God, AIDS, Africa & HOPE

pensées of a Catholic priest

HIV – curse or blessing?

For most people, on first side a pandemic is surely seen as a curse translating into sickness. In the case of HIV- without treatment – it turns into full-blown AIDS and consequently death. Who does not remember the eighties: a quick and cruel death for young people, killed in the prime of their lives.
HIV also means evolution: a small little bug jumps onto a different host and kills the host. Not intentionally of course and it will take a quite some time, maybe a couple of hundred years to develop into a symbiosis which lets bug and host live peacefully together. Otherwise it’s a dead-end for evolution and will at a certain point cease to exist.
HIV is a challenge: In the 1980’s the scientific world raced to find an answer what causes the syndrome. To isolate the bug, to find anti-bodies and consequently a test to determine infection and last but not least to develop first medications working to prevent full-blown AIDS took its time and toll. But HIV is also a challenge for every human being: transmission via bodily fluids means it touches on one of our strongest drive and urge: sexuality. And who controls this desire controls humans – just look into the history of religion and the significance of the control of sexuality via faith.
HIV mixes categories normally separated in society: youth and death. Death is anyhow so often hidden in modern society; now associated with youth and radical eradicating the beauty of it destroys the unspoken view how society works and develops. It changed the rules of engagement on that level dramatically and still does it in developing countries.
HIV means to open up to people living and loving in same sex relationships. Coming from the dark and hidden corners of social life gay people suddenly stood in the limelight of society. HIV and AIDS was part of a sometimes cruel outing process. In our days HIV is globally not anymore associated with homosexuality but the pandemic, almost as a side effect, opened up society to look at different life styles. And without any doubt the solidarity in gay circles in the beginning of the pandemic for their infected friends and partners was an impressive show of compassion and left traces which transformed into signs of normality and acceptance for gay love in the Western hemisphere. Obviously this triggers an antidote from the radical – fundamentalist side of society, mainly coming from the USA in an evangelical form even telling Africans what African culture means in Africa.
HIV is clearly a challenge for politicians and it was HIV which was put on the agenda as the first medical condition dealt with by the UN. This opened doors for other discussions on a global base like on Malaria or TB or all the other forgotten sickness of Africa and South America. We were reminded that they also kill millions a year and that they are in need of being addressed properly. The Global AIDS Fund was a first instrument of tackling a medical challenge on a global scale and not via bi-lateral negations which normally don’t’ see the full picture and are rather small –minded.
HIV means a challenge for society. While in Germany the campaign “Give AIDS no chance” with the commitment of the entire government prevented the pandemic to get into full swing, other countries and governments did not wake up to respond to the treat timely. The bible is right, that the sin of the fathers, in this case the sin of neglect comes onto the children and grandchildren. South Africa, but also Swaziland, is an example of failure with the result of hundred thousands of death and a generation born and plagued by HIV. What a challenge for the social coherence of society.
HIV translates into a challenge for religion, for our faith. Just a look at Ronald Reagan, who refused to act on the first reports of the new disease as it seemly “only” targeted gay people. His faith told him that they anyhow did not live according to God’s moral code; somehow no real action was needed. It reminds us also in this context of all those clerics calling the HIV pandemic the punishment of God for Sodom and Gomorrah in our times.
HIV is not a punishment but a clear sign of the time to reflect on our Christian theology – it has shown clearly that answering new questions with old answer do not serve humanity. The opposite is true: it endangers life. The question of protection cannot be answered with the reply given by authorities quite some time earlier on the question of procreation.
And how about the single human being infected with the HI Virus?
The challenges and reactions are as different as people are different: shock, disbelieve, despair, give–up mentality, defiance, hope….
What is indeed an almost general rule I discovered with people living positively is that after the balance in life is found again, there is a new sense for health and the value of life. HIV has shown how fragile life is and treatment has given almost the opportunity for a second chance in life. People infected mostly have a peace treaty with their boarder – always present even when tested undetectable. There is also the sense of gratitude and somehow, even if it sounds absurd, it changes from being a personal curse into a blessing. And I strongly believe that church should be and could be promoter of this transition, personal and in communities where stigma could be transformed into a blessing. The Catholic Student organisation of South Africa maintains in one of their publications that people living with HIV cannot live life to the fullest as stipulated in John 10.10.
They are wrong: God is giving everyone in his unconditional love the possibility to life their life to the fullest – for him, sexual identity or preference is not a hindrance nor is race or income or any other ability or disability or HIV or AIDS.
You will be a blessing for others – this promise of God applies to everybody who lives and loves with or without HIV.

