Christo Greyling – a
hemophiliac who tested HIV positive while attending theological
seminary in 1987. Since 1993 he started working as an AIDS
consultant. In the process he developed, implemented and
presented HIV/AIDS workshops to various target audiences
throughout South Africa. His vision and passion is to assist
the church to fulfill their calling on the terrain of HIV and
AIDS in Southern Africa.
HIV/AIDS is devastating the
world, and especially Southern Africa. This article attempts to
provide an understanding of the impact of the epidemic on South
Africa and the relationship between HIV/AIDS and poverty. It
will further explore the current involvement of the church and
make some practical suggestions to assist the Church in
implementing meaningful projects in its fight against this
AIDS. AIDS. AIDS. We hear it
on television and read it in the newspapers. The desperate
faces of people dying from AIDS cry out at us from the pages of
Time and Newsweek. The United Nations have special meetings and
government leaders make resolutions. We are swamped with
statistics and yet more statistics. The numbers of people
dying, becoming infected and children left orphaned become just
an incomprehensible bundle of figures. People are beginning to
experience AIDS fatigue: “Please, not AIDS again!”
But the reality we face does
not go away.
Let’s consider the reality we
face in a different way: An estimated total of 55 million
people died during World War II:
If we knew today that World War
II would start next week or next year, what would we do to
prevent the slaughter of millions of people?
Reality is, we are twenty years
into the HIV/AIDS epidemic. Since 1981 HIV/AIDS has spread
rapidly to every part of the globe, infecting 58 million people
and killing 22 million by the end of 2000.
Worldwide 36.1 million people
are currently living with the disease, the vast majority - 25.3
million - in Sub-Sahara Africa where 3.8 million were infected
during 2000 alone.
The overwhelming majority of
HIV infections, around 95% of the global total, live in the
developing world. This is a proportion that is set to grow even
further as infection rates continue to rise in countries where
poverty, poor health care systems, and limited resources for
effective prevention and care fuel the spread of the virus.
Sub-Sahara Africa is the worst
affected region with around 70% of the global total of
HIV-positive people. Most of these infected populations will die
in the next 10 years, joining the 17.2 million Africans already
claimed by the epidemic.
The war is on! What are we,
and the church as messengers of Hope, actually doing to prevent
the loss of so many human lives?
South African situation
An estimated 4 million South
Africans are currently HIV infected.
This number is expected to rise over the next 10 years – unless
major behavior change occurs that could significantly alter the
course of the epidemic. There could be around 5.3-6.1 million
infected individuals by 2005, and 6 to 7.5 million by 2010.
Currently just over 50% of all new infections occur in South
Approximately 15% of all South
Africans aged between 20 and 64 are infected and these levels
could rise to 20-23% by 2005 and 22-27% by 2010. HIV is a
disease that mostly affects younger people. Almost half of all
adults will become infected before they turn 25. More than 50%
of these young people will die before their 35th
HIV infections will continue to
increase until society at large appreciates the extent of the
epidemic, and people alter their behavior and their response to
those people who are infected and affected.
For many people, this has been
a sustained epidemic of infection without illness. As more
infected individuals become ill with AIDS, the epidemic is
becoming more visible. Due to the scale of this epidemic the
life of every person in the country is bound to be affected in
The number of deaths as a
result of AIDS is expected to rise rapidly in South Africa from
around 120 000 in 2000, to between 354 000 to 383 000 in 2005,
and up to 545 000 to 635 000 in 2010. Again, other sources
suggest that AIDS may result in 800 000 deaths in 2010.
Nationally the proportion of the adult population dying from
AIDS will reach 2 to 2.6% by 2010. At an AIDS in context
conference in Johannesburg, 2001, Debbie Bradshaw from the
Medical Research Council of South Africa showed that information
gathered from death certificates suggest that already half of
all adult deaths can be attributed to AIDS. It is clear that
the devastating impacts of this epidemic are already being felt.
Impact on Women
Women are heavily affected by
the epidemic. They are at greater risk of infection due to
physiological, anatomical and socio-economic reasons.
the lining of the vagina thickens due to hormonal changes at the
age of 15-16 to prepare the body for sexual intercourse. Should
a young woman become sexually active before this age, the lining
of the vaginal wall could easily rupture which would make her
more vulnerable to the transmission of HIV or sexually
transmitted infections (STIs).
women are the receivers of sperm, and this longer contact with
possibly infected semen increases the risk of transmission.
Women might even be more at risk to infection due to undiagnosed
STIs inside the vagina. The cultural practice of dry sex –
inserting leaves, tissues or tightening agents into the genital
tract to pleasure their men – is also wide spread. It puts a
woman at enormous risk for contracting HIV and STIs, as the dry
membrane inside the vagina ruptures easily and torn lesions
provide easy access to the HI-virus. Mucous also contains
immune cells, which gives added protection against infection.
women often lack the power to negotiate safer sex or the use of
contraceptives, be it with her own regular partner, as a sex
worker, even sometimes within marriage if she doubts the
faithfulness of her husband, and certainly during rape.
Socially she might be under the sexual control of her partner
who provides for her and her children. There are also many
different cultural practices in various societies that
traditionally place the women in a disempowered position.
