Hope and Dignity In the Developing World
www.crs.org
©Copyright 2009 Catholic Relief Services—United States Conference of Catholic Bishops. Published in 2009 by: Catholic Relief Services 228 West Lexington Street Baltimore, MD 21201-3413 Telephone: 410-625-2220 Internet: www.crs.org Email: HIVunit@crs.org
Project Coordinator: Daphyne Williams Graphic Design: Valerie Sheckler Cover Photos: Rick D’Elia, Rita Villanueva, Rick D’Elia, Sean Sprague, Dave Snyder
Acknowledgements: This publication would not be possible without the hard work of Catholic Relief Services country programs and local partners. The staff members in country programs and partner offices are the ones who make CRS’ great work possible. A heart-felt thank you is extended to all field staff, dedicated and committed to their work in HIV programming. We would also like to thank all Regional Technical Advisors for HIV, Country Directors and program staff who worked diligently to assist in the production of this document including: Michelle Lang-Ali, Gaye Burpee, Jack Byrnes, Ana Maria Ferraz de Campos, Lorainne Currie, Eda Cabaluna-Detros, Dr. Daniel Dharmaraj, Laura Dills Alexandre Diouf, Alemayehu Gebremariam, Candida Gil, Brian Gleeson, Brian Goonan, Alan Isaac, Tracy Kaye, Karen Kent, Natalie Kruse-Levy, Linda Lovick, Anna McCrerey, Pamella Mittelholzer, Cheryl Morgan, Flor Idalia Munoz, Shuhbra Phillips, Leslie Santamaria, Dorothy Madison-Seck, John Service, Mayling Simpson, and Kristin Weinhauer. Additionally, we would like to thank HIV and AIDS Unit and headquarters staff who assisted in the completion of this document including: Gabrielle Bielen, Caroline Bishop, Mychelle Farmer, Sharon Abrams-Gordon, Michelle Harrington, Carrie Miller, Mark Levy, Karen Moul, Prakash Nellepalli, Mary Riddick, Wendy-Ann Rowe, Shannon Senefeld, Carl Stecker, Jim Stipe and Daphyne Williams. We would like to thank Valerie Sheckler for her layout and design of this publication. Finally, we would like to thank the donors who enable us to implement such a wide range of HIV programming. Without your support, we would not be able to have such an impact. If you have any questions about this document or would like this document sent to you, please contact the HIV and AIDS Unit within the CRS Program Quality and Support Department at HIVunit@crs.org. Important Note: The photographs in this publication are used for illustrative purposes only; they do not imply any particular health status (such as HIV or AIDS) on the part of any person who appears in the photographs.
Hope and Dignity In the Developing World
Table of Contents
Introduction............................................................................................................................ 1 State of the Epidemic............................................................................................................ 2 Community-Based Care and Support............................................................................. 4 Orphans and Vulnerable Children................................................................................... 7 HIV and AIDS Prevention...................................................................................................10 Treatment—Antiretroviral Therapy...............................................................................13 Food Security and Nutrition.............................................................................................15 Livelihoods.............................................................................................................................18 Injecting Drug Use...............................................................................................................21 Prevention of Mother-to-Child Transmission..............................................................23 HIV and AIDS Policy and Advocacy................................................................................25 A Brief History of CRS..........................................................................................................27
Hope & Dignity in the developing world i
INTRODUCTION
In 25 years, HIV has infected almost 70 million people; AIDS has killed more than 25 million and affected millions more on every continent. The rising tide of illness and death—and the millions of orphans left behind—endangers the development of many regions of the world. Prolonged sickness and eventual death of those with AIDS diminishes a family’s ability to sustain its livelihood and a community’s ability to maintain social cohesion. Pressures on family and society affect the poor disproportionately. Young women, in particular, carry the greatest burdens and risks related to HIV. As Catholics, we are compelled to act. This catalog provides an overview of Catholic Relief Services’ HIV and AIDS programming around the world—which helps millions of the poor and vulnerable live longer, healthier lives. CRS supports more than 280 HIV and AIDS projects in 62 countries. We will continue to expand our programming as the disease continues to devastate lives of families and communities overseas.
Hope & Dignity in the developing world 1
State of the Epidemic rick d’elia
HIV, or Human Immunodeficiency Virus, is the precursor to AIDS. An HIV-infected cell works to produce new HIV retroviruses. HIV retroviruses replicate in and kill the cells that our bodies use to fight against illness. HIV is only spread through • D irect contact with needles and other sharps contaminated with HIV infected blood • Contaminated blood products and transplanted organs • T ransfer from an infected mother to her child during pregnancy, the birth process or breastfeeding • Sexual contact with an HIV-infected individual AIDS, or Acquired Immunodeficiency Syndrome, is the advanced stage of HIV infection. This stage is generally characterized by the appearance of opportunistic infections. These are infections that take advantage of a weakened immune system and can include pneumonia, tuberculosis and other crippling illnesses.
HIV and AIDS Quick Facts1 • I n 2007, there were approximately 33 million adults and children living with HIV and AIDS around the world. Sub-Saharan Africa is the worst affected region, with nearly 22 million cases. • T here were 2.5 million new cases of HIV in 2007, 420,000 of which were children under the age of 15. • I n 2007, there were 15 million children between the ages of 0-17 orphaned as a result of AIDS. • T here were 14.1 million women aged 15 and older living with HIV in 2007. • A IDS-related illnesses killed 2.1 million people worldwide in 2007 (1 in 6 were children). • A IDS is the leading infectious cause of adult deaths worldwide. • G lobally everyday, around 7,400 people become infected with HIV (1 person is infected every 12 seconds) and over 5,700 people die from AIDS (1 person dies every 16 seconds).
2007 Updates1 • H IV continues to be the most serious of infectious disease challenges to public health in the world. • T he global percentage of people infected with HIV remained steady in 2007. • T here was a decrease in the number of AIDS deaths in 2007 due to increased access to treatment and longer survival times. • T here were reductions in the percentage of people infected with HIV in some countries, such as Botswana, Rwanda, and Zimbabwe. • G lobally, in 2007, there was a decrease in annual new HIV infections.
1 UNAIDS (2008). 2008 Report on the Global AIDS Epidemic. Retrieved November 5, 2008 from www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp
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Haiti has an HIV prevalence of around 2.2 percent with more than 120,000 people living with HIV.
Latin America and the Caribbean have more than 2 million people living with HIV.
EPIDEMIC Women, HIV and AIDS HIV and AIDS affect men and women of every race, ethnic group and economic level. But women in the developing world face heavy economic, legal, cultural, and social disadvantages that increase their vulnerability to the epidemic’s impact. For example, families often withdraw young girls from school to care for family members who are ill with the virus. This lack of education has a major impact on
the girls’ lives—leaving them less able to provide income for their families and more vulnerable to HIV infection. In addition, older women often shoulder the burden of care when their adult children fall ill. Later they become surrogate parents to orphaned grandchildren. Young women widowed by AIDS may lose their land and property after their husbands die—
whether or not inheritance and laws are designed to protect them. Widows are often responsible for producing their families’ food and may be unable to manage alone. In order to adequately address the HIV epidemic, programming must recognize these additional burdens that the disease places on women in the developing world.
HIV Population in Heavily Affected Regions2
Eastern Europe and Central Asia had 1.5 million people living with HIV in 2007.
North Africa and the Middle East have approximately 380,000 people living with HIV—190,000 are women aged 15 and over.
