Ecumenical HIV/AIDS Initiative in Africa

(EHAIA)…for an AIDS competent Church

http://www.wcc-coe.org/

Cameroon

Acknowledgments

I would like gratefully acknowledge the professional support provided by many individuals and organisations that helped to write this report of the mapping of HIV/AIDS activities of churches in Cameroon.

Dr Christoph Mann and the Regional Reference Group of Central Africa members encouraged me to undertake myself this mapping exercise instead of commissioning somebody else to do it. This mapping helped me very much to familiarise with the issues and challenges related to HIV/AIDS in Cameroon.

My special thanks are extended to Dr Tih Pius Muffih, Director of Health Services of the Cameroon Baptist Convention who provided not only copies of many useful reports on HIV/AIDS but also logistic means such as transportations free of charge.

Heartfelt thanks are devoted to the many church leaders who were involved in this mapping exercise. I am grateful for their kindness towards during this study.

No acknowledgement would be complete without the recognition of the World Council of Churches that provided funds and material resources to make this mapping a reality.

Foreword

After two decades, HIV/AIDS has become a global emergency with far-reaching effects. Today, there is no country that has been left unscathed by the Epidemic. It affects all countries including Cameroon socially, economically, spiritually and culturally. HIV/AIDS threatens development and human security. In 1986, the HIV prevalence in Cameroon was estimated at 0.5% and reached 12% in 2002. In the absence of a greatly response that has a significant impact, the HIV prevalence is projected to exceed 15% in 2010 where nearly one in five adults will be infected. As a result a decrease of 10 years in life expectancy at birth will be achieved in 2010.

Time is come to recognise that there have been barriers among faith-based organisations based on religion, class, age, nationality, physical ability, gender, sexual orientation which have generated fear, stigmatisation, discrimination, persecution and even violence. These obstacles within religious communities did much harm than good especially when it comes to prevention measures. Today Christians and clergy are dying of AIDS. This means that AIDS does not only appear to “other people”.

I call upon faith-based organisations to adopt as highest priority the confrontation of stigmatisation and social exclusion of people infected and affected by HIV/AIDS. Despite the devastating impact of HIV/AIDS, members of faith communities must acknowledge that they are called by God to affirm a life of hope and healing in the midst of HIV/AIDS. The enormity of the pandemic itself should compel faith-based organisations to join forces despite differences of belief. Christian traditional calls the faith-based organisations to embody and proclaim hope, and to celebrate life and healing in the midst of suffering.

Faith-based organisations must assure that all of who are infected and affected by the epidemic regardless of religion, class, age, and gender and sex orientation will have aCCess to compassionate, non-judgemental care, respect and assistance. God does not punish with sickness but is present together with us (including faith-based organisations and people of good will) as the source of strength, courage and hope. The God of my understanding is in fact, greater than AIDS.

1.   General and Epidemiological Data

1.1.  General data on the Republic of Cameroon

1.1.1.     The Republic of Cameroon country profile

The Republic of Cameroon is located in western Central Africa. It lies between longitudes 8 and 16 degrees, east of Greenwich Meridian and between latitudes 2 and 13 degrees, north Equator. It is bounded to the northwest by Nigeria, to the Northeast by Chad, to the east by Central African Republic, to the South by the Republic of Gabon, the Republic of Congo and Equatorial Guinea. The Republic of Cameroon covers a total of 475,442 square kilometres and has two main climates: Equatorial and tropical. The north has a hot dry Sahelian climate. The south is covered by dense equatorial rainforest. The north-south vegetation pattern is substantially modified by the relief and human activities. The Benue river basin and the tributaries of Lake Chad lie further north. The west of the country is dominated by a rang of volcanic mountains, stretching northeast from Mount Cameroon which is high. The Sanaga River runs through the centre of the country, entering the Atlantic near Douala. The main seaport and largest city is Douala; the Capital Yaoundé, is second largest.

1.1.2.     Population

At the end of 1996, based on the projections of 1987 population census, the population was estimated at 16,184,748 million people of whom 51% female and 49% male. ACCording to the Ministry of Health, life expectancy has been rising over the past decades, and is now 59 years for women and 55 years for men. Taking into aCCount the high birth rate (5.9 children/women) and “increased life expectancy”, these have led to rapid expansion. There are 24 African languages, with French and English as official languages. Tradition African religious beliefs influence both Muslims who constitute 20% (concentrated in the north) and Christians 40% (concentrated in the South) and indigenous beliefs 40%. Cameroon has over 200 different ethnic groups presented in the table below:

Table 1: Ethnic groups

Source: The World Fact 2002

The 200 tribes and clans speak at least one of the many African languages and major dialectes.

Table 2: Demographic indicators

1.1.3.     Economy

The Republic of Cameroon's economy is predominantly based on agriculture and oil resources. Cameroon has one of the best-endowed primary commodity economies in central Africa. Over 79% agricultural products aCCount for the country's export earning. Despite the fact that agriculture is a relatively productive sector, 48% of Cameroonians live beneath the poverty level. Additionally, the Cameroonian's economy has been in decline in food production since the main cities are experiencing an unprecedented rate of rural exodus. ACCording to the World Bank, the Cameroonian's external debt was USD 10.9 billion in 2000 and that is why it was subject to structural adjustment programmes instituted by the World Bank. In January 2001, the Paris Club agreed to reduce the Cameroon's debt of 1.3 billion by USD 900 million, total debt relief now amounts to 1.26 billion (the World Fact, 2002). However, the International Monetary Fund is pressing the authorities for more reforms, increasing budget transparency and privatisation. The Cameroonian's currency is the “Communauté Financière Africaine Franc”, note-responsible authority of the Bank of the Central Africa States.