Polygamous marriages are still a common practice; as is the
brother of a dead man taking the latter’s widow and progeny
under his care and protection; and rape is common in all
societies, especially those ravaged by war, violence and
Women-headed households in
South Africa tend to be poorer than those headed by men, and
therefore have fewer reserves. Unemployment is far higher among
women than men. Even among married women there is a high level
of economic maltreatment. A recent survey indicated that the
partners of one in five married women regularly withheld money
for essential living expenses such as food, rent or bills, while
spending money on other things.
Violence against women is high - 13% of women reported being
beaten by a partner. Many women face the risk of abandonment
and abuse if they disclose their HIV positive status. Women
traditionally provide care to the terminally ill and female
children in particular may be required to provide care,
especially in single-parent households or when one parent has
already died of AIDS. Widows may become dependent on a
husband's male heir for support under some customary legal
arrangements, which may make them more vulnerable.
Orphans are perhaps the most
tragic and long-term legacy of the HIV/AIDS epidemic. Of the
more than 13.2 million AIDS orphans, over 90% are in Sub-Sahara
Africa. Caring for them is one of the greatest challenges
facing South Africa. By 2005 an estimated 1 million orphans will
be under the age of 15, rising to about 2.5 million in 2010. The
majority of these orphans will be children over 4 years of age.
Many orphans will grow up as
street children or will form child-headed households to avoid
being separated from siblings. Others will be brought up by
grandparents with limited capacity to take on parental
responsibilities. All will have been traumatized by the illness
and death of parents, and often by separation from siblings.
Trauma will be exacerbated by the stigma and secrecy around
HIV/AIDS that hampers the bereavement process and exposes
children to discrimination in their community and even in their
extended family. Orphans will probably be more susceptible to
becoming HIV-infected through abuse, sex work or emotional
instability leading to high-risk relationships.
As children grow up under these
conditions, they are at high risk of developing antisocial
behavior and of becoming less productive members of society. The
consequences for affected children and society as a whole will
If we consider all the
above-mentioned statistics and realities, how prophetic do the
words of the assassinated ANC leader, Chris Hani, now ring in
We cannot afford to allow the
AIDS epidemic to ruin the realization of our dreams. Existing
statistics indicate that we are still at the beginning of the
epidemic in our country. Unattended, however, this will result
in untold damage and suffering by the end of the century (AIDS
conference in Maputo, 1990).
Why is the South African epidemic
There are a number of
predisposing factors that have made and continue to make South
Africans susceptible to a particularly severe epidemic. These
epidemics of other sexually transmitted diseases (STDs).
These increase the likelihood of HIV transmission.
transport infrastructure and high mobility, allowing for
rapid movement of the virus into new communities.
to the use of condoms, based on cultural and social norms.
status of women in society and within relationships.
Economic dependency and the threat of physical force in
particular, make it difficult for women to protect
themselves from infection.
that accept or encourage high numbers of sexual partners,
especially amongst men.
norms that frown on open discussion of sexual matters,
including sex education for children and teenagers.
family and communal life due, in part to apartheid, migrant
labor patterns and high levels of poverty in the region.
In a sense HIV/AIDS is
repeating what apartheid did - marginalizing a section of the
population and tearing families apart. People who are infected
and directly affected by HIV/AIDS are stigmatized and
discriminated against - even by their very own family members.
As was the case during apartheid, women and children bear the
brunt. Their vulnerability and powerlessness in the face of the
onslaught of HIV/AIDS are made worse by poverty, patriarchy and
The relationship between Poverty
HIV/AIDS and poverty are closely
linked and each in turn increases the other:
increases poverty and poverty increases the risk of HIV
infection and the impact of HIV/AIDS on families and
How does HIV/AIDS increase poverty?
As a person
progresses from HIV infection to AIDS, they suffer many
bouts of illness for which they seek treatment. In the
process they spend money on medical care, traditional
healers, etc. as well as on nutrition and supplements to
help them remain healthy for a longer period of time.
family member has AIDS, a large portion of the family income
is spent on medical care, food and other needs for the sick
person. Often the family income is already reduced as a
result of the person with AIDS being unable to work.
members of the household who are in the weakest positions
suffer the most – in affected households, health expenditure
for the infected person increases while spending on food and
other essentials decreases, impacting on women and children.
reserves are slowly eroded as income decreases and medical
needs increase over time.
are increasing due to the shortage of grave space in urban
cemeteries (a grave in a township can now cost R3, 000 just
for the plot).
a very important element of cultural tradition and a great
deal of money is spent on food and drink for the duration of
the funeral. Funerals extend over a number of days and are
attended by family, extended family and the community at
large. Therefore funerals continue to be costly and consume
valuable resources, which could have been used by the
surviving family members. The impact of a death is most
serious on poorer households.
employers, seeing the impact of HIV/AIDS on their
workforces, are not employing staff with full benefits, but
rather take them on as temporary staff with no benefits such
as medical aid, etc. This means that pensions, etc. will
not be available to meet family needs when they are most
needed and payouts will no doubt be consumed as they are
received, not invested or kept until all other resources
have been exhausted.
