Congo/brazzaville

Acknowledgements

First of all, I wish to express my deep gratitude and appreciation to the World Council of Churches especially Dr Christoph Mann whose moral and financial support made the mapping of Congo on HIV/AIDS a reality.

Moreover, special thanks are extended to individuals and church leaders of various churches and church-based organisations who made positive contributions to the data collection.

Furthermore, I would also like to thank EMBABA-EKONGO Baudelaire, with his valuable assistance who acted as interpreter during the data collection in some oCCasions as I could not fully understand the many local languages spoken in Congo Brazzaville.

Finally, I would like to thank the many people I met and interviewed in Congo/Brazzaville through focus group discussions or in-depth interviews with regard to this mapping. They helped and encouraged me a lot to work on this document through sharing so generously their experiences, problems and hopes for the future.

Hendrew LUSEY GEKAWAKU
HIV/AIDS Coordinator for Central Africa

Foreword

In Congo, HIV/AIDS has, in a period of just two decades, reached unprecedented crisis level. It is estimated that up to two third of Congo's population aged between 15 and 24 years are HIV infected in this country. Therefore, the human toll of AIDS is a tragic reality being experienced by families, communities and the nation at large. In addition, HIV/AIDS is the greatest challenge to prospects of social and economic development and security that the Congo/Brazzaville has never encountered since HIV/AIDS is reversing the gains which have been made in social and economic development since early eighties. As an increase number of people already infected develop opportunistic infections and die, AIDS has become the major cause of illness and death among young and middle age adults, depriving household and society of potential human resources whom communities can count on.

In Congo/Brazzaville, the number of orphans as a result of HIV/AIDS related premature death of men and women is estimated to swell to more than 65,000 by the end of 1999. Due to the lack of reporting and appropriate support structures for those affected, the number is undoubtedly much higher. The numerous consequences of HIV/AIDS are putting further strain on an already overstretched social and economic structures deteriorated by civil wars.

Congo Brazzaville has several different organisations involved in HIV/AIDS activities and these include the public sector, private companies, non governmental organisations, churches and community groups participating in HIV/AIDS prevention, control, care and impact mitigation. However, during the mapping exercise, I noticed that some churches have been powerless in the face of HIV/AIDS because of the existing mountain of fear, stigma, ignorance and inaction that surround HIV/AIDS and threaten the survival and the well-being of people throughout the country.

However, the churches have a particular responsibility for overcoming this attitude by proclaiming their messages of hope, faith, perseverance and courage. Of course, HIV/AIDS is an issue of no easy solution, but the reliance of churches on the basis of Christian faith and spirituality could be the source of motivation of the churches to reach out in a meaningful way people affected and infected by HIV/AIDS.

I believe that if more people with a deep sense of calling in the churches come foreword for this ministry of HIV/AIDS, the situation can be turned around. Additionally, I am grateful for the assistance that has been received from the several organisations dealing with HIV/AIDS and the international community especially the United Nations Inter-Agency Emergency Initiative in support of the government efforts to combat HIV/AIDS. The Director of the National AIDS programmes showed me the willingness to network with churches. The Ministry of Education is also working on integrating HIV/AIDS into the national curriculum.

The task for the Central Africa coordination office is to ensure that church leaders in Congo/Brazzaville are trained and motivated in dealing with AIDS through a participatory workshop in 2003. This will help them to emphasise the need to go beyond individual morality to address the social, economic and political issues that are directly related to HIV/AIDS. From the findings of the mapping exercise, I realised that churches have been among the first to respond to the HIV/AIDS crisis, but they can do more through a concerted and unified national church response. This is urgently needed in order to help churches bring the epidemic under effective and efficient control.

1.   General and Epidemiological Data

1.1.  General data on the Republic of Congo/Brazzaville

1.1.1.     Republic of Congo country profile

The Republic of Congo is situated in western Central Africa astride the Equator. It is bounded to the West by Gabon, to the North by Cameroon and the Central African Republic, to the South by the Angolan exclave of Cabinda with a short stretch of coast along the South Atlantic Ocean which extends over 170 kilometres, to the East by the Democratic Republic of Congo. The Republic of Congo is divided into 11 provinces of which Brazzaville is the Capital city. Congo's 11 administrative regions are administered by a Préfet nominated by the government. Regions are sub-divided into districts, headed administratively by sous-préfet . The Republic of Congo has a total of 342,000 square kilometres.

1.1.2.     Population

Many censuses which have taken place in Congo/Brazzaville showed that the population growth at a rate around 2,8% based on the 2000 census in which the total population was enumerated at around  2,864,000 inhabitants with 49% of men and 51% of women. 41% of the population lives in the rural areas whilst 59% are living in urban areas particularly in the South. The Bantu Bakongo make up nearly half the population, living primarily around Brazzaville and Pointe Noire. Pygmies live in the northern forests. There are 15 major ethnic groups in Congo. About half of the Congolese people practise traditional religions, the rest are mainly Christians, though there is a small Muslim minority.

1.1.3.     Economy

The Congo/Brazzaville's economy is predominantly based on the exploitation of its natural resources namely petroleum and woods. Congo's formal economy is based primarily on its petroleum sector, which remains by far the country's major revenue earner (65%). The Congolese oil sector is dominated by the French oil Total Fina Elf, aCCounting for 70% of the country's annual oil production. From a 283,000 barrels a day peak in 2000, independent observers estimate that oil production will decline gradually over 2001-2004. If substantial discoveries are not made in the next two to three years, Congo's oil sector is forecast to enter long-term decline.

