Testimony on HIV/AIDS

By

Dr. Galen Carey

Director of Advocacy and Policy

World Relief

7 E. Baltimore St.

Baltimore, MD 21202

December 15, 2003

Thank you for the opportunity to testify about the global HIV/AIDS
crisis. When I first joined World Relief in 1983, the world was only
beginning to become aware of the HIV virus. Since that time the disease
has taken a tragic trajectory, and even now we are behind the curve in
our response. In my more than twenty years with World Relief, including
five years in Africa, I have never seen a more compelling human tragedy.
I applaud President Bush for the leadership he has shown on this issue,
and the Congress for enacting strong authorizing legislation. However, I
believe that history will conclude that even with the President's
unprecedented initiative we have not yet fully risen to the challenge
that the HIV/AIDS pandemic presents. We can and must do even more.

Representing the deep humanitarian concern of evangelical churches and
Christians throughout the United States, World Relief has worked to save
lives and restore hope to impoverished communities since our founding in
1944. Working with more than two thousand churches, World Relief's
HIV/AIDS programs, known as Mobilizing for Life, have touched the lives
of hundreds of thousands of people throughout Africa and the Caribbean.
Our programs have the following objectives:

-   Prevent the spread of AIDS by promoting healthy patterns of family
    life and sexual practice.

-   Mobilize and equip churches to bring care and hope to persons and
    families affected by HIV/AIDS.

-   Enable individuals and families affected by HIV/AIDS to live with
    dignity by effectively addressing the economic burden of this
    disease.

We welcome the opportunity to share lessons we have learned through our
experience in implementing HIV/AIDS programs in many of the countries
that the PEPFAR initiative has targeted. I have divided my comments into
three sections.

1.  **[Program planning, implementation, and outcome
    measurement]{.underline}.**

One of the keys to creating high quality, high impact programs is
careful planning, starting with local community participation and
ownership. We understand and appreciate the need to move quickly; lives
are at stake and delay is deadly. However, in the rush to act, there is
a strong risk that local communities will not be sufficiently engaged
and that our interventions will not be sustainable. This is particularly
true when the desired outcome includes profound behavior changes. There
are no shortcuts, no substitutes for patient engagement that respects
the pace and priorities of the people we are trying to serve.

Community ownership, however, need not signify a lack of standards or
measurement. We have found it helpful to have clear goals, and to
regularly measure progress toward these goals. Our Rwanda program, for
example, conducted with support from churches and from the USAID local
mission, tracked key indicators over the course of its work with more
than six hundred congregations in three provinces. Findings from the
2003 program evaluation show that of the 674 parishes:

-   91% of participating parishes have awareness and anti-stigma
    programs.

-   46% have pastoral counseling programs for AIDS related issues.

-   42% had started adolescent sexual education and HIV/AIDS programs.

-   35% had begun home care programs for people living with AIDS.

-   100% use church-based volunteers to do the work.

Use of these indicators enabled us to make mid-course corrections and to
determine where greater effort and resources were needed.

2.  **[Effective partnerships]{.underline}**

World Relief's Mobilizing for Life strategy has focused on developing
partnerships with churches at the local, regional and national levels.
We work with a broad range of denominations and traditions. We have
chosen to work with churches for a number of reasons:

-   The Christian Church has a strong heritage of involvement in health
    and healing ministries. The church draws upon Jesus' example of
    humble service, compassion and sacrifice.

-   Churches are an almost universally distributed community institution
    that regularly ministers to people in need, strengthens community,
    and promotes behavior change. In many war-torn communities the
    church is the only functioning institution in civil society. The
    church brings members of the community together week after week,
    offering unprecedented reach in communicating its message.

-   People listen to church leaders and pastors when they speak. The
    church carries a moral authority that other sectors may not enjoy.
    Churches are often the most articulate advocates for the poor, the
    oppressed and the marginalized including those affected by HIV/AIDS.
    This is important when dealing with critical issues such as stigma,
    grief,

-   Church-related hospitals and health programs provide a significant
    percentage of the health care in many African countries, especially
    to the poor and those living in rural areas.

-   Church and mission-related health programs and congregational
    ministries have already proven that they are sustainable. Local
    church groups and institutions are organically connected with global
    networks that not only provide assistance in emergencies but on a
    continuing basis.