How does poverty increase the risk
of HIV infection and worsen the impact of HIV/AIDS on families
reduces children's chances of attending school, which in
turn lowers their chances of gaining employment and
increases their risk of HIV infection. Children often have
to drop out of school to care for sick family members, for
their younger siblings or to look for work. Children lose
the chance to “be children” because of these additional
increases the likelihood that young women (and men) turn to
commercial sex work, selling their bodies to survive, to
gain an income to support younger siblings, to secure their
next meal, to gain shelter, money for school fees, etc.
living in poverty often have low levels of self-esteem and
desire the material things which their friends have, which
may put them at risk of HIV infection through becoming
involved with “sugar daddies”, taxi drivers, etc. – people
who can give them the material things they wish for. “Gift
sex” is not seen as prostitution, and is extremely common in
fall ill with AIDS, they afford time to parenting their
children, leading to risk-taking behavior among young people
due to the lack of attention and guidance they receive. Risk
behavior often leads to unsafe sexual activity and, in turn,
to HIV infection.
children are intentionally neglected and abused or forced to
take on household tasks when they are taken in by relatives
or other families due to the illness or death of their
parents – they are also at risk of HIV infection as their
own self esteem plummets due to this abuse.
home based care providers
many AIDS patients die of malnutrition and not primarily of
AIDS-related illness – people simply do not have sufficient
food, leading to premature death even in the face of AIDS.
Role of the Church
It is with gratitude and
appreciation that we see the church nationally and
internationally slowly, but surely, waking up to the crisis in
our midst. It is very sad to note that this is only happening
after 22 million people have already died and twenty years into
the epidemic. As it very often happens, the church lagged
behind humanistic groups, NGOs, and even governmental
initiatives. Some denominations, such as the Anglican and Roman
Catholic churches, are exemplary in their compassion and
implementation of home based care and orphan care programs.
Some isolated initiatives from evangelical and Pentecostal or
Charismatic churches are commendable, but as a whole the
church’s reaction is led by the passionate few.
Wonderful resolutions have seen
the light. For example: already in the early days of the
epidemic, in April 1988, the Council of Bishops from the United
Methodist church made publicly declared their concern:
We, the Council of Bishops of
The United Methodist Church, join our voices and concern with
those of other religious and community leaders in the face of
what is proving to be a global concern - the existence and
spread of Acquired Immune Deficiency Syndrome. Perhaps, no
disease in recent memory threatens the human family in such
proportions, as does this phenomenon.
This was followed in 1992 by a
resolution from the United Methodist Church, which stated:
As members of the United
Methodist Church we covenant together to assure ministries and
other services to persons with AIDS.... We ask for God's
guidance that we might respond in ways that bear witness always
to Jesus' own compassionate ministry of healing and
reconciliation; and that to this end we might love one another
and care for one another with the same unmeasured and
unconditional love that Jesus embodied."
These, and other later
resolutions by various denominations demonstrate an
understanding and a theological commitment that faith
communities must become involved, but at grassroots level, i.e.
at congregation level, not much is happening. This is even true
about many of the above-mentioned denominations that are already
very much involved.
During the time of apartheid,
Christian churches nationally and internationally were very
vocal and active in their fight against discrimination as it was
implemented by the South African government of the time. It
even led to the official adoption of the confession of Belhar by
the Dutch Reformed Mission Church in South Africa
 in 1986. Section 4
of this confession states:
We believe that God has
revealed himself as the One who wishes to bring about Justice
and true peace among men; that in a world full of injustice and
enmity He is in a special way the God of the destitute, the poor
and the wronged and that He calls his Church to follow Him in
this; that He brings justice to the oppressed and gives bread to
the hungry; that He frees the prisoner and restores sight to the
blind; that He supports the downtrodden, protects the stranger,
helps orphans and widows and blocks the path of the ungodly;
that for Him pure and undefiled religion is to visit the orphans
and the widows in their suffering; that He wishes to teach His
people to do what is good and to seek the right;
that the Church must therefore
stand by people in any form of suffering and need, which
implies, among other things, that the Church must witness
against and strive against any form of injustice, so that
justice may roll down like waters, and righteousness like an
that the Church as the
possession of God must stand where He stands, namely against
injustice and with the wronged; that in following Christ the
Church must witness against all the powerful and privileged who
selfishly seek their own interests and thus control and harm
It is clear that the confession
of Belhar, as it was written in the high time of apartheid, is
still highly relevant in the year 2001. God is still ´… in a
special way the God of the destitute, the poor and the wronged…”
and “…that the Church must therefore (still) stand by people
in any form of suffering and need…” God’s call on us to
demonstrate His grace, compassion, love and forgiveness rings
true through the ages, also the age of HIV/AIDS.
The harsh reality is that HIV
infected and affected people experience the Church as silent and
absent in their suffering. Paper reflects beautiful written
resolutions, but no message of Hope sounds from the pulpits.
Religious leaders and Christians deny that Christians could be
HIV infected. Expressed or implied, the following is very often
the feelings expressed by congregation members and religious
leaders: “It’s not our people”; “They brought it on
themselves”; “They sinned!” “They were sleeping around”;
“It’s Gods punishment for a promiscuous life!” It is clearly a
“them” versus “us” situation with a very judgmental undertone.
The majority of Christians,
including the religious leaders, would strongly deny that they
could ever by judgmental, but in their silence and lack of
interest to become involved, they demonstrate their lack of
compassion for people infected or affected by HIV/AIDS.
