Democratic Republic of Congo

Introduction

The speed and magnitude of the spread of HIV/AIDS in the world at large and particularly in Sub-Saharan Africa is alarming. Sub-Saharan Africa is home to 70% of adults and 80% of children living with HIV. In DRC, 2,000,000 people are currently HIV infected and 30% of them have already developed AIDS and related diseases.

Since in the early days this disease was first found in homosexuals whose practises are condemned by the church, many African churches consider what is now a pandemic as a judgement from God against immorality. Given the fact that talking about sex is a cultural taboo in many settings and the church fears sexuality because sex is seen as something inferior and sinful, little has been done by most of the Congolese churches to fight HIV/AIDS aCCordingly.

It is documented that Africans are mainly infected through unprotected heterosexual contacts, and so the stigma that was put on homosexuality has been transferred to promiscuous heterosexuality. However, HIV/AIDS is an every day reality that Christians and churches can no longer pretend to ignore. There is no excuse for churches and church related institutions to bury their heads in the sand and pretend that the HIV/AIDS problem will disappear. Churches should understand that there is steadily mounting evidence that failure to act now will mean failure to prevent a national catastrophe. An effective and heightened response by the churches to HIV will make life liveable for millions of believers and unbelievers. Of course, HIV/AIDS is an important and burning issue with no easy solution, but conscious and concerted effort can bring gradual improvement.

Towards this end, a dialogue between three groups of partners: churches, ecumenical and church related organisations in Europe and North America; and the World Council of Churches, have shared a common concern by creating a joint ECUMENICAL HIV/AIDS INITIATIVE in order to help churches build their capacities to prevent further infections, to care for and to support those already infected and affected. One of the activities under this Initiative has been the mapping of relevant activities, experiences and resources of churches and church related organisations in Sub-Saharan Africa.

This mapping exercise focuses particularly on the Democratic Republic of Congo. It has concentrated on investigating the Churches' response in the following areas:

· Information, Education and Communication on HIV/AIDS

· Awareness for clergy, congregations and Laity

· Awareness for Youth

· Gender issues

· Training by Clergy and laity in counselling infected and affected

· Care and Prevention services available:

· Voluntary Counselling and Testing

· Prevention of Mother-to-child transmission

· Hospital and Home based care

· Care of children orphaned by AIDS

1.   General and Epidemiological Data

1.1   General data on DRC

1.1.1.     DRC-Country Profile

The Democratic Republic of Congo is a country located in Central Africa, bounded to the West by Republic of Congo, Gabon, to the North by Central African Republic and Sudan, to the West by Uganda, Rwanda and Burundi, to the South by Angola, Zambia and Tanzania. DRC is divided into 11 administrative provinces. Because of the civil war prevailing in the country since 1998, almost 1/3 of the country is under rebel oCCupation. DRC is not only geographically vast it has a total area of 2,345,000 square kilometres but also a sparsely populated country. A major part of DRC is covered by the Congo basin, its rivers and forests.

1.1.2.     People

The population of DRC is currently estimated around 60 million people with 45% of the population aged between 15-49 years old. Women represent 51% of the total population. 10 million of the population are living in Kinshasa, the Capital City while 60% in rural areas. There are 400 major tribes which oCCupy their own separate territory with their own traditional chiefs. Each tribe maintains communal ownership over its land. In general, Congolese tribes have a rich tradition of folklore, music and dancing and their lives are still strongly influenced by tribal institutions, norms and rules.

1.1.3.     Economy

DRC is a land of great potential since the country is rich in natural resources, currently, the country produces natural gas, lead, zinc, cupper, diamond, gold and magnesium and other resources not exploited today. Additionally, DRC is predominantly an agricultural country.

However, the human development index was 0,429 (142nd out of 162 countries) in 2000. The Gross Domestic Product stood at nearly 70US$ in 2001. This makes DRC one of the twenty least developed countries in the world partially because of mismanagement of resources from governments. Indeed, the specific aspects of the economic context that impedes the development progress are:

· rising inflation and devaluation of Congolese currency

· the collapse of the industrial base with many companies having folded due to the harsh economic environment

· fiscal crisis as a result of civil wars, armed conflicts and poverty

· apparent nil investor confidence in the country

· unemployment, budget cut especially in health and education sectors

· end of structural cooperation with the Breton Wood institutions

· looting and pillage of resources in 1991 and 1993

· wide gap between rich and poor

· heavy external debt estimated at 13 billion US$

· the 1996 and 1998 wars that killed around 2,405,000 people

1.1.4.     Profile of Human Development

· The literacy rate is estimated at 59% of the population. Males are more likely to stay longer in schools than females.