Congo Brazzaville's economy is also dominated by agriculture. Around 40% of the population earn their living from the land, mostly on smallholdings using traditional farming methods. The main food crops are plantains, cassava, sweet potatoes etc. However, reliance on this single commodity has left the economy very vulnerable.

Congo remains a highly indebted country as of 1 September 2001, Congo's external debt stood at US$:5.7 billion. In 1998, when Congo was US$:5.1 billion in debt, the government spent more than US$150 per capita on debt service repayments, as compared to approximately US$ 30 for education and US$ 10 for health (UN Plan 2002).

A number of factors which include poverty, unemployment, shortage of housing, gender inequality and some negative cultural norms and practices appear to fuel the spread of HIV.

1.1.4.     Education

Congo has had a strong education system characterised by high participation and literate rates by Sub-Saharan Africa standards. Although, Congo identified specific targets from 1990 UN Global Conference on Education in Jomtien, by 2000-2001, virtually no progress has been identified (UN, 2000). On the contrary, enrolment levels and the quality of education have been deteriorating for over a decade.

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 Congo is alarming in terms of 1,097 schools need rehabilitation. Additionally, 19% decreased in primary school participation between 1980 and 2000. An estimate of 247,500 primary school-aged children does not attend school. Chronic teacher shortages are an issue of concern particularly in rural areas where 150 schoolchildren are taught by 1 teacher. 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

In 2000, the Nation Health Policy adopted the Bamako's initiative that seeks to implement the following goals:

· Decentralisation of the health system

· Promotion of the private sector

· ACCess to health care for all

· Development of alternative methods for financing the health system

However, no new medical staff have been hired since 1985, no epidemiological surveillance system exists. Medical equipment and facilities have been destroyed or at best archaic and decaying and very often medicines are in short supply. Therefore, because of the many civil wars that prevailed in the country, Congo's health services are drastically deteriorated, under-resourced, understaffed and badly under-funded.

In addition, the peripheral neighbourhood of Brazzaville are characterised by the same problems as rural areas in Congo at large: aCCess to health care is difficult, clean water supply is insufficient; basic sanitation  is severely lacking (only 4% of families have aCCess to a latrine at home) and morbidity rates are highly linked to the deterioration of the environment, notably the faecal waste. The leading causes of death among 19 to 45 year-olds in Congo are malaria, diarrhoea-related illness including cholera, measles, tuberculosis and HIV/AIDS. This fragile state of their living environment leaves the Congolese population in vicious circle of poverty and bad health.

1.1.6.     Poverty and vulnerability

Congo financial crisis in the mid-1980s contributed significantly towards the negative growth trend because of the government's inability to provide quality education and health services. By 1995, an estimate of 70% of the population reached an absolute state of poverty in Brazzaville. In addition, the impact of the major two civil wars (1998-1999) centred in and around Brazzaville has exacerbated an already fragile situation, wiping the development gains of earlier decades.

The two civil wars made altogether a total of 800,000 rural and urban inhabitants to flee into neighbouring forests, rural areas and the costal town of Pointe Noire. The already impoverished rural population faced the lack of income since farmers were unable to sell their products while urban consumers faced high prices.

Armed forces appear to have especially high rates of infections as do economic sectors (notably the mining, transport and constructions industries). However, during the two civil wars, estimates suggest that as many as 60,000 women were raped. 25% of these women were 12 and 15 years old. In some regions, such as Pool, rape became a systematic practice of war. In many oCCasions, women who could not flee were forced to become “war wives”, exchanged among militaries like commodities. This is self explanatory why 55% of adults living with HIV/AIDS in 1999 were women. Hopefully, the widespread of women's rape ceased in 2000.

1.1.7.     Politics

The fragile Congolese democracy faced trials in 1993 and 1994. The new elected President Lissouba dissolved the Parliament in 1992 and called for new elections in 1993. The results of those elections were contested by the major political parties. This entailed the political un-rest in the country. However, under the auspices of France, Gabon and the Organisation of African Union, the 1994 Libreville Peace ACCord was agreed. Although the apparent stability was implemented, public violence started through the organisation of private militias among politicians. Presidential elections planned for 1997 did not take place, since Lissouba's, Kolela's and Sassou's militia exploded into a bloody civil war that destroyed much of Brazzaville.

1.2.  Epidemiological data

1.2.1.     The HIV/AIDS epidemic in Congo/Brazzaville

The first AIDS cases in Congo were diagnosed in 1993 and ever since, there has been a significant increase in the number of people living  with HIV/AIDS. In 1995, it was estimated that Congo's adult AIDS infection rate was 7.8%. The National AIDS Control Programme estimated 10,223 HIV/AIDS cases reported.

Comments

The National surveillance ceased in 1996 and it only recommenced in mid-2001. Meanwhile, HIV/AIDS has been spreading at an alarming rate in Congo. As a result of the two consecutive civil wars, notification of the number of AIDS cases has not been carried out systematically for many years. In 1995, the HIV/AIDS prevalence already stood 7.8%, above the UNAIDS threshold of 4% for downward control. The years following 1995 were years of violence, including large scale of sexual violence, disruption of the health system. This suggests that the current HIV prevalence of 7.8% is much lower than the reality on the ground, as a result of some studies. An estimate of infection rate of between 10 and 12% 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 Congo/Brazzaville.

