Written Testimony

from

Laura van Vuuren

HIV/AIDS Technical Unit

World Relief

7 E. Baltimore St.

Baltimore, MD 21202

for the

Presidents Emergency Plan for AIDS Relief

PACHA Town Meeting

National Press Club

Washington D.C.

December 18, 2003

Introduction and background:

As a representative of World Relief's HIV/AIDS technical team, and one
of the few who are not living in sub-Saharan Africa at the epicenter of
the pandemic, I appreciate this opportunity to provide input to PEPFAR
and the President's Advisory Committee on HIV and AIDS.

World Relief's history in addressing HIV/AIDS began in 1992 in Swaziland
and Malawi where I was then serving as country director. Our first
response was prompted by a chilling awareness that something both
colossal and terrible was growing silently in the communities where we
were working to alleviate poverty, empower women and help children live
beyond their 5^th^ birthday. Church cemeteries were full of fresh
graves, funerals were hindering our community development work, and the
death notices in the newspapers had younger and younger faces. The
strides we were making to help the poor in Africa build better lives in
the late 80s and early 90s were being undermined by the death of those
who provided the most hope to make a sustained change, Africa's
productive young adults.

My own journey was punctuated with personal loss, as AIDS claimed a
beloved relative, a close colleague, a young woman whom I had mentored,
neighbors and members of the church I attended. My passion to fight AIDS
has also been fueled through the years by witnessing the same
heartbreaking scenes that have transformed the hearts of celebrities and
government leaders and made them into outspoken AIDS activists: Vacant
-eyed children watching their parents waste away in abject poverty,
mothers whispering through swollen lips covered in sores: "Who will care
for my children after I die?" For the past few years, I've worn one of
my many versions of the "I Care" ribbon over my heart, as a conversation
starter. Always hoping someone will ask: "what is the red ribbon for
again?"

At the same time, the scope of the pandemic and the speed at which it
overtook the poor in the developing world along with the chronic lack of
resources from the West fostered feelings of frustration and
desperation. As a faith based development organization, we were often
passed over by government funded AIDS programs in the early days of the
pandemic. Our church support base in America was reluctant to give to
AIDS' programs, in spite of our efforts to convince them that people
living with AIDS mattered deeply to God, that they would be the very
ones He would embrace were He living amongst us today. But having few
resources made us more resourceful and careful that every cent would
make a difference.

But this is a new day! The resources are here. Many a weary solider in
the AIDS battle rejoiced last January when this monumental commitment
was made by our President during his state of the union address.

But at the same time, I worry what could happen if we don't leave our
egos and self-interest at the door, if we focus on making a big
impression and doing things too fast at the expense of the carefully
planned programs implemented when resources, were scarce.

## Planning implementation and partnerships 

We have learned that constructing a solid program foundation takes time.
For a program to be sustainable, we must listen, ask questions, and work
with local leadership before setting a strategy or proceeding with a
plan. Often outside implementers with an agenda don't want to take time
or work hard to understand the local way of doing things. And we
commonly underestimate the intelligence and resourcefulness of those we
are trying to help.

Yes, we welcome the resources, we need more hands and feet, but we must
not overlook the small but replicable victories that we've seen on the
field that deserve our support. A key challenge for all will be to
channel support to the community-level players who are already
responding to the HIV/AIDS crisis with their own resources. However,
this must be done in a very thoughtful way, using appropriate
intermediary structures, so that the external resources augment local
capacity without crushing or overwhelming local initiative.

World Relief has long believed that local congregations, who are
integral parts of AIDS affected communities and who know what will be
effective in terms of prevention and care, are key players in the AIDS
battle. They have the platform of compassion and family centered values
along with faith and a can-do spirit that has survived poverty,
genocide, civil strife and dictatorships. As my colleague Dr. Carey
pointed out, World Relief has steadily worked to equip local
congregations to plan, implement and monitor their own programs. Our
goal is to fuel a grass roots movement that gains momentum over time and
that will continue without us. Our programs may not be flashy or boast
clinics or orphanages, but they are sustainable.