· Approximately 80% of the population are Christian and many of them are in contact with church structures which comprise HIV/AIDS programmes.

· Life expectancy increased in 1980s. Due to HIV/AIDS, it has dramatically dropped from 54 years to 49 years in 1998 for people living with HIV/AIDS.

· Many censuses which have taken place in DRC showed the population growth at a rate of around 3,0%. With the impact of AIDS, the population growth is expected to decline from 3,0% to 2,9% in 2010. (PNLS, 2001).

1.1.5.     Health

Provision of health services is very expensive because the Government can no longer fund them. Quality of care in most of the public health sector is increasingly problematic since essential drugs are less available and drug shortages are frequent. An exodus of highly qualified and experienced health professionals also crippled the public health sector. The low morale among medical doctors and nurses has been manifested by several strikes since 1990. In addition, the low payment of health professional salaries and wages coupled with the political unrest in the country has severely weakened the public health sector. However, nearly 70% of health services are delivered by churches and church related institutions with meaningful results.

With relation to HIV/AIDS, tuberculosis and malaria are still major threats in DRC.

“Any effective effort to reduce the burden of disease faced by world's poorest people must concentrate on AIDS, tuberculosis and malaria. Combined these three diseases could aCCount for 500 million or more illnesses a year and at least 6 millions deaths”

Tuberculosis

DRC is the 11th country out 22 most infected in the world and 4th in Africa. In 2000, the total of notified case was 60,627. This represents the incidence of 116 per 100,000 habitants. The World Health Organisation (1999) stressed that the co-infection TB/HIV was about 25%. In a cohort study launched in DRC in 1999, the tuberculosis cured rate was 59,1%. Death rate was 1,875 out of 34,923 cases. It has to be mentioned that 40% of death are linked to AIDS. The working days wastage is 3 to 4 months per year because of TB infection.

Malaria

In 2000, 10million malaria cases were reported of which children represent 59 to 86%. 500,000 people have died of whom 37 to 60% were children while 5% were pregnant women. In DRC, 3 beds out of 10 are oCCupied by patients suffering from malaria while 85% of blood transfusions in paediatrics are caused by malaria in Kinshasa's hospitals. This represents the second route of HIV transmission. The vast majority of these infections could be prevented by reducing unnecessary transfusions by effective clinical use of blood, educating, motivating, recruiting and retaining low-risk blood donors and screening all donated blood for infections agents.

1.1.6.     Poverty and Vulnerability

Poverty remains a major problem. The income gap between the richest and the poorest members of the society is widening. Unemployment and poverty due especially to looting of resources in 1991 and 1993 are found both in rural and urban areas. Rapid growth in the informal sector has been one of the main factors that explain some improvement in living standards in DRC.

Poverty influences choices people make including behaviour that increase the risk of HIV infection namely alcohol abuse, multiple sex partners and sex for money. Many young girls are forced into prostitution because of poverty. In addition to the lack of basic resources, extreme poverty dehumanises the individual to a point where self-esteem and morality become secondary. A young street girl whom I recently interviewed in Kinshasa said: “whereas a clerk in public sector earns about US$:20 per month, I can earn that much in a single week-end”.

1.2.  Epidemiological data

1.2.1.     The HIV/AIDS epidemic in DRC

The first cases in DRC were reported in 1983 and ever since, there has been a significant increase in the number of people living with HIV/AIDS. The National AIDS Control Programme (2001) indicated that 2,085,764 people are infected with HIV/AIDS.

Source: Congolese proposal form submitted to the Global Funds 2002

Source: “PNLS in infection à VIH/SIDA/IST en RDC 2001”

General comment

It has to be noticed that the available data do not reflect the reality of the dysfunction of the health information system and the decrease in health services aCCess particularly in the context of civil wars and armed conflicts particularly in the oCCupied territories. Recognising the limitations of available data, PNLS (Programme de lutte contre le VIH/SIDA) 2001 estimated at 5% the seroprevalence in the area under the government control against 20% in the rebel held area.

This can be due to the war context with armies from high prevalence countries such as (Zimbabwe, Uganda, Namibia, Rwanda and Angola) that are operating in DRC since 1996 up to now. It is known that in situations of conflict, the risk of sexual violence increases dramatically.