1.2.2      Sentinel Surveillance

In Congo Brazzaville, the HIV/AIDS information has been available since the 1980 especially among the women attending the antenatal clinic. Brazzaville and Pointe Noire have been considered the major urban areas where many studies have been carried out at that time. The median HIV prevalence rate among the antenatal clinic attendees in these areas increased from around 5% in the late 1980s to 8% in 1994. Although the HIV prevalence in 1993 was found to be 4% among women tested outside the major urban areas, the HIV prevalence among antenatal clinic women appeared to be similar to what was seen in Brazzaville and Pointe Noire. However, nearly 50% of sex workers tested HIV positive in 1987. No further information for this group 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 82,000 adults were reported to be living with HIV/AIDS of whom 45,000 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. A few studies carried out between 1990 and 2000 found the routes of HIV transmission below:

1.2.3.     Contributing factors to the spread of HIV/AIDS

The are many contributing factors to the spread of HIV/AIDS. They include:

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

· Poverty that hinds control effort

· Wars, armed conflicts and insecurity and its consequences (rape, sexual violence..)

· Socio-cultural issues:

• Negative cultural and perceptions issues that make women 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
• 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

1.2.4.     Impact of HIV/AIDS in Congo

Despite the fact that the HIV/AIDS situation is a looming national catastrophe with an adult infection in 1995 of 8% and rising since then, no empirical data on Congo 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 vast potential for agriculture, structural weaknesses, notably destroyed road infrastructure render Congo an importer of food since only 2% of arable land are currently cultivating (UN PLAN 2002).

In 2000, the education model developed by UNAIDS and UNICEF shows that, of around 450,000 primary schoolchildren, 3 900 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 35% of beds  in urban and semi-urban hospitals were oCCupied by AIDS patients. Additionally, based on limited studies in the Brazzaville morgue, the proportion of adult female AIDS cases is significantly higher than the proportion of male cases, 30.2% versus 21.0%. 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.   National HIV/AIDS Control Programme

2.1.  Background to the AIDS Control Programme

In Congo/Brazzaville, the first cases of HIV/AIDS in 1983 aroused 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.

2.2.  The National Response of Congo

The Congolese's response in the fight against HIV/AIDS has been effective before the 1990s since Congo was a pacesetter in this specific matter within Central Africa Region. At that time, Congo mounted a strong campaign against the pandemic. However, this progress has been halted 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.

During the mapping exercise I was invited to attend a meeting aimed at elaborating the National Strategic Planning 2002-2004. The main domains of interventions in the fight of HIV/AIDS were:

· Prevention

• Sexual transmission prevention through behaviour change and marketing of condoms
• Blood transfusion transmission
• Prevention of Mother-to-child Transmission

· Care

· Medical: voluntary counselling and testing, treatment of opportunistic infections and sexual transmitted infections

• Psych o -social: counselling, social ministry and pastoral care
• Socio-economic: care of orphans, widows etc.
• Rights and obligations of people living with HIV/AIDS
• Nutritional: provision of food towards the infected and affected people

· Epidemiological Surveillance

• Capacity building of notification systems
• Sentinel surveillance
• Epidemiological survey and studies

· Research

• Traditional medicine
• Behaviour change studies
• Socio-cultural studies
• Operational research

· Coordination, partnership

• Advocacy etc.

In order to contribute to halting the spread of HIV/AIDS, five main objectives were spelt out under the UN PLAN 2002 (which is working closely with the National AIDS Control Programme) namely:

· AIDS awareness and education

· Epidemiological monitoring

· Promotion of condom use and HIV testing

· ACCess to treatment and assistance for the affected

· National capacity and sustainable fund

Comments

It would be very crucial for the Congolese's National AIDS Control Programme to implement the required activities to achieve its objectives. 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 the stigmatisation, the discrimination and the rejection attached to HIV/AIDS. However, 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 Congo, it took many years before the establishment 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. However, the Mother-to-Child Transmission is receiving a strong political commitment from the first Lady of the country  who is partly hosting the programme in collaboration with other potential external donors.

2.3   Partnership

Although the two civil wars have destroyed much of Brazzaville including the HIV/AIDS information, several stakeholders namely local and foreign NGO, national secular and religious associations, churches, civil society, the private sector and external partners have thus associated their efforts with those already engaged by the National AIDS Control Programme to combat the HIV/AIDS.

NGO and National Associations

They are too numerous to be listed in Brazzaville. They are either secular or denominational established in the capital city and in Pointe Noire, the economic capital. Most of the associations intervene at different levels in the struggle of HIV/AIDS and are active especially in awareness raising and sometimes the care of people living with HIV/AIDS, orphans, widows, etc.

External Partners

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.

3.   Position and Involvement of faith based organisations in addressing HIV/AIDS

3.1.  The faith based organisations in Congo/Brazzaville

In regard to the mapping work of HIV/AIDS in Congo, I met either religious leaders or head of health services of the following faith-based organisations: Assembly of God, Catholic, Protestant, Kimbanguist, Orthodox, Salvation Army, Lutheran and Revival Churches. 

3.2.  Perceptions of HIV/AIDS by the faith-based organisations

For the time being, HIV/AIDS is not curable, but is preventive and increasingly treatable. Tragically, people continue to be put at risk of HIV infection and of an untimely death from AIDS-related illness because of the church politics and the diverse theological interpretations that hinder the right perceptions of HIV/AIDS by the many faith-based organisations. Church leaders should understand that 15 years ago, the number of reported of persons living with HIV/AIDS in Africa was only 2,324. Today an estimated of 28.1 million persons are infected in sub-Saharan Africa. Every church leader must personally break the silence about the norms and practices that fuel HIV/AIDS epidemic.

It has to be highlighted that the perceptions of the faith-based organisations vary from church to church. The following lines will deal with the perceptions of Assembly of God, Catholic, Protestant, Kimbanguist, Orthodox, Salvation Army, Lutheran and the Christian Ministry: New Life.

3.2.1.     “Assemblée de Dieu de Pentecôte”

This church puts a special emphasis on faith in the miracle of curing AIDS. During the mapping exercise, I saw many people suffering from various illnesses including HIV/AIDS who have chosen the church to be both their living room and hospital.

