Quarterly Bulletin

The emergence of HIV and AIDS has brought many challenges for Church not only in Zambia but also the entire world. Some of the initiatives the Church in Zambia has been engaged in the Home Based Care (HBC), which encourages their members to care and support those infected and affected. William Chilufya, a member of the Health Development Network (HDN) correspondent team, reflects in this article on the urgency for faith-based organisations to share the burden of responses to HIV and AIDS with government.

Mutale, like many people living with HIV in Zambia, credits the Church with saving her life. Mutale's hope was restored after she gained access to free antiretroviral drugs (ARVs) from the Chreso Ministries' faith-based antiretroviral therapy (ART) Centre.

BEYOND MEMORY LANE

"I would have been history had it not been for the church," said Mutale with a smile. A study released by the World Health Organisation (WHO) early this year, titled Appreciating Assets: Mapping, Understanding, Translating and Engaging Religious Health Assets in Zambia, estimated that 30 per cent of the country's health infrastructure is run by faith-based organisations (FBOs).

These Church-related health centres provide much-needed services to people living with HIV (PLHIV). But the failure of health policy makers to understand the influence of religion and the important role of FBOs in HIV care could seriously undermine efforts to increase access to treatment.

In 1998, Mutale lost her husband to an AIDS-related illness. A year after his death, her health began to deteriorate, prompting her to seek voluntary counselling and testing (VCT). She tested positive for HIV in 1999.

"The year I tested positive was very trying. I had to cope with depression and undergo treatment for opportunistic infections that I suffered from. I spent almost all the money I was left with," Mutale recalled.

Her CD4 count, a measurement of the strength of her immune system, was very low and she was prescribed ARVs at a time when the cost of the drugs was very high in Zambia.

"For me, [paying for the drugs] was not something that was tangible … the main issue was, will I be able to afford these drugs?" Mutale said. She said she thought at the time, "They are not for me. The people who are going to access these drugs have money. I was told that a balanced diet was important but I wondered how I was going to manage it. By then I had stopped selling at the market due to the illness."

ACCESS TO TREATMENT

In 1999 the cost of HIV drugs and tests in Zambia was about 300,000 kwacha, or US$120, a month. While the government later introduced a cost-sharing scheme at its two major hospitals, the University Teaching Hospital (UTH) and the Ndola General Hospital, which reduced the cost to about 40,000 kwacha a month, the price remained too high for many people. 

A doctor from UTH advised Mutale to go to the Chreso Ministries ART Centre where she could get ARVs for free. Sixteen percent of Zambian adults are living with HIV. In urban areas, two in every five women aged between 25 and 39 have the virus. Among those aged between 15 and 19, seven percent of women and two percent of men are HIV positive. There are at least 76,000 adults and 5,000 children receiving ARVs in the country.

Chreso Ministries, a renowned Zambian Pentecostal Church, also known as the Go Centre, started its work on HIV in 1996 with the help of a mobile VCT clinic. At the time, VCT was relatively unknown in the country and the Church opened an ART Centre to help people who could not afford the government's cost-sharing scheme.

"HIV and AIDS is one of the biggest challenges facing the Church in the 21st century. It is also one of the greatest opportunities the church has to follow Christ in his example of serving the world," said the director of the Centre, Dr Hamooya. 

"The Church wants to eliminate the stigma attached to the pandemic hence the reason why we have the ART Centre right here at the church's premises. We feel duty bound to help our Church members and poor people living with HIV access tre so far has 4,046 people receiving ARVs," he added. Chreso Ministries recognises the need for effective HIV treatment, care and support. It is impossible not to be inspired by the work of FBOs like Chreso Ministries towards helping PLHIV access treatment.

But WHO's report says that there is often little cooperation between these organisations and mainstream public health programmes. The report concludes that greater coordination and better communication are urgently needed between organisations of different faiths and the private and public health sectors if progress is to be made towards the goal of universal access to HIV prevention, treatment, care and support by 2010.

CHURCH’S INDISPENSABLE ROLE

"Faith-based organisations are a vital part of civil society," said Dr Kevin De Cock, Director of WHO's HIV/AIDS Department. "Since they provide a substantial portion of care in developing countries, often reaching vulnerable populations living under adverse conditions, FBOs must be recognised as essential contributors towards universal access efforts."

Since the start of the HIV epidemic, local communities have been at the forefront of efforts to care for those affected. FBOs are rooted in local structures and are therefore in an excellent position to mobilise communities to respond to the crisis.

In many cases, religious organisations and people of faith have been among the first to respond to the basic needs of people affected by the disease, and have pioneered many of the community-based responses to the epidemic.

"In Zambia the FBOs provide about one third of treatment, care and support to people living with HIV through organisations like the Church Health Association of Zambia (CHAZ) and the Expanded Church Response to HIV and AIDS," said Father Michael J Kelly, a Jesuit priest and HIV activist in the country.

Like many agencies tackling the disease world-wide, Zambia's FBOs acknowledge that their response to the HIV epidemic has not always been perfect. A Zambian woman who was a member of the Treatment Advocacy and Literacy Campaign died recently after her pastor advised her to stop taking ARVs.

"We deeply regret instances where FBOs have contributed to stigma, fear and misinformation," a group of Zambian FBOs said in a recent statement. Despite their mistakes, however, FBOs represented at a Special General Assembly on HIV, including the Catholic Agency Fund for Overseas Development (CAFOD), the World Council of Churches and the Anglican Communion, expressed their ongoing commitment to working within their communities for the dignity and rights of people living with HIV.

URGENCY FOR COLLABORATION

FBOs in Zambia share the burden of the responses to HIV with the government, NGOs and UN agencies. The capacity of FBOs needs to be maximised by giving them the necessary levels of training and resources to address the impact of the disease.

Religious and cultural norms and values define the health-seeking strategies of many Africans. Without FBOs, the hope of universal access to prevention, treatment and care would be lost.

Given the need for dialogue, as observed by WHO, it is crucial that religious leaders in Zambia gain basic levels of public health literacy and that public health practitioners gain basic levels of religious literacy.

Through engagement with the government, FBO health facilities have the potential to increase in strength and value and become more effective in the long-term. In this way, they can support the recovery and resilience of individuals, families and communities and provide hope and a chance for survival to people like Mutale.

William Chilufya
Afya Mzuri
Lusaka

Go to JCTR website www.jctr.org.zm to download excellent materials on HIV and AIDS, especially the booklet written by Michael J. Kelly, S.J. entitled: “HIV and AIDS: A Justice Perspective”.