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 weekly club meeting with visiting speakers and professionals.

Outcome

The Archdiocese of Yaounde response has been very encouraging. With courage and compassion, the Archdiocese has contributed to mobilise resources to care for and support those affected and to assist others in remaining uninfected. Particularly, senior people living with HIV/AIDS are providing moral support towards those newly tested HIV positive.

The condom issue is very controversial since it does not provide a lasting solution aCCording to Dr Anne Darban. Instead, she proposed a constructive dialogue that is based on mutual respect, trust, faithfulness, testimony and marriage. 24 youth were trained on peer educators techniques to train others on those positive and Christian social values.

Lessons learnt

· The meeting of people living with HIV/AIDS have improved the quality of life of their colleagues in terms of updated information and experience sharing. Since most of resource persons are HIV positive or have been affected, so they are living examples of active people who have experience positively with HIV/AIDS.

· Alongside meetings, specific issues of coping with infection and taking the responsibility for self and family well-being are discussed in the presence of counsellors. People living with HIV/AIDS appreciate that they have been given time for them to express their concern and to know specialist to whom they can be referred to in case of acute infections.

3.2.5 The Muslim Community

The Muslim Community Programme activities focus on: Prevention and care.

v Prevention:

The Muslim circles are blunt that HIV/AIDS is the result of disobedience to God's law. The prophet said: “ when sexual wander and its consequences will prevail in society, God's will punish upon the society ”. The Imam said that the World Bank and the International Monitoring Fund have imposed the condom use that encourages sexual promiscuity. ACCording to the Koran, “ …fornication and adultery are forbidden. Whoever does not abstain from sex will fail. Once the humankind is not in good relation with God, the flesh takes the lead. This is where sins begin… ”.

When I asked the question if they had a youth programme to combat HIV/AIDS, the answer was: “ when the youth reaches the reproductive age, he ought to marry ”.

Comments

It is clear for the Muslim of Cameroon that abstinence and faithfulness are the two preventive measures that are promoted. However, they should understand that HIV/AIDS can happen to anybody. It is no longer the matter of people who fail to be faithful. Even someone who is faithful, but who is “sero-ignorant” can be infected or can pass on the virus to others. In addition, religious communities that have no policy for the youth interfere in youth projects to the extent that they become obstacles instead of facilitating them to acquire life skills to avoid HIV/AIDS.

For instance, Switzerland promoted condom use and now the result is that many youngsters choose to postpone sexual involvement. Similarly, Uganda did the same by allowing people to talk about all the methods to prevent AIDS. Now increased abstinence among young people is obvious. Uganda remains one of a few African countries to have turned a major epidemic around from 14% in the early 1990s to 8% in 2000. There is no scientific evidence that the more you talk about condoms, the more promiscuous people become.

v Care of HIV infected

With regard to people leaving with HIV/AIDS, the Muslim said that they are not abandoned for the Koran recommends to help anybody who is needy, whatever his/her fault. The Muslim circles have hospitals and health centres where these people would be care for.

v Lessons learnt

The suCCess of HIV/AIDS programme in Muslim circles includes the following:

· Widening the knowledge of the people about HIV/AIDS

· Making local posters on HIV/AIDS available to schools and communities

· Helping people talk about HIV/AIDS

· Increasing Voluntary Counselling and testing, prenatal and premarital HIV testing

· Active listening during sensitisation workshop

· Adoption of some behavioural change

· Reaching the target in the communities, schools, mosques

· Reduction of the stigmatisation of HIV/AIDS

4.   Poverty and Human Rights

The AIDS epidemic has a profound impact on economic growth, income and poverty. It is estimated that the annual per capita growth in sub-Saharan countries with a high HIV prevalence, is falling by 0.5-1.2% as a direct result of AIDS. It is obvious that people at all income levels are vulnerable to the economic impact of HIV. However, the poor people suffer the most as the epidemic is driving forward the cycle of impoverishment. As mentioned earlier in this report, HIV/AIDS has risen to alarming levels in many parts of Cameroon among the 15-45 years old who are the most productive workers. The consequences will be felt in all sectors.