 “In spite of dedicated individuals of good will and pragmatic organisations dealing with the pandemic,  the HIV/AIDS has become a human, social and economic disaster with many implications for individuals and communities. However, it has to be said that HIV/AIDS is a disease that could be treatable and even curable depending on God's will.”

Rev.DEMBA MBAKOU Albert, the National Church Leader of the Assembly of God.

3.2.2.     “Archidiocèse Catholique de Brazzaville”

In view of the Roman Catholic, the HIV/AIDS is a scourge which negates the efforts of the Republic of Congo in addressing the economic and political crisis into which the country has been plunged for many years.

“The Catholic Church in Brazzaville understood that already HIV/AIDS is the leading cause of death in Congo, and unless faith-based organisations and other stakeholders can do something to combat this deadly disease, the pandemic will continue to wipe out the earliest progress gained over the years.”

Dr MBOUSSOU

“The HIV/AIDS pandemic is spreading at an alarming rate in Congo. This should help church leaders not to work in isolation even if the churches are a little bit later behind in the fight of HIV/AIDS”

MANOU Paul Richard, General Secretary of Caritas Congo.

3.2.3      “Eglise Evangélique du Congo”

Basically it is in the prevention that the EEC is heavily involved. Since the human kind is infected particularly due to the lack of information on the mode of HIV/AIDS transmission, discussions have been organised by the church at the parish level.

“As far as the EEC is concerned, after twenty years into the HIV/AIDS pandemic, nobody has taken the responsibility to reflect upon this issue. Consequently, HIV/AIDS is still a taboo probably because of the lack of knowledge”

Mrs KODIA LEMBA, Director of Health Service.

“Yet the church has not fully taken its responsibility that is why meaningful actions to slow down the pandemic is hardly visible in the society. At parish level, the issue of HIV/AIDS is talked with reluctance. This shows why stigma and discrimination of people living with HIV/AIDS characterised by silence, fear and denial fuels are increasing on the spot.”

Ms. Andréas SENGOULOU, Journalist in the Evangelical Church of Congo/Brazzaville.

3.2.4.     “Eglise Kimbangusit”

In the opinion of the Kimbanguist church, AIDS is obviously a disease caused by HIV. However, it is considered as God's punishment. This is why the Kimbanguist church cannot play a prominent role in the dissemination of preventive measures that are likely to encourage sexual promiscuity and prostitution.

“HIV/AIDS is God's punishment because people do no longer obey God's laws. One could get the HIV/AIDS infection if s/he wants it since adultery is the main entry point of HIV/AIDS. No one could suffer or die of HIV/AIDS if every body was faithful to his/her sexual partner.” Rev. BIYEKOLA Emile, the National Director of Evangelisation.

3.2.5.     “Eglise Orthodoxe”

I held a discussion with the Reverend Father Serge. In his opinion, the AIDS epidemic poses an unprecedented challenge to the entire society. However, he did not have the required knowledge tackle this issue.

 “I do not know neither what needs to be done to fight HIV/AIDS nor what works. The challenge I am facing is to acquire the required knowledge and to turn it into action since it seems that the HIV/AIDS pandemic would be changing over the time.”

Father Serge MATULEMO SOUAGBO, Pastor of the Orthodox Church.

3.2.6.     “Lutheran Church”

Abstinence, chastity and faithfulness are the basis of the prevention measures promoted by the Lutheran Church in Congo. The use of condom is considered as one of the leading cause of spreading HIV/AIDS.

“Sins are the leading cause of death rather than HIV/AIDS. Indeed, HIV/AIDS kills the physical body while sins are soul killers. HIV/AIDS could be considered as God's punishment because the human kind has currently the tendency to by-pass God's laws since God is patient. The world is overcrowded by so many sinful actions such as sexual liberty and condoms use that God has allowed the outbreak of HIV/AIDS. Consequently, God has not yet enabled scientists to discover the effective cure of HIV/AIDS because of the overwhelming sins in the world.”

“The condom use worsens the situation and sins are oCCurring everywhere. As long as the condom use is aCCepted in the community, sexual promiscuity becomes obvious. Condom is a devil's strategy that aimed at promoting sexual transmission of HIV/AIDS and sexual violence particularly against women. After misleading Eve in Eden's garden, the devil is nowadays working to cheat the human kind in the same way he tempted Eve with the so-called safe condom.”

Rev.POUNGI SAMBOU, the National President of the Lutheran Church in Congo.

3.2.7.     The Salvation Army

Whilst in many countries, the Salvation Army is often considered an important partner in the fight against HIV/AIDS. However, the main emphasis of the Salvation in Congo is mainly put on social issues such as: resettlement of refugees and displaced people.

 “Because of the many civil wars that killed many people in Congo, the HIV/AIDS is no longer a top priority issue because the church is  struggling to provide care and hope to million of civil wars displaced people and refugees.”

The in Chief Secretary of the Salvation Army

3.2.8.     “Ministère Chrétien:Vie nouvelle, Eglise d'Antioche”

This revival church insists on abstinence before marriage and fidelity of couples. The use of condom is merely authorised to discordant couples. During the mapping, I have been invited to speak about HIV/AIDS from the pulpit on Sunday. 107 people attended of whom 49 youth, 40 women and 18 men. Important questions have been asked, this shows the hunger of churches to receive aCCurate and updated information.

“HIV/AIDS is a matter of both Christians and non Christians. 3 Christians within my church have already died of HIV/AIDS. In my opinion, I feel that HIV/AIDS should be spoken from the pulpit even though there are so many warning messages on TV and radios. Fairly soon, Jesus Christ might be back. Who will see him if most of Christians die of AIDS ?”