Effective partnerships are based on mutual respect, building on natural
competencies and allowing each player to do what they do best. For
example, we accept that ARVT is necessary to prevent parent to child
transmission of AIDS, but for treatment to reach its full potential we
need to be holistic in our approach with a goal of making testing a
normal part of antenatal care. We must first break down stigma and fear
and create an enabling environment for testing and treatment. So rather
than training pastors and lay leaders to administer Nivarapin, we have
equipped them to provide counseling to families and raise awareness in
the community that would counteract stigma and fear.

The church is also well positioned to help build safety nets and
mobilize community efforts in caring for those amongst them who are
living with AIDS. As many of you know who have witnessed it firsthand,
AIDS brings a terrible and cruel death even in the nicest of hospices
surrounded by family, friends and flowers. But most people with AIDS are
dying alone in abject poverty without even an aspirin or a clean cup of
water, rejected by friends too frightened to touch them and communities
who believe they are cursed.

Most of the current effective responses to the needs for care are hidden
in the community and are unsupported or unprogrammed. We need to build
on household coping strategies and support existing community safety
nets if we want to sustain responses and reach the scale of need.
Through working within community structures, equipping, and providing
*continued* support and encouragement we can meet basic needs for most
people living and dying with AIDS and their millions of orphans.

The family is also the primary institution for care of orphans and other
vulnerable family members such as the elderly. Though taxed beyond
coping ability in some cases, the majority of extended family members
and the community surrounding them are the best homes for children whose
parents have died. Community institutions and informal infrastructures
can support the family, keeping children at home where they belong.

Engaging the community and building local capacity through participatory
training and dialogue is key. The tenets of training that transform are:
interactive involvement, engagement and respect of the trainees,
training that is held in the local environment, utilizing people's own
experience and readily available resources, training that is reinforced
by trusted authorities, training that builds on beliefs and provides
reflection and guidance toward understanding truth when beliefs may
contradict fact, and the opportunity to act on the lessons learned and
then to reflect on the results of that action.

When time and effort are taken to meet people on their own terms, using
their own community, religious, or family structures, very traditional
beliefs can be discussed. Building trust is critical to deciphering
erroneous traditional beliefs about AIDS. Some religious communities in
Kenya and Uganda began to change some of their views and reduce stigma
associated with AIDS through training and role models of key leaders. A
lesson learned in a large USAID/AIDSCAP project in 1996 demonstrated
that change does occur among church and community leaders when leaders
can trust sources of information, and they are given opportunity to
dialogue together.

The burden is on us as development professionals to find ever more
innovative ways to show our solidarity with the households and
communities we support.

# Programme development and NGO partnerships

World Relief was blessed in 1997 to welcome two committed AIDS warriors,
Debbie Dortzbach and Dr. Meredith Long to our team, who had created many
of the foundational AIDS materials still used by FBOs today. Since then,
we have built a library of prevention, counseling and care resources,
that were developed with the communities they were intended for and
designed to be easily adapted and translated in into different local
contexts and dialects. We have freely shared these resources with other
organizations and have developed other materials through NGO
partnerships.

World Relief has chosen to work in some of the world's most challenging
environments: post conflict, and post disaster areas where economies are
in tatters, trust has been shattered and widows and orphans abound even
without AIDS. We have pioneered and planted maternal and child heath,
poverty alleviation and food security programs in post genocide Rwanda
and Cambodia, post war Mozambique, Sierra Leone, Liberia, Haiti, Kosovo
and Nicaragua - we consider places like Malawi and Burkina Faso our easy
countries. Remarkably, we found local churches who had survived many
atrocities and changes in government with whom to partner. Lessons
learned in these environments have also helped us understand the
complexity and cross cutting nature of AIDS.

From the start our interventions have integrated prevention, care,
counseling and economic strengthening with the common foundations of
family and community and the church. We have worked hard to integrate an
appropriate response to HIV/AIDS into our microenterprise development,
maternal child health and youth programs to realize greater impact and
more efficient use of our resources.

While we want local programs to be locally initiated and locally driven,
we feel that as an NGO, WR has a role in representing our field work in
professional forums and bringing best practices from professional forums
to the field.

