3. In 1989, his Eminence the Chief Khadi of Uganda attended a national AIDS-education workshop held by the Islamic Medical Association of Uganda. As a result of the workshop he declared a 'jihad' or 'holy war' on HIV/AIDS. This declaration of support from the highest level of Uganda's Muslim community was the first step in mobilising the Muslim community to become active in HIV/AIDS prevention and care.

What can be done to encourage more groups to be involved?
There are many answers - some of which are suggested on the following pages. In the case of religious organisations, responses need to be sensitive to their writings, thinking and beliefs (see page 5). Religious and non-religious organisations can engage positively with each other, learning from each other and respecting the different and diverse views which individuals and organisations hold.

 
The forum aims to encourage advocacy and to help members to: 
 

	share information and expertise
	provide advice in reproductive health which is God-centred, respecting of human dignity, technically sound and sustainable
	develop comprehensive reproductive health programmes
	carry out activities at local, regional and national levels.

As part of the Forum's activities, International Family Health co-ordinated a symposium, - Breaking the Silence. Religious Health Organisations Speak Out on HIV/AIDS - at the XIIIth World AIDS Conference, South Africa, and developed a video, featuring Desmond Tutu, based on the symposium (see Resources page 8). 

Future activities will include developing a web-site, continuing production of the Forum Review newsletter and research activities in Africa. 

Contact: International Family Health 
Tel: +44 (0) 20 7247 9944; Fax: +44 (0) 20 7247 9224. 
E-mail: fsaini@ifh.org.uk 


Responses can also begin when religious health organisations widen their activities to include religious leaders, as well as health workers.

The Islamic Medical Association of Uganda (IMAU) began organising HIV/AIDS workshops for Imams in the early 1990s. Talks between health professionals and religious leaders at early workshops revealed the need for HIV/AIDS projects that reached Muslim families through educators trained with and sanctioned by imams.

Three projects were developed. 
 

	The Madarasa AIDS education and prevention project provides HIV/AIDS education to young people in Muslim schools and aims to teach young people to empathise with and help people living with HIV/AIDS.
	Community action for AIDS prevention works within an urban setting to provide HIV/AIDS training to religious and community leaders. In addition, the project trains groups of bicycle taxi drivers and market vendors to pass on information about HIV/AIDS through their interaction with the public.
	The Family AIDS education and prevention through Imams project aims to provide education, basic counselling and motivation for behaviour change through individual home visits to people living with HIV/AIDS.

Initially, information about condoms was not included in these projects, but after talking with Islamic leaders, project leaders agreed that education on responsible use of the condom (as a third line of defence against HIV/AIDS after abstinence and having sex only within marriage) could be included. 

Community-level responses often involve community health workers and community volunteers. The HIV epidemic means that an increasing number of people need physical and spiritual care and this means an increasing workload for religious health workers. Volunteers from within religious communities can help to share this task. Volunteers and religious health workers may need training and support to understand about HIV and the needs of people living with the disease, and support for themselves so that they do not experience 'burnout'.

Where to start

In this article we consider how faith-based organisations can start to respond to HIV/AIDS.
 

The example of service to and care for others and the provision of emotional and spiritual support are common to most faiths. Many faith-based groups have been at the forefront of the response to HIV/AIDS, especially in sub-Saharan Africa.   Mission hospitals, such as Chikankata in Zambia, have been pioneers in providing home-based care for people with HIV/AIDS. Faith-based organisations, such as the Family AIDS Caring Trust (FACT) in Zimbabwe, have developed ways of supporting and caring for orphans and children affected by HIV/AIDS. Many groups have developed ways of working with young people within the faith community to prevent HIV/AIDS, e. g. AIDS Care Education and Training in Uganda.

The Family AIDS CaringTrust (FACT) Church programme was set up in 1994. The programme began by holding discussions with church leaders to sensitise them to the issues around HIV/AIDS, and then church leaders mobilised church members. The programme focuses on raising awareness about HIV/AIDS and supporting and training volunteers.  Six hundred volunteers support 10-12,000 people with HIV/AIDS and 15,000 orphans. Volunteers give basic nursing information to those caring for the sick and basic nursing care to sick people with no carer. The programme also provides people with HIV/AIDS with food, clothes, school fees and medicines.  Children orphaned by HIV/AIDS are supported through home visits, provision of food, school fees and legal advice. Volunteers also provide bereavement counselling and spiritual support. However, limited resources and a harsh economic climate pose a challenge to coping with large numbers of orphans. Programme workers have identified supporting the increasing number of child-headed households and coping with the long term psychological effects of HIV/AIDS on children as the main challenges for the future.  For more information contact Lorraine Muchaneta, FACT PO Box 970, Mutare, Zimbabwe Tel:+263 2061648, Fax:+263 20 65281