Filed under: Catholic Church, General, HIV and AIDS, HIV Prevention, HIV Treatment, Reflection, Religion and Ethics, Society and living environment, Uncategorized, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

UNAIDS Press Release regarding the Milleniumgoals

In lead-up to June High Level Meeting, progress report presents overview of efforts needed to help countries achieve universal access to HIV services and zero new HIV infections, discrimination and AIDS-related deaths.

NAIROBI, 31 March 2011—Thirty years into the AIDS epidemic, investments in the AIDS response are yielding results, according to a new report released today by United Nations Secretary-General Ban Ki-moon. Titled Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths, the report highlights that the global rate of new HIV infections is declining, treatment access is expanding and the world has made significant strides in reducing HIV transmission from mother to child. Between 2001 and 2009, the rate of new HIV infections in 33 countries—including 22 in sub-Saharan Africa—fell by at least 25%. By the end of 2010, more than 6 million people were on antiretroviral treatment in low- and middle-income countries. And for the first time, in 2009, global coverage of services to prevent mother-to-child transmission of HIV exceeded 50%. But despite the recent achievements, the report underscores that the gains are fragile. For every person who starts antiretroviral treatment, two people become newly infected with HIV. Every day 7 000 people are newly infected, including 1 000 children. Weak national infrastructures, financing shortfalls and discrimination against vulnerable populations are among the factors that continue to impede access to HIV prevention, treatment, care and support services. The Secretary-General’s report, based on data submitted by 182 countries, provides five key recommendations that will be reviewed by global leaders at a UN General Assembly High Level Meeting on AIDS, 8–10 June 2011.

“World leaders have a unique opportunity at this critical moment to evaluate achievements and gaps in the global AIDS response,” said Secretary-General Ban Ki-moon at the press briefing in the Kenyan capital. “We must take bold decisions that will dramatically transform the AIDS response and help us move towards an HIV-free generation.” “Thirty years into the epidemic, it is imperative for us to re-energise the response today for success in the years ahead,” said UNAIDS Executive Director Michel Sidibé, who joined Mr Ban for the launch of the report. “Gains in HIV prevention and antiretroviral treatment are significant, but we need to do more to stop people from becoming infected—an HIV prevention revolution is needed now more than ever.”

Rebecca Auma Awiti, a mother living with HIV and field coordinator with the non-governmental organization Women Fighting AIDS in Kenya told her story at the press conference. “Thanks to the universal access movement, my three children were born HIV-free and I am able to see them grow up because of treatment access,” she said.

In the report there are five recommendations made by the UN Secretary-General to strengthen the AIDS response:

  • Harness the energy of young people for an HIV prevention revolution;
  • Revitalize the push towards achieving universal access to HIV prevention, treatment, care and support by 2015;
  • Work with countries to make HIV programmes more cost effective, efficient and sustainable;
  • Promote the health, human rights and dignity of women and girls; and
  • Ensure mutual accountability in the AIDS response to translate commitments into action.

The Secretary-General calls upon all stakeholders to support the recommendations in the report and use them to work towards realizing six global targets:

  • Reduce by 50% the sexual transmission of HIV—including among key populations, such as young people, men who have sex with men, in the context of sex work; and prevent all new HIV infections as a result of injecting drug use;
  • Eliminate HIV transmission from mother to child;
  • Reduce by 50% tuberculosis deaths in people living with HIV;
  • Ensure HIV treatment for 13 million people;
  • Reduce by 50% the number of countries with HIV-related restrictions on entry, stay and residence; and
  • Ensure equal access to education for children orphaned and made vulnerable by AIDS.

As international funding for HIV assistance declined for the first time in 2009, the report encourages countries to prioritize funding for HIV programmes, including low- and middle-income countries that have the ability to cover their own HIV-related costs. It also stresses the importance of shared responsibility and accountability to ensure the AIDS response has sufficient resources for the coming years.

The report and more information about the High Level Meeting on AIDS can be found online at: unaids.org/en/aboutunaids/unitednationsdeclarationsandgoals/2011highlevelmeetingonaids/

 

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Politics and Society, , , , , ,

UN: SWAZILAND: A culture that encourages HIV/AIDS

Anecdotal evidence that entrenched cultural beliefs among Swazis actively encourage the spread of HIV/AIDS has been confirmed by a joint government and UN report. The study by UN the Population Fund (UNFPA) and Swaziland’s Ministry of Health and Social Welfare – The State of the Swaziland Population – echoes warnings by local NGOs that “AIDS cannot be stopped unless there is a change in people’s sexual behaviour.” Despite consistent efforts to curtail the most severe AIDS epidemic in the world, it appears to have gained ground. “Swazis are very traditional people, and their sexual behaviour is inbred and totally against safe sexual practices, like condom use and monogamous relationships, that limit the spread of HIV,” Thandi Mngomezulu, an HIV testing counsellor in Manzini, the country’s main commercial city, told IRIN. The report, based on focus groups and surveys, found that maintaining a centuries-old cultural belief in procreation to increase the population size, was having devastating consequences in the age of AIDS.