Pastor  EKOUAYA Barthélemy, Apostle of Christian New life Ministry, the Church of Antioch.

Comments on churches' perceptions

1. Despite the above miss-opportunities of HIV/AIDS, some church leaders are raising concern about the way HIV/AIDS is jeopardising human security, undermining economic development and threatening to destroy the fabric of society.

2. However, the HIV/AIDS is still perceived by other church leaders to be merely as a health issue. When I visited churches, some church leaders sent me straight to talk with health professionals rather than with the church leaders themselves. This attitude is self explanatory that churches are not fully involved in fight of HIV/AIDS.

3. Experience around the world shows that by discussing HIV/AIDS openly and sensitively and then taking action, leaders can make a difference to fight HIV/AIDS.

4. In addition, taking into aCCount the stigma and discrimination of people living with HIV/AIDS, many churches are not seen to be places of refuge for the infected and the affected. PLWHA are automatically considered as sexually promiscuous.

5. Furthermore, because of the many misconceptions surrounding the HIV/AIDS, the voice of church advocacy has been too often silent in Congo Brazzaville.

6. ACCording to medical sources in the country, the fear of discrimination is preventing people from seeking treatments for opportunistic infections and from acknowledging their HIV status publicly.

7. In my opinion, I do think that it is by confronting stigma and discrimination that the fight of HIV/AIDS could be won.

8. In conclusion, the churches are lacking the language to address HIV/AIDS issues.

3.3.  Involvement of the Churches in HIV/AIDS Awareness for Clergy and Congregations and Laity

3.3.1.     “Eglise Evangélique du Congo”

The EEC is one of the major protestant churches in Congo/Brazzaville. The church authorities allowed the health service professionals to undertake talks and negotiations with external donors in view to apply for HIV/AIDS funding.

Main activities

With regard to HIV/AIDS, “the Eglise Evangélique du Congo” focus is awareness raising and peer educator's training.

Awareness raising

ACCording to Mrs KODIA LEMBA, the director of the Health Service, two workshops would have been organised during the last years: The first workshop was held at the attention of the youth and the second was a sort of in-service training of health professionals. However, no report was available. Contrary to the many churches which do not aCCept the condom, the Eglise Evangélique has allowed the use of condom for those who cannot abstain from sex or be faithful especially people living with HIV/AIDS. In those situations, the ECC believes that people living with HIV/AIDS should be allowed and challenged to use condoms for two reasons: First of all, they must prevent the transmission of HIV to others. Secondly, they should protect themselves from additional infections.

“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.”

Peer education training

Although 5 young people have been trained to involve the youth department in the struggle of HIV/AIDS, there is no formal peer education training programme within the church. The Eglise Evangélique is running a theological college where student's spouses are trained on HIV/AIDS as part of the reproductive health modules. With a French church partner, the Eglise Evangélique is looking forward to training 120 pastors next year. However, the AIDS module is neither available nor integrated into the theological college curriculum.

Young adults constitute the most active segment of Congolese population. They have been both the victims and actors in the repeated armed conflicts, many of them through joining militias and participating in the destruction of the socio-economic infrastructure. Rehabilitation work and education will provide them opportunity to participate in the restoration of better living conditions for affected communities. Peer education will be an opportunity to restore their sense of responsibility, work and the common good for Congo. Youth in Congo trust the church, then one could realise what an opportunity the church has to make a difference.

3.3.2.     The Catholic Archdiocese of Brazzaville

As the morbidity and the mortality of HIV/AIDS rates rise through the Congolese society, most bishops are aware that HIV/AIDS is weakening the country institutions and wiping out the progress gained over the previous years. That is why a workshop for Central Africa Bishops was held in Libreville/Gabon in 2000. Each diocese has been allowed to train local people who can lead the struggle against HIV/AIDS at the grass root level (congregation).

In 2001, another Bishop's seminar was held in Malabo/ Equatorial Guinea. One of the visible outcome of this workshop was the creation of the Regional Council AIDS Control programme that aims at providing technical advice to local congregations or dioceses with regard to its felt needs. As far as the Archdiocese of Brazzaville is concerned, a part from sporadic interventions, there is no formal HIV/AIDS programme to slow down the spreading of the pandemic. ACCording to Dr MBOUSSOU, a plan of action has been elaborated. However, the Archdiocese did not provide any funding that is likely to help the team implement the so-called programme.

Main activities

Awareness raising

· Prevention: This programme focus is life skills training, “mouvement pour la vie, foyers chrétiens”, pastoral care for AIDS patients in the terminal phases.

· In October 2002, a seminar was held in collaboration with the Catholic Relief Service. There was an agreement reached on the need to train trainers namely clergy and laity in order to disseminate information, education and communication on HIV/AIDS.

3.3.3.     Lutheran  Church of Congo/Brazzaville

The Luther an church seems to be active in its response to the HIV/AIDS crisis. Its approach is visionary despite “its religious extremism”. What is outstanding in the Lutheran Church is the involvement of women and youth in the awareness raising. Additionally, HIV/AIDS would be preached from the pulpit.

However, the temptation to use the pharisaic approach of merely saying that: “ if you want to avoid AIDS, keep God's law ” is widespread in the Lutheran Church. In my opinion, this approach is blind because it does not take into aCCount the realities of women who have especially been raped by soldiers during the civil wars and who are living under extreme poverty because of the death of their husbands due to the bloody wars. In my opinion, there is evidence that unless the church leaders meet people living in poverty, really listen to them and try to understand their situation, most church leaders will have a skewed theology as well as a skewed morality.

