Poverty, HIV and AIDS – the challenge to the Church in the new millennium
Action plans to mobilize the church towards HIV/AIDS prevention, care and support in South Africa

Christo Greyling – a hemophiliac who tested HIV positive while attending theological seminary in 1987.  Since 1993 he started working as an AIDS consultant.  In the process he developed, implemented and presented HIV/AIDS workshops to various target audiences throughout South Africa.  His vision and passion is to assist the church to fulfill their calling on the terrain of HIV and AIDS in Southern Africa.

HIV/AIDS is devastating the world, and especially Southern Africa.  This article attempts to provide an understanding of the impact of the epidemic on South Africa and the relationship between HIV/AIDS and poverty.  It will further explore the current involvement of the church and make some practical suggestions to assist the Church in implementing meaningful projects in its fight against this epidemic.

AIDS.  AIDS.  AIDS.  We hear it on television and read it in the newspapers.  The desperate faces of people dying from AIDS cry out at us from the pages of Time and Newsweek.  The United Nations have special meetings and government leaders make resolutions.  We are swamped with statistics and yet more statistics.  The numbers of people dying, becoming infected and children left orphaned become just an incomprehensible bundle of figures.  People are beginning to experience AIDS fatigue: “Please, not AIDS again!”

But the reality we face does not go away.

1          The reality

Let’s consider the reality we face in a different way:  An estimated total of 55 million people died during World War II:

1. 25 million military personnel
2. 25 million civilians
3. 5 million Jews.[1]

If we knew today that World War II would start next week or next year, what would we do to prevent the slaughter of millions of people?

1.1        Global situation

Reality is, we are twenty years into the HIV/AIDS epidemic.  Since 1981 HIV/AIDS has spread rapidly to every part of the globe, infecting 58 million people and killing 22 million by the end of 2000.

Worldwide 36.1 million people are currently living with the disease, the vast majority - 25.3 million - in Sub-Sahara Africa where 3.8 million were infected during 2000 alone.[2]

The overwhelming majority of HIV infections, around 95% of the global total, live in the developing world. This is a proportion that is set to grow even further as infection rates continue to rise in countries where poverty, poor health care systems, and limited resources for effective prevention and care fuel the spread of the virus.

Sub-Sahara Africa is the worst affected region with around 70% of the global total of HIV-positive people. Most of these infected populations will die in the next 10 years, joining the 17.2 million Africans already claimed by the epidemic.

The war is on!  What are we, and the church as messengers of Hope, actually doing to prevent the loss of so many human lives?

1.2        South African situation

1.2.1       HIV infections

An estimated 4 million South Africans are currently HIV infected.[3]  This number is expected to rise over the next 10 years – unless major behavior change occurs that could significantly alter the course of the epidemic.  There could be around 5.3-6.1 million infected individuals by 2005, and 6 to 7.5 million by 2010.  Currently just over 50% of all new infections occur in South Africa.

Approximately 15% of all South Africans aged between 20 and 64 are infected and these levels could rise to 20-23% by 2005 and 22-27% by 2010.  HIV is a disease that mostly affects younger people.  Almost half of all adults will become infected before they turn 25.  More than 50% of these young people will die before their 35^th birthday.

HIV infections will continue to increase until society at large appreciates the extent of the epidemic, and people alter their behavior and their response to those people who are infected and affected.

For many people, this has been a sustained epidemic of infection without illness. As more infected individuals become ill with AIDS, the epidemic is becoming more visible.  Due to the scale of this epidemic the life of every person in the country is bound to be affected in some way.

1.2.2       AIDS deaths

The number of deaths as a result of AIDS is expected to rise rapidly in South Africa from around 120 000 in 2000, to between 354 000 to 383 000 in 2005, and up to 545 000 to 635 000 in 2010.  Again, other sources suggest that AIDS may result in 800 000 deaths in 2010.  Nationally the proportion of the adult population dying from AIDS will reach 2 to 2.6% by 2010.  At an AIDS in context conference in Johannesburg, 2001, Debbie Bradshaw from the Medical Research Council of South Africa showed that information gathered from death certificates suggest that already half of all adult deaths can be attributed to AIDS.  It is clear that the devastating impacts of this epidemic are already being felt.

1.2.3       Impact on Women

Women are heavily affected by the epidemic. They are at greater risk of infection due to physiological, anatomical and socio-economic reasons.

Physiologically the lining of the vagina thickens due to hormonal changes at the age of 15-16 to prepare the body for sexual intercourse.  Should a young woman become sexually active before this age, the lining of the vaginal wall could easily rupture which would make her more vulnerable to the transmission of HIV or sexually transmitted infections (STIs).