AIDS is a costly disease, which requires medical care for patients and an increasingly significant proportion of available hospital beds. As a result, programmes in Cameroon that aimed at combating HIV/AIDS run the risk of absorbing an increasing portion of the budget, at the expense of other activities within the health sector and elsewhere. In addition, public and private health institutions are not able to provide the necessary care for AIDS patients. This means that the significant increasing number of AIDS patients will weaken an already fragile health system.

AIDS pushes people deeper into poverty as households lose their breadwinners to AIDS, livelihoods are compromised, and saving is consumed by the cost of health care and funerals.

When I collected data related to the religious communities' perceptions, I observed that a couple church leaders were talking about the many epidemics that are embedded within AIDS pandemic. On the surface, it looks like those Cameroonian church leaders are getting open to fight AIDS. However, openness of course, must not exist only at talking level. It should be aCCompanied with concrete actions. A part from, the Cameroon Baptist Convention I did come across any church project which holds a visionary approach to fight both poverty and HIV/AIDS.

“Church leaders who use AIDS to control their congregations adopt very often misleading messages and approaches. But church leaders who are using their church to control AIDS become more realistic and competent in the way they approach HIV/AIDS”

Another aspect that deserves much attention is the lack of knowledge and the effects of harmful traditions. The spread of HIV epidemic is also exacerbated by tradition that stipulate that, while women are prohibited from having sex during their first two years of breastfeeding after each delivery, men are expected to have sex almost daily, based on the myth that to stay healthy, men need sex. This leads to heavy use of oCCasional partners and prostitutes, followed by infection of spouses and subsequent children.

With regard to human rights, stigma, denial and discrimination impede efforts to slow down the spread of HIV/AIDS and to improve care and support of PLWHAs in Cameroon. With a HIV prevalence of 12%, the discriminatory attitude of health personnel, the church and the larger community hinder efforts to ensure voluntary counselling and testing and adequate treatment for opportunistic infections. Many programmes run by the religious communities to combat HIV/AIDS have focused on awareness raising, sensitisation workshops and training of youth volunteers. Strategies to fight HIV/AIDS in Cameroon should underline factors which make people silent about HIV/AIDS. Stigma and discrimination of people living with HIV/AIDS should be definitely considered as sins and as human rights violation.

5.   Partnership Between Government and Religious Communities

As a component of HIV/AIDS programming, strategic planning has undergone valuable and deep changes in Cameroon. In the early days of the epidemic, strategic planning was largely conducted in a top-down approach fashion within the Ministry of Health. However, this top-down has proved to be unworkable. Religious communities involvement is nowadays seen to be the key to suCCessful planning, and the strategic planning in Cameroon has begun to involve faith-based organisations in quite all aspects of planning, implementation and evaluation. This involvement has strengthened the process greatly by ensuring participation and inputs of faith-based organisations at all levels.

The partnership between government and faith-based organisations is visible. Church leaders were quite fully involved during the World AIDS day to gather information about what works, what needs improvement and where gaps exist within their congregations to strengthen the churches' response to HIV/AIDS.

Additionally, faith-based organisations received funds to start implement their projects. One extremely critical difficult component that strategic planning faced in Cameroon was the development of budget scenarios. Most of the faith-based programmes did not prioritise their plans aCCording to available funds and resources. Therefore, it was difficult for the National AIDS Control Committee to ensure a consensus on the priority interventions and on the funding and resource available to implement them. In order words, most budgets were overestimated. There seems to be a clear consensus that the resource available for HIV/AIDS programming has been grossly inadequate to produce an effective response. However, many churches are still turned to their traditional donors while recently at the Abuja Summit on HIV/AIDS, African leaders committed to spend 15% of their gross national product for health care and a response to HIV/AIDS. This is an illusion for many African countries including Cameroon.