India had an estimated 2.4 million people living with HIV in 2007.
South and Southeast Asia had 4.2 million adults and children living with HIV in 2007.
SubSaharan Africa has just over 10 percent of the world’s population, but is home to nearly two-thirds of all people living with HIV —some 22 million people.
1 2 UNAIDS (2008). 2008 Report on the G lobal AIDS Epidemic. Retrieved N ovember 5, 2008 from www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp
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COMMUNITY-BASED CARE AND SUPPORT lane hartill
There are approximately 33 million people32in the world living with HIV and AIDS. Our HIV and AIDS policy calls for us to affirm human dignity and to seek effective means of addressing the AIDS crisis. CRS helps those living with the virus to care for themselves and others through a comprehensive continuum of care—from initial testing to nutritional support and ART to homebased and palliative care. In partnership with other faith-based and nongovernmental organizaitons, CRS directly supports more than 4.8 million people affected by HIV and AIDS throughout the world. However, travel to and from care facilities is often difficult for the patients who need it most due to illness and geographic location. For this reason, CRS delivers community-based care and support worldwide.
The Basics Our approach to community-based care and support is based on these practices: • Care for people living with HIV and AIDS should be holistic. It should include medical and nursing care, counseling and psychosocial support, spiritual support, socio-economic support, and referral. • The needs of people, families, and communities are integral in the planning and delivery of HIV and AIDS care and support programs. People living with HIV and AIDS, their families, and their communities must be the central focus of problem analysis, project design, implementation, and management of home-based care programs. • Care and support activities should be complemented by HIV prevention education. • Home care is the preferable means of care in many cultural settings. Home care programs are often more sustainable over the long term and more successful when they are based within communities. When many members of a community are involved 3 UNAIDS (2008). 2008 Report on the Global AIDS Epidemic. Retrieved November 5, 2008 from www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp
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Community-based Care and Support Quick Facts • T he Catholic church provides care for one out of every four people living with HIV and AIDS in the world today. As a Catholic organization, CRS is uniquely positioned to make a difference in the lives of these individuals. • I n fiscal year 2009, CRS supported more than 280 HIV and AIDS projects in 62 countries with a total value of more than 170 million USD. • M ore than 2.2 million children are now living with HIV; 1.8 million of them live in sub-Saharan Africa.
in care and support, there is less likely to be stigma associated with the disease. • The roles of men, women, and children as caregivers are an important consideration. Women and girls are often the primary caregivers of people living with HIV. To address this imbalance, both men and women should be encouraged to explore questions of who provides care and support to family members.
CRS in Action: SUCCESS Zambia is one of the sub-Saharan African countries most affected by the HIV pandemic. An estimated 14% of Zambians are infected, amounting to over 1 million persons in need of care and treatment. The burden of HIV continues to pose a major challenge to Zambia’s health care system, as well as to overall national development. The CRS Zambia Scaling Up Community Care to Enhance Social Safety-nets (SUCCESS) project began in August of 2003. Its purpose is to support the provision of comprehensive home-based care (HBC) in the country, including the provision of basic medical care and training family members to care for HBC clients.
SUPPORT SUCCESS-Return to Life (RTL) started in July 2006, as a follow-up project to SUCCESS. The name “Return to Life” reflects the return of people living with HIV to productive lives after diagnosis, care, and treatment by programs such as SUCCESS. Trained volunteers, recruited from local communities, are instrumental in facilitating HBC services for clients. Volunteers visit clients in their homes at least weekly, depending on the level of illness. Clients receive basic psychosocial and pastoral support, as well as health and prevention education on a number of topics. SUCCESS-RTL is
Protein) to moderately malnourished clients and a fortified peanut-butter product (RUTF = Ready to Use Therapeutic food) to severely malnourished ones. • I nitiated Savings and Internal Lending Communities (SILC) for the caregivers and clients. Participation in SILC groups enhances retention of caregivers within the project by providing them an opportunity to obtain loans to start income generating activities. • P artnered with the Palliative Care Association of Zambia, which under the slogan “Pain Relief is Human Right”, advocated for authorization from the Ministry of Health for hospices to dispense morphine to manage severe pain related with terminal illness. • W orks with implementing partners across 6 Dioceses, 7 provinces, and 11 hospices; in association with the Palliative Care Association of Zambia.
CRS in Action: Home-based Care and Support in Eritrea The prevalence of HIV in Eritrea is less than 3 percent. Given poverty, the mobilization and demobilization of troops, lack of awareness, and commercial sex activity in urban areas it is likely the prevalence will increase. HIV-related stigma decreases willingness to disclose HIV status or seek counseling and testing. These factors make it difficult to meet the needs of people living with HIV in Eritrea. dave snyder
making a difference in Zambia. By offering quality care and other HIV services, clients are returning to productive lives. People can once again work and care for their families, lessening the burden on the community. There has been a reduction in stigma and discrimination due to this project and fears of the disease have diminished, encouraging more people to get tested for HIV, disclose their status, and seek care and treatment. The SUCCESS Program • Provided care to 38,307 clients since it begun in 2003. • I ncorporated a nutritional component to the project providing soya porridge mix (HEPs = High Energy
CRS has been providing home-based care and support (HBCS) in Eritrea since 2003 in partnership with the Eparchy of Asmara Catholic Church. This project helps to meet the medical, nutritional, and psychosocial needs of people living with HIV by improving access to health care and HBC providers, providing food rations and livelihood security, and using in-kind grants for income-generating activities. Beneficiaries have enjoyed an increased quality of life as a result of the project. A compassionate environment has been created where beneficiaries and HBC workers share ideas, learn from one another, and provide support through discussions and support groups. The program has also helped orphaned children return to school and beneficiaries gain access to HIV treatment. Of the clients who received grants for incomegenerating activities, three-quarters have already paid back the program.
Hope & Dignity in the developing world 5
SUPPORT Mrs. Hiwet’s Success Mrs. Hiwet is a 52-year-old widow, mother of nine, living with HIV. When her husband was sick, Mrs. Hiwet heard rumors that he was suffering from AIDS but she disregarded the gossip. Upon his death, she was formally informed that he did in fact die from AIDS. Mrs. Hiwet was tested for HIV at that time and was HIV positive. She immediately felt despair and a loss of hope, thinking of her children becoming orphans. The counselor that was working with Mrs. Hiwet connected her with the CRS homebased care and support project, which changed her life. Mrs. Hiwet
was assigned a HBC caretaker who visited her at least twice a month. The caretakers provide emotional, physical, and spiritual support. The church also organized a monthly coffee ceremony where people living with HIV and their caretakers gather to share ideas and experiences, care, and learn. Mrs. Hiwet has disclosed her status to her children and now has their support. The church also helps Mrs. Hiwet with school materials for her children and linked her with the clinical management service providers for her HIV medical care and treatment. She is also
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the beneficiary of interest-free microfinance assistance, which helped her to open a small shop with her elder children. She was able to repay her loan in a short time. Mrs. Hiwet proudly states, “With the steady increase in prices on all commodities, house rent, and the shortage of supplies in the city, it is difficult to stand alone without external assistance until the market stabilizes. I am covering all the expenses of my rental house bills, school fees, and earning some amount for my living. All my children are continuing their education without any problem.”