Because the hetero-sexual relationship is the main root of HIV transmission, many church leaders, Christian and people of good will fear that more open talk about sex and sex education will result in the increase of promiscuous behaviour.

1.2.2.     Sentinel surveillance

In DRC, the HIV information has been available among the antenatal clinic attendees since the mid-1980s. The median HIV prevalence rate among antenatal clinic women in Kinshasa fluctuated between 3% and 7% over the 15-year period 1985 to 1999. In 1999, 4% of antenatal clinic attendees were tested HIV-positive.

It has to be mentioned that surveillance outside of Kinshasa is not frequent. A few studies only conducted in provinces namely Kananga, Kasumbalesa, Kimpese, Likasi, and Lubumbashi that showed 3-4% the prevalence rate among antenatal women tested between 1988 and 1993. Recently, Save the Children/UK has launched a study that showed more than 20% of antenatal clinic women tested positive in Kalemie, Katanga Province (Ministry of Health 2002, personal communication).

Among sex workers tested HIV-positive in Kinshasa the prevalence of HIV/AIDS is fluctuating between 27 and 38%. In spite of the limitation of HIV information outside Kinshasa, a study conducted in Orientale Province in 1991 reported that 25% of sex professionals were HIV positive. In 1997, 29 % were tested HIV-positive in Mbuji-Mayi, Kasai Province. (UNAIDS, 2000)

1.2.3.     Contributing factors to the spread of HIV/AIDS

There are many contributory factors to the spread of HIV/AIDS. They include:

· Poverty that obstructs control

· Wars, armed conflicts and insecurity since the armed forced involved in the wars in DRC are well known to come from the highest HIV prevalence countries

· Socio-cultural issues:

Discussion of sexual issues is taboo in many cultural settings

Stigma, shame, rejection and blame that are associated with HIV/AIDS add an extra layer of suffering to the already difficult lives of those infected with HIV in society at large and particularly in church settings.

Cultural practices and perceptions which expose women in particular to the risk of HIV infection

· Global economic policies and injustices

Structural adjustment with its cut in government health and education spending

Employment practices, wars and armed conflicts that disrupt families for long periods and promote unsafe sex

Heavy external debt

Antiretroviral in the North while HIV/AIDS in the South

InaCCessibility of Voluntary Counselling and Testing

· Conflicting media messages and images about sex, sexuality and love

1.2.4.     Impact of HIV/AIDS in DRC

Demographic impact: the demographic impact is devastating.

· In 1999, UNAIDS (2000) reported 680,000 the number of children who lost their mother or both parents due to HIV/AIDS at age 14 or younger since the beginning of the epidemic.

· In 1999, UNAIDS (2000) indicated 95,000 the estimated AIDS deaths. Because of AIDS (UNAIDS,1988) showed the decline of population growth from 3,3 to 3,0%. The projection for the year 2010 will be 2,9%.

· The increased mortality rate among children under the 5 years old will go from 97/1000 per year to 116/1000 in 2010 (USAID, 1998)

· The life expectancy has decreased to 49 years old from 54 years in 1998

Economic impact

· A fairly recent study by the Harvard Institute of International Development estimated that the total cost to DRC by 1995 due to AIDS associated death was US$: 350 million, which was about 8% of Gross Domestic Product (Ojo, 1997)

· The preliminary results of a model developed in 2000 estimate the decline in GDP per capita growth as a result of AIDS by 2010 to be 0.7% (Bonnel, 2000).

· A study of a textile mill in Kinshasa found that the highest rate of HIV prevalence was discovered in the managers, followed by the foremen, with the lowest rates found in the workers. Thus the effect of HIV/AIDS will be felt most strongly in the more highly skilled workers, who are more difficult to replace. (PHNFlash issue. Feb 22.1995)

Agricultural impact

· Though no data are found for the impact of HIV/AIDS on the agricultural and business sectors, however, it is believed that the loss of members will entail the drop of their income. Thus, HIV/AIDS is reducing labour and productivity. If the productivity and the competitiveness are compromised, this will discourage new investors. (UNAIDS, 2000)

· In addition, as a result of AIDS companies should see rising sick leave rates, and higher insurance and medical care expenses, while soaring rehiring and retraining costs drive productivity down and eat into their profit margins.

