This article appeared in the August 2007 edition of the Catholic Medical Quarterly

Return to Aug 2007 edition of CMQ

AIDS in Africa

Part 1.The AIDS pandemic, the Catholic response, and its reception in the media

Bernard Farrell-Roberts

Brotherhood of the Holy Cross

In this series of articles, Bernard Farrell-Roberts set out to evaluate the theories and beliefs that have led to current differences of opinion on strategy in the fight against the African AIDS pandemic; to see if anything can and should be done about the recent media coverage.

In 1959 a blood sample was taken from a dying man in Leopoldville, Congo. Years later it was discovered to be carrying what is known now to be the Human Immuno-deficiency Virus (HIV).

In 1981 numerous cases of AIDS were identified. At that time it was called GRID, (Gay Related Immune Deficiency). In 1982 it was renamed “Acquired immunodeficiency syndrome,” (AIDS). In 1983 the heterosexual AIDS epidemic in central Africa began to be reported, and in 1983-1984 human immunodeficiency virus (HIV) was identified as the cause of AIDS by researchers at the Pasteur Institute (Paris) and the National Cancer Institute (Bethesda).[1]

In December 2005 UNAIDS and the World Health Organization (WHO) released their annual Global Summary of the AIDS Epidemic, indicating that there were more than 40 million people living with HIV or AIDS, with deaths exceeding 3.1 million a year.

Africa has emerged to be the area most affected by HIV. It has over 60% of the infected population of the world. The United Nations, World Health Organization, and hundreds of support organizations from numerous countries are working there among the infected and vulnerable[2].

The Catholic Church provides 28% of this help[3], and Catholic policy on AIDS[4] has had remarkable success in the fight against the spread of the virus. Yet its AIDS policy in Africa has been subject to severe criticism[5], and often to ridicule, by both the media and others working in the field of AIDS control and policy[6], and it has not been invited to send a representative to this year’s United Nations run International Conference on AIDS.

 

Strategy adopted by western governments and organizations

Despite the fact that the World Health Organization began developing protocols for dealing with the AIDS virus as far back as 1985, the western world’s response to the AIDS crisis in Africa got off to a very slow start indeed. It was not until 1995 that the Joint United Nations Programme on HIV/AIDS (UNAIDS) was formed, and 1997 before it launched its first antiretroviral (ARV) programme in Africa, the first big intergovernmental led initiative. However, this initiative concentrated on the provision of drugs, and did not address other critical issues such as the spread or prevention of AIDS.

AIDS policy became “a major world commodity, right up there with shiploads of computers, crude oil and wheat.” (Warren, Patricia, AIDS and the World Bank: Global Blackmail, A & U Magazine, June 27th, 2000). In July 2000, the Export-Import Bank of the United States offered $1 billion a year for five years in loans to Sub-Saharan Africa to finance the purchase of U.S. HIV/AIDS medications, related equipment, and services, from U.S. pharmaceutical firms. This was seen by many as a move by the U.S. to create further financial dependency among the African states, whilst financially benefiting the U.S. economy. Oxfam accused 39 U.S. corporations of Human Rights violations, saying that they were trying to prevent access to needed drugs by keeping prices artificially high.[7].

Uganda began its own community based response to AIDS in 1987, and the epidemic had been widely reported since 1983. Why then was there such a lengthy delay in the implementation of intergovernmental programmes against the AIDS epidemic in Africa?

The early signs in Europe and the USA indicated that the disease was associated almost exclusively with gay men, the heterosexual epidemic being associated only with Central Africa. The risk to the general public was therefore deemed to be minimal, available resources being used to address the local AIDS problem.

It was not until the late 1990s that the heterosexual AIDS epidemic in Kosovo became headline news in western mainstream newspapers, followed by similar news from other European countries and Latin America. This led to a change of political perception, with AIDS being accepted as a global threat to the international community. On 30th April 2000 the Clinton administration, fearing that the global threat of AIDS could destabilise the world, announced that the AIDS virus posed a threat to U.S. national security. They stated that: “the global spread of AIDS is reaching catastrophic dimensions that could topple foreign governments, spark ethnic wars and undo decades of work in building free-market democracies abroad”.[8]

The worldwide significance of the AIDS virus suddenly became headline news in international media. The effect of this, and the resultant increased public awareness, caused a significant acceleration in the provision of resources, funding, and strategies to fight the virus, especially in Africa.

