US-funded AIDS programmes being handed over to Africans to administer
Catholic News Service
CAPE TOWN, South Africa – US-funded programmes to fight AIDS and HIV are being handed over to Africans to administer, and at least one nun hopes treatment efforts will not be harmed.
As administrators of the President’s Emergency Plan for AIDS Relief, known as PEPFAR, in South Africa are celebrating a successful transfer of administration in 2009, concerns are being raised in Nigeria that the hand-over planned for March could pose serious problems for patients and other programme participants.
The two countries are getting much of the attention because more than a third of the estimated 22 million HIV or AIDS cases in sub-Saharan Africa are in South Africa and Nigeria. UNAIDS, the Joint United Nations Programme on HIV/AIDS, estimated that in 2009, about 5.6 million South Africans and 2.6 million Nigerians had HIV or AIDS.
Our Lady of Fatima Sister Mary Bulus, health services coordinator in Nigeria’s Lafia Diocese, expressed concern that the organisations named by CRS to take over the programme currently “don’t have the capacity to take on this enormous task.”
Among the organisations named by CRS to run the programmes is the Catholic Secretariat of Nigeria, the administrative office of Catholic Bishops’ Conference of Nigeria.
“I have worked with them (the secretariat) and know their weaknesses,” Sr Mary told CNS in a telephone interview from Akwanga. She said it is likely that “a priest who is not a doctor or a manager” will be put in charge.
“Project management is very different from pastoral care,” she said, adding that she would like to “see serious recruitment of professionals for this work.”
Funded since 2004 under PEPFAR, many of the programmes throughout Africa have been administered by CRS and have encompassed treatment for people with HIV and AIDS as well as support programmes for family members and children orphaned by the disease.
PEPFAR funds support numerous services such as providing free antiretroviral medicines for eligible patients, support for families devastated by AIDS, after-school programmes for children whose parents died from the disease and their caregivers, transportation for health services and counselling.
CRS administration of AIDS-related programmes across Africa has been held up as a model because of its focus on meeting local needs. However, PEPFAR guidelines require that all funded programmes be run by local organisations by 2012.
“CRS’s intention has always been to hand over” to local ownership, Karen Moul, communications officer for CRS, said in a 10 November telephone interview from Baltimore. “(This is) not a dumping and getting out.
“We have known for a long time that this has to happen by 2012 and we have been gradually working toward it,” she said.
Under the transfer arrangements, CRS remains available to offer local organisations assistance and advice.
The PEPFAR funds on which these programmes rely are unlikely to expire “anytime soon,” Moul said, noting that in 2008 the US Congress reauthorised the programme with up to $48 billion in funds through 2013.
Despite the assurances from CRS, Sr Mary said she is concerned that HIV programmes will run short of vital antiretroviral medicines.
“There needs to be a proper hand-over to competent people who will handle the programmes in the way CRS does now, so that the high-quality care can be maintained,” she said.
Catholic News Service attempts to reach representatives of the Nigerian Bishops’ conference for comment were unsuccessful. Across the continent in South Africa, where the transfer of PEPFAR-funded programmes to local partners took place in 2009, the hand-over went smoothly, said Dominican Sr Alison Munro, director of the AIDS office of the Southern African Catholic Bishops’ Conference.
She told CNS by phone in mid-November that recipients of the Church’s HIV services “wouldn’t have noticed there’s been any change in ownership.”
In South Africa, the Bishops’ conference and St Mary’s Hospital now receive the US grants directly.
The Southern African Catholic Bishops’ Conference runs 33 after-school programmes for orphans in South Africa. The programmes provide for the general care of the youngsters, including meals, school fees and transportation to a doctor for treatment of illnesses. Sr Alison said most of the children live with a surviving, though often HIV-positive, parent, foster parents or relatives or in child-headed homes.
“Orphanages are unsustainable financially, and we think it’s healthiest for children to live in normal circumstances in their communities as far as possible,” she said.