Educational impact

· In public sectors, the loss of skilled labour such as school teachers is increasing. A model developed by UNAIDS and UNICEF in 2000 shows that, of around 830 000 primary school students, 7300 would have lost a teacher. This leads to discontinuity in teaching, loss of schooling and a change in teachers. Therefore, teachers cannot be trained swiftly enough to replace the predecessors who suCCumbed to HIV-related illnesses.

· Basic primary education should constitute a fundamental human right because to an illiterate person, immune-suppression is an incomprehensive concept.

Medical impact

· The health sector systems especially in Mama Yemo Hospital are coping with many difficulties. Because, 6,4 to 8% of employees of Mama Yemo Hospital tested HIV-positive in 1984 and 1986 respectively, reflecting a two-year incidence rate of 3.2 (Ngaly et al, 1988).

· In addition, the percentage of hospital beds oCCupied by HIV-positive in Mama Yemo Hospital in Kinshasa was approximately 50 percent in 1995. This implies that it is becoming more and more difficult for patients with other illnesses to receive treatment, due to possible crowding out by HIV-positive patients. (Matela et al.1993)

· The World Bank and the UNAIDS(2000) stressed that the annual cost of scaling-up HIV/AIDS programme is estimated between US$ 66 million and US$ 105 million.

· Recent data show that the cost of treating an AIDS-related condition, cryptoCCocal meningitis was US$870 in DRC several times higher than the per capita income. Even though the treatment was the most expensive, advanced treatment, only 150 additional days of life were gained. Thus few families would choose to undertake the treatment, even if it were available. (Squire, 1998)

Social impact

· Social data are practically unavailable in DRC. Taking into aCCount the burden of HIV/AIDS especially the high morbidity and mortality rates, from my own experience I see children removed from school in order to take care of the ill family members and to regain income.

· Almost everywhere and even in DRC, the extra burden of care and work are deflected onto women, especially the young and the elderly.

· Because of the war context, children who survive wars often end up as orphans with no skills to face the challenge in life. This obviously leads to a truly vicious cycle. (Givans, 2001)

· An early longitudinal study on the status of orphans due to AIDS deaths found that there was no health or socio-economic impact on their status, because the extended family was able to care for them. (Ryder et al. 1994)

· This pattern was not observed, however, in another longitudinal study that performed home visits to evaluate the welfare of AIDS orphans. This study found that, although the orphans were living with relatives, the relatives could not meet their health care and education expenditure needs. Frequently, these children were absorbed into relatives' families under a spirit of duress. The children faced a hard time, they were first to be pulled out of school, exploited as domestic and family labour, the last to be fed and they suffered from malnutrition. (Matela et al. 1993)

2.   National HIV/AIDS Control Programme

2.1.  Background to the AIDS Control Programme

In the Democratic Republic of the Congo, the first cases in 1983 aroused the interest of the government who, while starting information and awareness raising 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.

2.2.  The National Response of DRC

The Democratic Republic of Congo's response in the fight against HIV/AIDS has been quick but ineffective. In addition, political commitment and resource allocation were very slow to take off. Subsequently, its allocated budget has been largely inadequate to make any meaningful action to mitigate the impact of AIDS. (See box details for important dates and significant events)

The main domains of intervention in the fight of HIV/AIDS are:

· Communication for behaviour change

· Prevention of the transmission from mother to child

· Safe blood transfusion

· Sexually transmitted infection care (prevention and control)

· Care of People living with AIDS and HIV positives

· Epidemiological surveillance and operational research

· Management and programme coordination

Five main objectives were spelt out under the PNLS namely:

· To mobilise communities and specific groups (youth, teenagers, sex professionals, workers, refugees and displaced people etc.)

· To mobilise decision-makers, opinion leaders, managers, traditional leaders and religious leaders

· To improve aCCess to prevention, diagnostic, support of those infected or affected by HIV/AIDS

· To reinforce the capacity building of institutions and actors involved in the fight of HIV/AIDS.

· To reinforce the national and international partnership for effective multisectoral approach to AIDS control.

It would be crucial for DRC's National AIDS Control Programme to achieve its designed objectives. However, the general public has been very critical of the Government's inadequate response, lack of prioritisation and inability to address the stigma, discrimination and rejection attached to HIV/AIDS.

In DRC, it took almost 15 years before the first Voluntary Counselling and Testing (VCT Centre) was established and the Mother-to-Child Transmission (MTCT) treatments protocols are still in their infancy. Availability of treatment of opportunistic infections is quite rare and the prospect of aCCess to anti-viral therapy remains remote except for those with sufficient financial resources to by-pass the system.