Table 3: Economic indicators

Source: AIDS in Africa, page 39

1.1.4.     Education

Cameroon is one of the few countries in Central Africa to offer mass education. In consequence, the literacy rate is quite high. School facilities are available both in rural and urban areas. Due to the cultural harmful practices on education, some ethnic groups are less educated than others particularly in rural areas. For instance, the Fulani tribes are nomadic cattle rearers that move constantly from place to place in quest for pasture for their cattle.  As a result, many of the school-aged children do not attend school. In addition, in the Muslim circles especially those in the Northern provinces send a few of their children to school but discriminate between the sexes.

Therefore, girls are sometimes expected to go into early marriages before they have opportunity to go to school. For instance in 1997, the Banso Hospital of the Cameroon Baptist Convention conducted a survey of the sexual histories of 1701 post-primary schools at 14 schools in Northwest Province. The survey revealed that 8% of students had had sex by age 10, while 58% of students in secondary school were sexually active. This shows partly why the level of education is so low among the northerners especially the female children. Therefore, the need to start HIV education during primary school is felt. The same survey was repeated in 2001 in all the 14 schools. The survey indicated that 63% of the students were virgins and that 7% of students had had sex by age of 10. This helps to understand that HIV education works and such programme needs to be replicated elsewhere.

There is a higher number of Cameroonians who are literate in terms of primary school. The remaining large group is made up of those who have completed secondary education and may hold university degree. Many of those who have university level education lack employment. This constitutes a big back for Cameroonians.

Table 4: Education indicators

1.1.5.     Health

ACCording to the Ministry of Public Health, as of November, 1998, Cameroon had 284 hospitals, 1042 health centres and 215 pharmacies. Faith-based organisations are also key players in the provision of health care. For instance, Catholic health service is managing 179 health clinics of which 8 hospitals and 1315 health personnel. Protestant churches are under the umbrella of FEMEC ( Fédération des Eglises et Missions Evangéliques du Cameroun ) have 163 health institutions of which 28 hospitals and 2683 health personnel. The ten leading causes of death are malaria, HIV/AIDS, meningitis, tuberculosis, pneumonia, diarrhoea/worms, cardiovascular disease, post-operation complications, hepatoma and diabetes mellitus (Tih, 2003).  Taking into aCCount the fact meningitis and tuberculosis are “twin sisters” of HIV/AIDS, it could be said that over the past decade HIV/AIDS has become the leading cause of death in Cameroon. This will result in the decrease of life expectancy, high morbidity and mortality rates, population reduction and changes in the distribution of population by age and sex than would otherwise be expected.

Table 5: Health indicators

1.1.6.     Poverty and vulnerability

Problems related to income distribution and poverty have regained importance and have become a topical issue in Cameroon, especially since the country adopted economic reforms and liberalisation policies after the onset of the economic crisis in 1986-1987, a crisis which lasted a decade until 1994/1995. The first of the economic reforms were designed by the Cameroonian government and supported by the International Monetary Funds and the World Bank not only to correct the structural imbalances in the economy that triggered the economy crisis but also to liberalise the economy, disengage the government from productive sector of the economy, and to prepare the private sector as the possible engine of economic growth.

Although the Cameroonian's economy regained the path of growth since 1995, the effect of the crisis have been such that inequality in the distribution of income and poverty have increased the addition of social dimension to these adjustment programmes as well as the debt alleviation measures which are just beginning to be implemented. However, these programmes put more emphasis on economy efficiency to the detriment of equity considerations. These criticisms have been raised by several organisations and authors namely UNDP (1990, 1997) and Killick (1984).

With regard to vulnerability, 48% of Cameroonians are falling below the poverty line while 30% of Cameroonians are facing unemployment. This makes them vulnerable to HIV/AIDS since most of them have to sell themselves in order to have some money for survival reasons. This could partly explain why 600 Cameroonians are getting infected with HIV daily.

1.2.  Epidemiological data

1.2.1.     The HIV/AIDS epidemic in Cameroon

Cameroon 's first case was reported in 1986 and ever since, there has been a significant increase in the number of people living with HIV/AIDS. As of December, 1994, the total number of AIDS reported was 5,375. Cameroon's HIV/AIDS epidemic is defined as one of the significant risk. Subtype O, a rare variant of HIV, has been detected in Cameroon, and 3% of the sexually active population is estimated to be HIV+; in some regions the prevalence has passed 10% (Bamenda). Ninety percent of HIV transmission is by heterosexual sex. Seventy-five percent of reported cases are found between 20-39 years of age. HIV seroprevalence in women age 15-24 years, range from 0.7% (Yaoundé) to 8.5% (Bamenda). By the year 2005, the government estimates 10,000-14000 new AIDS cases since the seroprevalence increased from 0.5% in 1987 to 12% at the end of 2002.

Table 6: Estimated number of people living with HIV/AIDS

53,000 are the estimated number of adults and children who died of AIDS during 2001.