Anatomically women are the receivers of sperm, and this longer contact with possibly infected semen increases the risk of transmission.[4]  Women might even be more at risk to infection due to undiagnosed STIs inside the vagina.  The cultural practice of dry sex – inserting leaves, tissues or tightening agents into the genital tract to pleasure their men – is also wide spread.  It puts a woman at enormous risk for contracting HIV and STIs, as the dry membrane inside the vagina ruptures easily and torn lesions provide easy access to the HI-virus.  Mucous also contains immune cells, which gives added protection against infection.[5]

Socio-economically women often lack the power to negotiate safer sex or the use of contraceptives, be it with her own regular partner, as a sex worker, even sometimes within marriage if she doubts the faithfulness of her husband, and certainly during rape.  Socially she might be under the sexual control of her partner who provides for her and her children.  There are also many different cultural practices in various societies that traditionally place the women in a disempowered position.  Polygamous marriages are still a common practice; as is the brother of a dead man taking the latter’s widow and progeny under his care and protection; and rape is common in all societies, especially those ravaged by war, violence and discrimination.

Women-headed households in South Africa tend to be poorer than those headed by men, and therefore have fewer reserves.  Unemployment is far higher among women than men.  Even among married women there is a high level of economic maltreatment.  A recent survey indicated that the partners of one in five married women regularly withheld money for essential living expenses such as food, rent or bills, while spending money on other things[6].  Violence against women is high - 13% of women reported being beaten by a partner.  Many women face the risk of abandonment and abuse if they disclose their HIV positive status.  Women traditionally provide care to the terminally ill and female children in particular may be required to provide care, especially in single-parent households or when one parent has already died of AIDS.  Widows may become dependent on a husband's male heir for support under some customary legal arrangements, which may make them more vulnerable.

1.2.4       Orphans

Orphans are perhaps the most tragic and long-term legacy of the HIV/AIDS epidemic. Of the more than 13.2 million AIDS orphans, over 90% are in Sub-Sahara Africa.  Caring for them is one of the greatest challenges facing South Africa. By 2005 an estimated 1 million orphans will be under the age of 15, rising to about 2.5 million in 2010. The majority of these orphans will be children over 4 years of age.

Many orphans will grow up as street children or will form child-headed households to avoid being separated from siblings.  Others will be brought up by grandparents with limited capacity to take on parental responsibilities.  All will have been traumatized by the illness and death of parents, and often by separation from siblings.  Trauma will be exacerbated by the stigma and secrecy around HIV/AIDS that hampers the bereavement process and exposes children to discrimination in their community and even in their extended family.  Orphans will probably be more susceptible to becoming HIV-infected through abuse, sex work or emotional instability leading to high-risk relationships.

As children grow up under these conditions, they are at high risk of developing antisocial behavior and of becoming less productive members of society. The consequences for affected children and society as a whole will be profound.

If we consider all the above-mentioned statistics and realities, how prophetic do the words of the assassinated ANC leader, Chris Hani, now ring in our ears:

We cannot afford to allow the AIDS epidemic to ruin the realization of our dreams.  Existing statistics indicate that we are still at the beginning of the epidemic in our country.  Unattended, however, this will result in untold damage and suffering by the end of the century (AIDS conference in Maputo, 1990).[7]

1.3        Why is the South African epidemic so severe?

There are a number of predisposing factors that have made and continue to make South Africans susceptible to a particularly severe epidemic. These include:

• Established epidemics of other sexually transmitted diseases (STDs). These increase the likelihood of HIV transmission.
• Good transport infrastructure and high mobility, allowing for rapid movement of the virus into new communities.
• Resistance to the use of condoms, based on cultural and social norms.
• The low status of women in society and within relationships. Economic dependency and the threat of physical force in particular, make it difficult for women to protect themselves from infection.
• Social norms that accept or encourage high numbers of sexual partners, especially amongst men.
• Parallel norms that frown on open discussion of sexual matters, including sex education for children and teenagers.
• Disrupted family and communal life due, in part to apartheid, migrant labor patterns and high levels of poverty in the region.

In a sense HIV/AIDS is repeating what apartheid did - marginalizing a section of the population and tearing families apart. People who are infected and directly affected by HIV/AIDS are stigmatized and discriminated against - even by their very own family members.  As was the case during apartheid, women and children bear the brunt.  Their vulnerability and powerlessness in the face of the onslaught of HIV/AIDS are made worse by poverty, patriarchy and violence.

2          The relationship between Poverty and HIV/AIDS

2.1        HIV/AIDS and poverty are closely linked and each in turn increases the other:

• HIV/AIDS increases poverty and poverty increases the risk of HIV infection and the impact of HIV/AIDS on families and communities.