4.   The involvement of the churches in the struggle against poverty and the defence of human rights

The many civil wars have impoverished communities and dislocated their social organisations in Congo/Brazzaville. In order to alleviate the apparent effects of this situation, many churches with the help of International Organisations initiated projects in Brazzaville to feed and give aCCommodation to displaced people. However, they should focus on capacity building of the communities to identify and execute projects themselves. In addition, church leaders were concerned with women and young girls who are increasingly vulnerable to HIV/AIDS due to extreme poverty and rape. Towards this end, they were planning to set up once again the many vocational training centres that were destroyed during the civil wars. During the mapping, I realised anyway that the major religious organisations have many good intentions but few concrete actions.

The causes of poverty are manifold. For instance, the provision of quality of health and education services in Congo is among the worst in the developing countries, particularly in rural areas. Already in 1995, before the last two civil wars, absolute poverty had reached 70% in Brazzaville, making poverty reduction a top priority. However, what is lacking in this approach is a sustained advocacy before governmental authorities for a better distribution of the national wealth with a view to reducing poverty which is the main leading cause of both the oCCurrence of civil wars and the spread of HIV/AIDS. Transparency in the government economic is an ongoing concern. The restoration of the rule of law should be vital, underpinning the fight against corruption, emphasising the need for transparency in public office and an end to the culture of impunity.

With regard to the defence of human rights, “the Eglise Catholique, Eglise Evangélique du Congo, Armée du Salut, Eglise Kimbanguiste and Eglise Evangélique Luthérienne” have formed the National Council of Churches that is the member churches of the World Council of Churches. They work together to promote peace, reconciliation and respect for human rights in the country through their annual ecumenical prayers. Actually, there are over 100,000 refugees that require assistance, and in some cases, repatriation, and/or resettlement. However, for the time being, churches and religious organisations are not yet aware of the link between human rights and AIDS. This may justify why there is so much stigma, and stigmatisation towards people living with HIV/AIDS.

The risk of discrimination and stigmatisation is high in respect of HIV/AIDS and is being encountered by people living with HIV/AIDS in many spheres of life. To achieve full human and constitutional rights for people living with HIV/AIDS, government corrective measures are needed to eliminate stigma against PLWHA.

5    Partnership between Government and Faith-Based Organised

In view of the severity of HIV/AIDS, the Congolese government has taken its responsibility to provide the leadership through the Ministry of Health to combat the pandemic. Most of the churches I visited were invited to attend at least one of the many seminars that have been organised so far by the Ministry of Health. Since 2/3 of Congo's population is aged between 15 and 24 and are the highest risk group for sexually transmitted infections and HIV/AIDS, the Ministry of Health has acknowledged the religious organisations as important partners in the fight of HIV/AIDS given their influence and their moral authority towards the youth.

Since efforts to HIV/AIDS control can be contained and eventually brought through a coherent and sustained multisectoral approach supported by political and civil leadership at all levels of society, it has to be mentioned that there is currently no fruitful partnership between the government and faith-based organisations. The lack of effective existing networks among the churches is partly the reason of this shortcoming. Consequently, churches are very often under-represented during the discussion between the government and other stakeholders in respect of HIV/AIDS. Additionally, the lack of coherent approach among and within churches is a serious impediment to reaching suCCessful results.

 “The government has recently launched a national campaign to slow down the epidemic. However, a catholic priest who attended a recent talk with me in the Ministry of Health made it clear that the Catholic church would no longer be involved in that campaign because the government is promoting the condom use as one of the many strategies to curb the HIV/AIDS crisis” (personal communication)

Since the response to HIV/AIDS requires considerable political leadership and resources, in view of the magnitude of the resources needed for HIV/AIDS prevention, control, care and impact mitigation churches should commit themselves to work hand in hand with the government and other stakeholders to contribute resources to combat HIV/AIDS. Therefore they need overcome doctrinal barriers for the sake of the Congolese people.

6.   Ecumenical organisations and resource facilities

6.1.  Caritas Congo

In partnership with “Médecins d'Afrique”, Caritas Congo has been active in prevention and awareness raising about the HIV/AIDS crisis. A reflection day has been implemented throughout Dioceses that recognised the contributory factors which lead to the spread of HIV/AIDS including poverty, denial of the illness, and the harmful effects of the media, negative beliefs and harmful cultural practises. Additionally, dioceses have found the importance of networking through the implementation of a unified plan of action. Towards this end, the local technicians are urging the 6 Bishops of Congo Brazzaville to hold a meeting where the only HIV/AIDS and its implications should be discussed. Caritas Congo is well known in Brazzaville for home care programmes and for treatment of opportunistic infections.

6.2.  “Médecins d'Afrique”

“Médecins d'Afrique” is a national, non profit, non governmental organisation that seek to improve the well-being of current and future generations including the AIDS orphans and people living with HIV/AIDS around the country and to help achieve a humane, equitable and sustainable balance between people living with HIV/AIDS and the resources. The HIV/AIDS has left at 65,000 children orphaned in Congo. Due to the lack of reporting and appropriate support structures for those affected, there is no doubt that the number should definitely be higher. Médecins d'Afrique is working in close partnership with UN agencies to provide support for those children.

In addition, Médecins d'Afrique has shown a great dedication to the children who were coming back from the forests when the civil wars were over. These children were given deworming drugs. Moreover, this NGO has trained peer educators within catholic dioceses.  Médecins d'Afrique conducts social science research (income generating scheme for orphans and people living with HIV/AIDS) and public health research and helps build professional capacity in Congo/Brazzaville.

