Ending the HIV/AIDS Epidemic alongside Faith-Based Organizations
December 1, 2020
by Abigail Kim, University of Southern California Undergraduate and CCIH Communications and Advocacy Intern
COVID-19 and HIV/AIDS
On this World AIDS Day – December 1, 2020 – we find ourselves nearing the nine-month mark from which COVID-19 was declared an official pandemic. While many of the latest headlines and health updates have surrounded COVID’s rising death toll, lockdown measures, and the progress of vaccine development, there is unfortunately much more at stake. The pandemic’s far-reaching effects have been felt across borders, especially threatening the global HIV/AIDS response.
As a result of antiretroviral (ARV) treatment disruptions, Friends of the Global Fight projects an additional 500,000 deaths due to AIDS-related illnesses in Sub-Saharan Africa. These sobering projections jeopardize long-term UNAIDS goals and highlight the importance of remaining vigilant and innovative with ongoing efforts.
This article seeks to shed light on the current scene of HIV/AIDS and to illustrate the work of three organizations today: the Children’s AIDS Fund International, the Zimbabwe Association of Church-Related Hospitals, and the Adventist Development and Relief Agency.
It explores one overarching theme: the necessity of a holistic, multifaceted response and the central role faith-based organizations (FBOs) and faith leaders play in achieving this. While the article does not necessarily provide an all-encompassing solution to the current fears of HIV/AIDS projections as a result of the pandemic, it highlights the innovative, collaborative, and inclusive responses that have been conducted in response to HIV/AIDS thus far and the very capable men and women worldwide who have risen to meet the challenges of COVID-19.
HIV/AIDS, 20 Years Ago and Now
To learn more about the progress of HIV/AIDS prevention and treatment in recent years, I spoke with Anita Smith, President of Children’s AIDS Fund International (CAFI) and long-time advocate in the field. Twenty-five years ago, CAFI was one of the earliest organizations in the U.S. responding to the growing concern of HIV/AIDS in Africa. Treatment sites starting with private funds were rolled into PEPFAR (The President’s Emergency Plan For AIDS Relief) after PEPFAR’s conception, becoming part of the U.S.’ monumental response to the AIDS epidemic.
Given the current political climate in the U.S., Mrs. Smith remarks how as a completely bipartisan initiative, PEPFAR is a victory Americans should be proud of. PEPFAR has driven forward incredible progress against HIV/AIDS by equipping communities across the world with the necessary tools and resources to respond. It was designed with sustainability and the empowerment of local leaders and professionals as a key component of its mission. Mrs. Smith explains, “The goal was to work ourselves out of a job.” And that is exactly what they have been doing. By the end of seven years, 85 percent of CAFI’s global partners have succeeded in obtaining direct federal funding in their respective countries–many of which have grown and expanded with innovative programs.
One partner organization in Zambia has developed an effective model reaching men, and they are now teaching this model to neighboring countries. As part of its initial program, PEPFAR developed an initiative specifically engaging FBOs and faith leaders at the country and community level. Most of CAFI’s partners are FBOs, and Mrs. Smith points out the critical role they have played in the sustainability of the local HIV/AIDS response. In communities across the world, faith leaders and organizations hold great credibility, influence, and the important ability to offer spiritual hope in times of crisis.
One concern Mrs. Smith brings attention to is that HIV/AIDS interventions have slowly begun shifting their focus away from behavioral change, namely the ABC (Abstinence, Be Faithful, Condoms) programs. These programs were focused, for example, on keeping girls in school to delay sexual debut and lower risk of HIV transmission. Some working in the HIV field have raised concerns about the ABC’s limitations, saying that it does not take factors like gender inequity, poverty, and stigma into consideration–while instead encouraging that funding be allocated into a framework that may be inapplicable to varying contexts around the world.
Yet through further conversation, it seems apparent that Mrs. Smith’s concern is not to push for an oversimplified behavioral prevention approach, but rather to recognize the dangers of the current trend away from behavioral prevention in general. Especially in countries where greater than 50 percent of the population is under 15 and there is declining emphasis on primary prevention, she worries about its cascading effects.
