Chad

1.   General and Epidemiological Data

1.1.  General data on the Republic of Chad

1.1.1.     The Republic of Chad country profile

Chad is located in Central Africa region and it has a total of 1,284,000 square kilometres. Chad is bounded to the East by Sudan, to the South by Central Africa Republic, to the North by Libya and to the Northwest by Niger. The Republic of Chad is divided into 11 provinces of which Ndjamena is the Capital city. A Préfet nominated by the government administers Chad's 11 administrative regions. Regions are sub-divided into districts, headed administratively by sous-préfet . Apart from its huge superficial area, Chad is landlocked country since it does not have aCCess to the sea. As far as the aCCess by port is concerned, Chad relies on Cameroon, Central Africa Republic and Congo/Brazzaville's ports.

1.1.2.     Population

Based on the 1999 population census, the population was estimated at 7,5 million people of whom 44% are 15 to 49 years old and 42% are under 15 years old. Old people represent 5%. Taking into aCCount the high birth rate of 2, 4%, this has led to rapid expansion. Ethnic groups are numerous. Sara's people are located mainly in the South whilst Arabic, Peulhs, Baguirmians, Kanembous at the Centre. Kotokos and Boudoumas and other Saharan people are nomadic and rely mainly on cows and trade market products.

There are 12 African languages, with French and Arabic as official languages. Intellectual people mainly speak French in urban areas whereas Arabic and Sara are the vernacular languages. African religious beliefs influence both Muslims who constitute 60% (concentrated in the north and in the centre) and Christians (Catholic and Protestant) 40% are concentrated in the South. Indigenous beliefs are still prominent in the communities.

1.1.3.     Economy

Chad is one of the poorest countries with a GDP estimated at USD: 230. The life expectancy is 47 years. Obviously, this will be dramatically reduced with the explosion of HIV/AIDS. The economy, which depends highly on the subsistence agriculture, remains fragile and is not properly industrialised. Suffice is to say that nearly 80% of Chadians are relying on this economy. The second sector is less developed because of the highest cost of petroleum and energy. Agricultural products are being transformed by a few industries namely COTTONCHAD (for cotton and soap), SONASUT (for sugar) and breweries. The third sector is dominated by the informal sector. However, this is undermined by lack of road infrastructure, less air flights liaisons and the fact that the country is landlocked. Much of infrastructure has been destroyed during the long civil wars and political unrest that prevailed in the country. The country has been stabilised in 1990 whilst the economic production started in 1997. The Chadian's currency is the “Communauté Financière Africaine Franc”, note-responsible authority of the Bank of the Central Africa States.

1.1.4.     Education

Chad has had an education system characterised by low participation and low literate rates by Sub-Saharan Africa standards. Roughly ¾ of women in Chad aged 15 to 49 have no schooling, 80% marry while in their teens. Although, Chad committed itself to revitalise the education system that was heavily deteriorated during civil wars that affected the country from 1972-1982 before adopting Education-Training-Employment, it has be noted that virtually little progress has been achieved since skilled personnel are lacking in many areas of social life. This situation is due to difficulties listed below:

· Enrolment levels and the quality of education have been deteriorating for over a decade

· Insufficient of scholarly infrastructure

· Insufficient and lack of qualified personnel

· Scarcity of learning and teaching material

· High disparity between regions and sexes

In addition to the above shortcomings, the economic crisis that prevails in the country and the subsequent high demographic pressure (2, 4%) make it difficult for the government to provide appropriate financial and material resources that can solve the education problems with the existing infrastructures. Primary, secondary school and vocational institutes are under-resourced, of insufficient quantity and low quality particularly in rural areas.

The depleted condition of state education in Chad is alarming in terms of many schools that need rehabilitation. Additionally, technical and vocational training are characterised by:

· Shortage and under qualification of teachers

· Tendency to conduct traditional training that is no longer relevant to the communities needs. A baseline study would be necessary in order to match the training with community needs.

· Drop-out of both rural and urban areas are due partly to a combination of parent's poverty, teacher shortage and the poor quality of education.

1.1.5.     Health

The government is committed to promote Health for All in Chad. However, despite this political will, there are increasing difficulties from professional and resources perspectives. The current health coverage does not match with the general population demand of 1, 4 medical doctors for more than 100,000 people. Additionally, medical and other paramedical specialists are heavily lacking in the field of health. Training institutions are falling short of the population needs. Vehicles for urgencies and biomedical material such as microscopes, radios etc are badly needed. Donor and partner's contributions helped Chad to rehabilitate and equip partly the deteriorated infrastructure by the civil wars during 1979-1992.

Additionally, the partner's inputs contributed to implement projects and programmes for disease control namely: malaria, onchocerchiasis, trypanosomiasis, leprosy, tuberculosis, paediatric disease, respiratory truck diseases, diarrhoea and HIV/AIDS. ACCording to the Ministry of Health, more than 50% of people living with HIV/AIDS are 15 and 45 years old.

Despite such efforts, Chad's health care system is woefully unprepared with AIDS or any other serious medical problems. For instance, the main hospital in Doba, a major town in the oil region, has no electricity and is lighted at night by kerosene lamps. Medical material are not sterilised, but rather washed in warm water, and disposable syringes are routinely reused, say health specialists who recently visited the hospital (personal communication).

1.1.6.     Poverty and vulnerability

Nine of ten HIV infections in Chad are caused by sexual activity. Therefore, most of factors related to sexual promiscuity that happens in some areas of Chad are leading to the spread of HIV/AIDS. This is not limited to those outside the church. AIDS is real and it is in denominational churches. Poverty is the leading cause of HIV infections particularly among the youth. In early days of the onset of HIV/AIDS, wealthy men who used to visit sex professionals are now looking for young girls in schools, believing that they are HIV/AIDS free. In addition, Chadian culture often creates a feeling of inferiority in girls. Since, sex education is no longer available either in family or in school; girls do not find it easy to reject a man's advances. Therefore, young girls are particularly in great risk of getting HIV infection.

In many areas of Chad, ignorance about AIDS is profound. I think that ignorance is one of the main reasons why the epidemic is still prevailing. Because of the increasing number of burials of young adults, Chadians are beginning to observe that something sinister and catastrophic is happening.  In addition, there are many people who are living with HIV/AIDS without having a clue of having the virus. Some people do know that they have the virus but do not know how they got it. Although, surveys revealed that many Chadians had the opportunity to acquire basic facts or to attend a workshop on HIV/AIDS, because of high degree of illiteracy (80%), a few Chadians had the chance to read pamphlets or books on AIDS. Schoolteachers hold little information about HIV/AIDS.

s infected with HIV, often s/he is ashamed and frightened. S/he may deny his/her illness and s/he will hide his or her condition from others in order to lessen the risk of becoming outcast from the family and of being rejected by neighbours.

Additionally, affected family rarely does not admit that AIDS was the cause of a beloved one's death. If you ask questions to probe why somebody dies, they say that it was from malaria, tuberculosis or witchcraft. In a country where levirate marriage customs, the marriage of young orphan girls, particular sexual practices allowed in traditional society, the belief in witchcraft could be enabling causes of the spread of HIV/AIDS.

Recent oil found in Doba province in Chad could also provide an opportunity for HIV to be spread. As the consortium was gearing up for construction in 2000, Chad and Cameroon used a World Bank loan to hire a health consultant to analyse the pipeline impact on AIDS cases. He predicted that unless aggressive measures are taken, the pipe line project would lead to 100 additional AIDS deaths annually within several years. He went on stressing that the pipeline would cause an HIV rate increase because that is what happened with previous projects in Africa. The promise of jobs drew thousands of truck drivers and workers from local areas and neighbouring countries. Since tons of material was trucked to the Chadian oil fields from Douala, a Cameroonian port town, where tests found that 17% of truck drivers are HIV+, at a boarding crossing on the M'Bere River were trucks stop to clear customs, 55% of the commercial sex worker in a pipeline shantytown were HIV+. You had all the conditions for HIV to work its way into Central Chad with the truck drivers ”, Jobin said.

1.1.7.     Politics

With regard to public health, Chad does not have its own written policy. Instead, Chadian government is heavily relying on French public health policy which does not take into facts and realities of Chadian context on the ground. This shows that Chad is one of the poorest countries with a precarious health system. In 1990, 25 % of Chadian was estimated to have aCCess to Health for All package compared to 30% in 1995.

In terms of health personnel, the health system is largely deficit in quantity and quality. For instance, Chad had only 250 medical doctors of whom 50 are expatriates (Annuaire des statistiques 1997, Tome A).

As part of its health policy, the Chadian government is committed to reduce the morbidity and mortality rates due to HIV/AIDS. Special attention is given to prevention and care of people living with HIV/AIDS. This prompted the government to set apart a budget worth of 400 million of Francs CFA for the care of the infected.