“It’s helpful to have scientific data to focus our efforts. For instance, the study shows that Swazis believe it is ideal if a Swazi woman has a minimum of five children. We can ask people why this is, and how to counter the belief,” said Mngomezulu. Joseph Dlamini, a pastor and youth guidance counsellor, told researchers that “It all boils down to this: Nothing must stand in the way of procreation. Increase the population at all cost.” However, he noted that this belief had come about when the population was a tenth of its present size of about one million. “All humans have sexual urges, but behaviour is determined by social norms. Swazis still believe that a woman’s role is to bear children continuously, and that a man’s role is to impregnate multiple partners, which is why polygamy is so strong here, both as an institution and in the minds of young men, who may not ever get married but still have many children from multiple girlfriends,” Dlamini said. A survey of nearly 2,000 women attending antenatal clinics in the country’s four regions found that 42 percent tested HIV positive in 2008, up 3 percent from the last survey, in 2006.
If population growth was the social factor prompting sexual behaviour, the report found it ironic that sexual practices intended to boost the population had opened the door to AIDS and decreased life expectancy. In 2000 life expectancy was 61 years; now it is 32 years, according to the Human Development Index of the UN Development Programme.
“In Swazi culture, decision-making has traditionally been a male prerogative. Family-planning decisions, therefore, lie with the man,” the study found.

“Women report that they have been subjected to continuous childbirth by their husbands or in-laws, against their will. Researchers noted that Swazi men strongly defended the practice of “kungena”, or wife inheritance, whereby a widow becomes the wife of the deceased man’s brother, a practice found to spread HIV.
Swazi men defended polygamy as a cultural necessity, but also lamented lapsed cultural practices they said could stop the spread of HIV/AIDS, like “kuhlawula”, in terms of which men or boys who impregnated unmarried women were fined five cows by their community elders, but these laws were no longer enforced.
Another cultural factor was gender preference – often insisted upon by in-laws – that a woman bear a boy. The birth of a birth of a girl is immediately followed by an effort to have a male heir, because in traditional law only a boy can lead a family into its next generation.  Other data followed established patterns in developing countries: where there is urbanization and a more educated populace, birth rates decline. Swaziland is mainly rural, but in the northern Hhohho Region, where the capital, Mbabane, is located, the fertility rate is 3.6 children per female, compared to 4.3 children in the underdeveloped southern Shiselweni Region. The fertility rate among women whose education finished at primary school was 5.1, but only 2.4 – less than half the number of children – among students who advanced to tertiary education. The poorest Swazi women have a fertility rate of 5.5, while the figure among the richest is only 2.6 children. “The rich/poor fertility divide is testament to the lack of a government social safety net – like a good pension scheme for the elderly – so, for those without assets, their only security comes from lots of children, who together can support their parents when they are older,” said Tanya Kunene, a social welfare officer in Manzini Region.
The study found that, like many traditional societies, Swazis lived in isolation and were generally suspicious of other cultures – practices like monogamy, family planning and birth control were considered foreign and suspect.
That may be changing. According to the study, some survey participants “called for the recognition of multiculturalism in Swaziland, which would create tolerance for other cultures co-existing with our own”, and thus make “foreign” practices found to be effective in curbing HIV/AIDS more acceptable.
Source:

http://www.irinnews.org/report.aspx?Reportid=83937

Filed under: HIV and AIDS, Reflection, Society and living environment, Uncategorized, , , , ,

21.10.2009 More than four million…

More than 4 million people in low and middle-income countries were receiving antiretroviral therapy (ART) at the close of 2008, representing a 36% increase in one year and a ten-fold increase over five years, according to a report released by the WHO, UNICEF and UNAIDS.

Towards universal access: scaling up priority HIV/AIDS interventions in the health sector highlights other gains, including expanded HIV testing and counselling and improved access to services to prevent HIV transmission from mother to child.

“This report shows tremendous progress in the global HIV/AIDS response,” said WHO Director-General Margaret Chan. “But we need to do more. At least 5 million people living with HIV still do not have access to life-prolonging treatment and care. Prevention services fail to reach many in need. Governments and international partners must accelerate their efforts to achieve universal access to treatment.”

Treatment and care

Access to antiretroviral therapy continues to expand at a rapid rate. Of the estimated 9.5 million people in need of treatment in 2008 in low- and middle-income countries, 42% had access, up from 33% in 2007. The greatest progress was seen in sub-Saharan Africa, where two-thirds of all HIV infections occur.