6.3.  Association Congolaise pour le bien-être familial

In the context of the HIV/AIDS, men and women should be informed that engaging in sex with a partner of unknown status or with different partners poses a high risk of sexual transmitted infections and HIV transmission. The “Association Congolaise pour le bien-être familial” found that prevention campaigns are reaching a lot of people, but they are also missing too many young people. That is why the youth and schoolchildren are targeted. Condoms are not being distributed whilst the incidence of new HIV infections is still on the increase. However, the Director of this association said that he is willing to collaborate with faith-based organisations wherever this is possible.

6.4.  United Nations Inter-Agency Emergency Initiative

In order to contribute to halting the spread of HIV/AIDS in Congo, five UN agencies namely the World Health Organisation, UNFPA, UNICEF, WFP and UNDP have created the joint Initiative. This project is seeking to join and multiply their efforts in the fight against HIV/AIDS from November 2001 to October 2003. Activities are focused on interventions that target groups at risk such as youth, vulnerable groups (women, orphans, and victims of sexual violence). In addition, this Initiative is planning to help building capacity to produce recent and reliable data on HIV/AIDS in Congo. Since all Congolese are the expected beneficiaries of this Initiative, church leaders are expected to submit project proposals in view of obtaining funding.

7.   Organisation of the churches into a network

7.1.  The National Council of Churches

The HIV/AIDS is a serious problem of major national significance with far reaching socio-economic impact. Therefore it necessitates a strong and unified response. However, the churches' response to HIV/AIDS has been insufficient to slow the spread of HIV and effectively and address its numerous consequences in Congo.

“Churches are not networking in Congo as they work in isolation. The so-called National Council of Churches is about to allow member churches just to aCCept each other. There is no concerted effort to fight HIV/AIDS. Perhaps, the tensions and hesitancies surrounding the issue of condom is still sap much of the collective energy that should strengthen the church's response to HIV/AIDS”

Ms Andréas SENGOULOU

“As far as the National Council of Churches is concerned, there is no ecumenical HIV/AIDS programme to tackle this issue by the member churches. We are looking forward to launching such initiative since HIV/AIDS situation is a looming national catastrophe.”

Mgr Anatole MILANDOU, Archbishop of Brazzaville.

Indeed Christian denominations can work harmoniously within the same organisation. For instance, the Catholic church, the Evangelical church, the Salvation Army, the Kimbanguist Church and the Lutheran Church are brought together into the National Council of Churches and yet the HIV/AIDS has not been recognised as a priority by the church leaders. That is why HIV/AIDS is not integrated into their planning and programming. Church leaders should notice that:

 “It is not only heads of state who have to lead in the fight against HIV/AIDS. We all have to lead, especially the million of people who are infected and affected by HIV/AIDS, and the millions more who are vulnerable to this epidemic. We are in this together. And we should lead our way out of it together.”

7.2.   The National Strategic planning on HIV/AIDS: 2002-2004

During the mapping exercise, the national strategic planning elaborated by the government and the national consultant of the UNAIDS and other professionals was underway. I was invited myself to attend the meeting organised by the National AIDS Control Programme in collaboration with UNAIDS to make improvements on the national strategic planning document. However, I was disappointed to see that the churches were under-represented. I personally raised concern about it, hopefully, I was assured that the churches' voice are very important and they will be integrated in the national strategic plan in due time.

Conclusion

In Africa in general and particularly in Congo, church based institutions are key players in the fields of health and development. The churches have large captive and loyal audience which meets at least once a week. And yet, the churches fail to use this opportunity to aCCurately inform and sensitise their audience about HIV/AIDS. There is no doubt that churches have done a lot to combat this epidemic. However, I think that they could do more if they could tackle both the ethic of sexuality and that of preserving and saving life of people. Of course, Jesus Christ said: “I came that you might have life and have it abundantly”, but HIV/AIDS raises great challenges to that promise. What is the churches response to AIDS challenges?

My first conclusion is that many church leaders considered what is now a pandemic as judgement from God against immorality. This is why church leaders are reluctant to speak out about the HIV/AIDS and they failed to be in the forefront in breaking the silence. Therefore, instead of informing and liberating people from misconceptions, many church leaders put restrictions on sex education and place theological burdens and pitfalls that are heavy to carry.

In addition, although the civil wars should not be taken as an excuse, nevertheless, it has to be highlighted that the civil wars have destroyed much of Congo. Reliable data are inexistent, this may explain partly why churches cannot appreciate the severity of the pandemic since the HIV prevalence (7.8%) of 1995 is still considered as aCCurate.  A part from the awareness raising, I did not come across or visit any relevant, efficient and effective HIV/AIDS programme set up by the churches. The missed opportunities, misinformation and suspicion on the part of many church leaders have slowed down meaningful behaviour change whereas the HIV/AIDS crisis continues to kill people during their productive age leaving behind older people and orphans.

Moreover, there is a widespread belief at least in Brazzaville within the Kimbanguist and the Lutheran Church that HIV/AIDS happens to “other people notably: pagan, prostitutes etc.” On one hand, this attitude undermines prevention, care and support. On the other hand, it increases the impact of the epidemic on individuals, families, communities and nation. On the light of the above reasons, stigma and discrimination should be addressed. There is evidence that challenging the stigma and discrimination can lead to immediate improvement in copying capacity for people living with HIV/AIDS. Most people infected and affected by HIV/AIDS are living positively because of the social support provided by the churches, the family and people of good will etc.

Furthermore, the National Council of Churches should be the required channel and network that can bring at least the member churches of the World Council of Churches into an effective struggle against HIV/AIDS. Since most of the churches of this network are nationwide, their objective should be to harness their respective efforts for increased efficiency with regards to HIV/AIDS especially for youth, women and street children and the general population at large.