1.2.  Epidemiological data

1.2.1.     Epidemiological data of HIV/AIDS epidemic in Chad

As in many countries of Africa, the first cases of AIDS were reported in Chad in the mid-1980s, but the disease has not spread as widely as it did elsewhere on the continent, probably because of the country's isolation. In 2000, it was estimated that Chad's adult AIDS infection rate was 6%. From 1986 up to 2000, the National AIDS Control Programme estimated 13,385 HIV/AIDS cases reported.

Source: Etude sur la législation en matière de lutte contre le VIH/SIDA/IST au Tchad 2001, page 16.

Comments

In my opinion, these figures are not reliable. In fact, during the onset of AIDS, the government stances towards the AIDS pandemic was characterised by denial of the disease. The government seriously took its responsibility when AIDS cases increased from hundreds to 1010 in 1993. This subtle increase could be the consequence of the 1980s when many stakeholders including the government did not properly deal with the epidemic. As a result, from 1993 to 1996, the National AIDS control Programme has diagnosed more than one thousand of AIDS cases per year. And ever since, this is on the increase. In December 2000, 1704 cases were diagnosed within the national territory of which 63, 2 % were 15 to 49 years old.

The above table shows the evolution of HIV/AIDS as a result of the long civil wars and the notification of the number of AIDS cases has not been carried out systematically for many years. In many rural areas, there are little testing facilities and record keeping. Some statistic gathering in the National AIDS Control Programme is partly guesswork since the years following 1990 were years of violence, including large scale of sexual violence and disruption of the health system. This suggests that the current HIV prevalence of 6% is much lower than the reality on the ground, as a result of some studies. An estimate of infection rate of between 8 and 10% may be true bearing in mind that if the HIV/AIDS is still unchecked; this epidemic will erase the benefit of peace and post-war reconstruction in Chad.

1.2.2.     Sentinel Surveillance

Ndjamena and Doba have been considered as the major urban areas where many studies have been carried out. The median HIV prevalence rate among the antenatal clinic attendees in Ndjamena increased from around 2% in the late 1995 to 6% in 1999. Outside of Ndjamena, a mean of 5% of antenatal clinic women tested HIV positive in ABECHE, BOL, BONGOR, and SARH in 1999. In 1995, 13% of commercial sex workers tested in Ndjamena were HIV positive. Additionally, 10% of military personnel tested in Ndjamena were HIV positive. Due to low level of HIV testing and counselling in Chad, most people do not know their HIV status. No further information for vulnerable groups was available due to the economic turmoil and the civil wars that took place in the country.  At the end of 1999, an estimated of 13,000 adults were reported to be living with HIV/AIDS of whom 53% were women.

During the previous 5 years, since the surveillance system did not exist, thus the aCCuracy of the epidemiological data is questionable. Therefore, the existing data do not reflect the reality of the pandemic on the ground taking into aCCount the many contributing factors that are likely to spread the HIV/AIDS. However, limited information is available on HIV prevalence among the general population.

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 refusal to admit the presence of HIV/AIDS in Chad for a long time

· The failure of political and religious leaders to mobilise the resources at their disposal to establish effective structures which would respond to the crisis and bring hope to the people

· The persistent culture of silence within the faith-based organisations

· Poverty that hinds control effort

· Wars, armed conflicts and insecurity and its consequences (violence and uncontrolled migration)

· Socio-cultural issues:

§ Negative cultural and perceptions issues that make women and young girls vulnerable to HIV

§ Discussion about sex and sexuality is a taboo

§ Stigma, discrimination and rejection attached to HIV/AIDS that force people who test HIV positive to remain inadvertent killers by spreading the disease and the hiding away of AIDS suffers

§ Gender inequity: women continue to be subject to widespread discrimination at home, in the workplace, before law, and in public institutions

· Global economic and injustice

§ Heavy external debt

§ Structural adjustment with its cut in government health and education spending

§ InaCCessibility to anti-retroviral and, to voluntary counselling and testing: For those with HIV/AIDS, effective treatment is available in N'Djamena hundred miles from remote rural areas.

1.2.4.     Impact of HIV/AIDS in Chad

Despite the fact that the HIV/AIDS situation is a looming national catastrophe with an adult infection in 2000 of 3, 6% and rising since then, no empirical data on Chad were found in the literature review. However, like in many other sub-Saharan African countries, the impact will obviously be felt in sectors such as: agriculture, education, medical, economic, etc.

In household and in the agricultural sector, illness and death due to HIV/AIDS will lead to increased expenditure, reducing saving and productivity. Despite the relative potential for agriculture, structural weaknesses, notably destroyed road infrastructure and climate variations render Chad an importer of food since only little of arable lands are currently cultivated.

In 2000, the education model developed by UNAIDS and UNICEF shows that, of around thousands primary schoolchildren, many of them would have lost a teacher to AIDS in 1999. This increasing mortality rates among schoolteachers leads to discontinuity in teaching with many schoolchildren that are forced to change their teachers.

In 2001, a United Nations' study found that AIDS patients oCCupied many beds in urban and semi-urban hospitals. Additionally, based on limited studies in the N'djamena morgue, the proportion of adult female AIDS cases is significantly higher than the proportion of male cases.

In response to the warnings about AIDS, the World Bank and the consortium sponsored a prevention programme that includes distributing free condoms, steering women away from prostitution, and treating sexually transmitted infections that increase the risk of HIV. But the programme offers HIV testing only to pipeline workers and provides no treatment for AIDS. HIV/AIDS is still considered as a biomedical issue. Therefore, the country has taken few steps to improve existing Anti-AIDS programmes, which are under funded and mostly ineffective.

In conclusion, further data is required for an understanding of how the pandemic is affecting the agriculture, education, health and economic sectors for the implementation of the national strategic planning which is underway.

2.   The National HIV/AIDS Control Programme E

2.1.  Background to the AIDS Control Programme

The interest of the government, which while starting information and awareness building activities, approached the World Health Organisation for technical assistance. Under this technical assistance, it was decided that the National AIDS Control Programme (PNLS) would be established within the Ministry of Health. Chad's government runs a limited testing programme and reported 1,704 new AIDS cases in 2000. The World Health Organisation estimates that 3, 6 % of adults in Chad are HIV+.

2.1.1.     The National Response of Chad

The Chadian's response in the fight against HIV/AIDS has not been effective before the 1990s since Chad national authorities found unable to admit the existence of HIV/AIDS in Chad. This has been worsened by the economic turmoil and the two civil wars. Currently, little is done to reverse the spread of HIV/AIDS. The box bellow will provide important dates and significant events.

Comments

As in other parts of Africa, the AIDS epidemic has led the government in Chad to reassess its national health priorities, and in particular focus on the difficulties facing by the general population to address the issue of AIDS. However, the general public has been very critical of the government inadequate response to prioritise HIV/AIDS as a top issue and its inability to address stigmatisation, discrimination and rejection attached to HIV/AIDS. Therefore, leaders at all level not only in government but also religious and even traditional have the responsibility to create a more open society that is free from stigma, silence or denial about the epidemic.

In Chad, it took many years before of the first voluntary Counselling and Testing centre was established and the Mother-to-Child Transmission treatments are still in their infancy stages. Additionally, aCCessibility, availability and affordability of anti-retroviral therapy remain a major obstacle except for those with sufficient financial resources to by-pass the informal system.

In response to these challenges, the Chadian government with outside donors developed a national health strategy, and a National AIDS Control Strategy Plan. To support this, the World Bank is providing the government with financial inputs both under a Health Sector Support Project and for a population and AIDS Control project. ACCording to many testimonies, these two structures are not enabling the multisectoral approach that the government wanted to put in place for HIV/AIDS prevention and care at the community level partly because of bureaucratic attitudes.

The above dates and major events of the National Response are self-explanatory that Chad lacked the political commitment from the onset of HIV/AIDS to combat the epidemic. Taking into aCCount the culture of silence and denial of the disease associated with HIV/AIDS; this could justify why Chad has become one of the 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 especially in church settings

· No or little implication of the government sectors other than health sector to effectively combat HIV/AIDS

· Increased HIV/AIDS prevalence especially among the 20-39 years old

2.2.2.     Partnership

An initial population and AIDS project, which became effective in 1995, helped the government to put in place a multi-sector AIDS prevention plan and trained more than 40 local non-governmental organisations in project development and management. They are some NGOs involved in the fight against HIV/AIDS in Chad. They are either secular or denominational established in the capital city and in major urban areas such as DOBA, Abéché, etc. Most of the associations intervene at different levels in the struggle against HIV/AIDS and are active especially in awareness raising and sometimes the care of people living with HIV/AIDS, etc.

The National AIDS Control Programme works in collaboration with the following partners such as WHO, UNAIDS, UNDP, WHO, World Bank, GTZ, French Cooperation, UNICEF, OXFAM, Red Cross, FNUAP, WFP, European Union and USAID, etc.

2.2.3.     Faith-based organisations

The partnership between the Chadian Government and the faith-based organisations is nation-wide through the Catholic, the Entente des Eglises et des Missions Evangéliques au Tchad, the Organisation des Eglises Pentecôtistes and the Muslim. 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 action. The venture should build on the strengths of each religious community to provide national leadership.