ORPHANS AND VULNERABLE CHILDREN martin lueders
Beyond providing care for people living with HIV and AIDS, CRS is called to support entire communities affected by the pandemic. The population of children orphaned and made vulnerable by HIV has risen into the millions. In sub-Saharan Africa alone, more than 11.5 million children have been orphaned due to the ravaging effects of AIDS. CRS programming for orphans and vulnerable children (OVC) is intended to stop the cycle of vulnerability that continues to put children at risk from and to HIV infection. Some of the most pressing problems vulnerable children face include the burdens of caring for an ailing parent and younger siblings, the loss of family income as parents become ill or die, and withdrawal from school to care and provide for family. With shrinking availability of public funds to cope with this issue, local organizations must enhance their capacity to respond to the needs of children affected by HIV and AIDS in an effective and sustainable manner. CRS programming responds to the needs of OVC by supporting efforts to strengthen the means and ability of families to cope with problems brought on by HIV and AIDS. Key program areas include: • E nhancing the capacity of children and youth to meet their own needs • R aising awareness within communities to create an environment that supports children affected by HIV and AIDS
Orphans and Vulnerable Children Quick Facts • M ore than 15 million children under the age of 17 have lost one or both parents to AIDS. • Orphans and vulnerable children are at greater risk of malnutrition, illness, abuse, sexual exploitation, and HIV infection. • E ach day, approximately 1,200 children become infected with HIV. • S upporting those who care for orphans and vulnerable children • P roviding psychosocial support for children and their families
CRS in Action: Lesotho MOVE Project The Mountain Orphans and Vulnerable children Empowerment (MOVE) project provides food security and nutrition, education, health and HIV services, life skills education and HIV prevention services and support and child protection to children living with and affected by HIV in Lesotho. The HIV epidemic in Lesotho has had a profound effect on the nation’s children. CRS works closely with UNICEF and the National AIDS Commission in promoting the cause of OVC in Lesotho. The total number of orphans due to HIV-related illnesses is around 180,000, with an estimated 100,000 children having lost both of their parents. By 2010, orphans are expected to account for more than 25 percent of all Basotho children, and four out of five of those are estimated to be orphaned as a result of AIDS. Although approximately 141,000 of Lesotho’s orphans currently are in school, the enrollment figures are beginning to decrease as many children are dropping out to care for ill family members or to head households themselves. Female children are dropping out at disproportionate rates.43
dave snyder 4 IRIN Report (2007, January 3). Lesotho: New policy to help orphans and vulnerable children. Retrieved November 5, 2008, from http://ww.irinnews.org/report.aspx?reportid=63001
Hope & Dignity in the developing world 7
ORPHANS AND VULNERABLE CHILDREN CRS lesotho
The MOVE pilot was designed to respond to these multiple needs through interventions such as assistance with school enrollment and long-term structural change by engaging and reviving community spirit and cohesion. CRS is working closely with the Lesotho Catholic Bishops Conference, the Clinton Foundation, Partners in Health, and Mission Aviation Fellowship with the goal of bringing a complete continuum of HIV and AIDS care and support to the communities served. The program has implemented a child protection curriculum; has provided assistance to beneficiaries in gardening and food preservation, which has led to the availability of food throughout the year; has increased school attendance since children are provided with school uniforms and essential supplies through the project; and has improved the community emphasis on education. Children in the project report that they now eat between two and three meals a day since their caregivers now have increased food supplies.
2007 MOVE facts • T he project targets 6,000 OVC and 3,000 OVC household members. • Eighteen schools are being reached by the project. • F arming materials have been distributed to OVC households. • A child protection curriculum has been developed which is being shared with other programs.
CRS in Action: Tsungirirai Station Days, Zimbabwe The Tsungirirai Private Voluntary Organization, located in Norton, Mashonaland West Province in Zimbabwe, provides support for children orphaned or made vulnerable by HIV and AIDS. The organization also supports a community preschool, home-based care for people living with HIV, HIV counseling and testing, and community education for HIV prevention. Tsungirirai began providing support to OVC in 1998, when staff and volunteers encountered the range of needs of children whose parents had died as a result of AIDS. Support has expanded to the rural areas outside of the town of Norton since 2000. Station Days began in 2003, through volunteer insight and suggestion. This is an activity that allows for the regular and accurate collection of data on children’s health and psychosocial status, called “Monitoring and Evaluation.” The Station Days program is set up to benefit children directly and immediately, in addition to gaining the long-
rick d’elia
8 Hope & Dignity in the developing world
ORPHANS AND VULNERABLE CHILDREN term benefits of the data collected on Station Days, by disseminating material goods and information as children pass through “stations” in which psychological, physical, and social functioning are assessed. These Station Days are enjoyable for the children, as it is time for them to express themselves and be heard. Strategies for collecting information from the children are designed to meet the
developmental capacities of children in various age-specific groups. In addition to the Station Days, each week 200 OVC come to Tsungirirai’s drop-in center for meals, psychosocial support, and library activities. The data collected from the Station Days serve as a way of monitoring and evaluating the drop-in center’s effectiveness in meeting the care and support needs of OVC.
Station Day Stations The Gate Each child is given a vitamin tablet or sweet and a ticket to check off each station as the child completes it. Clinic Station A nurse records the child’s height, weight, and general health status; children are checked for communicable diseases. Counseling Station Five standard questions are asked that focus on life at home, school and the Tsungirirai center. Knowledge about HIV and other topics covered by the program is assessed. Meet Gogo or Sekuru Meet with volunteers, who are their elders, to receive advice about manners, health and hygiene. Library Station Assessment of children’s academic performance as well as school attendance and development of an action plan if there are problems. Children may receive pens and borrow textbooks. Supplies/Token Station Children receive tokens for attending that can be used for basic necessities like soap, toothpaste, hats, petroleum jelly, blankets, oranges, toys and even a meal.
Hope & Dignity in the developing world 9
HIV and aids PREVENTION dave snyder
Catholic Relief Services (CRS) is responding to the HIV pandemic in 62 countries around the world—primarily in Africa, but also the most impacted areas of Asia and Latin America. A critical part of our overall response is to reduce the transmission of the virus while caring for those who are most in need. CRS takes an integrated approach to prevention that uses best practices and is grounded in the Catholic church’s teachings on human sexuality. All prevention program activities encourage abstinence and mutual fidelity within marriage and contain health education messages about risk-avoiding practices that are widely recognized as essential components of successful HIV and AIDS prevention interventions. CRS also supports risk-reducing practices—including delaying sexual activity, limiting the number of sexual partners, programs for counseling and testing, treatment of sexually transmitted infections, and precautions that promote blood safety and limit blood-borne infections. The majority of CRS prevention programs are offered in concert with the local church. CRS works to advance the capacity of the church to respond to HIV and AIDS around the world, while expanding the numbers of people exposed to healthy educational messages through the church’s vast educational and pastoral infrastructure. We also work with the church to engage other faith-based groups and advocate for appropriate government responses.
CRS in Action: Lesotho Faith Based HIV Prevention Project In October 2008, CRS, received funding from the United States Agency for International Development through PACT to develop a faith-based HIV prevention response in Lesotho. With about 90 percent of the population affiliated with a Christian denomination, a faith-based intervention has the potential to be very effective in Lesotho. HIV
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Prevention Quick Facts • P revention is the only hope for reversing the HIV epidemic. • F ewer than one in five people who are at risk for HIV has access to HIV prevention services. • Only one in ten people living with HIV has been tested for HIV. • F or every two people receiving antiretroviral therapy for HIV, five are newly infected. • I nformation, and services to help prevent HIV infection are out of reach for the most at risk.