However, Cameroon deserves encouragements since the government did its best to distribute the money that should help religious communities to fight AIDS (see the list page 8). Here are some of the problems that faith-based organisations faced to lobby resources towards the government:

· Some of the faith-based organisations have no experience writing project proposals

· Not all the faith-based have the same level of experience in project development

· Faith-based organisations tended to overestimate their capacity to implement and their proposed coverage of populations, geographic sites and budget

· A considerable amount of times in terms of back and forth was required before a mutually satisfactory budget and programme of activities was finally agreed between the National AIDS Control Committee and the concerned faith-based institution

· Some faith-based implementing partners never implemented HIV prevention programme and did not receive training of the basic principles

· There were limited financial resources in the government institutions

· Some faith-based organisations did have appropriate and skilled human resources

· Communication was difficult within resource-poor setting in rural areas

· Because of lack of effective network among and between faith-based organisations, they are still working in isolation. Instead of reaching concerted efforts, the money divided the faith-based organisations to fight HIV/AIDS collectively

· Strategic errors in oCCur in the rush to select great geographic areas and populations.

6.   Ecumenical Organisations and Health Facilities

Ecumenical organisations

FEMEC (Federation of Protestant Churches and Evangelical Missions in Cameroon)

FEMEC has been acknowledged by most of the church leaders as a required channel that would bring most of the protestant churches to combat HIV/AIDS altogether. This is true because protestant churches are working with the same objectives when it comes to preventive measures (abstinence, faithfulness and condom use) since recognising the magnitude of HIV/AIDS, church leaders have declared HIV/AIDS as one of the many security and development issues, Cameroon is facing today. However, resource allocation remains a key challenge for suCCess. While a growing number of effective clinical and behavioural interventions are being made available to reduce HIV transmission and improve care and support for those living with HIV/AIDS in government departments, the resources available for churches to effectively implement these interventions is insufficient. In addition, Catholic and Muslim were still uncomfortable to deal with these HIV preventive issues.

CLE editions

To combat the HIV effectively, new partners and stakeholders should be identified and brought up to date on state-of-the art knowledge about HIV/AIDS. CLE editions would be on of the new partners since it has many years of experience to publish books and literature that people are able to read and understand as they are written in their own languages. The Director of CLE went on commenting that interventions targeting individuals have shown suCCess. But individual behaviour  is strongly influenced by broad factors such as a societal norms, aCCess to programmes and services influences and public policy. In my opinion, I think that for HIV/AIDS programmes to be suCCessful and sustainable, information must oCCur on multiple levels to influence individual and societal norms, improve health services, and alleviate structural and environmental constraints to prevention and care.

The Bible Society of Cameroon

Experience has shown that consistent messages from a variety of legitimate sources must be disseminated in an interaction fashion to affect behaviour change. The Bible Society of Cameroon is willing to publish portion of biblical verses of HIV prevention that aimed at changing individual, community and societal behaviour change. I encouraged the staff of the communication and Human Management Resource departments who are willing to publish those biblical verses to avoid judgmental attitudes and verses that would encourage stigmatisation and discrimination of HIV infected and affected. Indeed HIV/AIDS-related stigma continues to inform perceptions and shape the behaviours of PLHAs, which can hamper prevention programmes. The Bible Society of Cameroon will do a great job to develop policies to combat discrimination that is crucial to any HIV prevention. Stigma reduction is both a human rights and a public health issue.

AFCEDD

The “Association des Femmes Chrétiennes Engagées pour le Développement de la diaconie” (AFCEDD) is aware that there is a big deal of lack of awareness of HIV transmission and personal infection in pregnant women, and underdevelopment of voluntary counselling and testing services, including limited integration into the Mother-to-Child Transmission sites, low compliance in taking longer-course ARV and inconsistent care for mothers living with HIV/AIDS. Additionally, AFCEDD acknowledges that once HIV prevalence reaches 10% (as it is currently in Cameroon), it can surpass 50% in just one to five years. That is why AFCEDD is fighting poverty which is the leading cause of HIV/AIDS transmission in Cameroon. This programme has proved to be very effective in disseminating messages about HIV/AIDS. It is evident that, in order for women to make headway in combating the epidemic, there is a need for collaboration of other stakeholders that are influential in the community. Though women are still considered as key players to fight HIV/AIDS, they are continuously undermined by men. This must change since women have the potential to be a substantial resource in the struggle against HIV/AIDS.