A flurry of activity ensued. In 2000 the United Nations Millennium Development Goals were modified to include the reversal of the spread of AIDS. In 2001 the World Health Organization (WHO) stepped into the fight between poor countries and pharmaceutical companies over ARV drug patents with its DOHA Declaration.[9]

In 2002 the first round of the Global Fund Grants were announced. In 2003 the UN launch an initiative to increase the number of people with access to ARV treatment from 400,000 to 3 million.

The length of time it took the United Nations, the World Health Organization, and western governments, to begin to address the problems of AIDS in a serious manner, has been severely criticized. In 2003 Stephen Lewis, the U.N.’s special ambassador on AIDS, lashed out at the U.N. Bureaucracy responsible for co-ordinating the international response to the epidemic calling it “paralysed, uncritical, and preposterously deferential”.[10]

 

AIDS in Africa – Strategy adopted by the Catholic Church

The Catholic Church was heavily involved in education and community care in Africa long before the AIDS virus had been first identified. The Church’s presence in countless villages in central and southern Africa made it well placed to work with each country’s leaders to tackle the AIDS problem.

However, the specific response to AIDS “got off to a slow start, influenced by the socio-political problems of the 1980s and 1990s, by ethical dilemmas, and by an inability on the part of church and community to recognise signs of impending calamity, so blatantly obvious now” (National Library of Medicine, Gateway[11]).

However, despite the slowness of a global response, on a local level Church leaders and workers worked tirelessly to resolve the social and medical problems posed by AIDS. This is not surprising as. Catholic tradition and the history of medicine are very closely connected, the first hospitals being run by the monasteries.

The Rule of St Benedict states: “The care of the sick is to be placed above and before every other duty”, (Buckley, Charles, OSB, The Rule of St Benedict, Chapter 36).

The Catholic Church’s efforts in Africa increased following the apostolic exhortation of Pope John Paul II “Ecclesia in Africa”, written in 1995, where he said: “I too ask pastoral workers to bring to their brothers and sisters affected by AIDS all possible material, moral and spiritual comfort.” He went on to ask the world’s scientists and political leaders to “use every means available to put to an end this terrible scourge.” (Pope John Paul II, Ecclesia in Africa, Vatican City, 1995). 

The Catholic Church soon became instrumental in the formation of new AIDS programmes in South Africa, Swaziland, Botswana, Lesotho, and Namibia. Often Bishops became leaders in the development of these programmes.

The Catholic approach to the fight against AIDS has been to tackle the sociological problems that are both partly responsible for, and partly caused by, the virus. Whilst the international community concentrated on the provision of drugs and condoms, the Church addressed the root causes of the spread of the disease.

In 1991 representatives from several African countries met in Senegal for the International-Conference on AIDS and Sexually Transmitted Diseases in Africa (ICASA). The statement released at the end of this conference mirrors Catholic policy regarding AIDS policy:

“We believe that individuals and whole communities have the inherent capacity to change attitudes and behaviours. The power to fulfil this capacity is often denied or is not exercised. This power must now be recognised, called forth and supported.

We recognise that behaviour change is inextricably linked to such basic human values as care, love, faith, family and friendship, respect for people and cultures, solidarity and support. The present pandemic affects everyone. We believe that behaviour change is the most essential strategy in overcoming the HIV pandemic.”[12]

Due to the Catholic Church’s absolute respect for the sanctity of human life, there is no room for any form of artificial contraception in their AIDS policy, as all of these forms involve the prevention or cessation of life.  However, the effectiveness of their strategy, based upon education, sexual abstinence outside Marriage, marital fidelity, and respect for life and others, has been demonstrated in Uganda and other countries, where the number of sufferers, and rate of infection, have both dropped

The abstinence initiative in Uganda deliberately set out to reach not only those who were already having sex, but also those who were not - it started with the education and promotion of an abstinence program for youth called ``True Love Waits.", that focused on abstinence until marriage[13] as a way to prevent all sorts of adverse consequences associated with extra-marital sexual activity. More than thirty thousand Ugandan youths were involved with the program at any one time. Other programmes have followed in other countries.