2.2        How does HIV/AIDS increase poverty?[8]

• As a person progresses from HIV infection to AIDS, they suffer many bouts of illness for which they seek treatment.  In the process they spend money on medical care, traditional healers, etc. as well as on nutrition and supplements to help them remain healthy for a longer period of time.
• When a family member has AIDS, a large portion of the family income is spent on medical care, food and other needs for the sick person.  Often the family income is already reduced as a result of the person with AIDS being unable to work.
• Those members of the household who are in the weakest positions suffer the most – in affected households, health expenditure for the infected person increases while spending on food and other essentials decreases, impacting on women and children.
• Household reserves are slowly eroded as income decreases and medical needs increase over time.
• Burial costs are increasing due to the shortage of grave space in urban cemeteries (a grave in a township can now cost R3, 000 just for the plot).
• Funerals are a very important element of cultural tradition and a great deal of money is spent on food and drink for the duration of the funeral.  Funerals extend over a number of days and are attended by family, extended family and the community at large.  Therefore funerals continue to be costly and consume valuable resources, which could have been used by the surviving family members.  The impact of a death is most serious on poorer households.
• Many employers, seeing the impact of HIV/AIDS on their workforces, are not employing staff with full benefits, but rather take them on as temporary staff with no benefits such as medical aid, etc.  This means that pensions, etc. will not be available to meet family needs when they are most needed and payouts will no doubt be consumed as they are received, not invested or kept until all other resources have been exhausted.

2.3        How does poverty increase the risk of HIV infection and worsen the impact of HIV/AIDS on families and communities?

• Poverty reduces children's chances of attending school, which in turn lowers their chances of gaining employment and increases their risk of HIV infection.  Children often have to drop out of school to care for sick family members, for their younger siblings or to look for work.  Children lose the chance to “be children” because of these additional burdens.
• Poverty increases the likelihood that young women (and men) turn to commercial sex work, selling their bodies to survive, to gain an income to support younger siblings, to secure their next meal, to gain shelter, money for school fees, etc.
• Young people living in poverty often have low levels of self-esteem and desire the material things which their friends have, which may put them at risk of HIV infection through becoming involved with “sugar daddies”, taxi drivers, etc. – people who can give them the material things they wish for.  “Gift sex” is not seen as prostitution, and is extremely common in many societies.
• As parents fall ill with AIDS, they afford time to parenting their children, leading to risk-taking behavior among young people due to the lack of attention and guidance they receive. Risk behavior often leads to unsafe sexual activity and, in turn, to HIV infection.
• Some children are intentionally neglected and abused or forced to take on household tasks when they are taken in by relatives or other families due to the illness or death of their parents – they are also at risk of HIV infection as their own self esteem plummets due to this abuse.
• According to home based care providers[9] many AIDS patients die of malnutrition and not primarily of AIDS-related illness – people simply do not have sufficient food, leading to premature death even in the face of AIDS.

3          Role of the Church

3.1        Current situation

It is with gratitude and appreciation that we see the church nationally and internationally slowly, but surely, waking up to the crisis in our midst.  It is very sad to note that this is only happening after 22 million people have already died and twenty years into the epidemic.  As it very often happens, the church lagged behind humanistic groups, NGOs, and even governmental initiatives.  Some denominations, such as the Anglican and Roman Catholic churches, are exemplary in their compassion and implementation of home based care and orphan care programs.  Some isolated initiatives from evangelical and Pentecostal or Charismatic churches are commendable, but as a whole the church’s reaction is led by the passionate few.

Wonderful resolutions have seen the light.  For example: already in the early days of the epidemic, in April 1988, the Council of Bishops from the United Methodist church made publicly declared their concern:

We, the Council of Bishops of The United Methodist Church, join our voices and concern with those of other religious and community leaders in the face of what is proving to be a global concern - the existence and spread of Acquired Immune Deficiency Syndrome. Perhaps, no disease in recent memory threatens the human family in such proportions, as does this phenomenon[10].

This was followed in 1992 by a resolution from the United Methodist Church, which stated:

As members of the United Methodist Church we covenant together to assure ministries and other services to persons with AIDS.... We ask for God's guidance that we might respond in ways that bear witness always to Jesus' own compassionate ministry of healing and reconciliation; and that to this end we might love one another and care for one another with the same unmeasured and unconditional love that Jesus embodied." [11]

These, and other later resolutions by various denominations demonstrate an understanding and a theological commitment that faith communities must become involved, but at grassroots level, i.e. at congregation level, not much is happening.  This is even true about many of the above-mentioned denominations that are already very much involved.

During the time of apartheid, Christian churches nationally and internationally were very vocal and active in their fight against discrimination as it was implemented by the South African government of the time.  It even led to the official adoption of the confession of Belhar by the Dutch Reformed Mission Church in South Africa [12] in 1986.  Section 4 of this confession states:

We believe that God has revealed himself as the One who wishes to bring about Justice and true peace among men; that in a world full of injustice and enmity He is in a special way the God of the destitute, the poor and the wronged and that He calls his Church to follow Him in this; that He brings justice to the oppressed and gives bread to the hungry; that He frees the prisoner and restores sight to the blind; that He supports the downtrodden, protects the stranger, helps orphans and widows and blocks the path of the ungodly; that for Him pure and undefiled religion is to visit the orphans and the widows in their suffering; that He wishes to teach His people to do what is good and to seek the right; 

that the Church must therefore stand by people in any form of suffering and need, which implies, among other things, that the Church must witness against and strive against any form of injustice, so that justice may roll down like waters, and righteousness like an ever-flowing stream;

that the Church as the possession of God must stand where He stands, namely against injustice and with the wronged; that in following Christ the Church must witness against all the powerful and privileged who selfishly seek their own interests and thus control and harm others.