It appears as if Christians
concentrate on God as a Righteous God. While reading Colossians
3, which teaches us the rules of holy living as new people in
Christ, many Christians seemingly concentrate on the first part
of this chapter:
to death, therefore, whatever belongs to your earthly nature:
sexual immorality, impurity, lust, evil desires and greed, which
is idolatry. 6Because of these, the wrath of God is
But in their thinking about
HIV/AIDS and people living with HIV/AIDS, they do not apply the
rest of the text, which states:
as God's chosen people, holy and dearly loved, clothe yourselves
with compassion, kindness, humility, gentleness and patience.
13Bear with each other and forgive whatever
grievances you may have against one another. Forgive as the Lord
forgave you. 14And over all these virtues put on
love, which binds them all together in perfect unity. (NIV)
It is as if Christians want to
protect God and feel comfortable with the righteous God, but
they feel very uncomfortable with the Vulnerable God who shared
his life with sinners, who had compassion for them, loved them
unconditionally, forgave them, and died for them.
As we know so well, God calls
us to renewed thinking and actions. We are Christ's
ambassadors, whose love compels us, and who gave
us the ministry of reconciliation: that God was reconciling the
world to himself in Christ, not counting men's sins against
them. 2 Cor 5: 14-19 (NIV)
To be relevant as Body of
Christ in the new millennium, HIV/AIDS challenges us to
demonstrate this ministry of love and reconciliation, as Christ
would have done it.
As a result of the current
situation, HIV positive people and their families are afraid to
trust the Church. They are afraid to be judged or rejected by
the ones they hope would accept them with love. The reason
therefor lies in the fact that these people do not hear God’s
heartbeat for HIV positive people through the church. They do
not see the church’s involvement in terms of HIV/AIDS around
them. The result is that these people suffer without the
support from the faith communities they belong to.
As we’ve already seen, most
people with HIV/AIDS come from disadvantaged, poverty stricken
communities. As a result of apartheid those that “have” do not
have any contact with people from these communities, and
therefore are not aware of the extent of need in these
In Uganda, who first
experienced the brunt of the African AIDS epidemic in the early
1980s, the church played a major role to turn the tide. They
stopped asking, “How did you get it?” and realized it was their
congregation members, or their families, who were dying and
instead started to demonstrate their love, compassion and care.
In a speech delivered to
religious leaders from all the major faith groups Dr. Zola
Skweyiya, Minister of Social Development of South Africa said:
Faith-based organizations and
their agencies possess extensive and effective networks
throughout our country. They are committed and closest to the
disempowered and most vulnerable members of our society.
There is therefore no way that the government, the business
sector or local Communities will succeed in the battle against
HIV/Aids acting on their own.
The partnership against HIV/Aids requires the resolute
leadership and sustained involvement of the religious sector in
all facets of the epidemic.
It is wonderful to see that the
South African government realizes the importance of the role of
faith communities at large in the fight against HIV and AIDS,
and the fact that government would not be able to succeed in
this quest without the buy-in of the faith communities.
The opportunity to illustrate
what we stand for is knocking on our door and if we want to
demonstrate our relevancy in the world, this clearly is the
chance to do so. The Church should be in the front line of the
fight against AIDS because we are the largest social institution
in South Africa. Everywhere in this country - in every small
little town and big city there is a church congregation within
reach. The Church has tremendous infrastructure. There are
more kitchens standing empty for most of the week than in all
the fast foods outlets combined.
The majority of churches have
well developed social actions with excellent infrastructure and
professional people. Human resources - we have a wealth of
potential in congregation members with a variety of passions and
gifts, who are already internally motivated as Christians to
make a difference. The Church has an ethic of sexual
responsibility and of caring for others. In many congregations,
especially in congregations serving the more privileged white
communities, there is a wealth of professional people whose
expertise can be mobilized to build skills in areas that
desperately need them. We now have an excellent opportunity not
only to address HIV and AIDS, but also to address other issues
such as poverty alleviation and the development of desperately
needed skills at the same time.
But, above all, we as Church of
Christ, which knows what it is to be forgiven and to be renews
by grace alone, we have the platform to demonstrate
unconditional love, forgiveness and acceptance. We have a
message of Hope in the risen Christ that is not only true for
the dying, but has an existential life changing message for
people infected and affected who are living and facing the harsh
realities of HIV/AIDS today.
The link between HIV/AIDS,
poverty and apartheid is clear. The Afrikaans churches played a
leading role in the institution of apartheid. These churches
have a wealth of skills within their members. HIV/AIDS presents
them, and all the other churches in South Africa, with the
opportunity to bring a divided church together. This is the
chance to go beyond guilt to fight a new common enemy. This is
an opportunity to demonstrate reconciliation in action.
But to achieve this, the
churches, their leaders and congregation members, need to be
effectively mobilized to understand the extent of the problem,
to develop compassion and to know where and how they can start
to make a difference.
Action plans to mobilize the church
If the church wishes to be true
to its calling, it will have to be a space where those infected
and affected by HIV will feel safe to share their pain.
Influential leaders and opinion
makers in the church will understand the impact of HIV/AIDS on
South Africa. They will continuously stress the need for
religious leaders and congregations to become actively involved
in HIV/AIDS prevention, support and care programs in their
communities. Pastors will be sensitized for the need and
understand the importance of their support for congregation
based AIDS programs. Congregations and church members will take
responsibility for values based prevention programs and
practical support and care programs within congregations as well
as in distressed communities. Support services such as program
guides, sermon outlines and liturgies, training programs,
resources, courses, etc. will be available for the various
prevention, support and care programs.