Presbyterian Theological Seminary of Kumba

HIV/AIDS is being taught in an interdisciplinary ways in Old and New Testament, Systematic Theology, Practical Theology and African Traditional Religion. The course is aimed at making students familiar with the phenomenon of AIDS, its history, including its transmission and possible prevention measures and its current magnitude especially in Africa and elsewhere. Students are expected to develop in creative and critical ways a Christian and pastoral response towards attitudes and policy concerning HIV/AIDS of various churches and especially the Presbyterian Church of Cameroon. This includes perspectives on new sexual ethics, theological perspectives in response to AIDS and pastoral care and counselling for people affected by AIDS. This initiative is worthwhile to be replicated elsewhere.

Faculty of Protestant Theology of Yaoundé

Having organising the Theological workshop on HIV/AIDS in close collaboration with the Theological Consultant for Africa, the Faculty of Protestant Theology in Yaoundé is looking forward to running HIV/AIDS modules for theological students. What is outstanding is the “Ecumenical space” that teaching has taken. In fact, a national committee was set up after the workshop. This committee is constituted of the Dean of the Protestant Theology of Yaounde, the Dean of “Faculté de Théologie de l'Université Catholique d'Afrique Centrale”, the Dean of Presbyterian Theological Seminar of Koumba and the Dean of Theological School of Kaélé. The committee has been given the mandate to integrate the module of HIV/AIDS in the curriculum of their respective institutions. Contrary to common understanding of theological institutions in Africa, the network of theological faculties in Cameroon has made a substantial commitment to the spiritual journey of hope for those both infected and affected by HIV/AIDS by training aCCordingly future pastors.

Health Facilities

Central Hospital of Yaounde

Experience has shown that people living with HIV/AIDS may live longer before their HIV infection leads to secondary and eventually AIDS. Antiretroviral treatment has demonstrated impressive results. Antiretroviral are now available in many developing countries including Cameroon. However, they are still available to a very small and mainly wealthy minority. Hopital Le Roseau , a private hospital run by a team of private medical practioners and Laquintinie , one of the public hospitals in Douala have established special services to offer ARV treatment and counselling to persons who seek clinical care.

Hopital du Jour

Hopital du jour which is the HIV/AIDS treatment and counselling centre at Central Hospital of Yaounde is managed by Dr Tardy Michele who felt the need to facilitate the acquisition of ARV drugs at lower-than-market cost by people living with HIV/AIDS. Before then, ARV were available at a very cost (approximately 450,000FCFA or about 650USD). Since the Cameroonian subsidised prices, the cost is about 25,000 FCFA). Counselling within the Hopital du jour is done by people living with HIV/AIDS. However, there were shortcomings in terms of :

· drugs were aCCessible to a very small and mainly wealthy minority

· biological testing were still expensive as ARV (85,000 FCFA) that are needed to be renewed each six months

· ARV treatment is still misunderstood by both health professionals and the general community

· compliance: therapy requires a strict individual protocol and reliable psycho-social support. A good compliance remains a challenge since ARV is expected to be administrated for life.

· the re-emergence of HIV strains resistant towards ARV is still a public concern.

· Drugs were obtained in an irregular manner and very few medical practitioners had clinical experience on their use.

Banso and Mbingo Hospitals

It is too soon to conduct a formal evaluation process. However, from testimonies of patients and aCCording to the Health Personnel, the efforts of the two hospitals of the Cameroon Baptist Convention have assisted in achieving among other things, increased and adequate HIV/AIDS care and treatment, changes in policies regarding safe dispensing and good adherence to treatment protocols. The psychosocial support provided to people living with HIV/AIDS in collaboration with the HIV/AIDS coordination in the Northwest Province has had an added advantage to relieve their emotional and social problems. However, most patients complained about the cost and said that until now ARV treatment is aCCessible to a very minority of people. They proposed that the government should allocate more public funds to finance anti-retroviral therapy drugs more affordable and available for the growing number of people living with HIV/AIDS in Cameroon irrespective of their socio-economic situations.