None of us have all the answers or even the abilities to fully apply the
answers we are discovering. We need one another and should value and
respect what each one brings to the table and challenge each other to do
our best for the common good. In spite of the development world being in
silos, cross-sectoral understanding and partnerships are essential. If
there is a silver lining in the dark cloud of AIDS, it is the way it has
brought diverse individuals and groups together who normally would not
be talking or sharing lessons learned. There are ways, albeit not easy
ones, to collaborate with one another and to forge multi-sectoral
alliances---what is required is our will to make them happen.

World Relief has worked hard is to get HIV/AIDS on the agenda of the
practitioner networks to which we belong: the Small Enterprise Education
and Promotion (SEEP) Network and the CORE network whose focus is
maternal and child health. I have the privilege of facilitating the
working group on HIV/AIDS and microenterprise development at the SEEP
Network and our health director Dr. Long has helped forge the AIDS
agenda for the global health network, CCIH, Christian Communities for
International Health, where he serves as president .

We have also encouraged this dialogue at the national level in countries
where we have a presence. For example, in Cambodia and the Philippines,
World Relief has sponsored forums that brought the economic and health
sectors together to discuss cross-sectoral collaboration for HIV/AIDS.
In Rwanda, we helped establish the Rwanda Microfinance Forum, a group
well aware of the economic issues of HIV/AIDS, addressing economic
coping strategies and promoting AIDS education to member organizations.

World Relief helped form a network of local and international NGOs in
Malawi that were not only HIV/AIDS specific but multi-sectoral. The
network meets quarterly to inform each other of events, materials
developed and lessons learned.

In Kenya our staff was on the organizing committee of the Kenya AIDS NGO
Consortium (KANCO) with present membership over 100 local and
international NGOs working in Kenya.

Information is vital to share. For that purpose we attend and present at
international forums including the global International AIDS
Conferences, the International Conference on AIDS and STDs in Africa,
the Microcredit Summits in Asia and Africa and the US and conferences,
townhalls, committees etc here in Washington, DC.

**The involvement of people living with HIV/AIDS in World Relief's
work:**

World Relief's program staff and volunteers are predominately nationals.
They are exceptional people with a desire to serve and to help the least
fortunate in their communities. AIDS has touched all of their lives.
World Relief has lost valued and beloved staff and our staff has lost
countless family members. Those of our staff who are HIV positive bring
a valuable dimension to their work through their acceptance and openness
about their status. Albertima serves on World Relief's AIDS team in
Mozambique. She is HIV positive but still healthy and wants to squeeze
every drop out of life. An accomplished cake decorator, hair stylist and
singer, her latest goal is to learn to drive an 18-wheeler and repair
diesel engines. Tima's courage and willingness to share her personal
battle with AIDS inspires others who are afraid to open up. Many of our
community volunteers and some community members have willingly shared
their HIV status and have become spokespersons and role models for those
around them. Youth volunteers involved in our home care program are
known to take prevention more seriously as a result of regularly
ministering to people who are dying.

**Conclusion:**

I have prayed for years for the day when our government would make an
appropriate commitment to stem the tide of HIV and AIDS to alleviate the
great suffering it brings. It appears that day has come. My new prayer
is that not a cent should be wasted on hasty or cosmetic efforts, that
we would work in a spirit of cooperation and most importantly that
because of our joint efforts, those who have felt forgotten and
dismissed for so long would have new hope for the future.

\*\*\*

Laura van Vuuren serves as a technical advisor for dialogue education
and behavior change and the integration of HIV/AIDS into World Relief's
development programs. She has pioneered cross-sectoral efforts between
HIV/AIDS and microenterprise development and facilitates a practitioner
working group through the Small Enterprise Education and Promotion
(SEEP) Network. Laura spends time in Africa each year training trainers
in dialogue education and adapting materials. She has also authored AIDS
prevention and care curricula for group-based learning. Previously Laura
directed World Relief's community development programs in Malawi and
Swaziland where she lived from 1987 to 1995.