3.   Faith-Based Associations: Perceptions and Involvement in Addressing HIV/AIDS

3.1.  Faith-based organisations in Chad

With regard to the mapping exercise, I met religious leaders and heads of health services of the following religious communities: Eglise Evangélique du Tchad, Eglise Evangélique Fraternelle Luthérienne du Tchad, Eglise Adventiste du Tchad, Eglise Baptiste Mid-Mission du Tchad, Eglise Catholique, Assemblée Chrétienne du Tchad, Communauté Islamique du Tchad, Eglise Pentecôtiste du Tchad, Eglise de la Coopération and Entente des Eglises et Missions Evangéliques du Tchad (EEMET) .

3.2.  Perceptions of HIV/AIDS

AIDS remains a major concern for the many church leaders and heads of health services that I met in Chad . Many of them are still acknowledging that HIV/AIDS cases have been increasing at 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 a recent HIV/AIDS workshop that was organised by EEMET in collaboration with the National AIDS Control Programme.

3.2.1.     Eglise Evangélique du Tchad

PLHA are highly stigmatised in the Eglise Evangélique du Tchad because of the association of HIV/AIDS with certain sexual behaviours. Fear of stigma and discrimination means that few individuals are willing to divulge their HIV status or find out their status through HIV testing services which are not widely available. In addition, aCCess to antiretroviral is limited to those with money or international contacts.

“The Evangelical Church of Chad has already buried people dying of HIV/AIDS. AIDS is no longer a disease to be hidden although our unease to deal with sexuality issues that surround HIV/AIDS”

Pastor Djedouboum Moise, Deputy General Secretary of Evangelical Church of Chad.

3.2.2.     Eglise Evangélique Luthérienne du Tchad

One promissing development in the Eglise Evangélique Luthérienne du Tcahd has been the growth of anti-AIDS clubs for young people in schools and the community. Anti-AIDS clubs organise and conduct recreational activities, especially football games, drama, red ribbon campaigns, and community outreach. In addition, church leaders could describe main ways of getting and transmitting HIV and consequences of AIDS resulting from the respective social and cultural background. This could be the result of the many seminars and workshops that are going on. During the mapping, the church was running an important workshop on the implications of HIV/AIDS and the responsibility of Christians to develop appropriate response to HIV/AIDS.

“We are good at saying that God is everywhere, all the time, and sees and knows every thing-which means he is always with us. However, when we face the realities of life especially HIV/AIDS, things do not seem always so simple. That is why the Eglise Evangélique Luthérienne du Tchad decided to stop searching somebody else to blame as many people in this country blame the devil, the ancestors, witchcrafts or the Americans for spreading AIDS. Other people blame God and affirm that HIV/AIDS is God's punishment for evil or a result of breaking spiritual laws. I know that this is wrong. In my opinion, I do not think that somebody who is HIV+ is guilty.”

Pasteur Bourdanné KEREO

3.2.3.     Eglise Adventiste du Tchad

The devastating impact of HIV/AIDS is felt most acutely at the community level. Church leaders acknowledged that with thousands of people infected of whom most are youth and children orphaned by HIV/AIDS; Chad is facing a growing strain on its economic and social resources as it tries to meet the rapidly expanding need for services.

“HIV/AIDS is a social catastrophe which makes victims in our society as a result of humankind's disobedience towards God's and health principles. Romans 1: 24-30. However, God is love and merciful that is why he faces HIV/AIDS by limiting the increased number of AIDS victims and propels us to help those who are already caught in HIV/AIDS pitfalls”.

Pastor Rubens R. Da Conucao

3.2.4.     Eglise Baptiste Mid-Mission du Tchad

Faith-based organisations should play a vital role in reaching affected communities with prevention, care, and support services. Recognising this, the Eglise Baptiste Mid-Mission of Chad is on the front line of the war against HIV/AIDS although they find it difficult to obtain the resources they need to continue their valuable efforts.

“I resisted HIV/AIDS education at first, but my attitudes changed when church members started becoming infected and fell ill as a result of HIV/AIDS. Indeed, HIV/AIDS is a dreadful disease which claims life of many young people. Most of those who die from this disease are also churchgoers and Christians. The most disturbing is the fact that the epidemic and its impact are for the most part still hidden because of the epidemic's prolonged latency period. Most people do not know they are even infected. The worst of the epidemic is yet to come as HIV infected people may infect others and develop full blown AIDS”

Pastor Tompte Pierre, Eglise Baptiste.

3.2.5.     Eglise Catholique du Tchad

While Catholics around the world hold different views on how best to prevent HIV infection, many Bishops in Chad have developed relevant information on HIV/AIDS and compassionate care for the sick as core values. Additionally, Catholics operate in clinics, hospitals and teaching facilities. As the HIV/AIDS programmes are expanding in Chad, Catholics and other faith-based organisations will be important partners in providing voluntary HIV counselling and testing, home care, clinical services and advanced treatments.

“In 1986, two AIDS cases were mentioned whereas there is steady overall increase since nearly 13,000 people were suffering from AIDS at the end of 2000. This is on one hand of great challenge in Chad where the AIDS situation is alarming. On other hand, AIDS is not God's punishment. AIDS could be an opportunity that draws one near God in a true and sincere confession for one's salvation. Christians need to examine theologies of hope so that they can hold on to hope and care for people who need healing.”

Chadian Bishop's of declaration on HIV/AIDS.

3.2.6.     Assemblée Chrétienne du Tchad

Church leaders are aware that millions of people in developing countries including Chad are already infected by HIV and millions are at risk of infection. Stigma and discrimination breed the silence in which new infections take place and contribute directly to the denial that make life and death with AIDS more difficult than it has to be. As shapers of the community behaviours and values, churches can significantly reduce stigma by promoting respect for life, fidelity in committed relationships, valuing and providing life skills and education. Although some other agencies may not endorse all approaches to HIV prevention promoted by faith-based organisations, but some of the prevention measures can entail the reduction loss of life due to HIV.

“I am aware that AIDS is wiping away the last century's advances in many areas of life. Important people such as schoolteachers, health professionals, businessman etc. are dying thus reducing the quality of national services. Since HIV/AIDS is confounded with sexuality, it cannot be denied that the church has always taught abstinence for the youth and sexual activity for married people only as recommended by the Bible.

Condom use is merely advised for married couples as a mean of contraception. I still believe that if condom use has to be openly promoted for the youth, sexual promiscuity in terms of fornication and abomination will be found everywhere. It has to be mentioned that neither fornicators, nor adulteress will enter the kingdom of God, despite the impact of HIV/AIDS that is felt most acutely at the community level.”

Pastor Lawman Moverna Esaie DE-SIA, National Secretary General of the Assemblée Chrétienne.

3.2.7.     Muslim Community of Chad

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.

“In Chad, HIV/AIDS is a reality which spares no religion, 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 humankind to get back to their Lord Allah, since the Prophet Mohammed said people who will practise fornication would experience a dreadful disease that their predecessor did not know before. Therefore AIDS could be the prophesied disease. ”

Cheikh Ahmat Kinder, member of the High Council of Islamic Affairs.

3.2.8.     Eglise Pentecotiste du Tchad

The Pentecostal Church of Chad looks forward to strengthening its efforts with community initiatives at the grass root level where people live, struggle and die as a consequence of HIV/AIDS infection. This helps the church leaders to meet the needs of those infected or affected by HIV/AIDS.

“When we discuss statistics about AIDS, we often forget that behind these figures, there is a person or a family who are experiencing great suffering. Statistics mean nothing when it comes to consider the nightmare and tragedy that faced couple affected families that lost beloved within my church. This gave me the opportunity to have a new look on the suffering that AIDS brings into family, church and the society at large”

Pastor Yamtoingar D.Antoine Issa, Eglise de Dieu au Tchad.

3.2.9.     Eglise de la Coopération du Tchad

HIV/AIDS kills in slow motion, claiming one life after the other whilst spreading quietly and secretly making more and more victims. And yet, there is no end in sight. In Chad the fight against HIV/AIDS has just started because of many speculations during several years. These include the widespread belief that condom use would be the appropriate way to fight HIV/AIDS. Additionally, HIV would be released from a western laboratory to destroy African population. Finally, God invented the virus to punish the wickedness.

“Condom promotion has raised controversial and hot debates in Chad. Though condoms are now available and aCCessible since they are not combined with media campaigns that use culturally appropriate educational message to promote condom use and other forms of risk reduction, HIV/AIDS is still on the increase. Therefore, many people are still thinking that HIV/AIDS is either a divine punishment or a virus that was released in Western laboratories to destroy Africa.”

Pastor Altana Jérôme, Eglise de la Coopération au Tchad.