Cameroon National Association for family welfare (CAMNAFAW)

CAMNAFAW's goal is to support and re-enforce the efforts of the government in promoting in promoting the welfare of the Cameroonian population in the area of Sexual and Reproductive Health and Family Planning. Some achievements of CAMNAFAW are as follow:

· A model reproductive Health/Family Planning Clinic in Douala and Yaounde

· Youth guidance and counselling centres in Yaounde, Bamenda, Douala, Buea and Ebolowa

· A training centre for young girls in Yaounde called skills development unit.

CAMNAFAW also works in close collaboration with churches and church related organisations which share its views and concerns on health in general and reproductive health in particular.

7.   Organisations of the churches into a network

Federation of Protestant Churches in Cameroon

The epidemic is demanding churches to find better science, better ways of moving the government to action for his own people, better ways for carrying for each other, better ways of ensuring that others do not have to endure the night mare. However, despite the existing of this platform of churches (FEMEC) did not have a coherent HIV/AIDS policy. Each individual church submitted project proposals in isolation. FEMEC needs to be revitalised!

Conclusion

The only institution in our society that has large numbers of people gathering on a regular basis, with a common set of altruistic values, and intact system of communication are the churches. They should coordinate among themselves so that the needs of the people living with HIV/AIDS can be met. During the mapping in Cameroon, I saw thousands of volunteers of Cameroon's religious care for the sick, take people with AIDS to hospitals, clean homes, conduct rituals of remembrance and loss, provide a loving ear and a tender heart to someone facing uncertainty of the journey called AIDS.

However, for those involved in the day to day life of AIDS ministry it is clear that much harm has been done to persons with AIDS by segments of Cameroonian religions. Campaigns of hate, bigotry and discrimination have caused serious damage to the hearts and souls of people already stigmatised by a fatal disease. Therefore, it could be partly understood why some individuals want to distance themselves from the “churches” because of the acute amount of pain inflected on them by some church leaders who condemn them “intrinsically evil”. I have come myself across people infected or affected by HIV who considered the churches as their enemy. As one woman living with HIV/AIDS said to me:

 “…we only trust health professionals because they do their best to understand our condition. They are often available to answer our questions. Here in Cameroon, if you disclose your status, you will lose your membership in the churches, you will lose your job and family members, and the society and the church will reject you. In Cameroon HIV/AIDS is a taboo, it is shameful, and it is a curse. We would like to learn how other countries people managed to aCCept those who are HIV positive and speak about HIV/AIDS openly..”

Churches should understand that the advent of HIV/AIDS has also provided a means of re-examination of what faith means for us, how we find it, and how nurture it and how we can share it with others in the HIV/AIDS era. Churches must take the significance of the AIDS problem even more seriously than they have done up to now. There is no doubt that the way churches will handle the AIDS infected and affected will determine if they are churches of Jesus-Christ or not.

Time is come to welcome the infected and affected in a spirit of love, aCCeptance, tolerance and openness. This will help the churches to overcome judgemental attitudes and not ask where a member has become infected but rather how the church can support him or her. As followers of Jesus-Christ, church leaders/lay people need to become forerunners because of stigma and denial which is an important aspect of undermining prevention, counselling and care. Additionally, denial and silence are still prevents people speaking openly about HIV/AIDS.

Having exchanged views on the notion of ecumenism, I felt that there are numerous conflicts not only within the churches and religions but also among churches and religious. Christians should understand that HIV/AIDS can only be defeated if they work closely among themselves and among other religious. The faith in God that churches proclaim is a source of hope, empowerment and communion that surpasses all human understanding and experience, even in the face of suffering and death due to HIV/AIDS.

Recommendations:

Based on the above findings, my recommendations are as follow:

Policy

· Based on the Plan of Action of the Ecumenical HIV/AIDS Initiative in Africa or not each individual church should have its own Plan of Action in order to avoid the “church double-standards” regarding the HIV/AIDS issues

· Church leaders should also launch a solemn to all political, economic and social actors to combine their efforts in the formulation of efficient and sustainable policies and programmes as well as in the mobilisation of adequate resources to combat HIV/AIDS

· Church should pledge to establish systems of information, of collection and dissemination of information, statistical data and pertinent indicators on the impact  of HIV/AIDS on national level in order to enable positive action

· A realistic compromise of condom is required among churches/religions in order to help them conduct a vast programme of education, sensitisation, training. and communication for church members and the population at large

· Church should become welcoming communities of care and support for people infected and affected by HIV/AIDS and affirm and value their participation in all church activities and programmes.