At the end of 2001, the estimated number of children who lost their mother or father or both parents to AIDS and who were alive and under age of 15 were 210,000.

Source: Cameroon Epidemiological Fact sheets 2002 Updated

1.2.2.     Sentinel surveillance

HIV prevalence information among antenatal clinic attendees has been available since 1989. In Cameroon, Yaoundé and Douala are the major urban areas. In Yaounde, HIV prevalence was 11.2% and the median HIV prevalence in Douala was 11.6%. In 2000, the overall HIV prevalence among antenatal attendees in 28 sites was 10.8%. In areas outside Yaounde and Douala, HIV prevalence among antenatal clinic increased from less than 1% in 1989 to 8% in 1996 and this has continued to rise especially among 15-19 years-old and among the 20-24 years-old antenatal attendees across all the sites.

HIV prevalence among sex workers in Yaounde increased from 5.6% in 1990 to 45.3% in 1993. In 1994, 21% sex workers who tested both in Yaounde and Douala were found to be HIV+. However, this prevalence noticed a little decline (17%) in 1995. A couple studies conducted among truck drivers in 1993 and 1994 showed a medium prevalence of 13%. In 1996, 15% of military personnel tested were HIV positive. HIV prevalence increased among male sexually transmitted infections clinic patients tested from 5% in 1992 to 16% in 1996. In the countryside, HIV prevalence among STI clinic patients had reached 8% in 1992. Limited information was available on sexual behaviours although the age at first sex among the 20-24 years old surveyed in the 1991 Demographic Health Survey was 16.1%. The 2000 HIV/AIDS epidemiological data available shows that the HIV/AIDS vary from one province to another. These data are presented in the table below:

Table 7. HIV Prevalence by Provinces in 2000

Comments

Although, these statistics are bio-medical oriented, Amadoua, the North and the South-West of Cameroon seem to hold the highest HIV prevalence. This could be due to the following contributing factors.

1.2.3.     Contributing factors to the spread of HIV/AIDS

There are many contributing factors to the spread of HIV/AIDS. They include:

· The persistence culture of silence and denial to the spread of HIV/AIDS within the churches and the government

· Poverty that hinds control efforts

· Political instability of 1990s with its consequences: insecurity, rape and sexual violence

· Socio-cultural issues:

· Taboos surrounding discussion about sex and sexuality

· Stigma, discrimination and fear of rejection that force people not to be tested

· Gender inequity

· Lack of education that makes little girls to get married very earlier

· Global economic and injustice

· Heavy external debt

· Structural adjustments with its cut in social services

· Little opportunity to aCCess to antiretroviral

1.2.4.     Impact of HIV/AIDS in Cameroon

1.2.4.1.  Socio-economic impact

In Cameroon, HIV prevalence among the sexually active is presently at 12%, 22 times higher than in 1987, when it stood at 0,5%. The number of people living with HIV is estimated at 937,000 and 1 Cameroonian out of 9 among the sexually active today is infected. This situation calls on all the stakeholders involved in the fight against AIDS in Cameroon and especially the government for increased resources to help stem the epidemic. Cameroon has been granted a debt reduction about 36 billion FCFA for the year 2001 out of which 7 billion have been paid into a special aCCount and expendable. The government considers HIV/AIDS as a factor aggravating poverty, social and economic development.

1.2.4.2.  Health sector impact

The increasing mortality and the growth of the number of orphans pose unprecedented social welfare demand for countries such as Cameroon already burdened by huge development and health challenges. As mentioned elsewhere, HIV/AIDS is becoming a great threat in rural areas than in cities. Ironically, more people living with HIV/AIDS reside in rural areas. For instance, in Bamenda, HIV is the main the main leading cause of death among the clinic patients (Tih, 2003). Health care systems in Cameroon are overstretched as they deal with a growing number of AIDS patients and loss of health care personnel.

1.2.4.3.  Agricultural impact

The epidemic is undermining the progress of agricultural and rural development made during the previous decades. In contrast to other diseases, AIDS kills mostly people members of the productive age group (people aged 15-49 years). With regard to 600 Cameroonians who are getting infected daily, AIDS will cut productivity as more people will became ill and as more time will be devoted to caring for the sick and for funeral rituals. Researchers have calculated that HIV/AIDS is causing the loss up to 50% of agricultural extension staff in sub-Saharan Africa.

1.2.4.4.  Education impact

Teachers and students are dying or leaving school, reducing both the quality and efficiency of educational system. The qualified personnel who are now employed cannot be all replaced. This poses a humane resource problem for the entire community.

1.2.5.     Politics

Cameroon is one of the few stable countries in Central Africa region. However, a multiparty declaration was made by the current President in 1990. In 1991, the country experimented a political upheaval. Between 1999-2000, Cameroon became a state of emergency. Soldiers were sent out. It is well known that soldiers are among HIV high risk target (15% soldiers tested HIV positive in Cameroon), sexual promiscuity, rape, sexual violence took place. Additionally, HIV/AIDS high prevalence was found by the close settings in the plantation camps whereby most workers may venture into sexual intercourse to meet their financial needs.

Formerly a strong pro-natalist country, in 1992 Cameroon adopted both a National Population policy and a comprehensive family planning service delivery policy. Since, HIV/AIDS should be dealt in the light of sexuality; one can understand why the national response to combat HIV/AIDS was not so prompt.