Given the high sero-prevalence and a prevailing stigma attached to HIV/AIDS, a strong political commitment to the fight against AIDS is crucial. In fact, countries that have shown the most suCCess, such as Uganda, Thailand and Senegal, all have strong support from the top political leaders. This support is necessary for several reasons:

“First of all, it sets the stage for an open approach to AIDS that helps to reduce the stigma and discrimination that very often hamper prevention efforts. Second, it facilitates a multi-sectoral approach by making it clear that the fight against AIDS is a national priority. Third, it signals to individuals and community organisations involved in the AIDS programmes that their efforts are appreciated and valued. Finally, it ensures that the programme will receive an appropriate share of national and international donor resources to fund important programmes.”

Ainsworth, 1998

The Congolese Government should make AIDS a national priority, not a problem to be avoided because of the bloody war.

2.3.  Partnership

In the early days, HIV the epidemic was seen as a national multi-dimensional problem requiring a multisectoral and multidisciplinary approach. Several stakeholders namely local and foreign NGO, national secular and religious associations, churches, ecumenical organisations, civil society, the private sector and external partners have thus associated their efforts with those already engaged by the PNLS (Programme de Lutte contre le VIH/SIDA).

NGO and National Associations

They are too numerous in Kinshasa to be listed. They are either secular or denominational established in the capital city and in Lubumbashi, the economic capital. Most of them 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, orphans, widows and widowers.

External partners

The National AIDS Control Programme works in collaboration with partners such as UNAIDS, UNDP, WHO, World Bank, GTZ, French Cooperation, UNICEF, SWAA, European Union and USAID etc.

Church and ecumenical organisations

During a Recent workshop that was organised by PNLS in collaboration with UNDP and UNAIDS, the commitment of faith-based organisations of Kinshasa in combating the HIV/AIDS was remarkable.

3.   Position and Involvement of Faith-Based Organisations in Addressing HIV/AIDS

3.1.  The Faith based organisations in DRC

In regard to the mapping work of HIV/AIDS in Kinshasa/DRC, I met either religious leaders or heads of Health departments of the following faith-based organisations: Catholic churches, Muslim Community, Kimbanguist church, Independent churches, Protestant Churches, Orthodox church, Revival churches, Salvation Army and Sikatenda's God church.

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

In general, church politics and the diverse theological interpretations, often hinder the right perceptions of HIV/AIDS by the faith-based institutions. Very often, a perceived attitude of self righteousness, judgement, condemnation and rejection has characterised many of the messages from the pulpit coupled with a high level of ignorance and misinformation from the church leaders' side.

For a long time, HIV was perceived to be merely as a health issue. In addition, cultural taboos over the issue of sex and sexuality and discussion related to sex impacted negatively on the open involvement of faith-based organisations in the early days of the epidemic and still today in many churches. In consequence, many churches have not been seen to be places of refuge for the infected and affected and the voice of advocacy has been too often silent.

However, as morbidity and mortality rates rise and the effect cascade through Congolese society, most religious leaders are aware that the HIV/AIDS epidemic is weakening the country's institutions, and reversing decades of much-needed progress in health, education, literacy, human and economic development. However, it has to be highlighted that their perceptions of HIV/AIDS vary from church to church.

Roman Catholic church

The perception and the position of the catholic Archdiocese of Kinshasa is not different from Vatican. It is summarised in 5 points.

“As far as the Archdiocese of Kinshasa is concerned HIV/AIDS infection is a human disease and is not a divine curse meant for the only the sick. The catholic church is stressing the need to avoid judgemental attitude towards people living with HIV/AIDS. On the contrary, they need a deep sense of love and compassion.

HIV/AIDS is considered as any other disease even though the catholic church realises that it poses complex problems. One can be infected with HIV either by ignorance or by neglect. That is why Catholic Church of Kinshasa encouraged scientific sound research and medical care.

People living with HIV/AIDS are not alone in their journey, God is with them.

Linking HIV/AIDS to witchcraft is false religious doctrine

Faith in the miracle of curing AIDS without a prior reliable HIV test should be condemned because of the fear of spreading HIV/AIDS and its dire consequences.”