It is clear that the confession of Belhar, as it was written in the high time of apartheid, is still highly relevant in the year 2001.  God is still ´… in a special way the God of the destitute, the poor and the wronged…” and “…that the Church must therefore (still) stand by people in any form of suffering and need…”  God’s call on us to demonstrate His grace, compassion, love and forgiveness rings true through the ages, also the age of HIV/AIDS.

The harsh reality is that HIV infected and affected people experience the Church as silent and absent in their suffering.  Paper reflects beautiful written resolutions, but no message of Hope sounds from the pulpits.  Religious leaders and Christians deny that Christians could be HIV infected.  Expressed or implied, the following is very often the feelings expressed by congregation members and religious leaders: “It’s not our people”;  “They brought it on themselves”;  “They sinned!”  “They were sleeping around”;  “It’s Gods punishment for a promiscuous life!”  It is clearly a “them” versus “us” situation with a very judgmental undertone.

The majority of Christians, including the religious leaders, would strongly deny that they could ever by judgmental, but in their silence and lack of interest to become involved, they demonstrate their lack of compassion for people infected or affected by HIV/AIDS.

It appears as if Christians concentrate on God as a Righteous God.  While reading Colossians 3, which teaches us the rules of holy living as new people in Christ, many Christians seemingly concentrate on the first part of this chapter:

⁵Put to death, therefore, whatever belongs to your earthly nature: sexual immorality, impurity, lust, evil desires and greed, which is idolatry. ⁶Because of these, the wrath of God is coming. (NIV)

But in their thinking about HIV/AIDS and people living with HIV/AIDS, they do not apply the rest of the text, which states:

¹²Therefore, as God's chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience. ¹³Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you. ¹⁴And over all these virtues put on love, which binds them all together in perfect unity. (NIV)

It is as if Christians want to protect God and feel comfortable with the righteous God, but they feel very uncomfortable with the Vulnerable God who shared his life with sinners, who had compassion for them, loved them unconditionally, forgave them, and died for them.

As we know so well, God calls us to renewed thinking and actions. We are Christ's ambassadors, whose love compels us, and who gave us the ministry of reconciliation:  that God was reconciling the world to himself in Christ, not counting men's sins against them.  2 Cor 5: 14-19 (NIV)

To be relevant as Body of Christ in the new millennium, HIV/AIDS challenges us to demonstrate this ministry of love and reconciliation, as Christ would have done it.

3.2        The Need

As a result of the current situation, HIV positive people and their families are afraid to trust the Church.  They are afraid to be judged or rejected by the ones they hope would accept them with love.  The reason therefor lies in the fact that these people do not hear God’s heartbeat for HIV positive people through the church.  They do not see the church’s involvement in terms of HIV/AIDS around them.  The result is that these people suffer without the support from the faith communities they belong to.

As we’ve already seen, most people with HIV/AIDS come from disadvantaged, poverty stricken communities. As a result of apartheid those that “have” do not have any contact with people from these communities, and therefore are not aware of the extent of need in these communities.

3.3        The opportunity

In Uganda, who first experienced the brunt of the African AIDS epidemic in the early 1980s, the church played a major role to turn the tide.  They stopped asking, “How did you get it?” and realized it was their congregation members, or their families, who were dying and instead started to demonstrate their love, compassion and care.

In a speech delivered to religious leaders from all the major faith groups Dr. Zola Skweyiya, Minister of Social Development of South Africa said:

Faith-based organizations and their agencies possess extensive and effective networks throughout our country. They are committed and closest to the disempowered and most vulnerable members of our society.
There is therefore no way that the government, the business sector or local Communities will succeed in the battle against HIV/Aids acting on their own.
The partnership against HIV/Aids requires the resolute leadership and sustained involvement of the religious sector in all facets of the epidemic. [13]

It is wonderful to see that the South African government realizes the importance of the role of faith communities at large in the fight against HIV and AIDS, and the fact that government would not be able to succeed in this quest without the buy-in of the faith communities.

The opportunity to illustrate what we stand for is knocking on our door and if we want to demonstrate our relevancy in the world, this clearly is the chance to do so. The Church should be in the front line of the fight against AIDS because we are the largest social institution in South Africa.  Everywhere in this country - in every small little town and big city there is a church congregation within reach.  The Church has tremendous infrastructure.  There are more kitchens standing empty for most of the week than in all the fast foods outlets combined[14].