3.2.10 Entente des Eglises et Missions Evangéliques du Tchad

11 mainline churches namely Assemblée Chrétienne au Tchad, Eglise Evangélique au Tchad, Eglise Fraternelle Luthérienne au Tchad, Eglise Evangélique des Frères du Tchad, Eglise Evangélique en Afrique Centrale and Eglise Missionnaire au Tchad, etc have already formed the Entente des Eglises et Missions Evangéliques au Tchad (EEMET). 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.

“I believe that HIV/AIDS is steadily breaking down health, economic and social structures of countries throughout sub-Saharan Africa. Chad and Central Africa at large are still behind these countries in experiencing much of the ruin that AIDS brings. Therefore HIV/AIDS should be an opportunity that churches must take to demonstrate Jesus' teachings and deeds in a hopeless world because of the complexity of HIV/AIDS issues.”

Pastor Bako Ngarndeye, General Secretary of EEMET

Comments on HIV/AIDS perceptions by faith-based organisations

The need to distance the religious communities from the Angry punishing God and the “if you would like to avoid AIDS, abstain from fornication” attitude is critical. It must be addressed energetically and repeatedly at every level of the religious communities. This was seen particularly in the Muslim community.

In Chad, decisions related to sexuality, such as when to first engage in sexual activities and when to have children, are influenced by the church, the family and community as well as the individual. More importantly, in most cases old people and church leaders are very influential. Therefore, churches and families should play protective, safe and supportive role in the lives of young people as they have to face early important decisions about their sexual lives. However, evidence suggests that families and church leaders themselves often do not feel comfortable discussing sexuality with their children and their church members for a variety of reasons raging from cultural or social shame associated with sexuality and sexual practices. As a result, parents and church leaders are unfortunately perceived as real barriers to the adolescents' sexual decision-making process. Church leaders and families must seek appropriate language to address sexuality and HIV/AIDS issues.

Another issue of concern is the position of girls/women in Chad where men are expected to be the breadwinners. Boys are commonly considered as an asset and an investment for parents when they get old. This could be why boys get preferential treatment in many aspects of life including schooling or education. Therefore, the social preference for boys by family, community and the legal system gives them more options to suCCeed in life than girls. Many families still perceive girls merely as people who should get married with the family benefiting from the bribe price paid by the husband's family. This makes girls more vulnerable to HIV/AIDS. In order to curb and slow down the HIV/AIDS epidemic, church leaders must advocate for social transformation towards gender equality and equity, equal opportunities and equal aCCess to resources by women/girls etc.

Most of church HIV/AIDS programmes visited were led by clergy with little or not inputs from professionals belonging to fields other than theology. Church leaders should understand that HIV/AIDS is a technical issue that requires multidisciplinary and multisectoral approaches if we have to make a difference in combating the pandemic.

Faith-based organisations should be given support to do what they prefer to do, and what they do best: promote what they call abstinence and fidelity. The attempt to force FBOs to work in condom promotion risks alienating them from AIDS prevention efforts, and thereby losing the great potential they bring to such an effort. However, condom use can reduce the risk of HIV/AIDS and, in conjunction with other behaviour changes such as delayed sexual debut and sexual partner's reduction; they are key components of effective AIDS prevention programmes. In an interview entitled “the church has AIDS”, Bishop Kevin Dowling makes the following statement:

“If we simply proclaim a message that condoms cannot be used under any circumstances, then I believe people will find it difficult to believe that we, as a church, are committed to a compassionate and caring response to those who are suffering, often in appalling living conditions. For me, the condom issue is not simply a matter of chastity but of justice.”

3.3.  Involvement of churches in addressing HIV/AIDS

3.3.1.     Eglise Evangélique du Tchad (EET)

Among many other churches, the Evangelical Church in Chad remains one of the main pioneers in HIV/AIDS work in Chad.

Prevention:

EET's prevention strategy values the role of community participation, peer outreach, and involvement of people living with HIV/AIDS to make behaviour change messages more aCCeptable, understandable, and effective. Although not quantifiable, these activities would have helped congregations to create economic safety nets for vulnerable and families. When it comes to preventive measures, abstinence from sex before marriage and faithfulness in marriage, are promoted as the only God's way of avoiding AIDS. Despite their advantages in some situations, condoms are not considered the only answer to the AIDS public health problem, either from the medical, social or Christian standpoint.

Care

Through its health services, the Eglise Evangelique du Tchad provides a significant portion of health care and social services, outreach clinics and home based-care.

Support:

EET's interventions have trained community volunteers to provide home-based care and psychosocial support to those with HIV/AIDS and assistance to vulnerable children.

Comments

If it is true that condoms do not guarantee absolute protection, it is also true that promoting condom use as the total answer to HIV is not right. However, I see a real danger for churches that become anti-condoms instead of being anti-AIDS. In Chad, Christians became so divided about condoms that there is still a danger of losing focus. For a period of nearly 2 decades, condoms became evil rather than the sexual acts that are taking place outside the bond of marriage. In my opinion, church leaders should avoid wasting time and energies over condoms issues as it should be dealt on justice rather than on moral grounds.

3.3.2.     Eglise Catholique du Tchad

In Chad, one of the most supporting activities within Catholic settings is focused on supporting the “Reach out, show compassion” campaign to reduce stigma and foster support and compassion for those living with HIV/AIDS. With the cooperation of Bishops in Chad, the campaign aimed at increasing the number of dioceses and parishes, and humanitarian groups advocating for or engaged in care and compassion activities in the communities. Training of 1,296 clergy and laity has been conducted throughout the country to establish compassion and support programmes. National television and radio spots also incorporated quotes directly from the Bible that demonstrated compassionate behaviours. In their declaration on HIV/AIDS, Bishops committed themselves to working alongside the governments and other stakeholders in a united front against HIV/AIDS.

In this regard, the Centre Diocesain d'Information et d'ACCompagnement des Malades (CEDIAM) is a highly suCCessful initiative to help the dioceses care for HIV/AIDS affected families and individuals. Activities carried out in 2002 are presented as follow:

Voluntary Counselling and testing

People living with HIV/AIDS have a critical role to play in designing and implementing HIV/AIDS prevention, care and voluntary counselling and testing programmes. Though HIV testing facilities in Chad are not readily and widely available, Centre Notre Dame des Apôtres (CNDA) offers a unique opportunity to involve people living with HIV/AIDS to make voluntary counselling and testing more effective, appropriate and meaningful. CNDA counsellors work one-in-one with clients to help them assess their individual risk for HIV and engage them in a focused discussion of realistic ways to reduce the risk. Moreover, CNDA can help to connect clients with services including hospice care, support for orphans and vulnerable children.

CNDA faces a number of challenges namely:

· Stigma and discrimination make it difficult for a person to disclose his or her HIV status or become actively involved in community HIV/AIDS activities

· CNDA is unprepared to involve people living with HIV/AIDS especially at the decision-making level because of the lack of experienced, trained and skilled personnel since the only expatriate medical doctor who runs the programme is on leave for personal reasons

· Some people living with HIV/AIDS who wish to become involved in the programme need to develop new skills such as advocacy or counselling. Such programmes seeking to create an enabling environment in which people living with and affected by HIV/AIDS could come forward as educators, community mobilisers, and active participants in community and country programmes are rare.

Legend

P                =   Positive / N    =   Negative / U =   Unspecified

Comments

The above data are self explanatory in terms of the seriousness of tasks undertaken by the Roman Catholic to address in concrete and pragmatic ways the HIV/AIDS issues in Chad. However, little is done to avoid the caregivers' burn out, which constitutes a vulnerable population with regard to HIV/AIDS. In addition, the National AIDS Control Programme promised without suCCess to help scaled-up CEDIAM's activities.

However, the Bishops' Pastoral letter related to HIV/AIDS that aimed at mobilising the church community and empowering individuals and families to prevent HIV/AIDS was welcomed in 2002 by many Christians. As a result, many people including Muslim paid visits to CEDIAM in order to find out more information and HIV/AIDS facts in Chad. This is suffice to demonstrate that church leaders have extensive geographic reach, unmatched staying power as well as developed infrastructure to reach the community at the grass root level. There is no doubt that church leaders are keys to shaping values and behaviours with regard to HIV/AIDS as they can build awareness raising to confront stigma and mobilise community responses.

In service training for school teachers was provided by CEDIAM's staff. However, most of school teachers felt that they are not appropriate channels to teach HIV/AIDS to their school children. Others said that health professionals should do this. A few schoolteachers of whom half were women felt that they need incentive (in financial terms) to teach health education to school children.

While young schoolchildren are at great risk, they are also leading the way in reducing behaviours that increase the risk of HIV infection. This demonstrates the necessity of training schoolteachers since studies have shown that decreasing infection rates among young people are usually the first sign of an overall decline or stabilisation in HIV prevalence in the general population.

In addition, adolescents who become sexually active often do so without appropriate information and skills to protect themselves from HIV infection. Many young people that I met and talked to in Ndjamena did not believe they are at risk of attracting HIV. When it comes to obtain information and services, some young people reported that they often encounter prohibitive costs, insensitive health care providers, restrictions on providing services to unmarried adolescents, and lack of confidentiality. This pledges for teachers to become change agents to respond to the many HIV/AIDS challenges in Chad and elsewhere.