Finally, HIV/AIDS is a serious public health, social and economic and security problem affecting the whole country and requiring to be addressed as a major priority through appropriate individual and collective actions. The churches should collaborate with international agencies/organisations and the government on the HIV/AIDS policy in order to promote and guide present and future responses to AIDS in the Republic of Congo.

In the light of the above considerations, my recommendations are as follow:

Policy

· Since many church leaders still regard HIV/AIDS as a punishment for loose sexual behaviour, a fresh biblical interpretation is required through a theological reflection.

· Fear of rejection prevents many people living with HIV/AIDS from being open about their HIV/AIDS status. Church should develop policies to combat stigma and to promote the aCCeptance of people living with HIV/AIDS.

· Without information and education, people are still ignorant and helpless. Silence about HIV/AIDS is equivalent to death, consequently, clergy needs to be trained in theological and biblical colleges.

· A realistic compromise of condom is required since churches are slow, conservative and reluctant to move on that issue as if HIV/AIDS is equivalent to condom use.

· A situational analysis with community participation is needed to ensure that the AIDS programme will belong to the community as it is socially and culturally rooted.

Congregations

· Despite the dark moments of AIDS and civil wars, congregations should understand that they are not alone. They should minister those around them as did Jesus Christ at the Cross of Calvary since God is never, ever separated from us.

· Congregations should proclaim the message of hope, faith, perseverance and courage.

· Congregations must be equipped in pastoral care and social ministry to tackle AIDS.

Communities

· Need that the necessary aCCurate and updated messages on HIV/AIDS are given

· Should find out factors including beliefs, traditions and taboos that undermine churches' efforts to respond in the most effective ways.

· Should find out a safe space where sex and sexuality with relation to HIV/AIDS prevention should be discussed in a constructive and meaningful ways

· Should understand that the common enemy to be defeated is HIV/AIDS and not people living with HIV/AIDS

· Should aCCept people living with HIV/AIDS as resource persons and crucial allies in the struggle to overcome HIV/AIDS.

Counselling

· Churches should combat fatalism among the people by encouraging their members to know their HIV status through voluntary counselling and testing

· Because of the church's concern for people and the impact of stigma on their lives, church leaders should be encouraged to undergo HIV testing as role models

· People who provide counselling at regular or oCCasional basis should be provided with appropriate training on counselling and basic communication skills

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

· Voluntary counselling and testing services should be aCCessible and affordable throughout the country

· Disclosure is a very tough process, without disclosure, prevention and care are almost impossible. Therefore, psychosocial support should be provided at clinics, families, communities and church settings.

· Pre-marital counselling and testing is required with appropriate counselling and support attitudes, environment and response for people who test HIV positive.

Advocacy

· Leaders of faith-based organisations should be effective in calling upon government's responsibility to provide generic and anti-retroviral drugs

· It is the duty of church leaders to pledge for a society that is open from stigma, silence or denial about the epidemic.

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

· The church leaders should raise awareness so that families and communities can aCCess interventions such as prevention of mother-to-child transmission, care and support services as they become available.

· Participatory governance and aCCountability for resources and results are important to consider in developing new and innovative administration between churches and donors.

· Church leaders need to encourage the production, adaptation and distribution of HIV/AIDS learning and educational materials, especially in local languages.

Networking

· One particular challenge to address is the tendency of churches within and among themselves including the government to regard each other with suspicion, this often hinders opportunities for fruitful collaboration and partnership

· Alliance-building across denominational and faith organisations will be a key strategy for expanding the churches' response to the challenges of the HIV epidemic

· The National Council of Churches should integrate the fight of HIV/AIDS in its agenda and should be used as a platform for sharing best practices between member churches of WCC in terms of what works, where, when, by who and so forth

· There is a need for better quality information (aCCurate and timeous) for churches to collaborate with the National AIDS Control Programme and the UN agencies.

· If any significant impact is to be made in Congo against the tide of HIV/AIDS epidemic, the suCCessful initiatives undertaken by churches and other faith-based organisations need to be expanded so they reach individuals and communities.

Social services

· Up to date, the response to orphans, widows and vulnerable children has mostly come from NGOs, still lacking, however a clear commitment on the part of many churches to address the needs of the many orphans and other vulnerable children affected by HIV/AIDS.

· Church health services should be encouraged to develop AIDS control components

World Council of Churches

· The fight against AIDS could bear fruit unless another form of cooperation is promoted. Churches have a crucial role to play in order to have aCCess to funding, be they in the North or South.

· The World Council of Churches should urge the ecumenical organisations and member churches to brave doctrinal barriers and stand together in order to find out concerted and appropriate solutions in respect with HIV/AIDS.

· The World Council of Churches should reflect on the reservations made by certain church leaders who are not willing to collaborate with sects because of the many “harmful practices” notably faith in miracles to cure AIDS, starving of the already weakened people living with HIV/AIDS, polygamy etc.

References

BIT (1994): “Etude secteur informel au Congo” , Brazzaville

BIT (1997):“ Rapport du séminaire interregional de l'OIT sur la reintegration des groupes affectés par les conflits armés” , Genève.

Centre National de la Statistique et des Etudes économiques, de 1982 à 1989 et de 1994 à 1999, Brazzaville.

Ickonga-Somboko R.B (2000):” Situation des femmes et des enfants en République du Congo de 1970 à 2000 ”, PNUD, Projet PRC 2000/551, Brazzaville.

Massamba H., Bidounga N. (2000): “Diagnostic et analyse de la situation et politiques de santé, d'éducation et des conditions de vie ménages en République du Congo” , PNUD, Projet PRC 2000/551, Brazzaville.

UN Plan (2000), Together…Republic of Congo