Mgr BULAMATARI, Auxiliary Bishop of Kinshasa Archdiocese

Muslim Community

Contrary to the Muslim tendency in other African countries, in DRC the Muslim Community does not consider AIDS as a punishment of God. However, because HIV is mainly transmitted through sexual relationship, HIV/AIDS is thought to be the result of disobedience to the laws of God. That is why fornication is forbidden in Muslim circle.

“Since AIDS is no longer considered as punishment of God, people living with HIV/AIDS are not abandoned for the Koran recommends that help and relief should be given to any one who is needy whatever his or her fault.”

Eminence EL HADJI MUDILO, National President

Kimbanguist Church

HIV/AIDS could be interpreted as a breakdown of the relationship with God, with one's neighbour, with yourself and th e with life-giving earth. HIV and its modes of transmission are well known in the Kimbanguist settings.

“The position of the Kimbanguist church in the light the above considerations is that, Christians unlike non believers should resist in order not to fall into the clutches of HIV/AIDS. Those who are already infected should not spread HIV to others. In the opinion of the Kimbanguist church leader, AIDS must not be considered as divine punishment.”

Rev.Dr Bazinga, Deputy Legal Representative

This could explain why the Kimbanguist church is playing a prominent role in the dissemination of preventive information and cure of opportunistic infections.

Protestant Churches or “Eglise du Christ au Congo”

The ECC is threatened by HIV/AIDS because it is killing Christians and non Christians in their productive life leaving behind them little children and old people.

“If the faith based organisations and people of good will cannot save the country and people from AIDS, churches, mosque, synagogue, chapel and temples will be without human resources. Instead, they will be replaced by mosquitoes, spiders and flies etc. The remaining church leaders will resign because of unemployment”.

Mgr Marini Bodho, National President

In DRC, the health system was already weak and under-financed before the advent of AIDS. Those structures are now buckling under the added strain of soaring needs. Rebuilding health and social service systems is a priority that requires substantial national and international resources.

“Since HIV/AIDS is an army invading DRC and the neighbouring countries, the time has come to implement the war plans that are more likely to defeat HIV/AIDS in DRC and beyond.”

Mgr Marini Bodho, National President of ECC

Independent Churches

In Independent church circles, they are quite blunt on the matter that HIV/AIDS is the result of disobedience to the laws of God that provokes His wrath.

“Therefore, Independent churches are involved in the fight of HIV/AIDS in order to help people living with HIV/AIDS receive forgiveness and reconciliation from God because of their misbehaviour.”

Rev. Pastor Kalonji, National President

Revival Churches

“For most of Revival churches, the real cause of the widespread of the dreadful virus is the non-respect of God's law which is expressed by fornication, infidelity, loose living and the sex trade.”

Mgr Kankienza, National President.

In addition, the revival churches recognise that there are contributing factors such as: poverty which generally leads to rural exodus, migration and prostitution, to which are added ignorance, denial of the illness, the harmful effects of the media, beliefs and certain cultural practices.

Orthodox Church

The Orthodox Church recognised that HIV/AIDS epidemic is worsening since million are infected.

“Many others have died or have been orphaned so that HIV/AIDS threatens the social, economic, and cultural framework in DRC and beyond. In order to protect against the disease, the Orthodox church recommends to society and especially to Christians to revert to moral values and to God's laws.”

Prof Theodore Fumunzanza, Orthodox Church Secretary.

The Orthodox Church encourages abstinence, fidelity and chastity as the most advisable means of effective prevention.

Salvation Army

The Salvation Army is aware that AIDS is a reality of its time which Christians can no longer pretend to ignore. That is the Salvation Army applies human, material and financial resources to meet the needs of intervention activities as a practical expression of love.”

The Salvation Army uses its influence to remove stigma attached to HIV/AIDS since HIV/AIDS is like any other diseases.”

Sir Ludiazo, Colonel of the Salvation Army.

The SIKATENDA's church of God

“Because many of those people who are infected and those who will be infected today and tomorrow come to church on Sunday, and to church functions at baptism, confirmation, and at funerals etc., the SIKATENDA's church of God is very concerned about the disease. The church insists on total abstinence from sex before marriage and faithfulness in marriage between two uninfected partners.”

Rev.Pastor Sikatenda, Legal Representative.

ACCording to Deuteronomy 28:58-62, this church believes that HIV/AIDS is God's punishment. HIV/AIDS has been perceived to be the consequences of sinful action and the responsibility lies not with the church but with the offender. However, the SIKATENDA's God church also believes in faith miracles of curing HIV/AIDS by prayers etc. ACCording to the above Legal Representative, a few people infected with HIV would have been cured from AIDS within his church premises through prayers. This requires scientific evidence!