Elements in a church based AIDS
To reach this ideal, the
following elements for an integrated Church based AIDS plan can
and Training programs
Counseling and Care programs
and Prevention programs
facilitating, training and vision building
Sensitizing and Training programs
Sensitizing of Church Leadership
Very few of the influential
church leaders within most of the churches have been personally
confronted with the realities of HIV/AIDS. To mobilize them to
become ambassadors for the fight against HIV and AIDS within the
church, they themselves will have to undergo a life changing
A sustained change of heart
does not occur by reading an article such as this. It is
something that only happens as part of a process. AIDS programs
that successfully achieve this change would include the
attitudes towards people living with HIV and AIDS
up-to-date epidemiological data on the impact of the
in-depth information on the transmission of HIV, prevention
strategies, treatment options, etc.
participants to HIV infected and affected people who share
their life stories with the group
the emotional phases and needs experienced by people living
with HIV as the illness progresses.
strong theological input on the heart of God and his calling
on his church in the age of HIV /AIDS which could
guide them in a pastoral approach to HIV/AIDS
in their sermons and ministry.
them to NGO’s, etc. that are already involved with different
care projects, and that can share the needs of the
communities they work in.
enough time for participants to plan what can be done at
Church leaders at all levels of
church leadership need to experience this sensitization. This
includes top leadership, key decision makers and opinion
leaders. But the main focus should be on sensitizing local
religious leaders. For specific church groups this implies
organizing such workshops in their local regions, e.g. circuits
and local synods.
Experience has proved that
these workshops should not form part of scheduled annual
meetings, where full agendas tend to push the importance of
spending enough time on this process to the periphery. These
workshops can also be organized for local ministers’ fraternals
or as interfaith workshops for an area.
These workshops are not
intended for those who are already informed, or those who
already have a passion and compassion for those infected or
affected by HIV/AIDS. It is intended for those who have done
nothing, know very little, who might even be very skeptical, but
know that the church must do something, but do not know where to
These workshops are truly
sensitizing workshops, which aim to bring about a mind and heart
change. It opens up new angles and possibilities for the
ministry. Therefore these workshops need to be followed up with
other workshops to fulfill specific needs that might develop as
a result thereof.
Students at theological
institutions, youth leaders in training, social work students,
etc., who are on their way back into the church or communities
must undergo such a sensitizing workshop while they are still at
college or university.
Congregation based peer workshops
It is my conviction that we
will not impact significantly on preventing new infections and
the growing caring needs, unless the church becomes involved at
grass roots level. It means that congregation based AIDS
actions groups should be established to target prevention and
care initiatives within the congregation and the surrounding
To inspire a congregation to
initiate such AIDS based action groups which will activate
prevention, support and care programs within the congregation
and their community, again forms part of a process. This
process entails the selection of people from a number of
congregations within a specific community to attend a four-day
workshop. During this workshop they are confronted with
HIV/AIDS in different ways, they begin to understand the need,
they grow in compassion and commitment to go back and to do
something within their own congregation and community.
This congregation based peer
model is based on the very successful “I have Hope “ AIDS peer
which was originally developed as a secondary school based
HIV/AIDS peer program. In its adapted form such a peer workshop
will include the following key elements:
Phase 1: Selecting Key People:
Selecting the right people to
attend this workshop is crucial for the success of the project.
Six key representatives are selected from a maximum of nine
congregations. These people must be able to initiate and steer
a congregation based AIDS action group after the workshop. They
must also represent the different ministries within the
Phase 2: Peer workshop – challenging knowledge, attitudes,
beliefs and practices on HIV/AIDS.
This phase constitutes a
four-day workshop presented in a fresh, interesting and
practical way. The workshop has the following five components:
– Attendees are exposed to their own prejudices through
discussions about how they practically deal with HIV and
AIDS issues on a daily basis. These discussions often
highlight their lack of knowledge and lay the foundation for
the rest of the project.
– Basic and in depth facts are shared on how the virus
works, the progression of the disease from infection with
the HI-virus to the AIDS stage, the transmission of the
virus, treatment options, etc. AIDS cannot be separated
from human sexuality; therefore it is important to discuss
all issues around sexuality, gender roles, assertiveness and
– Many attendees have a ‘they asked for it’ attitude
towards people who become HIV infected. Through
discussions, visits to AIDS service organizations where they
interact with children who are HIV infected or people in the
terminal stages of AIDS, and meeting those who make a
difference by caring for these children or people with AIDS,
this component puts a ‘face’ to HIV and AIDS. By
interacting with HIV positive people who share their hopes,
disappointments, fears and dreams, they experience first
hand the impact of the disease.
This is the critical point of
departure for many attendees – for the first time the peer
leaders realize that it could easily be someone they know and
love. Due to the emotional impact, they are encouraged to share
their experiences with one another. As a symbolic gesture, they
are encouraged to light a candle in celebration of life. This
is when it becomes evident how their attitudes had changed and
when they become committed to making a difference.
Understanding the need
– During the
third day, the attendees are exposed to some of the
programs, projects, etc. that are already being implemented
in their area by health services or NGOs. They learn about
the needs, the pitfalls, the successes and where and how
they can make an impact.