The majority of churches have well developed social actions with excellent infrastructure and professional people.  Human resources - we have a wealth of potential in congregation members with a variety of passions and gifts, who are already internally motivated as Christians to make a difference.  The Church has an ethic of sexual responsibility and of caring for others.  In many congregations, especially in congregations serving the more privileged white communities, there is a wealth of professional people whose expertise can be mobilized to build skills in areas that desperately need them.  We now have an excellent opportunity not only to address HIV and AIDS, but also to address other issues such as poverty alleviation and the development of desperately needed skills at the same time.

But, above all, we as Church of Christ, which knows what it is to be forgiven and to be renews by grace alone, we have the platform to demonstrate unconditional love, forgiveness and acceptance.  We have a message of Hope in the risen Christ that is not only true for the dying, but has an existential life changing message for people infected and affected who are living and facing the harsh realities of HIV/AIDS today.

The link between HIV/AIDS, poverty and apartheid is clear.  The Afrikaans churches played a leading role in the institution of apartheid.  These churches have a wealth of skills within their members.  HIV/AIDS presents them, and all the other churches in South Africa, with the opportunity to bring a divided church together.  This is the chance to go beyond guilt to fight a new common enemy.  This is an opportunity to demonstrate reconciliation in action.

But to achieve this, the churches, their leaders and congregation members, need to be effectively mobilized to understand the extent of the problem, to develop compassion and to know where and how they can start to make a difference.

4          Action plans to mobilize the church

If the church wishes to be true to its calling, it will have to be a space where those infected and affected by HIV will feel safe to share their pain.  Influential leaders and opinion makers in the church will understand the impact of HIV/AIDS on South Africa. They will continuously stress the need for religious leaders and congregations to become actively involved in HIV/AIDS prevention, support and care programs in their communities.  Pastors will be sensitized for the need and understand the importance of their support for congregation based AIDS programs.  Congregations and church members will take responsibility for values based prevention programs and practical support and care programs within congregations as well as in distressed communities.  Support services such as program guides, sermon outlines and liturgies, training programs, resources, courses, etc. will be available for the various prevention, support and care programs.

4.1        Elements in a church based AIDS plan

To reach this ideal, the following elements for an integrated Church based AIDS plan can be implemented:

1. Sensitizing and Training programs
2. Support, Counseling and Care programs
3. Information and Prevention programs
4. Continued facilitating, training and vision building

4.1.1       Sensitizing and Training programs

4.1.1.1     Sensitizing of Church Leadership

Very few of the influential church leaders within most of the churches have been personally confronted with the realities of HIV/AIDS.  To mobilize them to become ambassadors for the fight against HIV and AIDS within the church, they themselves will have to undergo a life changing experience.

A sustained change of heart does not occur by reading an article such as this.  It is something that only happens as part of a process.  AIDS programs that successfully achieve this change would include the following elements:

• Challenging attitudes towards people living with HIV and AIDS
• Sharing up-to-date epidemiological data on the impact of the epidemic
• Providing in-depth information on the transmission of HIV, prevention strategies, treatment options, etc.
• Exposing participants to HIV infected and affected people who share their life stories with the group
• Explaining the emotional phases and needs experienced by people living with HIV as the illness progresses.
• Providing a strong theological input on the heart of God and his calling on his church in the age of HIV /AIDS which could guide them in a pastoral approach to HIV/AIDS in their sermons and ministry.
• Exposing them to NGO’s, etc. that are already involved with different care projects, and that can share the needs of the communities they work in.
• Providing enough time for participants to plan what can be done at local level.

Church leaders at all levels of church leadership need to experience this sensitization.  This includes top leadership, key decision makers and opinion leaders.  But the main focus should be on sensitizing local religious leaders.  For specific church groups this implies organizing such workshops in their local regions, e.g. circuits and local synods.

Experience has proved that these workshops should not form part of scheduled annual meetings, where full agendas tend to push the importance of spending enough time on this process to the periphery.  These workshops can also be organized for local ministers’ fraternals or as interfaith workshops for an area.

These workshops are not intended for those who are already informed, or those who already have a passion and compassion for those infected or affected by HIV/AIDS.  It is intended for those who have done nothing, know very little, who might even be very skeptical, but know that the church must do something, but do not know where to start.

These workshops are truly sensitizing workshops, which aim to bring about a mind and heart change.  It opens up new angles and possibilities for the ministry.  Therefore these workshops need to be followed up with other workshops to fulfill specific needs that might develop as a result thereof.

Students at theological institutions, youth leaders in training, social work students, etc., who are on their way back into the church or communities must undergo such a sensitizing workshop while they are still at college or university.

4.1.1.2     Congregation based peer workshops

It is my conviction that we will not impact significantly on preventing new infections and the growing caring needs, unless the church becomes involved at grass roots level.  It means that congregation based AIDS actions groups should be established to target prevention and care initiatives within the congregation and the surrounding communities.