The next two interviews underscore how two organizations are concretely attempting to strike the balance that critics and advocates alike are fighting for: the diversity and holistic approach towards behavioral change, prevention, and treatment initiatives.
Adventist Development and Relief Agency
Dr. Zivayi Nengomasha, Programs and Planning Director with the Adventist Development Relief Agency (ADRA) Africa Regional Office explains a new program ADRA launched to engage youth in various Southern African countries including Eswatini, Lesotho, Mozambique, Namibia, and Zambia. Developing out of a much older program which trained community-based counselors to form faith-based support groups who provide education and resources on HIV/AIDS, ADRA-Africa evolved the program to meet the needs of the younger generation.
Building on Dr. Larry Brendtro’s previously established Circle of Courage model and embracing its adaptation by the Seventh-day Adventist church into a youth program entitled Youth Alive, this program seeks to address the shifting dynamics of HIV/AIDS amongst youth. In many countries, more and more youth grow up living with HIV, and this program provides a chance to meaningfully impact their lives as well as the rest of the youth population. The four components of the program are Belonging, Independence, Mastery, and Generosity.
Belonging. This involves training adult mentors to oversee peer counselors who in turn each lead a “Friendship Group,” an age-based support group in their own faith communities. Through Friendship Groups, youth are organized for learning, peer support, and service.
Independence. In Friendship Groups, youth are taught a full curriculum on soft and hard life skills which have the potential to aid with decision-making and navigating various challenges throughout life.
Mastery. Youth are given the opportunity to attend vocational schools to build professional skills and be equipped for employment and entrepreneurship. They are also paired with profession-based mentors within their communities. In Namibia, because of their vocational training in agriculture, youth are now giving back by teaching women in their communities how to undertake climate-smart agriculture.
Generosity. Youth learn how to do basic needs assessments and creatively mobilize resources to address their community needs. For example, in Zambia, some youth are cleaning up garbage and recycling; in Lesotho, youth are involved in reforestation; and in Eswatini, youth clean homes for the elderly in their communities.
With this model, multiple aspects of primary intervention are addressed. Factors like delayed sexual debut by actively engaging youth in livelihoods, improved peer and community support which helps to reduce stigma and increase education on HIV/AIDS, and equipping the youth to recognize and respond to needs in their community are all upstream methods which reduce transmission as well as support those already living with HIV/AIDS.
Zimbabwe Association of Church-Related Hospitals
Dr. Vimbai Mandizvidza, a public health specialist with the Zimbabwe Association of Church-related Hospitals (ZACH), offers a look into the HIV/AIDS initiatives ZACH has been directing in Zimbabwe. With curriculum helping to deconstruct stigmas in faith communities around HIV/AIDS, their important Faith Community Initiative (FCI) program leverages the influence of faith communities to spread vital education and resources to their communities. Dr. Mandizvidza explains how their messages of hope seek to counter the “doom and gloom” often accompanying the topic of HIV/AIDS.
A newer project that has shown great promise is the establishment of community outreach posts. Borrowed from the Zambian organization, Circle of Hope, this model seeks to decongest public clinics and hospitals by increasing accessibility to testing services and ARVs, as well as providing ongoing support for individuals living with HIV/AIDS within their communities. ZACH has placed these community outreach posts in accessible public areas, like busy markets and bus terminals, where health care staff–a nurse and a counselor–can provide a range of HIV/AIDS prevention, treatment, and supportive services. FCI workers, referred to fittingly as Champions, distribute HIV self-test kits throughout five provinces in the country and help to direct the people testing positive to the nearest community outposts or clinics available for confirmatory HIV testing and additional services.
Opening up these posts and having them work in conjunction with Champions is one significant way of decreasing the barriers people face to testing and to receiving the necessary treatment and support after diagnosis. As more community outreach posts are established in Harare, and with the FCI Champions’ continual efforts, the goal is to alleviate and remove the ever-looming burden of accessibility. These outposts exist for the many people, especially men, who lack the means or time to travel for testing or to pick up their ARVs. They no longer need to make the arduous trip to a health clinic or hospital, but instead can stop by a post on the way or near their workplaces and homes.