– After being changed themselves, and being exposed to the
opportunities where they can become involved, the attendees
then plan how they envisage conveying the message in their
congregation and within their communities, and how they can
give practical assistance to HIV/AIDS service
organizations. They must assure that their local
congregation communicates its commitment and heart by the
implementation of prevention, support and care projects.
They are encouraged to be creative in this process, to
enable them to adapt communication methods to their unique
3: Reaching out:
Plans made at the workshop then
need to be translated into actions. Over the next months peer
group leaders implement their innovative and creative projects
in their congregations and communities. They are encouraged to
link these projects to every existing ministry of the
congregation, but also to develop new angles as they are
confronted with new needs. It is essential that these action
groups do not reinvent the wheel, but link with community based
NGOs and care centers to strengthen their existing projects. To
motivate and keep activity levels high, and to ensure that they
forge relations with community AIDS organizations, follow-up
sessions are conducted with the attendees. Other congregation
members are encouraged to join the initial peer group to
strengthen and broaden the reach of the congregation’s
involvement in the community. Through their initiatives, the
action group will ensure that the congregation becomes a safe
haven for HIV infected and affected people where they will be
welcomed and cared for with the love, care and compassion of
Training of trainers
It is clear that, although
these sensitizing workshops and congregation based peer groups
are effective in changing attitudes and mobilizing congregations
into action, it is a very time consuming process. There are no
short cuts in this process, and therefore it would be essential
to train trainers from a variety of religious groups,
denominations, culture, and language groups to take this message
Information and Prevention programs
The pursuit of an AIDS vaccine
remains a critical international goal and significant and
increasing funds have been made available for this purpose.
Clinical trials of vaccine candidates are presently underway.
Despite this, an affordable AIDS vaccine for South African risk
populations is unlikely to be a reality in the foreseeable
future. Therefore, efforts to achieve social mobilization
towards healthier and safer sexual behavior need to be
significantly increased and sustained. Data presented earlier
have shown continuous high rates of HIV infection in the
sexually active population, which indicates a high level of
high-risk sexual behavior.
For example, data from the
Demographic and Health Survey of 1998 indicate early onset of
sexual activity and low condom usage. The survey showed that
approximately 35% of non-married women, aged 15 to 19, had at
least one sexual partner during the previous 12 months, and that
only 16% of all women interviewed had used a condom in their
last sexual encounter with their non-spouse partner. Secondly,
findings from a national survey of South African teenagers,
published in 2001,
suggest that approximately one third of boys and girls, aged 12
to 17, have had sexual intercourse and that one in five of this
group reported having their first sexual experience at the age
of 12 or younger. Forty one percent of sexually experienced
young people in this survey said they did not always use a
condom when having sex.
A further example demonstrates
that people have a good knowledge of HIV/AIDS, its mode of
transmission, and how it can be prevented but often fail to act
on this. A study conducted in the mining community of
Carltonville indicated that the majority of responders correctly
answered all questions regarding risk factors for infection and
modes of prevention. However, there was a weak relationship
between perceived risk of infection and actual infection with
22% of those who thought they were at low-risk being infected,
compared to 29% of those who thought they were at high risk. Of
those who had no opinion as to their risk status, 36% were
infected. Men surveyed reported using condoms in less than 25%
of contacts with non-regular partners and in less than 5% of
contacts with their regular partner.
The greatest barriers to
achieving HIV prevention are fear, denial and ignorance. HIV
prevention efforts have been plagued above all by silence
brought on by the denial and stigmatization that is associated
with the disease. In one study of home based care schemes in
Southern Africa, fewer than one in ten people who were caring
for an HIV-infected patient at home acknowledged that their
relative was suffering from AIDS. Patients themselves were only
slightly more likely to acknowledge their status.
There are also fears that
concerted calls for the wide scale provision of anti-retroviral
drugs could undermine prevention efforts. The success of
prevention efforts are already regarded with some pessimism
despite convincing scientific evidence from other highly
affected, poorly resourced countries with plummeting rates of
infection as a result of sustained and well targeted prevention
efforts. This pessimism could be compounded if risk populations
perceive anti-retroviral drugs as a curative solution to HIV
infection. Scarce resources for HIV prevention efforts may also
be diverted to the provision of these drugs.
Once effective youth
interventions are adopted, their success will depend on how they
are implemented and sustained.
It is clear from the above that
the Church must join the State, employers, schools,
non-governmental and community-based organizations in their
quest to implement effective, sustainable and cost-effective HIV
The church's contribution can
include nurturing and teaching values through life skills
programs based on principles from the Word of God. In the
process it can help to shape and support relationships built on
respect and gender equality.
A prevention program within the
church implies that we have to break through traditional taboos
such as talking openly about sex and sexuality with young
Prevention programs within the
church in South Africa should focus on young people before they
become sexually active, but they cannot exclude adults, as many
adults within churches are also engaging in high-risk behavior.
Youth prevention programs must be supported by parental guidance
programs, which would assist them in talking to their children
about sex and sexuality from a Biblical perspective.
Three elements that can
strengthen church based prevention programs include:
development of values-based life skills programs for
young people presented in the church and in schools. A
variety of Christian youth organizations and experts on
outcomes-based youth education programs are currently
collaborating to develop such a life skills curriculum.
“Values do matter” does not address HIV/AIDS in isolation,
but attempts to address HIV/AIDS within the widest context
of living according to the values God teaches us in his
Congregation based HIV/AIDS youth peer programs
that function on the above principles can be implemented.
