SCIENCE AND SPIRIT: Uniting in the struggle against HIV/AIDS

The first of a series of seminars convened to forge firm links between KwaZulu-Natal's religious leaders and HIV/AIDS medical researchers in response to the epidemic was held at Durban's Jewish Club this week. Co-hosted by HIVAN (Centre for HIV/AIDS Networking) from Natal University and the Interfaith AIDS Forum of the World Council of Religion and Peace (WCRP), the seminar focused discussion on the ethics of AIDS vaccine trials and prevention of mother-to-child-transmission of HIV.

In explaining the importance of collaboration between faith leaders and medical researchers, Prof Jerry Coovadia, head of HIV/AIDS research at the Nelson R Mandela School of Medicine, said that religious leaders had a unique form of access to community and family structures that could assist healthcare practitioners in rolling out treatment, care and support strategies. In sharing the knowledge being generated by medical research with leaders of all faiths, it was hoped that they could act as conduits of such knowledge in their communities to uplift and empower their followers, all of whom were either infected or affected by HIV and AIDS.

Prof Coovadia highlighted three primary issues as being fundamental to the spread of HIV in our province: gender discrimination, orphans of AIDS, and violence. He said that women, young and old, whether HIV-positive or not, are the most vulnerable to and burdened by the HIV/AIDS epidemic, because of their marginalised position in the educational, cultural and economic framework of our society.

"By the year 2008, we will have approximately seven to eight million HIV-positive citizens in South Africa, and by 2015, we could see between two to four million children orphaned by AIDS," he said. "We simply do not have adequate programmes in place to support these children - and even if we can ensure material support for them, they need emotional and spiritual support as well."

With violence predominating in the daily lives of many, the institutions of marriage and family are often no protection for women and children. Problems such as financial hardship, mental and physical illness, trauma, ageing and substance abuse can cause broken individuals, relationships and communities, all of which weakens the structure of wider society. "Since these conditions drive the spread of the epidemic," said Coovadia, "there is a huge role for faith leaders to play in educating and supporting affected communities."

The Reverend Sbu Sangweni, a member of the Provincial AIDS Action Unit, outlined the aspects of community outreach that faith leaders were committed to addressing. As head of an interfaith committee recently formed to develop and implement a provincial "Faith in Action" plan, Rev Sangweni said their team would be working in partnership with all relevant stakeholders, government departments and community-based organisations to ensure that support and guidance for those affected by HIV and AIDS are managed in a structured way.

"FOHAP (Faith Organisations in HIV/AIDS Partnership) will, through co-ordinated pastoral care, uphold the quality of life for all," he said. "We will focus on the provision of respectful and compassionate care, dedicated, open and informed leadership, counselling for positive decisionmaking around HIV/AIDS, a holistic approach to death and dying to ensure dignity and grace at all burials and cremations, and commitment to an AIDS-free South Africa through effective prevention programmes."

Professor Graham Lindegger of Natal University's HIV/AIDS Ethics Group (HAVEG) chaired a discussion on "Vaccine Ethics", explaining that faith leaders are well placed to ensure that the key guidelines of ethical medical trials, i.e. understanding and respecting cultural contexts and ensuring community involvement, are observed. Dr Andrew Robinson, of the MRC's AIDS Vaccine Trials Unit, said that the ethical approach to all medical trials was universal, and not really specific to HIV vaccines. This approach includes, amongst other factors, protecting the participant's privacy, ensuring informed consent, minimising potential risks, and guarding against exploitation of vulnerable groups. For this reason, faith leaders are routinely involved in reviewing ethical protocols for vaccine trials.

Paediatrician Dr Nigel Rollins, who manages the world's largest mother-to-child-transmission research project, gave a presentation on HIV infection in infants and young children. "I prefer to avoid using the term 'mother-to-child'," he said, "because it assigns the burden of responsibility to mothers, and ignores the possibility that transmission might have resulted from sexual abuse. A better term would be 'Adult-to-Child' transmission."

Dr Rollins outlined the findings with regard to risk factors and the importance of voluntary counselling and testing, and explained the dilemma of breast- versus formula-feeding. He appealed to religious leaders to help reduce the denial and stigma that are impeding the success of prevention and support interventions, not only by imparting accurate information to their followers, but also through creative thinking around effective communication of the facts.

In response, Cardinal Wilfred Napier commented that addressing the need for behaviour change in the face of the HIV/AIDS epidemic is not only important for religious leaders to engage with, but is indeed their greatest challenge.

Dr Shakira Cassim, a paediatrician in private practice who is also a member of the Islamic Medical Association, added: "Apart from infant feeding, there are numerous issues linking faith practice and HIV/AIDS management, such as circumcision and intercourse during menstruation." A healthcare worker from McCord Hospital in Durban agreed: "There is so much we are doing and are required to do to educate and counsel patients around HIV/AIDS, we can barely cope with the demand."

Said Professor Philippe Denis of NU's School of Theology: "Because the HIV/AIDS epidemic is compelling faith leaders to become experts in so many related issues, this forum is invaluable, as it is a means of acquiring and assimilating this knowledge."

Prof Coovadia summed up by urging those present to move beyond sectoral boundaries. "Let us not partition ourselves - we medics can work on treatments to pre-empt infection in newborns, but if we work together with you (faith leaders) to reduce stigma, we can prevent the infection of women in the first place," he said.

"We need you to help us strengthen the call for anti-retroviral drugs for all as a basic human right," he said, "just as we would regard access to treatment for cancer or diabetes. Denial of such access shows a disdain for human life."

For details of forthcoming seminars, please contact:
Ms Debbie Heustice (HIVAN) on 031-260 3168 / 3195
Email: [email protected]