2.   The HIV/AIDS Control Committee

2.1.  Background information of the AIDS Control Programme

Cameroon across the Central Africa region is expanding and upgrading its response to HIV/AIDS. A Committee to fight HIV/AIDS was created in 1996 following the National AIDS Control Programme that took place within the Ministry of Public Health.

Table 8. Dates and major events of the National Response

Comment

These dates and major events of the National Response are self explanatory that Cameroon lacked the political commitment from the onset of HIV/AIDS to combat the epidemic. Taking into the culture of silence and denial of the disease associated with HIV/AIDS; this could justify why Cameroon has become one of the worst countries hit by HIV/AIDS in Central Africa.

Despite these above plans that aimed at consolidating and expanding interventions on HIV/AIDS, monitoring behaviour change and epidemic through epidemiological prevalence, the National AIDS Control Programme faced many shortcomings namely:

· Insufficient coordination mechanisms between stakeholders and programme partners

· Little resources allocated to the programme

· No or little implication of the government sectors other than health sector to combat HIV/AIDS

· Increased HIV/AIDS prevalence especially among the 20-39 years old

2.2.  The National response of Cameroon

However, today, Cameroon is one of the countries that have used to good report the present opportunities for mobilising resources for HIV/AIDS control in terms of how these resources have been utilised. The strategic document prepared by the government under the auspices of the World Bank in consultation with other partners, considers HIV/AIDS as a factor aggravating poverty and social and economic development. The elaboration of the national strategic plan has brought to the fore the AIDS problematic and has shown how and with what budgetary resources, HIV/AIDS control actions would cost in terms of financing in the forthcoming days in Cameroon. This programmatic framework has facilitated negotiations on the priority to be given to HIV/AIDS not only with the global poverty reduction strategy, but equally with respect to the allocation of additional resources obtained from debt reduction gains to face this epidemic.

The launch by the Prime Minister of the Strategic Plan with the technical support of co-sponsors and other partners in the amount of 200 million USD for 2001-2003 has helped to re-affirm the government's and the political will to consider HIV/AIDS not only as a priority but also integrating it in the Cameroonian's development instruments. Cameroon is has elaborated an ambitious emergency plan to make possible a 100% condom distribution to vulnerable groups such as drivers, truckers, soldiers, the police, gendarmes, custom agents, prisoners, prison wards and sex workers etc.

Testing and counselling, the prevention of mother-to-child transmission of HIV, the behavioural change programme among young people is underway. The government organised three days of discussions on reaching multisectoral programme whose goal is to halt the spread of the HIV epidemic in Cameroon. This will minimise the effects on those infected and affected by HIV/AIDS, by strengthening the means to fight to AIDS that are available to communities, for the design and implementation of strategies and sectoral plans 50 million USD that have granted by the World Bank towards this end.

2.3.  Partnership

The government has shown its openness to work with several stakeholders namely local and foreign Non Governmental Organisations, national secular and religious associations, churches, civil society, the private sector and external partners that have associated their efforts with those already engaged by the National AIDS Control Programme to combat the HIV/AIDS.

Faith-based organisations

Over the few past years, the government has been increasingly concerned about the epidemic of HIV/AIDS since the partnership is based on the premise that, in isolation, none of its constituencies be they government, civil society and or the various national and international organisations working against AIDS can turn the epidemic around. In addition, the government considered the faith-based organisations as appropriate channels to implement effective preventive measures as well as care, counselling and advocacy. The interventions of faith-based organisations are part of the sectoral response within the National AIDS Control Committee. In 2001, 17 conventions were signed between the faith-based organisations and the National AIDS Control Committee. 15 Faith-based organisations received an amount of FCFA: 253 981 333.- The religious communities which received the amount are presented in the table below:

Table 9. Faith-based organisations that received funding from the government in 2002

Source: Annual report of the National AIDS Control Committee 2002 page 30

Comments

The partnership between the Cameroonian Government and the faith-based organisations is nation-wide. I would like to suggest that its utmost important role would be at grass root level, where it would support national plans to fight AIDS and boost existing initiatives. With the various faith-based organisations sharing their experiences and suCCessful stories, the partnership can help transform isolated actions into coherent plans of actions. The venture should build on the strengths of each religious community to provide national leadership.

External Partners

The National AIDS Control Programme works in collaboration with the following partners: World Health Organisation, UNAIDS, UNDP, World Bank, GTZ, French Cooperation, UNICEF, Oxfam, Red Cross, FNUAP, European Union, USAID, etc.

3.   Faith-Based Organisations:
Perceptions and Involment in Addressing HIV/AIDS

Faith-based organisations in Cameroon

With regard to the mapping exercise, I met religious leaders and heads of health services of the following religious communities: Eglise Evangélique du Cameroon, Eglise Evangélique Luthérienne du Cameroon, Eglise Anglicane, Eglise Presbyterienne du Cameroon, Eglise Catholique, Cameroon Baptist Convention, Presbyterian Church of Cameroon, Muslim Community, Methodist church of Cameroon and Fédération des Eglises et des Missions Evangéliques du Cameroon.