To inspire a congregation to initiate such AIDS based action groups which will activate prevention, support and care programs within the congregation and their community, again forms part of a process.  This process entails the selection of people from a number of congregations within a specific community to attend a four-day workshop.  During this workshop they are confronted with HIV/AIDS in different ways, they begin to understand the need, they grow in compassion and commitment to go back and to do something within their own congregation and community.

This congregation based peer model is based on the very successful “I have Hope “ AIDS peer group model[15], which was originally developed as a secondary school based HIV/AIDS peer program.  In its adapted form such a peer workshop will include the following key elements:

Phase 1: Selecting Key People:

Selecting the right people to attend this workshop is crucial for the success of the project.  Six key representatives are selected from a maximum of nine congregations.  These people must be able to initiate and steer a congregation based AIDS action group after the workshop.  They must also represent the different ministries within the congregation.

Phase 2: Peer workshop – challenging knowledge, attitudes, beliefs and practices on HIV/AIDS.

This phase constitutes a four-day workshop presented in a fresh, interesting and practical way.  The workshop has the following five components:

• Sensitizing – Attendees are exposed to their own prejudices through discussions about how they practically deal with HIV and AIDS issues on a daily basis.  These discussions often highlight their lack of knowledge and lay the foundation for the rest of the project.
• Sharing information – Basic and in depth facts are shared on how the virus works, the progression of the disease from infection with the HI-virus to the AIDS stage, the transmission of the virus, treatment options, etc.  AIDS cannot be separated from human sexuality; therefore it is important to discuss all issues around sexuality, gender roles, assertiveness and negotiating skills.
• Facing reality – Many attendees have a ‘they asked for it’ attitude towards people who become HIV infected.  Through discussions, visits to AIDS service organizations where they interact with children who are HIV infected or people in the terminal stages of AIDS, and meeting those who make a difference by caring for these children or people with AIDS, this component puts a ‘face’ to HIV and AIDS.  By interacting with HIV positive people who share their hopes, disappointments, fears and dreams, they experience first hand the impact of the disease.

This is the critical point of departure for many attendees – for the first time the peer leaders realize that it could easily be someone they know and love. Due to the emotional impact, they are encouraged to share their experiences with one another.  As a symbolic gesture, they are encouraged to light a candle in celebration of life.  This is when it becomes evident how their attitudes had changed and when they become committed to making a difference.

• Understanding the need – During the third day, the attendees are exposed to some of the programs, projects, etc. that are already being implemented in their area by health services or NGOs.  They learn about the needs, the pitfalls, the successes and where and how they can make an impact.
• Planning ahead – After being changed themselves, and being exposed to the opportunities where they can become involved, the attendees then plan how they envisage conveying the message in their congregation and within their communities, and how they can give practical assistance to HIV/AIDS service organizations.  They must assure that their local congregation communicates its commitment and heart by the implementation of prevention, support and care projects.  They are encouraged to be creative in this process, to enable them to adapt communication methods to their unique environments.

Phase 3: Reaching out:

Plans made at the workshop then need to be translated into actions. Over the next months peer group leaders implement their innovative and creative projects in their congregations and communities.  They are encouraged to link these projects to every existing ministry of the congregation, but also to develop new angles as they are confronted with new needs.  It is essential that these action groups do not reinvent the wheel, but link with community based NGOs and care centers to strengthen their existing projects.  To motivate and keep activity levels high, and to ensure that they forge relations with community AIDS organizations, follow-up sessions are conducted with the attendees.  Other congregation members are encouraged to join the initial peer group to strengthen and broaden the reach of the congregation’s involvement in the community.  Through their initiatives, the action group will ensure that the congregation becomes a safe haven for HIV infected and affected people where they will be welcomed and cared for with the love, care and compassion of Jesus Christ.

4.1.1.3     Training of trainers

It is clear that, although these sensitizing workshops and congregation based peer groups are effective in changing attitudes and mobilizing congregations into action, it is a very time consuming process.  There are no short cuts in this process, and therefore it would be essential to train trainers from a variety of religious groups, denominations, culture, and language groups to take this message forward.

4.1.2       Information and Prevention programs

The pursuit of an AIDS vaccine remains a critical international goal and significant and increasing funds have been made available for this purpose.  Clinical trials of vaccine candidates are presently underway.  Despite this, an affordable AIDS vaccine for South African risk populations is unlikely to be a reality in the foreseeable future.  Therefore, efforts to achieve social mobilization towards healthier and safer sexual behavior need to be significantly increased and sustained.  Data presented earlier have shown continuous high rates of HIV infection in the sexually active population, which indicates a high level of high-risk sexual behavior.

