1	Shalom and HIV/AIDS W. Meredith Long, DrPH Director, Health Programs mlong@wr.org
2	SHALOM Fullness of life in every area of relationship To oneself To others—family, community, society To the environment—work and productivity To God—hope, meaning and salvation
3	Relationship to Self: Problems of Sickness, Death and Dominion
4	Problems Sickness
5	Declining life expectancy
6	Problems Low efficacy for change 90% of HIV positive people do not know they are positive
7	Attribution and Efficacy Many still attribute AIDS to God’s punishment or to other spiritual forces. Others attribute AIDS to internal and stable characteristics that cannot be controlled—”Men are men.” There is little sense of dominion or efficacy for change.
8	Relationship to Others
9	Problems Stigma divides communities and families and prevents coping behaviors (e.g. testing for HIV)
10	Family Relationships Oppression of women and children contributes to the spread of AIDS. In World Relief’s Rwandan program, six in ten of the sexually active girls said that their first intercourse was coerced. Sex trafficking. Inability to address the behavior of an unfaithful husband.
11	Problems Rise in orphans and loss of community safety net. Today more than 13 million children world-wide have lost one or both parents to AIDS. By 2010, this number is expected to jump to more than 25 million. 12% of all children in sub-Saharan Africa are orphans. (Children on the Brink, 2002)
12	Percent of children under age 15 that are orphans in Sub-Saharan Africa, 2005
13	Needs that households with orphans cannot meet Tanzania - 2002
14	Institutional answer? Cost comparison in Uganda shows that operating costs for an orphanage are 14 times higher than for community care. 1992 World Bank study in Tanzania shows that institutional care in one facility cost $1,000 per child; six times more expensive than the average cost of foster care. (Children on the Brink 2002)
15	Problems Reluctance to address sexuality In many places, parents, churches and other community institutions will not address issues of sexual relationships.
16	Relationship to Environment
17	Problems of Poverty and Conflict Population mobility and HIV/AIDS Migrant workers Refugees and displaced people
18	Problems Threatens essential services
19	Loss of labor force In Botswana, it is projected that the labor force will be reduced by 34.9% in 2020 compared to the size it would be without the impact of AIDS. (ILO, 2001)
20	Loss of teachers Between 1999-2000, 70% increase in the number of deaths of female teachers ages 30-34 in Kwa Zulu Natal, South Africa. AIDS is the leading cause of death among teachers in Cote d’Ivoire.
21	Problems Terrible synergy between disease, production and poverty.
22	The most affected African countries could lose up to 26% of their agricultural labor force within two decades. (World Food Program 2003)
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24	Problems Inequitable access to treatment and social justice
25	Treatment Issues At end of 2002, only 800,000 people globally were receiving ARV treatment - 500,000 of whom lived in high income countries. In sub-Saharan Africa where 29.4 million people are infected, only 50,000 received ARV therapy in 2002.
26	Treatment costs declining Average cost of treatment with ARVs decreased from $10–12,000 / patient / year in early 2000, to just under $300 / patient / year using generic drugs in May 2003. New deal will offer treatment for less than 40 cents per day in certain African countries. Even with reduction in costs, availability of ARVs will be limited, creating a wider divide between rich and poor within countries.
27	Relationship to God
28	Problems Guilt, fear, shame and hopelessness must be addressed in our relationship to God. God’s direction for family life provides the best protection against the spread of AIDS —avoiding risk better than reducing risk. God must be a part of our life story to give meaning, especially in times of distress. We must understand the essential character of God—His grace and holiness--to give direction to ministry.
29	Issue Groups In Africa, how will the huge increase in the number of orphans affect the mission movement and the churches? How and at what level do we intervene? How will the growing but still limited availability of ARVs affect medical missions/ Christian health care in the next ten years? Within the broader mission movement, what challenges and opportunities does the AIDS situation present to the church. Present at least three implications and possible responses.
30	Christian Responses to HIV/AIDS Must be multi-sectoral, Cannot be imposed (sold) from the outside, Must involve congregational ministry, Defies simple solutions.
31	Address W. Meredith Long World Relief 7 E Baltimore St. Baltimore, MD 21202 Tel: 443-451-1941 Email: mlong@wr.org Web: www.wr.org