Congregations

· The many church leaders who attended theological reflections and workshops must equip others in pastoral care and social ministry to tackle HIV/AIDS

· Should break the silence that surrounds issues of sex, sexuality and sexual relationship by developing and sharing experiences, strategies and educational material that enable open discussion on issues related to HIV/AIDS

· With regard to HIV/AIDS, congregations should proclaim message of hope, healing, compassion, perseverance and courage instead of promoting judgemental attitudes.

· Have the responsibility to ensure follow-up of lessons, material and personnel activities in the field

Communities

· Need that the necessary, aCCurate and updated information are given in a creative ways because people still have little or incorrect information of this disease

· Should disseminate preventive education to their constituencies by using theatre groups, seminars for women and youth leaders, pastors and evangelists

· Need to understand that people infected and affected of AIDS are their parents, children, brothers and sisters, all members of the body of Jesus Christ

· Therefore, they must aCCept them as resource persons and crucial allies in the fight against HIV/AIDS

· Must encourage people to take care of those infected and affected by HIV/AIDS, rather than blaming them.

· Must warn young people in affective way against the risks of uncontrolled behaviour

Counselling

· The major barrier to voluntary counselling and testing is fear of stigma. It is particularly important for churches to ensure that testing is performed and results given without breaches in confidentiality

· Voluntary counselling and testing instead of anonymous screening of samples taken for Sexually Transmitted Infections should be promoted at the national level

· Wherever counselling takes place, whether at home or in clinic, it must be held privately and confidentiality should be given priority

· Significant positive results can be achieved by moving counselling interventions closer to target populations and actively involving infected and affected people in counselling delivery

· Counselling services should be intended to provide comprehensive care for clients in the home and thus reduce the need for hospital admission

· Churches should make sure that drugs, psychological support and clinical care are available for people who test HIV positive

· Whatever approach is taken, the voluntary counselling and testing interventions must be evaluated regularly to determine whether it is being provided in aCCordance with the predetermined national protocol and is satisfying clients needs.

Advocacy

· Leaders of Faith-based organisations should be effective in calling upon government's responsibility to make HIV/AIDS a real priority and mainstream it into poverty reduction strategy which bears fruits at the grass root level

· It is the duty for church leaders to pledge for many infected persons who are currently lacking aCCess to palliative care services and medications. Palliative care should be provided in hospitals and in the home environment

· Church leaders should play an active role in disseminating non-stigmatising and discriminative preventive messages, and in leading the fight against stigma wherever it oCCurs

· Church leaders should understand that caregivers also need support to help them do their jobs well, avoid “burnout” and keeping going, free of HIV infection

· Social exclusion is at the root of HIV vulnerability. Extending dignity and respect to all people is therefore key to responding to HIV instead of exclusion of people from social support and networks because of their religion, social standing, HIV status etc.

Networking

· Alliance-building across denominational and faith organisations and the revitalisation of FEMEC will be a key strategy for expanding the churches' responses to the many challenges of HIV/AIDS and to lobby resources towards donors aCCordingly

· Educational and learning materials are already produced locally. In addition to any external one Churches should encourage its adaptation and distribution especially in local languages.

· A unified effort of churches is needed to fight HIV/AIDS since most of them have valuable experience, best practices and lessons to share, and these can aCCelerate this shared response.

· Prevention and care are complementary and not competing priorities. Effective prevention efforts that combine education, information, services and structural change to the social environment are needed on a massive scale around the country

· With regard to the condom use, Protestants seem to be close to the government's policies to combat HIV/AIDS. However, they should avoid the language of triumphalism

·  and seek ways to live in peace with those from other religions.

World Council of Churches and other partners

· The World Council of Churches and other partners have gained a vast amount of knowledge and about effective strategies against HIV/AIDS from the many international conferences organised, mapping of HIV/AIDS and community mobilisation. This knowledge must be used to translate commitments into action.

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