Prevention 
Many faith-based organisations are now moving from the more traditional area of care into HIV prevention. Different faiths have different views on how the spread of HIV can be reduced. Some faiths suggest abstinence, some suggest faithful relationships, some suggest condom use to prevent the spread of HIV. Encouraging open discussion about sexual relationships is important. Within faith-based organisations this can take place in:
 

	pre-marriage counselling
	youth groups and confirmation classes
	faith-based publications and radio programmes
	education at religious health facilities
	religious gatherings
	training programmes for religious and lay leaders.

The next step is for faith-based organisations to move into more challenging areas, such as needle exchange and working with marginalised groups, e.g. sex workers. The Evangelical Church of Eritrea began working with a group of 30 sex workers in 1998, training them to make handicrafts and supporting them financially during this training. Four of the 30 sex workers are HIV positive. The church is planning a meeting of church leaders to discuss issues around HIV/AIDS and to encourage them to write in their church newsletters about HIV/AIDS awareness. 

With thanks to Dominique Mathiot, Country Programme Adviser, UNAIDS, 5 Andinet Street, PO Box 53666, Asmara, Eritrea.
Fax: +291 1 151600.

Catholic Aids Action, set up in 1998, was the first national church- based programme of HIV/AIDS prevention and care in Namibia. The programme used the country’s 90 Roman Catholic parishes, 300 small Christian communities, Catholic hospitals, clinics, schools and hostels as a basis for spreading its message.  Home-based care and support for orphans and those affected by HIV/AIDS were relatively easy to include in the programme, because they are based on the Christian values of spiritual and physical care for others. It was harder to include AIDS prevention. Catholic AIDS Action realised that it had to address the issue of sex and sexuality and that the programme had to be open about the use of condoms. Serious moral dilemmas emerged over advocating the  use of condoms. After much debate, the programme decided to address condom use because, much as it might wish that everyone could fulfil a higher moral standard, it s first priority was to help prevent the spread of HIV. Lucy Steinitz, Catholic Aids Action, Windhoek, Namibia  Website: www.caa-namibia.org

Respecting beliefs

Faith-based organisations' responses to the challenge of HIV/AIDS can be strengthened if those responses are sensitive to religious beliefs and writings. 

Some organisations use teachings from religious texts to support their response to HIV/AIDS and to encourage people to accept and care for people living with HIV/AIDS rather than to judge them. Buddhist monks in Chiang Rai, Thailand, provide counselling and education services for people affected by HIV. When conducting educational activities the monks use Buddhist teachings on moral conducts for human behaviour. 

There are five moral conducts in Buddhism:
 

	do not destroy life
	abstain from sexual misconduct
	abstain from intoxicants
	do not take what is not given
	abstain from falsehood.

Catholic AIDS Action, Namibia, has designed a pastoral care handbook, which encourages people to respond to HIV in a Christian way. The handbook encourages Christians to turn their faith and prayers into action and includes prayers composed by Catholic teenagers as part of a Youth Leadership Retreat in 1998. 

'AIDS demands that we reaffirm our faith in Christ, that through him, love conquers death. If that is where we stand, seeing ourselves as the body of Christ on earth, then we must see HIV/AIDS as the call of our time to reach out in compassion and love to those who suffer. In loving these neighbours as ourselves, we will truly see Christ in them.' 

To love my neighbour: A pastoral care handbook for Namibia, Catholic AIDS Action, Namibian Catholic Bishops Conference, PO Box 11525, Windhoek, Namibia. Fax: +264 61 248 126. E-mail: ncbc@iafrica.com 

But can faith-based organisations use religious writings and beliefs to help them move into areas that are traditionally more difficult, e.g. talking openly about safer sexual behaviour? 

Treasuring the gift, a training manual by Project Concern International (Zambia) and the Lusaka Interfaith HIV/AIDS Networking Group, is designed for use with religious youth groups and examines how to approach discussions about sex and sexual behaviour from a faith-based perspective. The Lusaka Interfaith HIV/AIDS Networking Group aims to 'put aside doctrinal and denominational differences in order to work together against HIV/AIDS'. The book aims to provide material that can be used by youth groups of any faith (see page 7). Treasuring the gift - how to handle God's gift of sex, Project Concern International, Box 32320, Lusaka, Zambia. E-mail: pci@zamnet.zm 

'Talking about sex in the Church is very difficult because church leaders have not done it before, and sometimes they believe that a holy place should not be made unholy by such talk.' Rev Karl Dortzbach and Ndunge Kiti in Helpers for a healing community: A personal counselling manual for AIDS, MAP International 1994.