Perceptions of HIV/AIDS by the above Faith-based organisations

AIDS remains a major concern for the many church leaders and heads of health services that I met in Cameroon. Many of them are still acknowledging that HIV/AIDS cases have been increasing at an alarming rates during the past decades. In addition, they know that as far as the HIV/AIDS is concerned, there is neither cure and nor vaCCines. They also know the name of the virus that causes AIDS, its mode of action and the principal modes of transmission. This could be partly the result of the many theological seminars and workshops that are taking place in Cameroon. However, the perceptions of HIV/AIDS from church to church.

Eglise Evangélique du Cameroon

From the National President of the Eglise Evangélique du Cameroun viewpoint, HIV/AIDS is not a single epidemic. It should be understood to involve contributing factors such as poverty and immoral behaviours inconsistent with God's commandments, etc.

“HIV/AIDS is not merely a health issue but a life crisis of spirit, mind, and social environment due to socio-economic and political pressure in which we are living on. In Cameroon, people are dying daily as a result of HIV/AIDS and this tendency is rising dramatically. Many Ecumenical organisations in the North are still holding great planning to fight HIV/AIDS. Time is come now to undertake great action.”

Rev. FOCHIVE, The National President of the Eglise Evangélique du Cameroon.

Eglise Evangélique Luthérienne du Cameroun

The Eglise Evangélique Luthérienne du Cameroon is aware that HIV/AIDS is threatening the churches. Many of the church members are infected. The church itself is living with HIV/AIDS.

“From the onset of the disease, the Eglise Evangélique Luthérienne du Cameroon understood that HIV/AIDS is also an issue of churches. In order to help the church to break the silence around HIV/AIDS within its congregations, we called upon the Kenyan Journalist John who came to Cameroon in the 1990s to share his testimony of leaving positively with HIV/AIDS. This will help the church very much on the fact HIV/AIDS is no longer a private concern but could be spoken about openly and honestly by everybody including the church leaders”

“I used to pay my brother's tuition fees from the primary school up to the University. After completing his bachelor degree, my brother only taught 5 months before he died of AIDS leaving behind him his infected wife and many children that I have to look after. Much has been invested on my brother's training but he did not stay longer to contribute to the family economic growth.  Apart from my brother, I have lost up to 9 members of my family”.

Rev.Robert PINDZIE ADAMOU, Deputy President of EELC

Anglican Church of Cameroon

The perception of HIV/AIDS in the Anglican Church of Cameroon is similar to that of the Evangelical Church of Cameroon. HIV/AIDS is acknowledged as a reality with unprecedented consequences on medical, social, economic, religious and ethical aspects.

“The disease does not make any discrimination and everybody is concerned in one way or another as being infected or affected by its consequences. The Anglican church does not consider HIV/AIDS as a divine punishment since our God is a God of love and mercy who gives life and not death”

The RT.Rev.Jonathan RUHUMULIZA, Anglican Bishop.

Eglise Presbytérienne du Cameroon

The willingness and the commitment to combat HIV/AIDS of the Eglise Presbytérienne were visible. The general secretary of the EPC that I met showed that he has been sensitised on the serious of the problem.

“HIV/AIDS is a reality that we are facing in Cameroon as 600 Cameroonians get infected daily. The youth is paying the highest cost to this dreadful disease. Human resources are the mainstream of the development within a country. What's next if the whole population is infected by HIV/AIDS? There will be no more churches in Cameroon. Time has come now to halt the spread of this awful pandemic A dollar now is worth more than 1000 USD in future in the sense that a life lost cannot be redeemed. A dollar will save a life now.”

Rev.Dr MASSI GAMI Dieudonné, General Secretary of the E.P of Cameroon.

Eglise Catholique of Cameroon

Taking into aCCount the immense and manifold suffering in many parts of Cameroon, the Catholic's perceptions of the disease is that HIV/AIDS is a threat to all of us and to our communion.

“Since we consider HIV/AIDS as any other disease, the Catholic had recognised the urgent need to break the silence surrounding HIV/AIDS in our churches and congregations to provide prevention measures, care, counselling, support and advocacy”.

Sister Dr Anne Daban, Director of Health services Archdiocese of Yaounde.

Presbyterian Church of Cameroon

The Presbyterian Church of Cameroon is one of the pioneers in HIV/AIDS work in Cameroon. As mentioned earlier, the Presbyterian Church of Cameroon acknowledged that HIV infections have increased greatly both among people who are tested because they have symptoms of the Acquired Immune Deficiency Syndrome (AIDS), and among those who are tested as blood donors and on a voluntary testing basis.

“Time to combat HIV/AIDS is now. Tomorrow will be too late to save the population of Cameroon from dying of AIDS. That is why the PCC has been considering HIV/AIDS on the same level as malaria. People must be taught many times in order to prevent the past failure characterised by the fact that having attended a workshop on HIV/AIDS, they willingly aCCepted to avoid getting infected by HIV. However, as time goes on people forget their commitment to combat HIV/AIDS as they go back to their past lifestyles. People need to be preached about the HIV/AIDS from the pulpit just like John the Baptist preached in the wilderness”

Muslim Community of Cameroon

The Muslim community has not remained in the margin of the struggle against HIV/AIDS. Imams are doing their best to inform, train and enlighten their audience about the HIV/AIDS phenomenon and its socio-economic impact on individual and collective well-being.