    World Relief has built its strategy around those things that
    churches are uniquely gifted to do:

```{=html}
<!-- -->
```
-   **Community Mobilization** WR challenges, and equips churches to
    commit themselves and their resources to HIV/AIDS related programs.
    Interventions include AIDS awareness and stigma reduction, HIV/AIDS
    policy consultations for church leaders, the development of
    instructional materials, interactive training and skill development.

-   **Prevention** WR seeks to reduce the incidence of HIV infection by
    promoting abstinence and mutual fidelity, promoting the prevention
    of mother to child transmission by accessing available services, and
    by equipping pastors and church leaders to give appropriate counsel
    about testing for HIV and the use of condoms to reduce the risk of
    transmission. Youth and children are reached with age-appropriate
    curriculum and through church-based youth clubs.

-   **Care** WR mobilizes and equips churches to care for people living
    with HIV/AIDS. Churches assist through trained teams of volunteers
    providing and supporting family members with home based care.
    Support groups of people living with AIDS learn together, support
    one another and do projects such as "memory books" to leave behind
    for their children and family members. Church leaders and members
    trained in pastoral counseling address the emotional and spiritual
    needs of people living with HIV/AIDS and their family members.

-   **Orphan Support** WR enables churches to respond to the needs of
    orphaned children in the surrounding communities. WR promotes the
    involvement of churches in placing AIDS orphans with families and
    assisting in the support and nurture of that family's children.

-   **Economic Strengthening** To mitigate the impact of HIV/AIDS on
    families, WR promotes economic strengthening and coping strategies
    to protect vulnerable households from sliding into deeper poverty
    and destitution. Together with the microenterprise development
    programs of WR, the *Mobilizing for Life* program is currently
    studying sustainable approaches to assisting households affected by
    HIV/AIDS.

> While working with churches has proven an extremely effective way of
> addressing the HIV/AIDS pandemic, we have found that churches must be
> approached with respect, transparency and understanding. Churches are
> indigenous community institutions with unique values, vision, and
> structures. They respond best when approached by organizations and
> individuals who know and respect their distinctives. They want to be
> treated as partners, not as vehicles to be used and manipulated. [We
> would urge that initiatives which target churches as partners be
> undertaken by implementers who have previous experience in working
> with churches.]{.underline}

3.  **[Involvement of people living with HIV/AIDS in our
    work]{.underline}**

In Africa, persons living with HIV/AIDS include people from all walks of
life. This includes the staff and volunteers who carry out World
Relief's programs. Even those who are initially contacted as
beneficiaries are encouraged to join in the care of other neighbors, as
they are able. Some churches also establish support groups for those who
are infected or affected by the disease.

One of my most vivid images of World Relief's Mobilizing for Life work
comes from a church in rural Malawi. The church has a "Patients'
Fellowship" where persons living with HIV/AIDS gather weekly to support
each other. The Patients' Fellowships meet together regularly, and also
visit those who are too sick to come to meetings. The church has reached
out far beyond its own walls, breaking down many barriers. In fact, more
than half of the members of this particular support group are Muslim.
Many members of the group shared that they were initially afraid to
disclose their HIV status. But they drew strength and purpose from their
solidarity with each other. As one woman stated, "At first I was
depressed and just stayed home. But then someone invited me to the
Patients' Fellowship. I decided that, rather than just sit at home
waiting to die, I would go out and try to help those who are worse off
than me."

In conclusion, I would like to share an excerpt from an email which I
received just last week. A dear friend of mine in Africa is dying of
AIDS. I will call him Pierre. Pierre barely survived the genocide in
Rwanda, and found safety in another country in Africa. His wife wrote to
say, *"My husband is very bad, not walking, not feeling well, not seeing
well. Many problems. I do not know when the end will come. God knows.
For me to work is not easy. To control, to keep the children, the house,
is a big problem. I must be strong, but I need your help."*

Pierre and his family, and millions facing similar difficulties, need
our help. Their strength and courage in the face of unbelievable
adversity continues to inspire me. By working together, I believe that
we can rise to this challenge, and that we can look forward to a
brighter day for Africa and the world.

\*\*\*

Dr. Galen Carey serves as Director of Advocacy and Policy for World
Relief. Previously he was World Relief's Africa Regional Director,
overseeing the agency's HIV/AIDS, child survival, microenterprise
development, food security, and disaster response programs in ten
African countries.