“ Faith-based organizations play a crucial role in the fight against HIV/AIDS. The involvement of faith-based organizations is multifaceted and includes organizations, spiritual, emotional, psychological and value-related issues. Faith leadership plays an important role in motivating people to become involved in HIV/AIDS-related work…Faith underpins and propels the response of the Church as an institution to the HIV/AIDS epidemic. The morality of care and compassion obliges individuals and organizations to become involved in the prevention of spread of HIV and to care for the sick or those whose lives are affected by the sickness or death of family members.” 5 1 — Dr. Maretha de Waal, University of Pretoria 5 Dr. Maretha de Waal, University of Pretoria, Turning of the Tide: A Qualitative Study of SACBC Funded Antiretroviral Treatment Programmes, January 2005, p. 10.
PREVENTION prevention activities target church leaders, both at the national and local levels, and church congregations to help them understand and appropriately respond to the key drivers of the epidemic in Lesotho, including the problem of early sexual debut, trans-generational sex, and multiple concurrent sexual partnerships. Intervention activities include the promotion of prevention messages through established church structures and committees, within families, and between community members.
To assist two CRS partner organizations, the Ethiopian Catholic Church—Social and Development Coordinating Office of Adigrat and Alem Tena Catholic Church. Through the use of CRS private funds, the In Charge! Facilitator’s Guide was developed using a participatory approach with valuable input and field testing by many CRS, partner staff, and community members in their HIV and AIDS education programs for youth. dave snyder
It is believed that the incidence of HIV infection in Lesotho can be reduced by discussing positive youth and adult behaviours that are influenced by faith-based values and supported by their peers. These values are communicated through specific abstinence and faithfulness messages and discussions that protect those at risk of HIV. The project strategy uses church leaders at various levels and existing church structures, including congregational groups, to provide common and key HIV prevention messages on abstinence and faithfulness that are tailored to specific age and gender groups. A large number of HIV care, treatment, and support activities are already underway by branches of Christian denominations in Lesotho. These established structures and activities provide an obvious entry-point for further interventions and discussion.
CRS in Action: In Charge! Action Learning on HIV and AIDS for Youth In Charge! is a participatory methodology that helps youth aged 15-24 learn about HIV and AIDS, HIV prevention, and reducing stigma and discrimination. The main objective is to help youth take charge of their lives so they will not become infected with HIV. It empowers youth to make better decisions in their lives to avoid situations where unwanted and unwise sexual activity could occur.
In Charge! is based on the SARAR (Self-Esteem, Associative Strength, Resourcefulness, Action Planning and Responsibility) methodology which aims to raise self-esteem using pooled knowledge to gain associative strength, encouraging resourcefulness in finding solutions and action planning to bring about change. The curriculum can be used both in and out of school by trained facilitators. This methodology helps break the silence surrounding HIV and AIDS to help youth: • Learn correct information about how HIV is spread
“ Before In Charge! we talked a lot about HIV and AIDS, but when the students left the room, the discussion was over. Now our students tell their parents about what they have learned and the students come back to school the next day with questions from their parents. This never happened before. It means that the discussion continues and the students begin understanding on a deeper level that this disease is real and could affect their lives. In Charge! is the best learning method for HIV and AIDS that we have had so far.” — A teacher who uses the In Charge! methodology
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PREVENTION • L earn what they can do to avoid infection, including the importance of abstinence and being faithful to one’s partner • B ecome sympathetic to those affected by HIV and AIDS and seek to end stigma and discrimination • B ecome empowered to avoid situations where unwanted or unwise sexual activity could occur The guide is easy to follow and contains illustrations, sample activities, guidelines on how and where to conduct the group, and structured facilitation techniques.
CRS in Action: Proyecto VIDA HIV Prevention, Guatemala In Guatemala, access to HIV care and treatment is limited. Until recently, there was little response from the faithbased organizations to the HIV epidemic. To respond to the epidemic, CRS has supported the work of local partner, Proyecto VIDA (Project Life) to help improve the response in the faith-based community and increase access for people living with HIV in Guatemala.
and members of health pastorates are being trained in HIVrelated topics, so that diocese are able to provide spiritual guidance that promotes HIV prevention activities in their parishes. Additionally, as a result of the work of Proyecto VIDA community activities that promote reduction of discrimination, stigma towards people living with HIV has decreased. Due to the HBC interventions, people living with HIV have better access to HIV care and treatment. The Catholic church Guatemala is currently building its technical capacity in order to implement HIV prevention activities and provide pastoral accompaniment to people with HIV and their families. CRS estimates that worldwide one out of every four persons living with HIV receives care through a Catholic institution. Our affiliation with the Catholic church allows CRS to be highly effective as local treatment managers for people living with HIV. Although CRS has a spiritually based mission, we help people in need without regard to race, belief or nationality. In fact, most beneficiaries of our programs are not Catholic.
Since October 2004, Proyecto VIDA has been implementing HIV prevention actions and care for people living with HIV in the southwest area of Guatemala, one of the national HIV response target areas. The goal of the project is to contribute to the reduction of the spread of HIV by educating and raising awareness among Guatemalan Catholic health organizations. The project targets priests, sisters, and lay people from health pastorates to help reduce stigma and discrimination against people living with HIV and their families. Proyecto VIDA is also targeting beneficiaries and their families in addition to the outreach to religious leaders by providing home-based care and support. Now, an increased number of priests, sisters, lay people, CRS Guatemala
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TREATMENT— ANTIRETROVIRAL THERAPY RICK D’ELIA
Patients on ART still have HIV, but their immune system is stronger. With proper nutrition they are able to regain weight lost due to the disease and are better able to work to support themselves and their families. When antiretrovirals (ARVs) successfully contain the virus, people can expect to lead a full, productive life. Until recently, ART was unavailable in much of the developing world because of its high cost. Without this treatment many people with the disease would often die within five years of infection and often face debilitating infections while alive. This is particularly significant in Africa, where almost three quarters of people infected with HIV live. We are on the threshold of change. A promising combination of increasing awareness and decreasing costs are giving many people living with HIV in the developing world an opportunity to receive ART— and hope.
CRS in Action: AIDSRelief Consortium The goal of the AIDSRelief Consortium is to ensure that people living with HIV and AIDS in the developing world have access to high quality ART and medical care. Launched in March 2004 and funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Department of Health and Human Services, the project brings together the unique skills of a consortium of organizations to expand delivery of antiretrovirals to people infected with HIV in Africa, Latin America and the Caribbean. CRS is the lead agency for the AIDSRelief Consortium and is responsible for its management in nine countries.
Treatment Quick Facts • I n 2006, 127,300 children living with HIV received ART, a 70% increase from 2005. • I n 2007, 3 million people worldwide had access to ART, a 46.5% increase from the previous year. • A lthough there has been great progress in the past few years, more than 6.7 million people are in need of treatment and have no access. • T he CRS led consortium AIDSRelief currently provides ART to over 140,000 people and HIV care to over 380,000 people in 9 countries in subSaharan Africa, Latin America and the Caribbean through almost 190 local partner treatment facilities, mostly faith-based. • I n 2004, AIDSRelief was awarded 335 million U.S. dollars over five years by the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR), to reach those in need of HIV care and treatment in the hardest hit areas. PEPFAR has extended this project for up to four more years. • A IDSRelief is working to strengthen institutions and build up a reserve of trained staff to deliver ART. Doctors, nurses, community-based volunteers and other health care workers have been trained to administer various aspects of the therapy across the 9 countries.