The success of these programmes has led to wide recognition of their validity. Republican Senator Mark Souder, together with six other members of the U.S. Committee on Government Reform, said in a letter to the United Nations in 2002, ``Encouraging marriage, monogamy or abstinence, delaying the onset of sexual activity, discouraging promiscuity and casual sex, reducing the supply and demand of illegal drugs or providing treatment to drug addicts ... are the absolutely most effective approaches to reducing the risk of HIV." (Trafford, Sarah, Culture & Family Institute, 2002)[14]

Despite the above, and fast increasing evidence to the contrary, there are still many “experts” who continue to deny the effectiveness of strategies such as the one in Uganda, making one question their motives for doing so.

A Harvard study on the prevention of HIV in Uganda credits abstinence education with significant effectiveness in reducing AIDS in Uganda. The study found that between 1980 and 2001 the number of pregnant women infected with AIDS dropped from 21.2% to 6.2%. By contrast, in Botswana, where there is no such programme, condoms being used as the principal means of AIDS control in a U.N. led programme, 38% of pregnant women were infected in 2001, and an upward trend exists.

The US Agency for International Development (USAID) stated in 2002 that the most important single factor in the reduction in the incidence of AIDS in Uganda was the decrease in multiple sexual partnerships and networks. (Bureau for Global Health, What Happened in Uganda? USAID, September 2002).

As can be seen above, Catholic policy towards AIDS in Africa has centred around care of the whole individual, their family, and community, emphasising through education the need to change sexual habits and the prejudices of society itself, and tackling the problems of poverty. International AIDS policy has been centred far more on medical aid, contraception, (concentrating on the use of condoms), and sexual education.

Experience, investigations, and reports cited concur in that the former policy has been far more successful than the latter.

The next article in this series will examine the Catholic position on the use of condoms, and its reception in the media.

Return to Aug 2007 edition of CMQ

Bibliography 

Sacred Scripture

The Jerusalem Bible, Darton, London, Longman & Todd, 1974

Documents of the Pope and the Holy See.

References

  1. AIDS education, global information system, reviewed in the BMJ (BMJ 2001;322:1496 ) as the most comprehensive education website: http://www.aegis.com/
  2. UNAIDS, AIDS Epidemic Update, December 2006, ISBN 92 9 173542 6
  3. For example see http://catholicinsight.com/online/bioethics/AIDSAfrica.shtml
  4. Catholic bishops back government AIDS plan http://www.cathnews.com/news/308/77.php
  5. Vatican: condoms don't stop Aids, Steve Bradshaw, Thursday October 9, 2003, The Guardian, A full transcript of the BBC Panorama Programme can be found at http://news.bbc.co.uk/nol/shared/spl/hi/programmes/panorama/transcripts/sexandtheholycity.txt
  6. Replogle J, Sex and the Catholic Church in Guatemala. The Lancet, 2005; 366: Issue 9486: p.622-623
  7. Drugs giants set to cause violation of human rights, Oxfam Press Release, April 11th, 2001
  8. United Press International, April 30, 2000
  9. http://www.wto.org/English/tratop_e/dda_e/dohaexplained_e.htm

  10. http://AIDS.catholicregister.org/index2

  11. http://gateway.nlm.nih.gov, 07.07.2002

  12. http://www.ad2000.com.au/articles/2004/mar2004p10_1559.html

  13. AIDS/HIV rate slashed in Uganda after 10 years of True Love Waits, http://www.bpnews.net/bpnews.asp?ID=15307 also www.truelovewaits.com.

  14. http://uzweb.uz.ac.zw/science/maths/zimaths/71/AIDS.html