3.3.3.     Eglise Adventiste du Tchad

The Adventist Church of Chad implements HIV/AIDS programmes for young people innovative strategies to reach youth with appropriate and effective messages. These messages encourage continued abstinence for youth who are not yet sexually active and faithfulness for married couples. The Adventist Church delivers these messages in a variety of ways, including mass media campaigns, multisectoral programmes, peer education, and film projections and combinations of these approaches. These campaigns and other Adventist programmes work to reduce the vulnerability and develop the great potential of young people in KELLO region by giving them the information, services, and support they need to make healthy choices. As a result, these campaigns have contributed to behaviour change such as delay onset of sexual activity.

The multisectoral approach coupled by strong collaboration between health and societal sectors to implement activities such as HIV/AIDS training for sex professionals, life skills training for young people has proven to be of considerable and practical value. The Adventist church leader in KELLO region reported that some sex professionals decided to stop the sexual work they were doing since they were given micro-credit to generate income schemes in order to help them meet their basic needs whilst many other sex professionals were complaining about the decline of sexual clients. The Adventist church also works with education personnel to establish a positive environment for HIV prevention in schools.

3.3.4.     Eglise Fraternelle Luthérienne du Tchad

Church leaders acknowledged the greatest challenge to public health that HIV/AIDS represented since the nineties. That is why the brochure entitled “What is AIDS?” was translated in many vernacular languages since 1995. This brochure provided to church members considerable information on HIV/AIDS basic facts. Currently, this brochure is under revision in order to include section of sexual transmitted infections. In this regard, the National AIDS Control Programme is committed to provide funds.

In addition, through its HIV/AIDS programme led by Centre Chrétien d'Appui au Développement communautaire , the Lutheran Church works to prevent and counter the misinformation, misunderstanding and stigmatisation that continue to foster the perceived relationship between HIV/AIDS, sins and death. In 1998, the Lutheran church leaders were invited to attend a workshop organised by the National AIDS Control Programme. As a result of the above workshop, church leaders were motivated to organise a vast campaign targeting the youth within their respective parishes. These campaigns used drama and music video in order to reach youth with prevention messages in PALA and ABECHE parishes. Currently, the Lutheran church leaders have submitted a comprehensive HIV/AIDS project proposal to local donors without suCCess.

3.3.5.     The Muslim Community

The Muslim Community Programme activities focus on: Prevention and care. The programme objectives are to slow down the HIV infection through teaching HIV/AIDS information related to Islamic religious on how to avoid getting the HIV infection. The Supreme Council for Islamic affairs is contributing to fight HIV/AIDS in a pragmatic ways namely by:

· mobilising Imams and the Muslim community for a commitment to fight HIV/AIDS

· the care rendered to orphans

· And the support towards PLWHA.

The results acquired so far include the recognition of the HIV/AIDS existence and the threat of human violation that HIV/AIDS represents. Many Islamic people have shown both great respects towards people living with HIV/AIDS and righteousness to AIDS “victims”.

The challenges are that Muslims are convinced that HIV/AIDS is a result of sexual promiscuity although some people are still ignoring the existence of HIV and the impact of AIDS.

Comments

· The Muslim community in Chad could do a great deal by initiating frequent contacts with its members in order to help create a constructive and non-threatening environment within which pragmatic advice could be offered for the timely identification of HIV/AIDS issues. This also will facilitate the processes of ownership by its church members.

· Strong Information Education and communication are critical to the effective implementation of a population policy. In order to better design the IEC activities, knowledge, and attitude and practice (KAP) surveys need to be systematically carried out and their findings factored into the IEC tragedy.

· In order to correctly monitor or evaluate the impact of Information, Education and communication, indicators need to be included in the design of the programme. For the time being, this is not the case.

· During the mapping exercise, I found an apparent good relationship between Muslim and Christian Leaders. This could be a good opportunity for Chadian leaders to create or reinforce an interfaith HIV/AIDS committee to mitigate the adverse effects of HIV/AIDS in pragmatic ways. Right now, religious communities are fighting HIV/AIDS in isolation.

· The fight against HIV/AIDS requires not only the availability of resources, but all a comprehensive and shared vision.

4.    Poverty and Human Rights

Many people today will agree that September 11 th 2001 marked a turning point in our world's history. The terrorist attack of the twin towers in New-York warned the entire world that peace cannot be taken for granted. However, the world viewed with admiration the outpouring of sympathy and practical assistance that followed the bombing. Surely there is no comparison with the enormity of the AIDS situation in sub-Saharan Africa. But the proportions of the sympathy and help, both within and outside the country are minute compared to the tragedy.

Though the terrorist attack on New-York could not be dated as aCCurately as possible, but it has had and is having more terrifying consequences. Similarly, this plague called HIV/AIDS is claming millions of lives of men and women, children and adults, rich and poor. HIV/AIDS respects no tribe or race or national boundaries. It is true that poorer countries are much more vulnerable and are experiencing much larger number of casualties. It has to be noted that poverty does not cause AIDS per se, but it creates an enabling environment which militates against treatment and alleviation of suffering.

In many developing countries including Chad, HIV/AIDS pushes people deeper into poverty as households lose their breadwinners, livelihoods are compromised and savings are consumed by the cost of health care. The pandemic also adds to the strain on national institutions and resources, and undermines the social systems that help people to cope with adversity. In Chad, HIV/AIDS is eroding human security and productivity, undermining economic development, and threatening social development.

Poverty means lack of proper food, clothing, shelter, poor sanitary conditions and sufficient medicine. Poverty brings deterioration and death more quickly. Further, it destroys human and economic resources for development which promote further poverty. What is the Christian response to HIV/AIDS pandemic which is already responsible for more deaths than all the wars of history combined? Of course, death brought by war and terrorism comes through swords, bullet, bomb and atomic power. The so-called wealthy countries invest vast fortunes in sophisticated defence systems. But the terrible power of AIDS comes from its power to destroy the human immune system.

Sadly, Chadian government authorities and some church leaders were slow in educating citizens about how AIDS spreads and encouraging them to protect themselves by necessary personal behaviour change. This was due to the refusal to admit the presence of HIV/AIDS in Chad and the hiding away of those living with HIV/AIDS and tragically the incoherent response of the Chadian government response to develop an effective strategy to fight the disease.

Meanwhile the epidemic spreads and Chad as a poor country with weaker economy and meagre resources for health care is being devastated. One response to this frightening scenario should be directed to those who contracted HIV/AIDS. It is a community response to suffering. At the conclusion of the Paris AIDS Summit in 1994, 42 governments issued a declaration supporting great involvement of people living with HIV/AIDS in policy formulation and delivery. Despite growing recognition of its importance, little has been done to enable the involvement of PLHA in the delivery of prevention, care and support services particularly in the area of human rights.

To address this gap, Fraternité Plus , a Non-Governmental Organisation comprising 50 people living with HIV/AIDS was formed in order to achieve meaningful involvement of PLHA since they were highly stigmatised because of the association of HIV/AIDS with certain sexual behaviours and population groups. Fear of stigma means that few individuals were willing to divulge their HIV/AIDS or find out their HIV testing. In Chad, the main impetus for greater PLHA involvement has come from International donors, NGOs, and activists, which has supported the development of PLHA organisations and networks and encouraged the Chadian government to give priority to PLHA involvement in the response to the epidemic.

At first stage, PLHA learn not only about HIV/AIDS but also how to aCCept their HIV status and cope with infection, which can help motivate them to help others within Fraternité Plus.

“When I tested positive for the first time, I wish I could die. I felt so alone that I thought I was going to die soon. But the group of Fraternité Plus has been a great psychosocial support. Of course, I have been to a psychologist but I have been much helped by seeing and sharing my concerns with a group of people in the same situation; this has helped my self-esteem.”

HIV-positive member of Fraternité Plus.

Support groups also provide an opportunity to share intimate problems, offer mutual support and furnish a safe space for PLHA to become visible by overcoming stigma. Support group in Fraternité Plus has empowered PLHA by building their self-esteem and preparing them to be open about their HIV status.

“ The fight against HIV/AIDS is slow because of the persistent culture of refusal to admit the existence of HIV/AIDS in Chad. When I decided to disclosure my serostatus, many people were gossiping at me saying that I have been paid by the National AIDS Coordinator to talk about these bloody things of AIDS .”

One can understand that complacency and “AIDS fatigue” at government, religious communities and individual levels are contributing to this situation. Failure to maintain a balance between treatment and prevention has also weakened efforts to combat HIV/AIDS in Chad. As a result, more people with HIV/AIDS have little or no aCCess to treatment and HIV/AIDS related illness and death are commonplace.