These young people can, in their own unique way, contribute
to reduce new infections amongst their friends. They will
also be instrumental in addressing the topic of sexuality,
changing attitudes towards HIV positive people, and
assisting in the development of their own decision making
skills and those of their friends.
Training of community based HIV/AIDS
Service Year teams to act as role models for young
people. They can also help with values based life
orientation programs in congregations and schools and serve
in AIDS service
For the past
10 years a number of Church denominations and Christian
youth organizations such as Youth for Christ, Scripture
Union and the United Christian Student Association (UCSA)
train young people who commit as full-time volunteers for at
least one year to work with youth. The teams are trained
annually in January and February and work in specific fields
(e.g. adventure programs, primary schools, tertiary
institutions) during the year. During 2001 UCSA piloted two
community-based HIV/AIDS service year teams working in
Thembisa and Stellenbosch.
These teams work as volunteers at existing care and
prevention projects and mentor youth peer group leaders in
congregations and schools. In the process they enhance
co-operation between local churches, NGO’s and government
projects. After a year of practical experience in the field
of HIV/AIDS, these empowered team members will have a life
long commitment to remain directly or indirectly involved in
AIDS prevention, care and support. As a result of their
actions they also create a culture of youth volunteerism in
the field of HIV/AIDS.
These initiatives can greatly
enhance church based prevention efforts and therefore should be
supported financially and otherwise to enable implementation
throughout Southern Africa.
Support, Counseling and Care
As South Africa’s epidemic is
progressing into an advanced stage, the need for support,
counseling and care programs increase dramatically. To
illustrate the reality thereof consider that if the same levels
of care as in 1995 were to be maintained, spending on public
sector hospitals would have to increase 2.3 times. Anecdotal
reports exist of public hospitals refusing to admit patients at
all if they test HIV positive, or refusing them any form of
surgery even for trauma. There will be increasing temptation to
blame the victims of the epidemic for the strain on health
services and to deny them access to basic care.
Clearly, the challenge for both public and private health care
sectors is to shift to fundamentally more cost effective modes
of therapy, rather than resort to irrational or even
discriminatory exclusion from services. This will encompass
re-orientation towards lower-cost hospice-type care instead of
acute hospitalization and consistent and substantial support to
community-based care initiatives.
It is therefore evident that
the Church will have to play a major role in future to initiate
and support home based care programs for the terminally ill,
children with HIV/AIDS and AIDS orphans. Many such projects
have already been initiated with great success by churches such
as the Anglican, Roman Catholic and other churches. It is
essential that time is not wasted on reinventing the wheel. In
collaborating with these projects valuable lessons can be
learned and time consuming and expensive pitfalls can be
Voluntary counseling and
testing (VCT) is the process by which an individual undergoes
counseling enabling him/her to make informed choices about being
tested for HIV or not. This decision must be entirely the
choice of the individual. He or she must be assured that the
process will be confidential. In areas where VCT has been
applied correctly, it has proven to be very effective as
prevention and care strategy. VCT becomes an entry point to
medical care for TB, STDs, home based care, preventative
treatment for opportunistic infections. Women who know their
HIV status can receive counseling on all available prevention
efforts for mother to child transmission, feeding options and
family planning. During counseling a person can also discuss
the advantages and disadvantages of disclosure to one’s partner,
but it also opens the door to ongoing emotional and spiritual
care, legal and social services, and even social support. Now a
person can be assisted to plan for the future and the future of
his or her dependants.
The church has a wealth of
professional counseling services to offer via its professional
services, but through counseling courses lay counselors can be
trained to work in collaboration with local AIDS action groups,
clinics or hospitals to deliver this essential service to
HIV infected and affected
people are reluctant to trust the church with their pain of
living with HIV. They are afraid they or their loved ones will
be rejected or judged by the church community. This will not
change overnight in any congregation. But with sustained
marketing of their commitment to support, unconditional love and
acceptance, and the practical demonstration through their care
programs in the community, a local congregation can become the
place of Hope it should be. Support can be provided directly,
through support groups and prayer groups, or indirectly through
non-specific liturgical prayers for people infected or affected
by HIV/AIDS. In a congregation in Gugulethu (Western Cape,
South Africa) ten minutes of each service is dedicated to people
sharing their pain (and joys) of living with HIV. At first the
majority of people that shared their stories were not
congregation members, but people who were open with their HIV
status. Initially there was no reaction, but listening to
infected people sharing similar experiences indirectly supported
those who were in fear of disclosing. Gradually people started
coming forward to share their pain. Now this has become a
regular liturgical setting for intercession.
It is essential that support
would not only be provided to those infected or affected by
HIV/AIDS. The church has a major responsibility to the people
working in the field of HIV and AIDS. These include people
involved with prevention programs, home based caregivers,
counselors, etc. These people are confronted with suffering and
death on a daily basis. They have to be prayed for and “sent
out” as would be done with someone going to work as a
missionary. Retreats have to be organized to give these people
a chance to rebuild spiritually.
Continued facilitating, training
and vision building
None of the above can
materialize and be sustained if there was not a process of
continued facilitating, training and the crafting of a vision.
