Tag Archives: HIV prevention

Beyond the stand-off

Martin Pendergast

Oh to have been a fly on the wall in the Clinton household last week! The former US President was quoted in a BBC interview that it was “very important” to change peoples attitudes in favour of more monogamy – though he noted this was not just a problem in Africa. “To pretend we can ever get a hold of this without dealing with that, the idea of unprotected sexual relations with unlimited numbers of partners, I think would be naïve,” he said.

Commentators see Clinton’s remarks as evidence of a growing alignment between secular approaches to the HIV pandemic, and the values promoted by faith-based organisations (FBOs). A thawing of attitudes has occurred on both sides. Governments and international agencies have seen the quantity and quality of care given by FBOs, and also an increasing willingness from the latter to work within more comprehensive prevention frameworks. The need for fidelity in human relationships and its fragility is seen in a broader systemic context, not just about personal choices or individual behaviour change but also subject to factors such as poverty and structural violence, gender inequality and homo-negativity. The 17th International AIDS Conference, just concluded in Mexico, found some tired arguments and mutual suspicions still pursued on both sides of the debate. There is a real need for everyone to begin to think and act outside their own doggedly maintained boxes, learning and respecting each others HIV languages. Many faith groups see a growing convergence between values of mercy, compassion, and justice, and the public health principles driving global programmes of HIV prevention and treatment.

In different places, diverse cultures, and various theological contexts, tensions still continue. Secular entities observe a development of teachings taking place in faith groups around safer sexual or drug use behaviour, including condom use, and syringe exchange. FBOs publicly debate these issues increasingly, and many senior religious leaders recognise that prevention of death is about the promotion of life. There is an emerging convergence between secular AIDS entities and some FBOs, both in common action and shared discernment in finding responses to the multiple faces of HIV, its prevention and treatment.

The Catholic network of social welfare and development agencies, Caritas Internationalis signed a Memorandum of Understanding with UNAIDS, the UN’s HIV/AIDS coordinating body in 1999, renewed in 2003. UNAIDS recognises that as 70% of the world’s people identify as members of faith groups, such communities play a very significant role in influencing people’s behaviours and attitudes, and in providing care and support for people living with HIV/AIDS, with some 26.7% of HIV services worldwide provided by Catholic institutions . Acknowledging these positive interventions, UNAIDS encourages FBOs to tackle the negative impacts which can arise from some interpretations of doctrinal positions. Work remains to be done to eradicate stigma and discrimination, while some approaches to HIV prevention, and attitudes towards people at increased risk of HIV infection such as men who have sex with men, or injecting drug users, have sometimes hindered effective responses.

At the Mexico AIDS Conference, Peter Piot, UNAIDS’ retiring Executive Director, praised FBOs’ work, noting how his own attitude had changed over the past 13 years.  “ When I started this job I saw religion as one of the biggest obstacles to our work, particularly in the area of prevention, but I’ve seen great examples of treatment and care that came from the religious community, and lately in the area of prevention.” This echoed Piot’s challenge, issued at the 2006 Toronto AIDS Conference, to maximise the involvement of FBOs and religious leadership in the global AIDS response “and make sure this is part of your core business, because this is where it belongs, at the heart, at the core of what you do.”

UNAIDS prioritises work at the global level with networks representing a huge interfaith diversity. It collaborates closely with a range of Buddhist, Christian, Muslim, and Hindu groups, as well as the newly launched INERELA, an international, interfaith network of religious leaders, lay and ordained, women and men, living with or personally affected by HIV – www.anerela.org .

Cynics might suggest that as national governments struggle to fulfil their financial commitments to the Global Fund to fight AIDS, tuberculosis and malaria, UNAIDS might count on FBO resources to supplement spiralling deficits in funding for AIDS treatment, support and research. That would be unfair, since UNAIDS far from discredits the ability of faith groups to reach the parts of some populations that other agencies can never touch.

So, a rich global tapestry of cooperation and commitment – but is this reflected in the domestic picture? In the UK, CAFOD and Christian AID were quick to respond to world-wide challenges, alongside secular agencies like ActionAid. The UK Consortium on AIDS & International Development was formed to share inter-agency knowledge, and to respond strategically to governmental initiatives. In October 2006, the Consortium, recognising the number of FBO’s in its membership, launched a Faith Working Group (www.aidsconsortium.org.uk/faith) which seeks to improve the ‘faith-literacy’ of other non-governmental organisations as well as the UK’s Department for International Development. In 2007, it produced a review, “DFID, faith & AIDS” to inform DFID’s consultation updating “Taking Action”, the UK Government’s strategy for tackling HIV/AIDS in the developing world. The review suggested that DFID contacts in many countries provided a good understanding of the role of faith and faith groups in relation to HIV/AIDS. Others indicated that they had had to learn from scratch about the importance of faith in their particular geographical context. Many DFID staff in affected countries recognised faith-groups as important in the response to AIDS, and believed that the national strategy should include them for pragmatic reasons, rather than because they were religious bodies per se. This is based on the assessable impact of FBOs’ work in education, prevention and care, as well as advocating against stigma and discrimination. There is often a greater trust placed in faith groups, working amongst the people, than in multinational organisations whose agenda appear to be directed from outside the country. However, DFID staff frequently expressed frustration with some of the attitudes and approaches in faith groups, subsequently identified in DFID’s 2008 strategy document.