A basic belief for many faith-based communities is that care for others is important and that the relationship between people is an expression of, and a pathway into, a relationship with God. In view of this, many faith-based communities believe in:
 

	abstinence, if people are not married
	sex within a faithful marriage only.

Some members of faith-based organisations (and in the wider community) think that talking about sex may:
 

	result in increased promiscuity
	seem to condone sex outside marriage
	encourage young people to have sex earlier.

Some people also believe that promoting condom use could result in people practising 'unacceptable' sexual behaviour rather than abstinence. 

However, research has shown that educating young people about sex, HIV/AIDS and health in general does not result in increased sexual activity, but leads to a decrease in adolescent sex, unwanted pregnancies and STIs. 

If faith-based groups wish to move towards open discussion about sex it is important to acknowledge that:
 

	there is more sexual activity happening in communities than they might readily accept
	much of this sex is unsafe (as well as unlawful and unacceptable in churches' eyes)
	not all 'lawful' unions are safe.

'Sexuality [is] a topic the church has found difficult to address. Its silent and joyless condemnation of sexuality in general has been a contributing factor in the spread of AIDS. How can it promote a positive sexuality, a recognition of the gift and goodness of sex, the right relationship between men and women? This is particularly important for young people. In some African countries there is no sex education for the young because no one will talk about it [sex] except in condemnatory terms. The Church needs to be actively working with young people in communities, in promoting an open, caring discussion about sexuality. It needs to affirm the sacredness of sex as a gift to be valued.'  The Reverend Dr Susan Cole King

Activity The Three boats Use this exercise with a group of young people who know and trust each other. Start with everyone sitting in circle.  Ask the group 'What three ways can HIV be passed from one person to another?   Let the group answer. Correct any Incorrect Information and add points that are missed.  Make sure they mentions:   a. sexual intercourse without a condom  b. blood contact  c. mother to child. How can we can avoid HIV or sexually transmitted infections?   Let the group answer. Make sure the group mentions:  a. no sex (abstinence)  b. only having sex with one uninfected partner who has no other partners (faithfulness) c. condoms. Tell the group 'HIV is spreading like a flood - if we are not careful we will all drown'.  Ask the group: 'Are many people in our community in danger of drowning in the flood of HIV?' 'In a flood how do people usually save themselves?'  Make sure they mention boats.  Ask the group: 'Is it possible to avoid HIV infection?'  'How?' Remind the group that during a flood people can save themselves by getting into a boat and that there are three boats that can save us from HIV infection:  the NO SEX (abstinence) boat  the FAITHFULNESS boat  the CONDOM boat - using a new condom correctly every time you have sex. Ask the group:    'Who decides which boat you get into?' 'How easy is it to get into a boat?'  'Do we need help?' 'What kind of help?' 'Is it possible to help another person get into and stay in a boat? How?' 'Which boat or boats should a believer be on?' Choose three places in the room to represent three boats. Give each group member a character, e.g. an 8-year-old boy, an old farmer, a sex worker, a drunkard, a young girl, a member of the church choir, a businessman, a student. Ask each person to think about the family, work, social life of their character and decide which boat they would choose or whether they would stay in the sea of HIV. After five minutes ask each person to go to the boat they have chosen. Then ask why their character has chosen that boat. As a group discuss whether everyone agrees with this choice and why they do or do not agree. Adapted from Treasuring the gift (see page 6)

The Tanzania Episcopal Conference comprises 12 Catholic dioceses and its youth desk co-ordinates youth activities, including meetings on: 
 

	human rights
	poverty reduction
	sexual and reproductive health HIV/AIDS/STIs life skills education.

 

Youth groups talk about HIV prevention because HIV/AIDS affects all aspects of young people's lives and sexually active young people are most affected by HIV.

Prevention activities include: 
 

	peer training
	drama
	role plays
	anti-AIDS youth clubs.

Some groups also care for orphaned children or people with HIV/AIDS.

The youth training is supported by educational materials, including books, videos and posters about life skills and sexual health. 

Contact George Kanga, Secretary, Tanzania Episcopal conference, PO Box 2 133, Dar Es Salaam, Tanzania. 
Fax: +255 022 2850295 E-mail: tec@cotmetcom Website: www.rc.net/tanzania/tec/

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