Religious leaders who are already tasked with many other
functions cannot perform these additional tasks. It demands a
permanent one-stop center that could serve as a central office
from which church based HIV/AIDS initiatives can be supported
and developed, and from where information can be disseminated to
the broader church community. Such a center or centers will
stimulate and co-ordinate activities and bring various role
players and services together. They can liaise with role
players within the body of the church and outside the church to
access possible resources. They will also be responsible for
compiling a resource list of available material, such as sermon
aids and liturgies, prevention and care programs,
course material, videos, workbooks,
theological inputs, etc. If such material does not
exist, the center will be able to oversee a process to develop
such material. This center can assure that the Church media
will continuously provide theological input on the church's
responsibility to be involved in the fight against HIV/AIDS, but
also to provide ongoing feedback on church based HIV/AIDS
programs. They will be responsible for the training of trainers
to implement sensitizing workshops and congregation based peer
As part of their service to the
church community, this one-stop center can also facilitate the
development of a variety of training courses, such as home based
care, counseling, etc. These courses should be accredited to
provide the participants with the opportunity to accumulate some
academic credits that could result in a university degree. For
many South Africans this could result, not only in the much
needed development of skills to fight HIV and AIDS, but in a
dream come true.
The world, Southern Africa and
South Africa is facing the worst catastrophe ever. As Church we
face a huge opportunity to demonstrate the unconditional love of
Jesus Christ. Mother Theresa once said:
The important thing is not to
do a lot or to do everything.
The important thing is to be ready for anything, at all times;
to be convinced that when serving the poor, we really serve God.
May God find us doing just that
in the time that lies ahead of us.
Microsoft Encarta Encyclopaedia indicates that 5 million
Jews died during World War II, however other sources
indicate this as 6 million Jews.
UNAIDS Report June 2000 and updated for World AIDS day
2000. To be found at
The HIV/AIDS demographic projections presented here have
been made using the most recently calibrated version of
the Metropolitan Life Doyle model. The Doyle Model is
widely used and accepted for projecting the HIV/AIDS
epidemic in South Africa, and is currently being used to
produce projections for several government departments.
The model has been developed using data from both South
Africa and other African countries affected by HIV/AIDS.
The estimates mentioned here is lower
than estimates from other sources, such as the South
African Actuarial Society, which put the number of
currently infected people in South Africa at 4.5 to 5
Nell Lamond, Women in the AIDS Epidemic, (Positive
Outlook Vol. 3(4) Spring 1996) p18
Gender Violence and HIV/AIDS (PACSA Fact sheet No
46 November 1999) p2
South African Department of Health’s Demographic and
Health Survey of 1998
Hein Marias, To the Edge: AIDS Review 2000
(Pretoria, University of Pretoria, Centre for the Study
of AIDS, 2000), p.4.
Thanks to Alison Myesa from the Diakonia Council of
Churches’ AIDS Programme, who provided this
understanding of the link between HIV/AIDS and poverty
from their practical experience of working within the
communities of Durban and Kwazulu-Natal which has been
experiencing the highest incidence of HIV/AIDS in South
Sinosizo Home-based care programme provided feedback.
Received this quotation with great thanks from Pamela
Couture, Professor of Practical Theology and Pastoral
Care, Colgate Rochester Crozer Divinity School
From The United Methodist Church's Resolution on "AIDS
and The Healing Ministry of the Church," The book of
This confession was
officially adopted by the Synod of the Dutch Reformed
Mission Church in South Africa in session at Belhar,
Cape Town, in 1986 following the declaration of a status
confessionis in connection with the rejection of the
defence of apartheid on moral and theological grounds.
The confession of Belhar and its history can be
downloaded from the website of the Uniting Reformed
Church in Southern Africa at
Paper presented by Dr. Zola Skweyiya, Minister of Social
Development of South Africa, at the National Religious
Association for Social Development (NRASD) /
Evangelical Fellowship of Southern Africa (EFSA)
Institute conference, Escom Centre, Midrand, 7 August
Quoted by Prof Piet Naudé at a conference for religious
leaders Bureau for Continued Theological Education of
the Dutch Reformed Church, Bellville, August 2000.
The National Population Unit (NPU) of the Department of
Social Development of South Africa has undertaken the
compilation of South African case studies of good
practices in HIV/AIDS awareness, prevention and care.
The “I Have Hope” Peer Group Project, presented with the
help of Old Mutual, one of the largest life assurance
companies in Southern Africa, represents one of such
South Africa National
Youth Survey 2000, a national survey funded by the Henry
J Kaiser Family Foundation (a summary report was put out
by loveLife called Hot Prospects Cold Facts. Portrait of
Young South Africa www.loveLife.org.za),
Impending catastrophe revisited - An update on the
HIV/AIDS epidemic in South Africa (Report
commissioned by the Henry J Kaiser Family Foundation,
compiled by Abt Associates (South Africa) Inc and
published by loveLife) p22-23
Williams, B, Catherine McPhail, et al, The Carletonville
Mothusimpilo project – limiting transmission of HIV
through community based interventions, published in the
South Africa journal of science, volume 96, no 6
Impending catastrophe revisited - An update on the
HIV/AIDS epidemic in South Africa (Report
commissioned by the Henry J Kaiser Family Foundation,
compiled by Abt Associates (South Africa) Inc and
published by loveLife) p20
(Compiled by José Luis González-Balado, Mother Theresa
in my own words, Gramercy Books, New York, 1996, page