Bearing in mind this, “Ethique, Paix and Justice” which is a specialised branch of EEMET was created with the aim to avoid the fatalistic attitude that compelled HIV prevention and care initiatives and service to be allowed to run down. This has contributed to increase rate of unsafe behaviours and rising HIV/AIDS infection rates. This unfortunate situation is further compounded by illiteracy, poor aCCess to radio and print media, superstition, widow inheritance, poverty. Given its credibility, “Ethique, Paix and Justice” has ecumenically trained pastors, youth and church elders. These people who were trained are expected to replicate what they learnt at the grass root level.

As a result of AIDS, education system and standards too are being affected as more people are forced to leave school in order to look after their siblings. More than 5000 children have lost one or both parents to AIDS. The spread of HIV and the impact of AIDS are disproportionately affecting people, and therefore the future of the nation itself. In 2002, “Ethique, Paix and Justice” staff did a census where they identified 220 orphans of whom 22 are leaving under extreme poverty conditions. These 22 orphans are given contribution in terms of pastoral care, social ministry activities and school fees without which many of them would not have gone back to school. “Ethique, Paix and Justice” therefore has a huge potential for the fight against HIV/AIDS provided by pastors who used to think that HIV/AIDS is a disease for prostitutes. Currently, pastors who are in daily touch with the Christians and their communities are well trained to handle HIV/AIDS issues.

“I came to realise that people living with HIV/AIDS were normal people just like any other human being. Now I could eat with them and share the same plate with them. Now I think that I have understood HIV/AIDS much more than I did before”

Pasteur Chrysostome MATALOI, Director of the High Biblical School of DOBA

With regard to human rights, there was a legal blank in Chad since HIV/AIDS was dealt purely as a biomedical issue. In 2001, a baseline study was convened and carried by a designated Commission Members of Parliament. This study provided some hints on how the HIV/AIDS issues should be dealt in Chad. However, the “ Commission des Parlementaires Tchadiens ” 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.

5.   Partnership Between Government and Religious Communities

The Chad Population and AIDS Control project became effective in 1995. The project objectives were: (i) to advance fertility decline; and (ii) to mitigate the adverse effects of HIV/AIDS. It is being implemented by the Ministry of Plan and Regional Planning with the Ministry of Health providing technical support. The project addresses both population and HIV/AIDS issues through a two-pronged approach: policy-related activities are being implemented by the Ministries of Plan and Public Health, while NGOs and religious communities are being assisted through a social fund (FOSAP), to develop and implement grass-root activities.

ACCording the National AIDS Control Programme, the effort of the religious communities particularly Christians has become visible since 2000. However, condom use is widely disapproved especially in the Muslim settings. This is in contrast with the Islamic Medical Association of Uganda which has taken the lead in educating Muslim religious leaders on the education about the responsible use of condoms. After negotiations, the topic was reinstated and was aCCeptable within Islamic teachings.

In the context of FOSAP, more than forty local NGOs including churches have received training in project development, management, and implementation and are currently implementing population and HIV/AIDS prevention initiatives at the grass root level. In general, the partnership between the government and the religious communities is good and needs to be strengthened in order to help the capacity building of church leaders to respond to HIV/AIDS challenges without complacency.

6.   Ecumenical Organisations and Resource Facilities

6.1.  Ecumenical organisations

6.1.1.     EEMET (Entente des Eglises et Missions Evangéliques du Tchad)

EEMET 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 as a result of the workshop organised by EEMET in collaboration with the National AIDS Control Programme, protestant churches are currently working with the same objectives when it comes to preventive measures (abstinence and faithfulness). Having recognised the magnitude of HIV/AIDS, church leaders have declared HIV/AIDS as one of the many security and development issues Chad is facing today.

“Africa is home of the world's 2/3 of people living with HIV/AIDS. I am not scared by these statistics because many African governments have failed to deal properly with this epidemic. Communities are stretched beyond their capacities to cope with PLHA and orphans. Given the magnitude of HIV/AIDS, Christians should not be pessimistic rather optimistic and realistic in order to proclaim hope and compassion messages and provide pastoral care and support to the affected and infected..”

Pastor Bako Ngarndeye, Secretary General of EEMET

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 are insufficient. In addition, Catholic and Muslim were still uncomfortable to deal with these HIV preventive issues especially condom use.

v Comments on church networking

Every community, no matter how poor, possesses both strengths and weaknesses which affect its ability to respond to disaster such as HIV/AIDS. In Chad, church leaders acknowledged to be working in isolation partly because of dogmatic reasons. A pastor told me: “ how can we work together, when Catholics for instance are addressing their prayers to God through Mary and Jesus whereas Protestants praise God through the only Jesus .” These are issues that must be addressed if meaningful results have to be reached since if weaknesses within a community are seen as vulnerabilities, then strengths can be considered as the capacity to cope, and recover from hazards such as HIV/AIDS pandemic.

6.1.2.     The Bible Society of Chad

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 Chad is willing to publish portion of biblical verses of HIV prevention that aimed at changing individual, community and societal behaviour. I encouraged the Director of the Bible Society of Chad who is willing to publish those biblical verses to avoid judgmental attitudes by choosing 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.

6.1.3.     Université Evangélique de Ndjamena

The quest for relevant curriculum in theological teaching education to integrate the HIV/AIDS module is needed in Chad. Because in many cases, theological education is too theoretical, academic such as carbon copy of Western culture which does not have anything to deal with the African problems such as HIV/AIDS which affect thousands of people in Chad. The reasons could lie on the content of the curriculum, which is not centred in praxis, people and current issues that are affecting churchgoers and Christians. I met the Dean of the Theological Faculty in order to inform to join the training of trainers that was organised by the theological consultant of WCC in Rwanda. The Dean did not show any interest and he refused. One of the key issues that I realised is the fact that Ecumenism is widely misunderstood in Chad. Some people were very reluctant to share with me their concern as they were afraid of becoming member churches of the World Council of Churches. I told them that this was beyond of the scope of my trip. Instead, I was encouraging the religious community to be involved in the fight HIV/AIDS since AIDS does not discriminate. But men and women do.

6.1.4.     Réseau National Evangélique de lutte contre le VIH/SIDA

In September 2003, the interfaith workshop that was held for the first time in N'djamena proved to be of considerable and practical value. For the first time, this workshop brought together church leaders of various faiths namely Catholic, Protestant, Evangelical, Pentecostal and Muslim leaders. The workshop was organised by the Entente des Eglises et Missions Evangéliques du Tchad in collaboration with the National AIDS Control Programme. One of the visible outcomes of this workshop was the creation of the Réseau National Evangélique de lutte contre le SIDA.  This platform comprises only Evangelical church leaders and could later on include people of other faiths.

6.2.  Resource Facilities

6.2.1.     Association pour le marketing social (AMASOT)

In Chad, many churches have been reluctant to promote the spreading of information about HIV and sexuality because they believe this is contravention with the sixth commandment. However, research in this field revealed that awareness about sexuality and prevention do not necessary lead to increase in sex or unsafe sex. On the contrary, sex education can lead young people to postpone their own sexual debut to a great degree. That is why apart from dealing with disease control such as diarrhoea and malaria, AMASOT initiated the fight against HIV/AIDS and the reproductive health as top priorities on its agenda. Its activities are targeted to youth namely schoolchildren, lorry drivers, women, sex workers, soldiers, enterprises personnel, etc. Its activities range from condom sale and distribution to communication for behaviour change.

With regard to condom use, AMASOT staff mentioned that the Catholic and many Protestant churches are known in Chad for their opposition to modern family planning and therefore against the use of condom. Despite the fact that, AMASOT has sold 27 million of condom since 1996 up to date, different churches have solved the condom issues in various ways. Certain strongly stress on abstinence before marriage and faithfulness within marriage. Others argue against the condom use, emphasising that they are not 100% safe. Given the sensibility of condom issue in Chad, AMASOT does not impose its view towards church leaders and church members. On the contrary, AMASOT staff is pleading that if condoms are correctly and consistently used, they should be of some help to prevent and curb the spread of HIV infection.

6.2.2.     Association Tchadienne pour le bien-être familial (ASTBEF)

In the context of HIV/AIDS, men and women should be informed that engaging in sex with a partner of unknown status or with multiple and oCCasional partners' poses a high risk of sexual transmitted infections. The ASTBEF found that prevention campaigns reach a lot of people, but they are also missing two many young people. In order to address this, youth and schoolchildren are targeted by using Information, Education and Communication approach.

As mentioned earlier, a market campaign for condom use initiated by a USA's firm was considered as a chock for many churches. Many banners and hoardings that aimed at promoting condom use were destroyed. This could be one of the many reasons that did not lead the churches to take seriously their responsibility in the fight against HIV/AIDS.

The ASTBEF Director was concerned about the negative connections to condom nurtured by many churches which are detrimental to church members and to the general population at large. He went on stressing that if one of the spouses is infected, it is imperative that the discordant couple uses a condom in order to avoid infect the uninfected. In case of both of them are infected, condom use would prevent them to reinfect one another. However, given the many cultural taboos surrounding the issue of sexuality, churches find it difficult to talk about it in Chad. However, for the time being many churches namely catholic and protestant are still in contact with ASTBEF's staffs that are facilitating many church seminars and workshops related to HIV and AIDS.