Working in partnership with mostly faith-based institutions (both Catholic and non-Catholic), local non-governmental organizations, and community volunteers, the AIDSRelief Consortium provides the RICK D’ELIA
Hope & Dignity in the developing world 13
Treatment RICK E’LIA
following critical components of antiretroviral therapy: • Testing to determine if a person is HIV-positive and how far the virus has progressed • Antiretroviral medicines and related counseling directly to patients in need and their support systems/families • Training of staff to use equipment, administer treatment dosages and provide quality clinical care • Education of patients regarding the importance of taking all of their medications so that the virus does not mutate and become resistant to the medications • Equipment to hospitals and health care facilities, including instruments, machinery and materials critical to providing treatment
Ssenyonga: A Success Story from Uganda Ssenyonga A., at 5 years of age, lost his parents in 1997 as a result of AIDS. Following his parents’ deaths, he went to stay with an aunt who lives near Villa Maria, a hospital supported by the AIDSRelief project as well as CRS private funds. He irregularly attended a nearby government school, due to frequent illness. In 2003, he sought medical care at Villa Maria hospital and was found to be HIV positive. Encouraged by the staff of the Villa Maria program, he accessed
free medical care for opportunistic infections from the Butenga Health unit, a satellite health center of Villa Maria. As his condition continued to deteriorate, he was referred to Uganda Cares, a government unit 25 km away for Antiretroviral Therapy (ART). Villa Maria provided support for transport costs until support from the AIDSRelief project brought ART to Villa Maria in 2005, eliminating the need for travel. As his condition improved on ART, Ssenyonga was enrolled in apprenticeship training at a local
14 Hope & Dignity in the developing world
tailor near his home with other OVC trainees. Within a year and a half he graduated and was given a sewing machine by the hospital. Now, at 16 years of age, he earns a good income, which has improved his livelihood. He actively participates in activities to encourage HIV counseling and testing and adherence to ART. After realizing there are more orphans in a similar situation, Ssenyonga volunteered to train another young person in tailoring, who like him is living with HIV and on ART.
FOOD SECURITY AND NUTRITION rick d’elia
Food is a Fundamental Human Right According to USAID, food security occurs “when people at all times have both physical and economic access to sufficient food to meet their dietary needs in order to lead a healthy and productive life.” CRS believes that access to food is a fundamental human right. It is estimated that over 850 million people in the world do not have access to sufficient food, the majority of whom live in South Asia and Africa. All aspects of food security—availability of, access to, and use of food—are threatened by high rates of HIV and AIDS. This global
Food Security and Nutrition Quick Facts • B y 2020, AIDS will kill 20 percent of Africa’s farm workers. • S even million agricultural workers in sub-Saharan Africa have died from AIDS since 1985. Another 16 million will die in the next 20 years. In several countries, 60 to 70 percent of farms have suffered labor losses as a result of the epidemic. • A study in Zambia showed that households headed by a person who was chronically ill planted up to 53 percent less than households headed by a healthy adult. • T he death of an adult from AIDS has a greater negative impact than if the death were from another cause. This is because of high costs associated with care and treatment. epidemic has decimated families and left millions of people in danger of not having enough to eat. Part of the rising problem is the shift of the epidemic from cities to rural areas. People living with HIV and AIDS in developing countries are often the rural poor, a population that is often the least equipped to respond to the epidemic. HIV and AIDS are causing rural areas to disintegrate quickly as farmers and their families become too sick to work or too busy caring for their sick to cultivate food.
RICK D’ELIA
CRS distributes food rations to families affected by HIV and AIDS. To guard against food shortages in the future, we work with communities to promote sustainable agricultural practices and develop food markets. Together, we are making a difference in ensuring that every man, woman and child has basic access to food through agricultural programs and initiatives that help build stable and vital economies.
Hope & Dignity in the developing world 15
FOOD “Food aid plays a pivotal role in responding to HIV and AIDS. The first thing poor families affected by AIDS ask for is not cash or drugs, it is food. And food has to be one of the weapons in the arsenal against this disease.” — James T.
The Cycle of Poor Nutrition People living with HIV have special nutritional needs. As the infection progresses, they need more energy, to fend off infection and therefore more food. People living with HIV are also more likely to suffer a loss of appetite, thus reducing dietary intake at the very time when nutritional requirements are higher. Improving the nutritional status of those with HIV and AIDS improves their quality and length of life. Unfortunately in many parts of the world— especially in Africa—families and communities are already suffering from poor nutrition. People living with HIV are not the only ones affected. Children and adults whose family members are living with
HIV are also less well nourished and more likely to be sick. Evidence from East and Southern Africa demonstrated that households affected by HIV and AIDS eat fewer meals and consume less nutritious foods than households not affected by HIV and AIDS. In addition, these families have less money to spend on healthcare for non-infected family members. CRS programs work to promote “positive living.” This holistic approach encourages communities, including those infected with the virus to care for themselves through proper nutrition and other aspects of a wellrounded care regimen.
CRS in Action: THE PRODUCTIVE SAFTEY NET PROGRAM, ETHIOPIA Ethiopia is one of the poorest and most food insecure countries in the world. Eighty–four percent of the population relies on agriculture for its livelihood. After years of a system dominated by emergency relief food aid the government decided to move towards one that addresses the basic root problem of chronically food insecure households in a manner that protects their productive assets. In collaboration with donors, the Government of Ethiopia designed the Productive Safety Net Program (PSNP) with the objective of protecting and improving food security situation of targeted chronically food insecure households in 282 food insecure woredas. Specifically, the program is designed to address immediate human needs while simultaneously supporting the rural transformation process; preventing long term consequences of short-term consumption shortages; encouraging households to engage in production and investment and increasing household purchasing power thereby promoting market development. Food for work is provided to those who can work, while households who have no labor are entitled to receive safety net ration and are considered as direct transfer beneficiaries.
RICK D’ELIA
16 Hope & Dignity in the developing world
CRS, through its Catholic Church implementing partners at field level—Ethiopian Catholic Church—Social and Development Coordinating Office of Harar (ECC-SDCOH)
FOOD and Wonji Catholic Church (WCC)—has provided support including food, financial and technical assistance through the PSNP to targeted chronically food insecure households and local government offices since 2005. Funded by USAID Food for Peace (FFP), the PSNP is now entering its second phase and will continue though 2011. Partners are implementing PSNP in five Woredas in Oromiya Regional State and one Woreda in Dire Dawa Administrative Council.
improvement in all livelihoods—including those of people living with HIV. The program has also increased access to clean water and nutrition. Community members have increased financial assets as a result of integrated agroenterprise interventions. Nutrition education and food preservation techniques have been taught concurrently to improve long-term health and food security situation. PSNP Facts
In addition to food insecurity, Ethiopia faces the HIV pandemic with 3.5 percent of the population between 15- 49 years infected with HIV. There is an HIV knowledge gap and stigma towards people living with HIV, which deters people from seeking testing, care, and treatment. There has been little attention paid to rural areas in Ethiopia related to HIV programs. PSNP project interventions include soil and water conservation, water and irrigation system construction, hygiene and sanitation interventions, agro-enterprise, and seed voucher and livelihood fairs. HIV programming has been integrated into these activities. The districts targeted by the program are located in a mountainous, rural area. As a result of the PSNP, there has been an increase in HIV awareness, a reduction in stigma in targeted areas, and an
• T he project is targeting 168,696 beneficiaries across six districts (woredas) in Ethiopia—Kersa, Meta, Gorogutu, Dodota, Sire and Dire Dawa.. Some of the targeted communities live along a key trade and transportation route that runs to the port of Djibouti, which is identified as a “high risk corridor” for HIV. • T he first phase of project began in 2005 and completed in 2008. However, USAID/FFP and CRS have agreed to continue with a new Multi -Year Assistance Program (MYAP) through 2011. • T his MYAP is designed to sustain and build upon food security improvements achieved under complementary interventions funded by multiple donors undertaken by CRS in PSNP areas which continue to face high levels of food insecurity related to lack of availability, access to and utilization of food resources.