For example, data from the Demographic and Health Survey of 1998 indicate early onset of sexual activity and low condom usage.  The survey showed that approximately 35% of non-married women, aged 15 to 19, had at least one sexual partner during the previous 12 months, and that only 16% of all women interviewed had used a condom in their last sexual encounter with their non-spouse partner. Secondly, findings from a national survey of South African teenagers, published in 2001[16], suggest that approximately one third of boys and girls, aged 12 to 17, have had sexual intercourse and that one in five of this group reported having their first sexual experience at the age of 12 or younger.  Forty one percent of sexually experienced young people in this survey said they did not always use a condom when having sex[17].

A further example demonstrates that people have a good knowledge of HIV/AIDS, its mode of transmission, and how it can be prevented but often fail to act on this.  A study conducted in the mining community of Carltonville indicated that the majority of responders correctly answered all questions regarding risk factors for infection and modes of prevention.  However, there was a weak relationship between perceived risk of infection and actual infection with 22% of those who thought they were at low-risk being infected, compared to 29% of those who thought they were at high risk.  Of those who had no opinion as to their risk status, 36% were infected.  Men surveyed reported using condoms in less than 25% of contacts with non-regular partners and in less than 5% of contacts with their regular partner[18].

The greatest barriers to achieving HIV prevention are fear, denial and ignorance.  HIV prevention efforts have been plagued above all by silence brought on by the denial and stigmatization that is associated with the disease.  In one study of home based care schemes in Southern Africa, fewer than one in ten people who were caring for an HIV-infected patient at home acknowledged that their relative was suffering from AIDS.  Patients themselves were only slightly more likely to acknowledge their status.

There are also fears that concerted calls for the wide scale provision of anti-retroviral drugs could undermine prevention efforts.  The success of prevention efforts are already regarded with some pessimism despite convincing scientific evidence from other highly affected, poorly resourced countries with plummeting rates of infection as a result of sustained and well targeted prevention efforts.  This pessimism could be compounded if risk populations perceive anti-retroviral drugs as a curative solution to HIV infection.  Scarce resources for HIV prevention efforts may also be diverted to the provision of these drugs.

Once effective youth interventions are adopted, their success will depend on how they are implemented and sustained.

It is clear from the above that the Church must join the State, employers, schools, non-governmental and community-based organizations in their quest to implement effective, sustainable and cost-effective HIV prevention programs.

The church's contribution can include nurturing and teaching values through life skills programs based on principles from the Word of God.  In the process it can help to shape and support relationships built on respect and gender equality.

A prevention program within the church implies that we have to break through traditional taboos such as talking openly about sex and sexuality with young people.

Prevention programs within the church in South Africa should focus on young people before they become sexually active, but they cannot exclude adults, as many adults within churches are also engaging in high-risk behavior.  Youth prevention programs must be supported by parental guidance programs, which would assist them in talking to their children about sex and sexuality from a Biblical perspective.

Three elements that can strengthen church based prevention programs include:

• The development of values-based life skills programs for young people presented in the church and in schools.  A variety of Christian youth organizations and experts on outcomes-based youth education programs are currently collaborating to develop such a life skills curriculum.  “Values do matter” does not address HIV/AIDS in isolation, but attempts to address HIV/AIDS within the widest context of living according to the values God teaches us in his Word.
• Congregation based HIV/AIDS youth peer programs that function on the above principles can be implemented.  These young people can, in their own unique way, contribute to reduce new infections amongst their friends.  They will also be instrumental in addressing the topic of sexuality, changing attitudes towards HIV positive people, and assisting in the development of their own decision making skills and those of their friends.
• Training of community based HIV/AIDS Service Year teams to act as role models for young people. They can also help with values based life orientation programs in congregations and schools and serve in AIDS service organizations.  For the past 10 years a number of Church denominations and Christian youth organizations such as Youth for Christ, Scripture Union and the United Christian Student Association (UCSA) train young people who commit as full-time volunteers for at least one year to work with youth.  The teams are trained annually in January and February and work in specific fields (e.g. adventure programs, primary schools, tertiary institutions) during the year.  During 2001 UCSA piloted two community-based HIV/AIDS service year teams working in Thembisa and Stellenbosch. 
  
  These teams work as volunteers at existing care and prevention projects and mentor youth peer group leaders in congregations and schools.  In the process they enhance co-operation between local churches, NGO’s and government projects.  After a year of practical experience in the field of HIV/AIDS, these empowered team members will have a life long commitment to remain directly or indirectly involved in AIDS prevention, care and support.  As a result of their actions they also create a culture of youth volunteerism in the field of HIV/AIDS.

These initiatives can greatly enhance church based prevention efforts and therefore should be supported financially and otherwise to enable implementation throughout Southern Africa.

4.1.3       Support, Counseling and Care programs

4.1.3.1     Care programs

As South Africa’s epidemic is progressing into an advanced stage, the need for support, counseling and care programs increase dramatically.  To illustrate the reality thereof consider that if the same levels of care as in 1995 were to be maintained, spending on public sector hospitals would have to increase 2.3 times.  Anecdotal reports exist of public hospitals refusing to admit patients at all if they test HIV positive, or refusing them any form of surgery even for trauma.  There will be increasing temptation to blame the victims of the epidemic for the strain on health services and to deny them access to basic care[19].  Clearly, the challenge for both public and private health care sectors is to shift to fundamentally more cost effective modes of therapy, rather than resort to irrational or even discriminatory exclusion from services.  This will encompass re-orientation towards lower-cost hospice-type care instead of acute hospitalization and consistent and substantial support to community-based care initiatives.