6.2.3.     Conajelus

CONAJELUS stands for “ la Coordination Nationale des Jeunes pour la Lutte contre le SIDA  ». Until recently, many churches in Chad have communicated the message that true Christians will not catch HIV. They stressed that AIDS is God's punishment and judgement on people who have lived a sinful life. In this regard, the church has been part of the HIV/AIDS problem rather than solution since the youth is still vulnerable to HIV/AIDS. As time goes on, the youths realised that they are vulnerable to HIV/AIDS and that fellow colleagues who were affected by HIV/AIDS needed care and support rather than labelled as outcasts, they formed CONAJELUS as a result of HIV/AIDS awareness growing. Many young people are already providing care to sick family members, although very few have the appropriate knowledge and skills required to deal with the complex health needs and social issues associated with HIV/AIDS, such as stigmatisation. Training young people as caregivers and as agents of stigma reduction may help communities cope better with the impact of HIV/AIDS and help motivate young people to practise protective behaviours. Towards this end, CONAJELUS closely works with the Catholic Youth Association and the Young Men Christian Association particularly in the field of HIV/AIDS and the reproductive health issues, etc.

6.2.4.     Fraternité Plus

Fraternité Plus is an association of people living with HIV/AIDS who felt that they have a critical role to play in designing and implementing HIV/AIDS prevention and care programmes. People living with HIV/AIDS realised that the disease and its consequences are not just to be found outside the churches but also in the midst of churches and therefore represent the threat to the entire community members; they decided to disclosure their serostatus. Fraternité Plus is currently implementing innovative HIV preventive strategies related to behaviour change and help reduce fear and stigma. Since most of the Fraternité Plus 'members are people living with HIV/AIDS, their involvement in HIV/AIDS programmes benefits PLHA by reducing their isolation and empowering them to make a difference. The group promotes a variety of prevention modalities, such as condom distribution and behaviour change campaigns. Some of its programmes are currently focused on cross-border population of KELLO province.

However, Fraternité Plus faces the following challenges:

1. In Chad, stigma and discrimination makes it difficult for a person to disclose his or her HIV status or become actively involved in Community HIV/AIDS activities;

2. People living with HIV/AIDS felt that many organisations in Chad are unprepared to involve PLWHA especially at the decision-making level. Instead, they felt that the National AIDS Control Programme (PNLS) is making money on behalf of PLWHA without their fully involvement in the programme.

3. People living with HIV/AIDS who wish to become fully involved in the Fraternité Plus need to develop new skills such as advocacy or counselling which are not available in the country.

Despite the above challenges, Fraternité Plus is working to create an environment in which PLWHA are comfortable coming forward as educators, community mobilisers, and active participants in community and country programmes.

6.2.5.     UNAD

UNAD stands for Union Nationale des Associations Diocésaines de Secours et de Développement . Since 4 or 5 years ago, Catholic Bishops decided to be implicated in the fight against HIV/AIDS by initiating programmes that emphasised on care and support for people living with HIV/AIDS. In 2000, a meeting on HIV/AIDS for Christian leaders was held in Moundou. Every bishop in Chad attended, and a consensus was reached that AIDS prevention was an important national priority. Therefore, bishops helped the dioceses establish AIDS committees and AIDS programmes in every parish. Apart from health service programme, group of community volunteers' visit and care for the sick, AIDS preventive education dramas and income generating activities are among other activities that are coordinated by UNAD. These programmes have greatly improved the quality of life for people living with HIV/AIDS; assured dying parents their children will be cared for, and brought support and comfort to families and communities afflicted by AIDS.

6.2.6.     Centre Chrétien d'Education à la Vie Familiale (C.C.E.V.F)

Stigma and discrimination are major obstacles to HIV/AIDS prevention and care initiatives. Given their moral authority and their influence, Faith-based organisations are in a better position to help reduce the stigma that is often associated to HIV/AIDS. CCEVF has initiated and reinforced open and frank discussion about HIV/AIDS by the youth irrespective of their sex and church affiliation. An educational campaign helps the youth assess their risk of HIV/AIDS and other sexually transmitted infections. Peer education is a widely used approach for providing a safe and comfortable environment for adolescents to discuss sensitive sexual issues. In this regard, CCEVF is targeting both schoolchildren and youth who are outside the country formal education system. The programme also identifies and trains peer educators and develop peer education networks through music, street drama, talk shows and marches. Economic and social vulnerability to sexual abuse and exploitation also puts girls at high risk of infection. To bridge this gap, CCEVF distributes little money to young girls to help them meet their basic needs.

In Chad, HIV/AIDS is very often misunderstood as searching someone to blame. Many people have been readily identified including, tragically, people living with HIV/AIDS themselves. Many others see the cause of HIV/AIDS in the work of devil, in angry ancestors, in witchcraft, in American plot to destroy Africa. To overcome these missed opportunities, CCEVF are performing home-based care activities and home visits. They acknowledged the fact that instead of finding somebody to blame, empowerment of people to take charge of their lives is an ethical human response to combat the HIV/AIDS crisis.

6.2.7.     Jeunesse de l'Assemblée Chrétienne au Tchad (J.A.C.T)

HIV is the worst pandemic mankind has ever experienced and it is still a major problem in Chad. The Assemblée Chrétienne au Tchad did much to combat the epidemic, and yet the church also avoided much when it comes to youth's involvement in the struggle against HIV/AIDS. The church found it difficult to speak openly and frankly about HIV/AIDS, sex and sexuality particularly among young people for fear that this would lead to sexual promiscuity. In the context of HIV and AIDS where the disease is leading to death 8,000 people every day, such reluctance has led to many criticisms. That is why Pastor OBED launched a national trip that allowed him chatting with youth of various backgrounds. The main outcomes were that many young people who became infected did not have adequate information about HIV/AIDS in order to protect themselves from infection. There were also a big deal of ignorance, misconception and missed opportunities both among church leaders and young people.

Currently, JACT is running an innovative youth programme (peer educators) instead of dealing with early strategies that focused on decision-making about sexuality, which attempted to get the youth to change their behaviour through messages of fear and guilt. Though problems of forced sex and incest prevailed in Chad, JACT life skills programme is underway suCCessfully. Young people are taught skills that will help them deal with potentially harmful situations. Apart from that, young people especially young girls are given micro-credit that allows them to somehow pay their scholarship.

JACT is networking with the Ligue pour la Lecture de la Bible, Entente des Eglises et Missions Evangéliques du Chad and the Réseau National Evangélique de lutte contre le VIH/SIDA. JACT illustrates not only good practices but also the ways in which FBOs can contribute significantly to HIV prevention efforts.

Conclusion

In Chad , the seroprevalence of HIV/AIDS is low. This could be an indication why churches have reacted in different ways to the challenges of AIDS epidemic since the churches' response has in many cases been unsatisfactory. For instance, the first workshop for Catholic bishops was held in 2000. This helped bishops to sort out the Catholic's policy and guidelines about HIV/AIDS. By contrast, protestant church leaders met last September 2003.         to develop their plan of action on HIV/AIDS issues. Before then, in many cases, given the silence of the national authorities about the existence of the epidemic in Chad, churches have primarily communicated the message that Christian will not catch HIV. Many churches in Chad have considered HIV/AIDS as God's judgement on people who have live a sinful life. However, church leaders must understand that HIV/AIDS is not currently outside the church, amongst those who beggar on the church steps.

On the country, HIV/AIDS exists in many families, including those of pastors and church employees. What will happen when churchgoers and Christians will fall ill and die as a result of HIV/AIDS infection? Of course, these things are never taught in churches. But, poverty obviously will increase and the congregation income will dwindle since many people affected by HIV/AIDS will channel their financial resources into hospital for medicines and other health care including healthy food. It is well known that churches in Africa are willing to expand their evangelisation activities with many diaconal challenges ahead. HIV/AIDS threatens Chad and the whole society because many people diagnosed HIV+ are excluded, lose their job opportunities and social networks and are denied to live a dignified life because of stigma and discrimination.

There is no pill to cure stigmatisation and discrimination. They can partly be overcome by being opened to a frank and a constructive discussion on HIV/AIDS and sexuality. Additionally, stigmatisation must be counteracted so that people become aware that AIDS exists. This will enhance people's ability to cope themselves, both with a view to avoid HIV infection and to prolong the lives of those who are infected. Without complacency, churches must defend the rights of people affected by AIDS and advocate for treatment aCCess to those who need them.