RICK D’ELIA
Hope & Dignity in the developing world 17
LIVELIHOODS RICK D’ELIA
Loss of productive labor to HIV and AIDS forces households to sell livestock and other assets to cope with the mounting expenses associated with caring for the terminally ill and, when the time comes, burying the dead. One recent survey found that 40 percent of households in Zambia affected by chronic illness had sold assets to cover food, medicine, and funeral costs. Households already in severe poverty possess virtually no capacity to survive such additional burdens. HIV and AIDS are also diminishing the human capital of future generations. Children, particularly girls, are often taken out of school to care for sick family members. Girls may be sent to work in order to subsidize family income—preventing them from getting a formal education or learning important life skills.
Building Assets In order to live healthy, productive lives, people need a wide range of food, water, shelter, and security, among others. These assets allow individuals to start businesses, feed their families, obtain medical care, and educate their children. One of the most effective ways to improve the lives of those affected by HIV and AIDS is to ensure that these assets are available. In this way, vulnerable communities can care for the chronically ill; while through education and skills building avoid behaviors that put them at risk for HIV infection. CRS and our partners help people to build the assets they need to achieve sustainable livelihoods. For example, some programs help vulnerable communities produce more food through agricultural improvement programs, while others work with clients to build or improve water and sanitation systems for drinking, irrigation, and livestock.
Reducing Vulnerabilities An important goal of these programs is to increase the ability of communities and households to respond to the
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Livelihoods Quick Facts • E ach of the five capital assets—human, financial, natural, social and physical—are impacted by the HIV epidemic. • P eople are driven to adopt risky strategies to survive in the face of HIV and AIDS. The break-up of households due to labor migration in times of food insecurity as well as the exchange of sex for money or food during crises increases vulnerability, with women and children being particularly exposed. unanticipated shocks of natural disasters, disease, and conflict. Without this protection, vulnerable families are unable to climb out of poverty. CRS programs promote HIV and AIDS education and awareness to prevent future infections, offer micro-enterprise development activities including savings and internal lending communities (SILC) to help families create financial safety nets, and distribute food to prevent malnutrition. By helping to build and protect these assets, CRS and partners ensure that income-generating activities will endure. CRS complements its asset-building activities with emergency response plans so families and communities can protect the assets they have obtained.
CRS in Action: HIV and AIDS Livelihoods Project Svay Rieng and Prey Veng in Cambodia The current HIV prevalence in Cambodia is 1.6 percent. In Svay Rieng and Prey Veng provinces, there is an increasing need for treatment, care, and support services for people living with HIV and orphans and vulnerable children focused on livelihoods and sustainable systems. Approximately 40-45 percent of the Cambodian
LIVELIHOODS population lives below the poverty line. In the project areas, health-related expenses are a primary cause of poverty as families use their scant savings, sell their land and other possessions, and borrow money to pay for poor quality health care. The goal of the HIV and AIDS Livelihoods Project is to help improve the livelihoods of HIV affected families in Svay Rieng and Prey Veng provinces. CRS provided technical, financial, and administrative support to four partners in 88 villages. The project began in 2005 through funding from USAID and CRS private funds. The project used an integrated farmer group model. Through the HIV and AIDS Livelihoods Project, awareness of HIV and anti-stigma messages were spread among farmer groups and group leaders with support of our partners. The project reinforced the groups practice of to welcoming HIV-affected households into their groups for support. HIVaffected members were provided revolving funds and loans from the group to help get them started with composting, vegetable production, and chicken and pig raising. HIV-affected households experienced increased support and improved livelihoods. Orphans and vulnerable children have improved school attendance as a result of the livelihood projects.
CRS in Action: Junior Farm Field Schools (JFFS) in Zimbabwe Zimbabwe is in a state of political, economic, and humanitarian crisis, a situation compounded by an HIV prevalence of 15.6 percent. The country has the SEAN SPRAGUE
world’s highest number of orphans per capita and the fastest shrinking economy outside of a war zone. The cost of food and other basic necessities is increasingly out of reach for the average Zimbabwean. There are shortages of food staples, fertilizer, and spare parts, among other items, due to a lack of foreign currency to pay for imports and the impact of government-imposed price controls. More than two out of three Zimbabweans are not formally employed. Food insecurity across the country is increasing because of a severe shortage of supplies in most markets, very high market prices, and the continued erosion of people’s purchasing power. CRS has been working to implement the Protecting Vulnerable Livelihoods Program (PVLP) since 2004 to reduce the proportion of Zimbabweans who suffer from hunger and extreme poverty. PVLP supplies basic agricultural input, promotes innovative and appropriate agricultural strategies, strengthens community and household safety nets, improves access to communitymanaged water and sanitation, and mitigates the negative impact of HIV. Farmer Field Schools were developed as local centers of agricultural learning and seed production, and provide drip irrigation kits and seeds for community nutrition gardens. Junior Farm
Hope & Dignity in the developing world 19
LIVELIHOODS richard lord
Field Schools (JFFS) target OVC who may not be able to receive agricultural knowledge from a parent, as would traditionally occur. In addition to learning about cropping, soil conservation, and small livestock, JFFS participants also receive information on HIV prevention. JFFS also act as centers for training in the Participatory Health and Hygiene approach, to help reduce waterborne diseases inthe community. JFFS have not only benefited OVC by improving their food security and livelihood but also by providing excellent social interaction to encourage collective discussion about social problems such as HIV.
Cambodian Family Receives Community Support and Acceptance in Rural Livelihoods Pheanh Rong, 29, lives in Svay Rieng Province and is married with one young son. Both Rong and his wife found out they were living with HIV two years ago. Both receive care and treatment and have stayed strong over the past few years. They are working hard to support their family with the assistance of RADE, CRS’ partner in Prey Veng. Once Rong discovered he was living with HIV, only his very close relatives visited his family. Neighbors and other farmers no longer contacted him; he was not involved in any social support groups or committees in the community. He had to spend a lot of money to travel to the referral
hospital to receive care. In 2006, RADE began implementing HIV prevention and anti-stigma and discrimination awareness with community farmer groups, as well as mobilizing communities to understand, help, and care for vulnerable households facing challenges like HIV, TB, and extreme poverty. Rong and his family were invited to join the farmer group in his village to help him regain his livelihood and receive social and economic support from his community. Now, Rong explains that since joining the farmer group, “I have many people come to visit my family and help care for us and now we all understand clearly about preventing HIV and
20 Hope & Dignity in the developing world
how HIV is transmitted. I have also learned about animal raising and seed production, as well as other support; we are now growing vegetables from seeds supported by the group revolving fund for eating.” Rong and his wife received support and technical assistance from the farmer group leader and other members, including vital encouragement and support. Additionally, RADE has helped the family continue to send their son to school by providing a uniform, school bag, and soap. Rong and his wife hope to “find a good future for [their] child” and continue to live a healthy life with HIV.