It is therefore evident that the Church will have to play a major role in future to initiate and support home based care programs for the terminally ill, children with HIV/AIDS and AIDS orphans.  Many such projects have already been initiated with great success by churches such as the Anglican, Roman Catholic and other churches.  It is essential that time is not wasted on reinventing the wheel.  In collaborating with these projects valuable lessons can be learned and time consuming and expensive pitfalls can be avoided.

4.1.3.2     Counseling services

Voluntary counseling and testing (VCT) is the process by which an individual undergoes counseling enabling him/her to make informed choices about being tested for HIV or not.  This decision must be entirely the choice of the individual.  He or she must be assured that the process will be confidential.  In areas where VCT has been applied correctly, it has proven to be very effective as prevention and care strategy.  VCT becomes an entry point to medical care for TB, STDs, home based care, preventative treatment for opportunistic infections.  Women who know their HIV status can receive counseling on all available prevention efforts for mother to child transmission, feeding options and family planning.  During counseling a person can also discuss the advantages and disadvantages of disclosure to one’s partner, but it also opens the door to ongoing emotional and spiritual care, legal and social services, and even social support.  Now a person can be assisted to plan for the future and the future of his or her dependants.

The church has a wealth of professional counseling services to offer via its professional services, but through counseling courses lay counselors can be trained to work in collaboration with local AIDS action groups, clinics or hospitals to deliver this essential service to communities.

4.1.3.3     Support.

HIV infected and affected people are reluctant to trust the church with their pain of living with HIV.  They are afraid they or their loved ones will be rejected or judged by the church community.  This will not change overnight in any congregation.  But with sustained marketing of their commitment to support, unconditional love and acceptance, and the practical demonstration through their care programs in the community, a local congregation can become the place of Hope it should be.  Support can be provided directly, through support groups and prayer groups, or indirectly through non-specific liturgical prayers for people infected or affected by HIV/AIDS.  In a congregation in Gugulethu (Western Cape, South Africa) ten minutes of each service is dedicated to people sharing their pain (and joys) of living with HIV.  At first the majority of people that shared their stories were not congregation members, but people who were open with their HIV status.  Initially there was no reaction, but listening to infected people sharing similar experiences indirectly supported those who were in fear of disclosing.  Gradually people started coming forward to share their pain.  Now this has become a regular liturgical setting for intercession.

It is essential that support would not only be provided to those infected or affected by HIV/AIDS.  The church has a major responsibility to the people working in the field of HIV and AIDS.  These include people involved with prevention programs, home based caregivers, counselors, etc.  These people are confronted with suffering and death on a daily basis.  They have to be prayed for and “sent out” as would be done with someone going to work as a missionary.  Retreats have to be organized to give these people a chance to rebuild spiritually.

4.2        Continued facilitating, training and vision building

None of the above can materialize and be sustained if there was not a process of continued facilitating, training and the crafting of a vision.  Religious leaders who are already tasked with many other functions cannot perform these additional tasks.  It demands a permanent one-stop center that could serve as a central office from which church based HIV/AIDS initiatives can be supported and developed, and from where information can be disseminated to the broader church community.  Such a center or centers will stimulate and co-ordinate activities and bring various role players and services together.  They can liaise with role players within the body of the church and outside the church to access possible resources.  They will also be responsible for compiling a resource list of available material, such as sermon aids and liturgies, prevention and care programs, course material, videos, workbooks, theological inputs, etc.  If such material does not exist, the center will be able to oversee a process to develop such material.  This center can assure that the Church media will continuously provide theological input on the church's responsibility to be involved in the fight against HIV/AIDS, but also to provide ongoing feedback on church based HIV/AIDS programs.  They will be responsible for the training of trainers to implement sensitizing workshops and congregation based peer workshops.

As part of their service to the church community, this one-stop center can also facilitate the development of a variety of training courses, such as home based care, counseling, etc.  These courses should be accredited to provide the participants with the opportunity to accumulate some academic credits that could result in a university degree.  For many South Africans this could result, not only in the much needed development of skills to fight HIV and AIDS, but in a dream come true.

5          Conclusion

The world, Southern Africa and South Africa is facing the worst catastrophe ever.  As Church we face a huge opportunity to demonstrate the unconditional love of Jesus Christ.  Mother Theresa once said:

The important thing is not to do a lot or to do everything. 
The important thing is to be ready for anything, at all times;
to be convinced that when serving the poor, we really serve God.[20]

May God find us doing just that in the time that lies ahead of us.