“HIV/AIDS is a reality in Cameroon which spares no religions, particular gender, age, social or ethnic groups and races, etc. HIV/AIDS could be a divine test that has been given to the humankind. The root causes could be the result of disobedience to God's laws and sexual wanders. ACCording to the Koran, in the end of the days a certain number of sufferings will rise. This constitutes a warning message for the human kind to get back to their Lord, Allah.”

Oustaz Mouhammad Aminoudine, Lecturer at Yaounde-Mimboman

Cameroon Baptist Convention

Over the past decade, HIV infections have become the leading cause of hospital deaths at Banso and Mbingo Baptist Hospitals. Additionally, many other patients with HIV infections go home just to die. The Cameroon Baptist Convention has been increasingly concerned at the pandemic of HIV infections and the resulting increase in other infections.

“HIV has generated an AIDS epidemic that has spread to every part of the world including Cameroon. The epidemic has proved devastating effect on the population. It is reversing important development gains, robbing millions of their lives, widening the gap between rich and poor, and undermining social and economic security. The Cameroon Baptist Convention has a community based and focuses on training of AIDS educators who deliver AIDS education in schools, local communities, and in churches, educating people on how to stay safe from the VIH. They also give general counselling to people living with HIV/AIDS”

Rev. TANGWA Charles FONDZEFE, General Secretary of CBC

Federation of Protestant churches and Mission of Cameroon

11 religious communities (Cameroon Baptist Convention, Native Baptist Church, Evangelical Church of Cameroon, Eglise Evangélique Luthérienne du Cameroon, Eglise Fraternelle Luthérienne au Cameroun, Eglise Presbytérienne du Cameroon, Eglise Presbytérienne Camerounaise, Eglise Protestante Africaine, Presbyterian Church of Cameroon, Union des Eglises Baptistes du cameroun, Union des Eglises Evangéliques au Nord-Cameroon and Anglican Church of Cameroon)have already the Federation of Protestant churches and Mission of Cameroon. This could be used as an appropriate channel to acknowledge the scale of the HIV/AIDS problem and to help churches maximise resources to find out creative solutions responsive to their needs, since many of the church members are still facing the realisation that they urgently need guidance in dealing with the epidemic.

“ The HIV epidemic actually comprises multiple epidemics, such as poverty, gender inequalities, resurgence of controllable diseases: Tuberculosis, social injustice which increase the people's vulnerability to HIV/AIDS. As far as HIV/AIDS is concerned, we are facing a terrible epidemic because HIV/AIDS is erasing the hard won development achievements. The anti-retroviral drugs might be available. But, they cost 25,000FCFA. Still are Cameroonians who are unable to earn that much per month. As a result, people are loosing their immunity to this dreadful virus and disease”.

Rev. Dr NJAMI-MWANDI Simon, Executive Secretary of FEMEC.

“We are planning to combat HIV/AIDS with substantial contributions of the World Council of Churches and other potential partners. HIV/AIDS problems require love, tolerance and compassion. The money could be used as tool in order to implement what we feel inside of ourselves. HIV/AIDS should be considered as any other disease with which one could live positively. Like it or not, everybody will die anyway”

Rev. Pastor AMTSE Pierre SONGSARE, President of FEMEC.

Methodist Church of Cameroon

This church is about to launch its activities including the HIV/AIDS activities in Cameroon.

“There is no doubt that sub-Saharan Africa is by far the worst affected region in the world. Therefore, the AIDS epidemic has a profound impact on economic growth, income and poverty. As a result women and girls are more vulnerable to HIV/AIDS and are disproportionately affected and infected by the epidemic. In both rural and urban areas, the epidemic adds the already heavy burdens women bear as workers, caregivers, educators and mothers. I will do my best to persuade this new church in Cameroon to also deal with HIV/AIDS epidemic”.

Rev. Dr Catherine AKALE.

Comments on the perceptions of Faith-based organisations

From the results of the above perceptions, it is clear that faith-based organisations are aware of HIV/AIDS and its basic consequences although some misconceptions and misunderstandings were found during in-depth interviews when it comes to probe their knowledge. In addition, this mapping results also shows that church leaders are concerned with HIV/AIDS because it entails loss of productivity, wipe out the hard-won development achievements, worries, discrimination towards people living with HIV/AIDS.

Though, the results showed increased tendencies to stigmatise attitudes, partly due to the fact church leaders see HIV/AIDS as a consequence of sexual immorality, most of church leaders felt that, should any Christian/Muslim have the disease, they would care. This attitude was obvious especially to those who have lost parents, brothers, sisters or close friends. The challenge remains between the acquisition of relevant knowledge and the care of the HIV infected and affected people in the religious circles. Most of church leaders do not know how many orphans and widows those are needy in their congregations. Therefore, they could not undertake sound advocacy approaches to lobby resources neither to the government authorities nor to other stakeholders interested in the field of HIV/AIDS.

Involvement of Churches in Addressing HIV/AIDS

Evangelical Church of Cameroon (ECC)

Among many other churches, the Evangelical Church in Cameroon remains one of the main pioneers in HIV/AIDS work in Cameroon.

Its programme has a range of objectives including:

· To raise awareness on HIV/AIDS in the general population

· To reduce the risk of HIV/AIDS transmission

Main activities

The church's efforts have focused on the Youth and Women's ministry in:

· conducting awareness campaigns to the disseminate information and educate the population

· undertaking the training of trainers through seminars and workshops.