INJECTING DRUG USE martin lueders
Injecting Drug Use Injecting drug use is a risk factor for HIV. It poses a threat to the injecting drug user (IDU) population, where HIV is spread quickly due to sharing injecting equipment in a close IDU community. However, HIV is also a threat to the partners and children of IDUs. Drug users tend to be a marginalized group with complex needs and have poorer access to life-saving interventions. They are also more likely to be infected or co-infected with tuberculosis, which presents other life-threatening challenges.
The HIV Epidemic in IDUs Global trends illustrate that there are two broad patterns of HIV epidemics: generalized, sustained in the general populations of many sub-Saharan African countries, and concentrated, found among populations most at risk, such as men who have sex with men, IDUs, and sex workers and their sexual partners. The HIV epidemic in some parts of Southeast Asia and Eastern Europe is largely attributed to IDU. Interventions that target the IDU population include drug rehabilitation programs, education for IDUs and their families, increased access to care, and treatment and support for IDUs and their families. CRS has responded to the HIV crisis in the IDU population by providing holistic programming, including nutrition, education, and psychosocial support to IDUs and their partners and families. CRS programs help reduce the stigma around HIV in this population so more people are encouraged to get tested and gain access to care and treatment. CRS has involved local and faith partners to acknowledge the epidemic and helped build their capacity to respond.
CRS in Action: PANI, Northeast India It is estimated that national HIV prevalence in India is approximately 0.36 percent, which corresponds to an estimated 2 to 3.1 million people living with HIV, due
IDU Facts • Globally, 2.5 million IDUs are infected with HIV. • I n many countries of East Asia and the Pacific, IDUs constitute a large proportion of people living with HIV, ranging between 38 percent and 77 percent. • W HO estimates that 15 percent of the people with TB/HIV are living outside sub-Saharan Africa, many of these associated with injection drug use. Among the estimated 33.2 million people living with HIV, TB is one of the most common AIDS-defining conditions and the leading cause of death. to the large population in India. In recent years, the epidemic has stabilized, but there is still great variation between states within the country and certain population groups. Surveillance data from 2006 show an increase in HIV infection among several groups at higher risk of HIV infection, such as IDUs, men who have sex with men, and sex workers. In northeast India, more than 50 percent of the HIV infections are attributed to needle and syringe sharing among IDUs. Northeast India is also home to a mobile population and displacement due to civil unrest. HIV spreads rapidly in IDUs since this group is often connected through tight networks that share injecting equipment. IDUs continue to represent the group with the greatest risk; however the virus is also spreading rapidly in the general population. Unemployment and few income generating or career opportunities feed into the elevated rate of drug use. All of these factors highlight the need for a holistic approach to HIV prevention, care, and treatment among this population. CRS’ Preventing AIDS in Northeast India (PANI) project operates in four northeastern Indian states: Manipur, Nagaland, Mizoram, and Assam. The goal of the project is to contribute to the stabilization of HIV prevalence
Hope & Dignity in the developing world 21
INJECTING DRUG USE among women and youth and improved health condition of IDUs and HIV and AIDS-affected and infected groups in NE India. The project has worked to increase access to HIV prevention, care, and support, while also increasing the capacity of local and faith-based partners. After three years of implementation, the PANI project contributed to improved quality and access to HIV care, improved quality of life, decreased stigma and discrimination, the formation of several support groups for people living with HIV, and improved awareness and capacity among partners.
• 1,181 Adults living with HIV on antiretroviral therapy
PANI Facts
• H IV prevalence among the non-injecting wives of male IDUs increased from 6 percent in 1991 to 45 percent in 1997.
• 4,845 PLHIV registered for care and support services. • 640 Children living with HIV on antiretroviral therapy.
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• E ducation on HIV and stigma reduction provided to 35,141. HIV in Northeast India • I n Manipur, estimates from 2002 demonstrate an HIV prevalence of 55 percent among IDUs. • I n Manipur, it is estimated that 10.5 percent of women who visited sexually transmitted infections clinics and 1.8 percent of women who visited antenatal clinics were living with HIV.
• M ore than 50 percent of IDUs in Manipur were between the ages of 26 and 35 in 2002.
PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
DAVE SNYDER
Mother-to-child transmission of HIV may occur during pregnancy, labor, delivery or breastfeeding. United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) are working with agencies to build capacity and expand prevention of mother-to-child transmission (PMTCT) service delivery points, strengthen referral linkages, and model integration of PMTCT services within existing services, maternal and child health and community level structures and activities around the world. CRS is working in concert with global PMTCT goals to effectively promote primary prevention of HIV in women of childbearing age, prevent HIV transmission from a woman living with HIV to her child, and provide ART, care, and support to women living with HIV and their families. CRS is working with national governments to build effective PMTCT strategies and programs, strengthening health systems to provide HIV care and treatment for pregnant women and their children, and helping to promote HIV testing for all pregnant women. PMTCT Facts • A n estimated 370,000 children under 15 years were newly infected with HIV in 2007, nearly 90 percent of them in sub-Saharan Africa. Without treatment, an estimated half of these infected children will die before their second birthday. • E ffective interventions are able to bring the risk of children infected through mother-to-child transmission to less than 2 percent. Without intervention, between 20-45 percent of infants may become infected. • I n 2007, only 33 percent of pregnant women in low- and middle-income countries accessed HIV testing. • Of HIV infected pregnant women in 2005, only 34 percent received PMTCT antiretrovirals. • Of pregnant women who receive counseling for PMTCT, there is near universal acceptance for HIV testing.
HILDA M. PEREZ
CRS in Action: The Maryknoll Program, Cambodia The Royal Government of Cambodia has had a successful response to HIV, including extraordinary prevention efforts, the rollout of a national treatment program, and increased availability of voluntary testing and counseling. All have led to a decline in new infections among Cambodian adults (from 1.2 percent among adults aged 15-49 in 2003 to 0.9 percent in 2006) and the provision of ART to almost 30,000 adults and children. However, women were almost four times more likely than men to be among the newly infected, with 40 percent of new infections occurring among monogamous women. This shift in the gender distribution of HIV, where the epidemic existed previously among males who engaged in high risk injecting drug use and sex, has caused an increased emphasis to be placed on access to HIV services for women and children. PMTCT programs that focus on increasing mothers’ access to comprehensive care and treatment are needed to minimize vertical transmission of the virus from mother to child and to reduce orphanhood.
Hope & Dignity in the developing world 23
PMTCT The Maryknoll PMTCT program began in 2002 in response to the expressed needs of mothers in other Maryknoll HIV programs. The program, originally an offshoot of the Little Sprouts pediatric program, has grown into a highly respected program that offers comprehensive services. The Maryknoll PMTCT program complements the Cambodian National PMTCT program by providing muchneeded social support. The national program provides ART for mothers living with HIV according to national protocol. Maryknoll provides extensive services to more than 120 women per year in four main areas: • C ounseling and training for pregnant women and their partners about HIV testing, nutrition, safe infant feeding, and hygiene • H ome visits before and after delivery to ensure adherence to treatment, support infant feeding and prepare women for birth • D irect assistance for antenatal care and delivery fees, transportation, food and lodging • T raining and resourcing PMTCT and other facilitybased staff to enable them to carry out their functions effectively and safely. Maryknoll PMTCT Facts • I n 2007, the Maryknoll program assisted the National Maternal Child Health Program in bringing PMTCT services to 24 percent of all mothers living with HIV who were successfully delivered at PMTCT facilities that year. • I n 2007, the Maryknoll program reduced infant deaths to 0 from 3% the previous year. • In 2007, infected infants fell from nearly 7% in 2006 to 4%.