With regard to condom use which has wasted energy and time in many Chadian church settings and elsewhere, it is true that condoms do not guarantee absolute protection. In addition, promoting condoms as the total answer to HIV is not right. Throughout ages, Churches have nevertheless nurtured patriarchal view of society and must share its blame for the fact they have failed the more vulnerable sector of membership and the society at large by simply pronouncing moral directives without demonstrating the credibility of their positions in a society of powerful counter witness. For instance, a commercial sex worker told me in Ndjamena: “ The only way I could put bread on the table, and raise my children, is by selling my services. I had no other marketable skills.” There are many others like her crying for justice. In my opinion, education about condom is not condom promotion. My plea is about putting the condom in its rightful place as one among other measures of HIV prevention rather than drawing undue attention to its efficacy and faithfulness, or lack thereof, and its place within a hierarchy of what the Church teaches. Additionally, I know that distributing condoms is not the best way of solving the present HIV/AIDS problems. But let us not condemn the condom use until the better solution is actually in place.

Another issue that emerged during the mapping in Chad was premarital testing. Many churches have introduced a system of HIV testing for people who want to get married in church. There are several reasons that prompted churches to insist on HIV testing. For some churches, such testing would function as a preventive measure and encourage young people to refrain from premarital sex. For others, it is important for people who would like to get married to know whether they themselves or their future partner is infected with HIV. Bearing this in mind, they have to make an informed choice whether they want to enter into marriage or not. For other churches, HIV testing has a mandate to stop HIV+ persons from getting married at all, so that subsequent children do not end up as orphans.

With regard to HIV testing before marriage, churches must understand that it is a complex issue as it relates to human rights. Of course, it must be a right of individuals to decide whether or not s/he is wishes to be tested or not. Similarly people that are about to get married must know whether his or her future partner is infected. The problem that arose in Chad and elsewhere is whether the church has the right to refuse to marry a couple because of HIV infection especially when the partners themselves want to get married. Churches should understand that it is premature and unbiblical to rush into cancelling the wedding of a discordant couple. On the contrary, pastors need to gently and firmly guide them through this period characterised very often by chock, denial, and anger and on to aCCeptance of their condition. In short, churches must emphasise that the choice whether a discordant couple has to get married or not lies with the couple.

In Pentecostal churches, a concern on miraculous healing was raised. Pastors reported that two PLWHA were healed after a great deal of prayers and starvations. There is evidence that even in the midst of something as devastating as HIV/AIDS; Christians have a real hope in Jesus Christ. He is the prescription for hope. However, it is tempting to offer false hope to the persons who are infected with HIV, and assure them that God will heal them. God can obviously heal people with AIDS since he is a powerful God. However, healing must not be taken for granted and it does not necessarily happen when we need it. Churches should understand that God is sovereign and he does what he feels good for his children. As mentioned earlier, when the time for practical help and care of the infected person comes, the body of Christ, the church, must be willing to do what Jesus Christ would do. That is to counsel the PLWHA in a compassionate and biblical ways.

HIV/AIDS is a health, a security and a development issue. The dynamics of HIV epidemic are influenced by many different sectors of society, and vice-versa. In order to curb the spread of HIV and reduce the impact of AIDS, it is necessary for the churches to collaborate with various stakeholders in the society. In such pragmatic partnership, it is important to recall that various stakeholders will have their different strengths and different priorities and areas of focus. Therefore, the various stakeholders can compliment each other as long as the work is well coordinated. The involvement of those with HIV/AIDS is also an important contribution to the church as a whole and to the life of the parish. Together, churches can overcome the many HIV/AIDS challenges and realise tangible outcomes for God's glory.

Recommendations

Policy

· Responsibility is the Christian and human response that churches must promote for the Chadian society with a strong thread of willingness to take their full responsibility for the tragedy unfolding before Christians and the population at large.

· Churches should make use of opportunities through available liturgy, religious and other catechistic and pastoral functions to emphasise human dignity and human rights in order to reduce the stigmatisation of people living with HIV/AIDS

· Churches should address and condemn all forms of sexual violence, exploitation and other harmful practices carried out in the homes, schools, church institutions, at work and help those who are the “victims” of such attacks;

· Churches should address and condemn policies, traditions or practices that discriminate against people living with HIV/AIDS with regard to their working lives, education or social background, cultural or religious environment;

· Church leaders should mobilise the resources at their disposal to establish effective structures which will respond to the crisis and bring hope for the people.

Congregations

· Church leaders should avoid their irresponsibility that was characterised by the refusal to admit the presence of the disease inChad and in hiding stigmatising people living with HIV/AIDS;

· Church leaders should develop and deliver information about HIV/AIDS in such a way that this information does not contribute to an increase in stigmatisation and discrimination of people affected and infected by HIV/AIDS

· Churches should cooperate with other sister churches in Chad and in the region to address the problem of how the churches teach young people on sexuality, both in Chad and elsewhere;

· Congregations should support and care for people and families who are suffering from HIV/AIDS and doing this as an integral part of the “competent AIDS church” at the congregational level;

· Church leaders should also design migrants and nomadic populations as a priority target group for HIV/AIDS interventions.

Communities

· Nobody deserves to have AIDS. Church leaders must stop the culture of blame. Instead, they should have the ability to provide the people under their authority with hope and courage in the darkness related to AIDS;

· Communities need precise, up-to-date and complete factual information as part of the churches preventive work, both as regards the causes of the epidemic and its dimensions and consequences, and as regards how AIDS is linked to other issues on the church's agenda;

· The Church must aCCept that it has failed to educate its members on the value of sexuality and chastity. Churches in Chad must mobilise themselves to this end. But the Christian's response should be that of Jesus Christ: compassion, support and above not judging;

· The education for youth into a clear and consistent set of Christian values, which can help them survive in the era of HIV/AIDS, constitutes an essential Christian response right now.

Counselling

· The church must work towards the education of conscience in the context of HIV/AIDS since many people are sometimes confused about what is the right thing to do;

· During HIV testing, when the man or woman is found to be HIV+, it is easy for the pastor to be judgemental. Pastors must understand that they are shepherds and not judges since they will keep confidentiality of issues discussed with clients;

· Several denominations in Chad have advised their pastors to require their church members to HIV testing before marrying in church. The aim of these rulings should prevent the further spread of AIDS, restore people to the path of following Christ, and care for those infected, rather than to punish the people;

· The timing of the HIV test and counselling before marriage are very important. The HIV testing needs to be done at early stage in the marriage preparations and at least six months before the marriage. This will help the pastors and the couple not to reach into cancelling the marriage when all the preparation have been already done;

· The pastor should counsel the engaged couple for HIV testing in honest way by making it clear that he desires to help them have a healthy relationship, not that he is acting as a policeman;

· AIDS is a disease and not a sin, pastors cannot stop the discordant couple from being married, but it is his own decision before God whether or not he wants to perform the wedding ceremony. The couple must make an informed decision, and the pastor must keep the information confidential, even when it is tempting to do otherwise.

· Pastors should understand that HIV/AIDS also comprises medical issues that the pastor does not feel competent to discuss with the couple, he should feel free, with the couples' permission, to refer them to a health person for further help

Advocacy

· Church leaders must use national and international arenas to mainstream HIV/AIDS into church programmes and they must cooperate with sister churches be they in Chad or overseas to address the epidemic;

· Church leaders must work out strategies and lobby the appropriate national authorities so that the epidemic is given priority in Chad by the government, by churches and at international development cooperation;

· Church leaders should advocate that appropriate resources (medicines, technology) are available on a wider and fair basis with a view to help treat and support people living with HIV/AIDS, both nationally and internationally.

Networking

· The Réseau National Evangélique de lutte contre le VIH/SIDA should be strengthened since it constitutes a reliable forum for advocacy and lobbying.

R eferences and Bibliography

Le SIDA au Tchad: Connaissances et perceptions par les femmes-analyse approfondie des resultats de l'enquête démographique et de santé , 1997-ATEP (Association Tchadienne pour l'étude et la population-N'Djamena 1999.

Plan Stratégique National de lutte contre le SIDA  : 1999-2003 PNLS/MST, Décembre 1998

Nouveau Processus de Planification stratégique : Rapport synthèse . PNLS, Décembre 98.

Analyse de la réponse dans le cadre du nouveau processus de planification stratégique . PNLS/MST, Novembre-Décembre 1998

Tchad-Santé, Bulletin semestriel d'information épidémiologique du PNLS/MST , numéro 00, june 2000

Deyo J., (2001) Etude sur la législation en matière de lutte contre le VIH/SIDA/IST au Tchad , N'Djamena.

Conférence épiscopale du Tchad : L'Eglise et les communautés chrétiennes du Tchad face au SIDA, Mieux connaître le SIDA, N'Djamena, 2002.

Conférence épiscopale du Tchad : Déclaration des Evêques du Tchad sur le SIDA. N'Djamena, Octobre 2002

Stuart C., (2003): Responsibility in a Time of AIDS, A Pastoral Response by Catholic Theologians and AIDS Activists in Southern Africa , Pietermaritzburg, South Africa.

Edward C., (2003) Faith-Based Organizations: Contributions to HIV Prevention , Harvard Center For Population and Development Studies.