Outcomes

· Despite the chur ch leader's good intentions and perceptions on HIV/AIDS, this is still perceived by the general population as a taboo, curse made by witchcraft etc. In order to build up the EEC's capacity, two aspects need to be reinforced: The first one is helping the general population to gradually change their attitudes and behaviour about their perceptions on the disease in order to help them aCCept people living with HIV/AIDS as normal people either in their families or in the community at large. The second is about the coordination mechanisms. In my opinion, there is little coordination between the different programmes within the same church. The EEC headquarter should make sure that all the necessary activities are coordinated to avoid unnecessary duplication and frustration among the staff.

Lessons learnt

· Increased stigma and discrimination towards people living with HIV/AIDS impede the efforts of those who are willing to ge t tested for fear of rejection. The process to reduce stigma should lie on transforming the general public perceptions on HIV/AIDS. At the Health Centre of Garoua, there is a great number of anonymous screening of seropositive compared to those asking for testing and counselling on a voluntary basis (Personal communication). In additional, staff would be reluctant to disclose HIV results to the concerned client since they are not trained to do that.

· Visit exposure is a clue to help people change their mind about HIV/AIDS as they become actors rather than spectators. A couple young people went from ECC to the Democratic Republic of Congo particularly to the Youth department of Eglise du Christ du Congo. After completing their visit exposure and the training of trainers workshop, they went back home. They submitted their project proposals to various donors. They received funds which are helping to do a great job to train others on prevention measures and voluntary counselling and testing, etc. Young people are now willing to be tested.

· During the mapping, I met in Cameroon the Executive Secretary of the United Evangelical Missions based in Wuppertal. In his talk, he made it clear that HIV/AIDS is still a priority within the UEM's mandate. This helped the EEC's leaders to understand that HIV/AIDS is an issue worth to be concerned about.

Cameroon Baptist Convention (CBC)

The Cameroon Baptist Convention is providing care to all who need it as an expression of Christian love and as a mean of witnessing the Gospel in order to bring people to God through Jesus-Christ. With regard to HIV/AIDS, in close collaboration with the government and other active stakeholders in the field of HIV/AIDS, the CBC health board is running many activities such as:

· Training of pastors, students and the general population at large

· Care of orphans

· voluntary counselling and testing

· prevention of mother-to-child transmission

· Tuberculosis control programmes

a) Training of trainers

This programme began slowly in earlier 1992. In 1996-1997, the training of senior nurses took place for AIDS education in schools, churches and cultural settings. In addition, the CBC launched the training of trainers on community AIDS education. In 2000, 2 key nurses and 2 physicians were trained in Uganda on antenatal AIDS screening.

Table 10: Number of affected and infected seen by the Health Promoters

Outcomes

· A rise in the population reached was observed in June and November because  health promoters took the opportunity of political campaigns rallies to reach more people.

· The most sensitised population were youth followed by women and men

· A drop in the population sensitised were seen in April and August because most health promoters were on leave while health education was given to health units.

· The aCCeptance of people towards HIV/AIDS is high (98%)

· This helps the CBC Health board to know that the HIV prevalence is 10% in Bamenda.

· Nevirapine is administered to women during labour and afterwards. This reduced the HIV transmission about 50%. This helped children to stand healthier.

b) Care of orphans

The number of beneficiaries at the start of the programme was as follow:

Table 11: Number of beneficiaries

Comments

Two of chosen children and one caregiver died. This aCCounts for the reduction in the number of chosen children and caregivers. In this programme, the CBC Health Board decided to call the orphans “chosen children” in order to avoid the stigma associated with AIDS orphans in the communities.

At present, 623 chosen children were identified and registered. However, it has to be mentioned that this number is constantly increasing as health promoters, counsellors and churches continue to identify them. During the academic 2002-2002 academic year, the analysis of progress of chosen children was:

· 55 out of 65 chosen attended school

· 7 out of 11 chosen that had attended college were promoted to the next class

· 34 out of the 44 chosen children that attended primary school were promoted to the next class

· 1 of the chosen children is attending an apprenticeship workshop

· The other 9 were infants below school age.

In addition, these chosen children received the following assistance:

· School needs: Caregivers were reimbursed as they present receipts of the expenses for tuition fees, books and uniform

· Food subsidies: on two oCCasions, these chosen children were given food. The AIDS coordinator for North-West Province also provided foodstuff.

· Medical bills: CBC paid medical bills of the children who were ill.

· Christmas assistance: Caregivers were assisted to meet the needs for the chosen children.

c) Voluntary counselling and testing

The CBC is ensuring that voluntary counselling and testing does not stigmatise, debilitate or otherwise negatively affect the dignity of the very people who want to undergo testing. This helped CBC the shift from a medical driven approach to a participatory process. CBC has found a 9% positivity rate in blood donors and an 80% positivity rate in hospitalised patients with symptoms suggestive of AIDS during the period from January to October 2001. HIV/AIDS has been one of the main leading causes of death in 2002.