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KARL GROBL
HIV and AIDS POLICY AND ADVOCACY RICK D’ELIA
CRS works to raise awareness about key issues that affect the poor overseas. Our policy positions are based on Catholic teachings and informed by extensive consultation with our partners overseas and in the United Sates.
nations make it a priority policy issue for CRS. Therefore, we work with our overseas staff and partners to identify priorities and assess how to shape our HIV and AIDS policy in connection with other sectors, including food security, health, and education initiatives.
In the United States, our advocacy is undertaken directly in dialogue with decision makers in the United States government, including Congress, and international organizations. We engage Catholics in the United States to use the power of their citizenship to alleviate human suffering, remove its causes, and promote social justice. We also support local communities overseas as they engage in advocacy to address policies and practices that undermine justice.
CRS in Action: PEPFAR
HIV and AIDS Policy and Advocacy Our HIV and AIDS policy and advocacy work in the United States has focused on ensuring a comprehensive and morally appropriate response to global HIV and AIDS. CRS advocacy positions are fully in keeping with Catholic moral teaching, focusing on providing adequate treatment for those infected, preventing the spread of disease through education and behavior change, and assisting communities devastated by the disease. Advocacy in the countries where we have programs is a key element of CRS strategy to promote solidarity and stop the spread of HIV. CRS works to increase the capacity of local community organizations—including the regional and local church—to address both the root causes and the human, economic and political impact of the HIV pandemic. The HIV pandemic is not just a health issue, it is also a development and security crisis that impacts every facet of human survival, especially in the poorest countries. The sizes, spread, and impact of the HIV pandemic on the economic, social, and political structures of developing
The Catholic church is the largest provider of care for people living with HIV in the world. CRS alone is helping millions of people living with and affected by HIV across Africa, Asia, and Latin America. CRS is helping to save lives by providing ART to more than 140,000 people living with HIV worldwide as part of a large grant funded by President’s Plan for Emergency AIDS Relief (PEPFAR). CRS staff members have witnessed firsthand how women and men near death have returned to normal lives, and are now caring for their children and contributing to their communities. CRS was active in advocacy to influence the PEPFAR reauthorization in 2008. The United States Conference of Catholic Bishops (USCCB) and CRS welcome the passage of a new five-year version of the PEPFAR, a 48 billion U.S. dollars five-year commitment that will help alleviate the suffering of some of the world’s most vulnerable people. PEPFAR reauthorization contains the following principles, which were advocated by the CRS community: • S trengthens food and nutrition programs that are vital for treatment and care of HIV and AIDS patients, orphans and vulnerable children • I nvests in building up the healthcare workforce in countries with PEPFAR programs • R etains a strong “conscience clause” that allows religious organizations such as CRS to refrain from participation in activities that conflict with their moral teachings • E nsures that abstinence and be faithful programs to prevent HIV infections receive balanced funding.
Hope & Dignity in the developing world 25
ADVOCACY “I would also like to urge all people of good will to multiply their efforts to prevent the spread of the HIV virus, to oppose the contempt that often affects those who have the disease and to care for the sick, especially when they are still children.” — Pope Benedict XVI, November 28, 2007
CRS in Action: Africa Rising, Hope and Healing For years, advocacy groups, church leaders and humanitarian organizations like CRS have been calling for increased attention and funding to fight the pandemic ravaging sub-Saharan Africa. Until 2003, the United States government was only spending 1 billion USD annually against the AIDS pandemic. In 2001, CRS launched African Rising, Hope and Healing (www.crs.org/africa/campaign/), a campaign to bring attention to HIV, AIDS, peacebuilding, and poverty in Africa. Through the campaign, CRS promotes advocacy with the United States government, international financial institutions, and corporations to pursue policies that support the continent’s development. Africa Rising, Hope and Healing demonstrates our commitment to the African people and reinforces the call
Photo by Doug Kapustin/Baltimore Sun
26 Hope & Dignity in the developing world
from United States Catholic Bishops in “A Call to Solidarity with Africa” to join “our voices…with others to encourage a sustained, just and comprehensive engagement of the world’s vast resources to generate lasting solutions that respect the full, human dignity of our brothers and sisters in the poorest countries of Africa.” Many dioceses, parishes, national Catholic organizations, and Catholic colleges and universities have held prayer services and discussion roundtables, published news articles and organized fundraising drives, and planned Africa-themed celebrations. Most importantly, through the establishment of CRS’ legislative network (http://actioncenter.crs.org/site/ PageServer?pagename=ac_homepage), Catholics in the United States are communicating directly with their elected officials in Congress and the legislative branch to ask for greater United States involvement in addressing the issues facing Africa—particularly the HIV pandemic.
ANDREW MCCONNELL
A Brief History of CRS Catholic Relief Services began its work in 1943, resettling the refugees of war-torn Europe. More than 60 years later, our mission continues to focus on the poor overseas, using the teachings of Jesus Christ as the foundation of our mission.
• Emergency Response • HIV and AIDS • Microfinance (savings and credit programs) • Peacebuilding • Water and Sanitation
As the official international humanitarian agency of the United States Catholic community, CRS provides relief and development assistance to over 100 countries around the world. Our original mission of disaster relief has expanded to focus on helping individuals and communities build a stronger future. We reach more than 70 million people with initiatives that address:
CRS programs teach communities how to become selfsufficient and plan for future emergencies. We continually seek to help poor and marginalized populations throughout the world, providing assistance on the basis of need, without regard to race, creed, or nationality.
• Agriculture
Expanding Reach and Focus
• Community Health
As Europe regained its balance in the 1950s, CRS began to look to other parts of the world, seeking out those
• Education
Hope & Dignity in the developing world 27
who could benefit from the assistance of Catholics in the United States. For the next five decades, CRS expanded its operations, opening offices in Africa, Asia, and Latin America. In the 1990s, Catholic Relief Services worked in the aftermath of natural disasters like Hurricane Mitch in Central American and man-made tragedies like the war in Kosovo. And in just its first few years, the new century has brought hurricanes, flooding, more conflict, and the great Indian Ocean tsunami that CRS has responded to with temporary shelters, medicines, food aid, and hope. During our expansion, CRS build on a tradition of providing relief in emergencies and began seeking ways to help people in the developing world break the cycle of poverty. By building community-based programs that are sustainable over the long term, CRS can ensure that local residents are the central participants in their own development and that projects can be accomplished through the efforts and resources of local communities.
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Today these programs include agricultural initiatives, community banks, health education, and clean water projects. In addition, our justice and peacebuilding initiatives support our strategy of solidarity by addressing issues of mutual understanding and by supporting individual and community healing.
Looking to the Future With more than a half-century of experience overseas, we understand that rebuilding societies requires more than mortar and bricks. Through our work, CRS seeks to foster within the United States Catholic community a sense of global solidarity—providing inspiration to live out our spiritual tradition of compassionate service to the world. As we step into the next millennium, we renew our commitment to the most vulnerable members of our human family, mindful of the principles of Catholic teachings and the foundation upon which our work is built.
228 W. Lexington Street Baltimore, MD 21201-3413 USA Tel: 410.625.2220 • www.crs.org
©2009 Catholic Relief Services. All rights reserved.