The conference also operates 14 primary AIDS treatment sites around the country, with outreach centres in remote areas, many of which are at local parishes.
In Nigeria’s Lafia Diocese, a programme providing free antiretroviral medications, counselling and home-based care is complemented by support for 1,500 orphans in the diocese, Sr Mary said. Fifteen of the 25 HIV support groups that meet monthly are for orphans, she said.
“We teach orphans and other vulnerable children skills to enable them to take care of themselves and their siblings,” she said. “Without this programme these children would not be in school.”
– Pope Benedict XVI’s statement on condoms – that in some circumstances using a condom to prevent the spread of HIV-AIDS could be a step toward moral responsibility – is not likely to have a huge impact on Catholic programmes for the prevention and treatment of AIDS, two experts said.
Mgr Robert Vitillo, special representative on HIV-AIDS for Caritas Internationalis, said the Pope’s statement is likely to have a greater impact in pastoral counselling than on the hundreds of prevention and treatment programmes offered by the Catholic Church and Catholic agencies throughout the world.
In the book, Light of the World: The Pope, the Church and the Signs of the Times, which the Vatican newspaper excerpted on 20 November, Pope Benedict repeated what he said during a trip to Africa last year, that “we cannot solve the problem (of AIDS) by distributing condoms.”
Focusing exclusively on condoms damages human sexuality, making it “banal” and turning it into a kind of “drug,” the Pope said in the book. But he went on to say that in particular cases – he mentioned prostitutes – condom use may be justified as a first step toward taking moral responsibility for one’s actions.
Mgr Vitillo said the Pope’s remarks do not lessen the Church’s insistence that both the morally correct use of one’s sexuality and the safest sexual practice from a health standpoint is “abstinence outside of marriage and faithfulness inside marriage.”
Catholic programmes providing HIV care, support and treatment emphasise the safest route, he said.
The Pope’s statement, he said, “acknowledges that not everyone follows Church teaching” in that regard, but nevertheless the Church does not abandon them; rather, it recognises that when someone is living in a way that the Church does not consider moral, the use of a condom to protect a partner from infection may be the first step in their learning to take responsibility.
Mgr Vitillo said the Bishops’ conferences of Chad and of Southern Africa have issued pastoral letters saying Church workers must accompany married couples where one or both spouses are HIV-positive, helping them make a conscientious decision regarding the use of condoms to prevent disease while also understanding Church teaching that every sexual act should be open to new life.
In the new book, Pope Benedict did not address the issue of condom use by married couples to reduce the risk of disease.
Lesley-Anne Knight, secretary-general of Caritas Internationalis, said, “The Pope’s reported comments in this book illustrate the importance of compassion and sensitivity in dealing with the complexities of HIV-AIDS prevention. Caritas delivers its HIV-AIDS programmes in line with Church teaching and we will consider, in close consultation with the Holy See, whether there are implications for our work in these reported comments of Pope Benedict.”
Caritas Internationalis is the Vatican-based umbrella organisation of 165 national Catholic charities.
Dr Leonardo Palombi, who works with the Sant’Egidio Community’s DREAM programme of AIDS prevention and treatment in Africa, told CNS on 22 November that Africa has been virtually flooded with condoms, yet the disease continues to spread because of a lack of responsibility on the part of men, a lack of respect for women and the lack of antiretroviral treatment for all who need it.
“Condoms aren’t the response to everything,” Palombi said.
In fact, antiretrovirals are even more effective in preventing spread of the disease because “they reduce the viral load in the body and in all body fluids” – reducing the risk of mother-to-child transmission at birth or through breastfeeding and reducing the risk of transmission sexually as well.
“Condoms are given out in great quantities in Africa,” he said. “But a thousand boxes of condoms won’t help if a woman has no power to insist her partner use them.”
“Universal access to therapy is the best way to stop the spread of AIDS” and that is what the Catholic Church has been trying to provide for years, Dr Palombi said.