Table 12. Ten most common causes of death in Bamenda

Comments

Like in many other developing countries, malaria is still the leading cause of death. In 2002, HIV/AIDS was the second cause of death in Bamenda. However, since 22% of TB patients were found to be HIV positive and most of the meningitis cases could probably be associated with HIV/AIDS. Therefore, HIV/AIDS and its opportunistic infections could be the main leading cause of death in Bamenda.

d) Prevention of Mother-to-Child Transmission

Because of its expertise and its credibility, the Cameroonian government has chosen CBC to lead the prevention of Mother-to-Child Transmission within 6 institutions namely the CBC health centres, the government, the CDC, the Catholic and the Presbyterian health facilities. In 2002, the PTMTC were operational in 66 sites where 11,881 women received antenatal services and thus were pre-counselled for HIV screening. 805 (7%) women refused to get tested for many reasons including the increased stigmatisation and discrimination. The aCCeptance rate was 11,088 (93%) women. 91 of 11,088 left without receiving post-counselling for personal reasons. 1,056 (9.5%) out of 1088 pregnant women screened were found to be HIV positive.

4,740 deliveries took place in the 66 sites. 365 HIV positive women and 348 babies were treated with Nevirapine. About 191 babies are listed for follow-up. What is outstanding within CBC is the fact that husbands of women attending antenatal services are encouraged to do HIV test. In 2002, 121 husbands were screened and most of them were negative. What is remarkable in this PTMCT programme is that this programme is being expanded to villages by including trained traditional birth attendants to handle it.

e) TB control Programme

The fight against HIV/AIDS and tuberculosis within the CBC Health Board is in its fourth year. Generally, people in the productive age (14-45 years old) constituted the large number of TB patients during the year 2002. The distribution of patients by their HIV status is presented as follow:

Table 13. Distribution of patients by their HIV status

Comments

It has been acknowledged from scientific evidence the existence of co-relationship of HIV and Tuberculosis is very close. 40.7% of 887 patients were screened for HIV in Bamenda, while 59.6 refused. Out of 358 tested, 55.3% were found HIV positive. This can be one of the many reasons why in endemic countries, Tuberculosis patients usually show highest prevalence of HIV infection.

This comprehensive programme to fight HIV/AIDS deserves the Cameroon Baptist Convention's attention and encouragements since the CBC Health Board is one of the key players in Cameroon. For such a programme to be suCCessful, among other contributing factors; training at all levels is a prerequisite condition, following by good incentive and the assurance from the church's side that there is the right number of personnel with the appropriate skills available in the right place at the right time. However, from my observations I felt that the current committee formed in 1998 is dormant and need to be replaced with a more dynamic one. Additionally, despite the indubitable managerial qualities and capacities of the current Director of the Health Services, he is overloaded with work and responsibilities.

Eglise Presbytérienne du Cameroon

The Eglise Presbyterienne du Cameroon programme includes the AIDS education, HIV testing, clinical and home-based care. The AIDS education HIV/AIDS promotes awareness and prevention activities among the general public. The EPC emphasised on Abstinence and faithfulness. The condom use is merely recommended within a discordant couple. However, this programme has not taken a comprehensive approach that would include not only the medical demands but also social and emotional needs of persons living with HIV/AIDS. An additional approach would be the encouragement of persons infected or affected to participate in the planning and the implementation of HIV/AIDS programme because this would increase the profile of persons living with HIV/AIDS within the communities and thus reduce the stigmatisation. In my opinion, the programme is not fully structured to bear fruits.

I met the Medical Doctor of the Djoungolo hospital who told me that for medical reasons, “suspected HIV persons” are tested in the hospital without their consent. As mentioned for the Evangelical Church of Cameroon, the health personnel is ill equipped to disclose the result to the concerned client. I told the General Secretary of EPC and the Medical doctor that they should put more effort to undertake those activities aimed at promoting voluntary counselling and testing as opposed to the anonymous screening of samples taken for sexually transmitted infections.

It is necessary to stress that the integration of activities in different areas of HIV/AIDS prevention in the health institutions-that bring together in the antenatal care unit and other diagnostic services, counselling, health education, and surveillance of the HIV/AIDS epidemic could be of strong benefit to the community at Djoungolo. This will help increase commitment of the health centre's and hospital's management and will help stimulate preventive measures at the community level. I appreciated the fact EPC was able to establish a national HIV/AIDS coordination which is led by a Pastor: Rev Aoumou. I hope that the HIV/AIDS programme will be strengthened.

The Catholic Archdiocese of Yaoundé

For the time being, Dr Anne Daban (Medical Director) said that she received time and support needed to start her project from the Bishop of Yaounde and other authorities. Health personnel are now open mind to work on the HIV/AIDS programme.

Objectives

· To provide medical care for opportunistic infections, counselling and support services to facilitate voluntary counselling and testing

· To implement home care that is affordable, aCCessible and efficient

· To build networks throughout the country among individuals living with HIV/AIDS

· To provide a forum for an open discussion of intimate problems, which are otherwise never shared?

Main activities

The Archdiocese of Yaoundé home-based activities aim at providing treatment for opportunistic infections and psycho-social care to persons living with HIV/AIDS. HIV/AIDS prevention, education, and surveillance are also important parts of the work. The Archdiocese of Yaounde has 4 health centres downtown and 3 in rural areas. People coming to those health centres are very often referred from local clinics. Home-based care begins with the identification of potential clients as a result of HIV testing. If diagnosed HIV positive, the person receives counselling sessions that include assessment of individual needs and wishes. This assessment helps identify appropriate follow-up procedures once the patient has been discharged from the health centre.

Another area is the support activities for the association of PLWHAs. Its service includes training for family members, health care visits to members and referrals, meditation and spiritual support, a w