Why the Faith-based Response is Imperative to Ending the HIV/AIDS Epidemic
In relaying the past three interviews, I have briefly touched upon the relation between FBOs and the HIV/AIDS response. But here I want to allow for fuller discussion on what I argue is not only the importance of involving FBOs, but the necessity of it. When it comes to the issue of religion and health, hesitancy and apprehension are never far behind. Perhaps it comes with the territory–the politicization, diverse beliefs, practices, stigmas, and stereotypes of religious groups is something difficult to neatly sort into boxes and formulas for policies and programs as complex as HIV/AIDS prevention and treatment. Even so, FBOs have in the last few decades played an integral role in successfully reaching communities all over the world.
One of the first reasons for their success is the central role religion plays in nearly every community. Dr. Nengomasha says, “Africa is very spiritual, whether Christian or whatever else […] so when an intervention is disconnected from that central aspect, it is much less effective.” She continues explaining that people have greater confidence when they are learning in an environment and from people they can trust, amidst values they believe and uphold.
Decades of public health programs have shown the overall ineffectiveness of outside individuals and organizations, even their own government, delivering health messaging and resources into communities without the involvement of their own members. But rather when key figures and community members are the ones to advocate and plan, it is not only more effective, but also much more sustainable, as discussed previously with Anita Smith. Recognizing this, ADRA has invested in support groups within many different faith communities–Christian, Muslim, traditional healers, and others.
In conjunction with this point, faith communities hold immense networks and influence, often crossing economic and social barriers to reach the most vulnerable members of the population. Just as much as taboo and stigmas within faith communities, especially when it comes to HIV/AIDS, have marginalized and discriminated against individuals, faith communities have even greater power to reverse the tide. Dr. Nengomasha explains how it is much faster to bring about change when you have influential leaders on board as change agents, and involving FBOs and faith leaders provides an ideal opportunity to do so. It is not an easy task, but building trust and mobilizing FBOs and faith leaders is a major game changer. We see this not only in the effective HIV/AIDS programs of CAFI, ADRA, and ZACH, but also with the current COVID-19 pandemic. These organizations along with many others have successfully used their existing networks of FBOs, faith leaders, and community workers for the vital dispersion of information and resources regarding COVID-19.
The Way Forward
Taking it back full circle to the concern of simplicity of the ABCs as a prevention strategy, a multilevel and complementary approach is certainly necessary to account for the varying individual and community needs and to ultimately reach the UNAIDS’ 95-95-95 goal of ending the AIDS epidemic by 2030. Largely through the network and role FBOs play, organizations like CAFI, ADRA, and ZACH have been able to reshape existing models with new ideas according to the unique needs and situations within each country, creatively addressing primary prevention and treatment initiatives. Dr. Mandizvidza says, “We’ve done so much with the more traditional interventions, but we’re still not getting to the targets we set. So with this Faith Community Initiative, it’s a chance to think outside the box and see how different interventions and approaches complement each other [and to find] different ways of reaching the most vulnerable people.”
Although HIV/AIDS has presented a few of the greatest challenges in public health, undeniable progress has been made even in the face of such adversity. However, as Dr. David Barstow and collaborators with the Georgetown University Berkley Center remind us in Faith and HIV in the Next Decade: Mobilizing Religious Communities to End the HIV Epidemic, we are not there yet. Those in the field know that this is a battle of perseverance and continued diligence, not complacency. Dr. Barstow says, “We won’t end the HIV epidemic by 2030 if we don’t address the social issues, and we can’t solve the social issues without strong action from religious communities. We already know what to do—we just need to do a lot more of it.”
CCIH is privileged to partner with many individuals and organizations who have played pivotal roles in this progress, and we salute and cheer you on as we continue onward, together.
About the author: Class of 2022, Abigail Kim is currently studying Global Health and French at the University of Southern California. She plans on pursuing a joint medical and public health degree and working globally to combat health inequalities with sustainable, holistic solutions.