According to the United Nations Program on HIV/AIDS (UNAIDS), at least
34 million Africans have been infected with HIV. More than 95% of all new
HIV infections, including perinatal infections, occur in Africa. The UNAIDS
estimates that 11.5 million Africans have died from AIDS, and that there
are 5,500 funerals a day. Ninety percent of all AIDS orphans are African.
The effect of HIV/AIDS is so pervasive that life expectancy is decreasing
in many countries (e.g., Botswana has lost 17 years to HIV/AIDS).
HIV/AIDS hits the economic and social jugular of African society – young
men and women in the prime of productivity. Families of AIDS patients face
triple jeopardy: 1) a spouse may infect their partner, and both die, leaving
orphaned children; 2) families of AIDS patients face long years of penury,
declining productivity, and death of all patients; and 3) overwhelmed communities
and extended families are unable to afford the economic, health, and social
costs of caring for AIDS patients.
The destructive effect of HIV/AIDS is real for many reasons:
1. Poverty is a way of life in many countries where HIV is a close cousin
of poverty, and 40% of Africans live on one dollar a day.
2. Africa is still a male-dominated society, with extreme gender inequities
in many societies. Women often cannot refuse sexual advances of their husbands
even if aware of their high-risk status.
3. The congruence of cultural beliefs and witchcraft are still powerful
impediments to effective risk reduction against HIV.
4. The social stigma associated with HIV/AIDS is so powerful that relatives
of dead AIDS victims will not want the true cause of death listed in death
certificates, and HIV positive pregnant women will not seek treatment in
public hospitals.
5. The ethnic and nationalistic wars displace population groups and
create a conducive environment for rape, sexual violence, and trading sexual
favors for survival in refugee camps. This phenomenon was noted during
the Rwandan genocide.
6. The resurgence of tuberculosis and sexually transmitted diseases
is fueling new HIV infections.
95% of all new HIV infections
and
90% of AIDS orphans are found in Africa
7. Non-government organizations, including Christian missionaries, do
not have the material resources to respond comprehensively to either the
preventive or treatment issues of HIV/AIDS.
8. The religious and cultural sentiments against homosexual activities
are still strong in many countries. HIV infection is often seen as the
“wrath” of God for homosexual practices.
9. Few communities are participants in determining priorities and planning
programs because of existing military or autocratic rule.
10. The unofficial deafening silence about HIV/AIDS in Africa extends
from the presidential palaces to the churches, citadels of higher education,
health centers, and mud houses. This is one of the greatest secrets about
the disease in the continent.
Only recently did an “AIDS Train” crisscross South Africa to spread
the message about HIV/AIDS after many years of official government denial.
Most African governments, with the exception of Uganda and Tanzania, have
been slow to respond.
Helping Africans to Help Themselves
The global community should treat the HIV/AIDS epidemic as a crisis
far bigger than the famines or genocidal wars. Although the World Bank,
the UNAIDS, and WHO have articulated “strategic plans,” “action plans”
and “programs of action” for reducing the rates of HIV/AIDS in Africa,
real solutions must also include African-based government and non-government
organizations. The global response should not be an “aid” program but rather
should become a triangular partnership between the international community,
national governments in Africa, and community-based NGOs that include Christian-based
missions and health programs.
The global response to Africa should focus on three principal areas:
1) Providing urgent medical treatment to HIV/AIDS
patients, including pregnant women.
2) Preventing new infections and reinfections through aggressive
risk reduction campaigns.
3) Tackling poverty and other social inequities that fuel
the spread of HIV.
The Role of Christian Health Missionaries
Christian health missionaries have been pioneers in community-based
initiatives to comfort AIDS patients in Africa by combining preventive/clinical
care services with concerns for the social, psychological, emotional and
spiritual health of individuals and communities (see following article).
Christian health missionaries should be actively involved at three levels:
international/Western response; the role of African church leaders; and
the role of community-based missions and health programs.
1. International/Western Response
Christian health missionaries could mobilize their network and parishioners
to provide technical, fiscal, and operational support to combat HIV/AIDS
in Africa. They could also lobby or “pressurize” their governments and
business organizations to actively support such a global effort. More importantly,
Christian health missionaries could help “persuade” international institutions
such as the World Bank and the International Monetary Fund to devote additional
resources to the global effort against HIV/AIDS in Africa. The current
admirable role of Christian missions in the “debt forgiveness” debate could
serve as a model.
2. The Role of African Church Leaders
African church leaders must take a lead role in mobilizing their congregations
and national governments to recognize HIV/AIDS as a major crisis; devote
national public and private resources for risk reduction programs and clinical
service; end the ongoing stigmatization of HIV/AIDS patients and their
families; ensure that international assistance reach the intended target
population; and tackle poverty and other social inequities that influence
the propagation of HIV infection.
3. Community-based Christian Missions and Health Programs
All Christian missions and health programs at the community level should
work together to ensure the adequate utilization of scarce resources for
prevention and clinical services. This should include the development of
joint programs in risk reduction campaigns, clinical care, spiritual care,
and social relief programs. More importantly, community-based Christian
missions must work together to end the pervasive denial and conspiracy
of silence about the HIV/AIDS crisis in many African societies. It is also
important for Christian health missions to be at the vanguard for economic
and social justice in their catchment areas.
Conclusion
Africa has faced many crises before and will probably face more in the
future. However, HIV/AIDS is the greatest foe the continent has faced to
date. Christian health missionaries are natural leaders in any global,
continental, national, and local response to the HIV/AIDS epidemic in Africa
because of their consistent attention to the physical, mental, and emotional
well being of their patients.
SELECTED BIBLIOGRAPHY
1) UNAIDS. AIDS Epidemic Update: December 1998. Geneva,
1998.
2) Piot, P. “The Science of AIDS: A Tale of Two Worlds,”
Science 280 (5371): 1844.1998.
3) World Bank. Confronting AIDS: Public Priorities in
a Global Epidemic. Washington, DC, 1999.
4) World Bank. Intensifying Action Against HIV/AIDS in
Africa: Responding to a Development Crisis, Washington, DC, 1999.
5) World Bank. World Development Indicators, 1998. Wash.,
DC, 1998.
6) Akukwe, C. “HIV/AIDS: Slowing the Global Pandemic,”
Cornell University AFRICA NOTES, Sept. 1998.
7) Akukwe, C. “The Role of Christian Health Missionaries
in International Public Health,” CCIH Forum, June, 1998.
8) Population Council. Community-Based AIDS Prevention
and Care in Africa: Building on Local Initiatives. New York, 1998.
9) USAID. USAID Responds to HIV/AIDS: A Strategy for the
Future. Washington, DC, 1998. .
10) Fountain, DE. AIDS Care as Avenue for Ministry in
Congo (see following article).