Despite the significant degree of support offered in many places, there are strong indications that DFID’s financial assistance to faith groups is not remotely proportionate to their contribution in the response to the pandemic. Furthermore, DFID’s support did not appear to be systematic, but fragmented, and probably dependent on the understanding and commitment of relevant DFID staff. It appeared that DFID was not seeing the best return from faith groups’ potential, in spite of having Programme Partnership Agreements with a number of UK-based FBOs. Even though DFID supports a range of FBOs HIV programmes, this is a small percentage, both of DFID’s budget and of FBOs’ overall work on HIV, compared with activity levels of other secular development agencies. The scope for DFID to strengthen its support to civil society organisations, and faith groups in particular, appears to be weakening as the pressure to reduce both its own and agencies’ overhead costs increases. A key question is whether DFID understands faith entities as a distinctive
part of civil society with their own modes of operation, underlying values, assumptions and motivation.

DFID’s updated strategy, Achieving Universal Access, published in June 2008, gave new and welcome recognition to the role of faith leadership, and a more detailed comment:

“ Faith-based organisations (FBOs) form a distinctive part of civil society. As 70% of the world’s people identify themselves as members of a faith community, FBOs can reach many people. They often provide a significant number of basic services in developing countries; in 2004, the World Bank estimated that faith groups account for half the education and health care provision in sub-Saharan Africa. They also have the potential to shape social norms that influence people’s behaviour and attitudes towards someone living with HIV. However, some preach unhelpful messages around sex, condom use, homosexuality, and women’s rights. Those that foster respect and understanding can have significant impact and should be supported.”

‘Faith-literacy’ is not only an issue for those dealing with HIV and developing countries. On the home front, the Department for Communities & Local Government recently launched a framework for partnership in our multi-faith society, Face to Face & Side by Side, strongly encouraging government departments and local authorities to overcome fear or reticence in developing work with faith-groups. Faith-fear has certainly impacted negatively on the practical contribution that faith-based HIV groups in the UK can make to confront stigma and prejudice, promoting prevention, health improvement, or offering care and support.

Most local AIDS funding is now spent on HIV treatment costs; hence little, if any, supports faith-based initiatives. Some groups have benefited from limited National Lottery funding, or the government’s Faith Communities Capacity Building Fund, and the new Faiths in Action programme, operational from August 2008 may offer further possibilities.

Nevertheless, faith matters have been recognised by HIV voluntary sector groups and research units. The Terrence Higgins Trust has focussed, nationally and regionally, on the links between faith and HIV. Its annual CHAPS conference for gay men has held sessions on HIV & Faith for the past two years. The leading sexual health research project, SIGMA, now routinely includes general faith questions in its surveys, as well as conducting specific studies examining links between faith and HIV.

As various secular groups have come to see faith’s relevance as part of the solution in the struggle to stop HIV, rather than only a problem, so it is time for FBOs to develop an inclusive HIV-literacy. CAFOD has given a strong lead, expressing its comprehensive HIV policy with the image of the HIV Tree and showing the interconnectedness of roots through an analysis of systemic factors such as stigma, poverty, gender inequity, structural violence, as well as individual behavioural choices. Similarly, INERELA promotes the SAVE prevention model – Safer practice, Available medication, Voluntary HIV testing, Empowerment through education – as a more comprehensive model than that of ABC: Abstinence, Be Faithful, and if not use Condoms.

Even though the stand-off between faith and HIV shows signs of ending, it is regrettable that some people of faith have hardened their attitudes, promoting uncritical approaches to ‘abstinence-only’ programmes or denying validity to studies supporting alternative models. As research on different models of prevention, treatment and support filters down to grass-roots organisations, greater confidence is given that embracing a comprehensive approach to the challenges of HIV is not simply value for money, nor just that they work, but is a strong affirmation that they are the right thing to do, entirely consistent with believers’ commitments to faith, compassion, and justice.

(A slightly edited version of this article appeared in The Tablet, 16 August 2008)

Enhanced by Zemanta