Prices of the most commonly used antiretroviral drugs have declined significantly in recent years, contributing to wider availability of treatment. The cost of most first-line regimens decreased by 10-40% between 2006 and 2008. However, second-line regimens continue to be expensive. Despite recent progress, access to treatment services is falling far short of need and the global economic crisis has raised concerns about their sustainability. Many patients are being diagnosed at a late stage of disease progression resulting in delayed initiation of ART and high rates of mortality in the first year of treatment.

Testing and counselling

Recent data indicate increasing availability of HIV testing and counselling services. In 66 reporting countries, the number of health facilities providing such services increased by about 35% between 2007 and 2008. Testing and counselling services are also being used by an increasing number of people. In 39 countries, the total reported number of HIV tests performed more than doubled between 2007 and 2008. Ninety-three percent of all countries that reported data across all regions provided free HIV testing through public sector health facilities in 2008.

Nevertheless, the majority of those living with HIV remain unaware of their HIV status. Low awareness of personal risk of HIV infection and fear of stigma and discrimination account, in part, for low uptake of testing services.

Women and children

In 2008, access to HIV services for women and children improved. Approximately 45% of HIV-positive pregnant women received antiretroviral drugs to prevent HIV transmission to their children, up from 35% in 2007. Some 21% of pregnant women in low- and middle-income countries received an HIV test, up from 15% in 2007. More children are benefiting from paediatric antiretroviral therapy programmes: the number of children under 15 years of age who received ART rose from approximately 198 000 in 2007 to 275 700 in 2008, reaching 38% of those in need.

Globally, AIDS remains the leading cause of mortality among women of reproductive age. “Although there is increasing emphasis on women and children in the global HIV/AIDS response, the disease continues to have a devastating impact on their health, livelihood and survival,” said Ann M. Veneman, UNICEF Executive Director.

Most-at-risk populations

In 2008, more data became available on access to HIV services for populations at high risk of HIV infection, including sex workers, men who have sex with men and injecting drug users. While HIV interventions are expanding in some settings, population groups at high risk of HIV infection continue to face technical, legal and sociocultural barriers in accessing health care services. “All indications point to the number of people needing treatment rising dramatically over the next few years,” said Michel Sidibé, Executive Director of UNAIDS. “Ensuring equitable access will be one of our primary concerns and UNAIDS will continue to act as a voice for the voiceless, ensuring that marginalized groups and people most vulnerable to HIV infection have access to the services that are so vital to their wellbeing and to that of their families and communities.”

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, , , , , , , , , ,

22.09.2009 more fundamental questions…

In the last days I described my stance on mandatory testing and the pre-testing counseling. Having now more time to dedicate my energy towards the HIV/AIDS portfolio, there are more topics I feel are necessary to persue in the coming months and years. I have spoken already about the need to end the stigmatization within the health sector itself.  On the political front I can forsee to look more intensive into the question of travel freedom of people living with the virus. The ban to visit certain countries or the ban to get a work permit if you are HIV positive as you can find it in Australia, Singapore and many other countries is not only a sign of a lack of maturity of politicians in the respective countries but also a clear violation of human rights. I am aware that the UN, but also the German “AIDS Hilfe” is dealing with the issue, but we should all join hands and start to pressurize political systems allowing such violations of dignity and human rights.
In some of the blogs I mention the work with HIV positive priests and religious as well as seminarians. This is indeed a very tricky question and I hope that in October, when I am in Rom to meet together with Joachim Franz with the papal council for health care workers, to get this council on board to have a hard look how we deal with HIV and AIDS in our own ranks. Is the refusal to take a HIV positive person into e.g. monkhood or a seminary not a sign of fear and immaturity of the church? Are we as a church really allowed to deal with infected people in refusing them to follow their vocation? I am sure that God does not mind the status of a person. So we also shouldn’t mind the HIV status of a person. What kind of AIDS policies are regulating the life of the church and their institutions? Do we advocate the acceptation of people living with the virus only for the area outside the church? Tough questions, but we owe it the greater love of God to check our own balances on those questions and see whether they add up.

The ethical question of ceasing treatment if somebody does not adhere at all – also a tricky question. I mentioned the criminal law as a tool of prevention, which I find absolutely unreasonable in the way it is administered in most countries, specially also here in Africa.

Those are some of the questions in my mind, where I would like to contribute towards a solution which ends the madness of stigmatization and discrimination, which forces governments and churches to act reasonable and always upholding the dignity and human rights of every person.

Filed under: General, HIV and AIDS, HIV Treatment, Medical and Research, Networking, Politics and Society, , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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