3.3.  Involvement of the churches in HIV/AIDS awareness for clergy and Congregations and laity

3.3.1.      « Eglise du Christ au Congo »

ECC has 64 churches from various backgrounds and doctrines. ACCording the 1998 census, ECC has approximately a membership of 19 million people. Traditionally, its activities have often been community based and have targeted the grassroots including the vulnerable and the un-reached irrespective of gender.

In its health work, The Eglise du Christ au Congo (ECC), the SANRU III implementing partner in DRC unites the majority of protestant congregations. In addition, SANRU III project covers all the provinces through 75 health zones. It also works closely with other faith networks (Catholic, Kimbanguist) and secular organisations as well as government health authorities.

Main activities

With regard to HIV/AIDS, SANRU III focus are HIV testing, counselling, treatment and training.

HIV testing

Testing for blood transfusion and for people at risk (anaemia, prolonged delivery, etc.) is a key step for stopping the spread of HIV. Currently many hospitals and health centres (particularly in rural areas) do not have HIV testing equipment and capacity partially because of the high cost of HIV reagents. SANRU III looks forward to providing HIV tests and confirmation tests to all reference hospitals.

Source: SANRU Annual report 2001

Counselling and testing

Patients with sexually transmitted infections are known to be four times more likely to contract or to spread HIV infection than any one else. Counselling and treatment for STI is a key strategy to slow down the spread of HIV/AIDS. SANRU III will provide drugs and counselling materials to health zones. 7000 condoms are currently provided per Health zones per year.

Another interesting component of SANRU III is “health worker protection and post-exposure protection. Because of the lack of gloves and other barrier materials, health workers are more exposed to HIV. Health professionals are dying after years of reasonable training and experience. SANRU III will provide the drugs needed for post-exposure for post-exposure prophylaxis to reduce HIV infection after pinpricks, rape and other known exposures”.

Training

Currently, SANRU III is responsible for the in-service training of 63 medical doctors and other health professionals on safe blood transfusion, Syndromic plus management and laboratory tests.

In addition, health professionals will be trained and given educational materials for educating and counselling students, military and sex workers about HIV. They will also be trained in the promotion of care and support programmes by the community for AIDS patients and AIDS orphans.

ECC HIV/AIDS Coordination office

Given its national influence, ECC is planning to undertake a national mobilisation to fight HIV/AIDS through the involvement of its church members and related institutions. In consequence, the President is willing to create an HIV/AIDS coordination office under his direct supervision. This programme would be discussed by the Executive Committee of ECC in the forthcoming days. ECC could be a key actor in HIV/AIDS related activities if a specific coordination of activities is established with clear objectives.

ECC has the moral authority and influence, particularly with regard to behaviour change communication. Therefore, it could fight stigma, denial, discrimination, and rejection attached to HIV/AIDS from grass-root level. Subsequently, through the involvement of ECC member churches, people would be stimulated to do voluntary testing and counselling and also contribute to break the silence towards HIV/AIDS.

3.3.2.     Catholic Church

The Archdiocese of Kinshasa has several arms to its activities including the Medical Direction (BDOM), Youth and Women, Justice Commission etc. In addition, the Archdiocese has appointed a full-time national coordinator on HIV/AIDS who is based in Kinshasa.

During the nineties, as AIDS progressively became a leading cause of death in DRC, the Archdiocese set up a 5-year programme. This programme focused on:

Prevention: awareness raising through

· “Centre Education à la vie” which is networking within 300 schools

· Catholic School Coordination office

· “Bureau Diocésain des oeuvres médicales”

· Charismatic Renewal

· Catholic Mothers

· Mabota Commission (for family and couple)

· Radio Elykia (Radio of hope)

· Commission of CEVB

· Liturgy and Catechism

· Youth Commission

Training

· Voluntary people against the HIV/AIDS

· Counsellors for couples

· Teachers for facts of life

· Radio Journalist

Support and care

· Medical (Pre and post counselling and treatment of opportunistic infections)

· Visit and home based care

· Training of carers in family settings

· Psycho-social support

· Material support (food, shelter, funeral, medical and tuition fees)

Behaviour Communication for change

Care of orphans and Pastoral Ministry

· Through the pastoral ministry, the Catholic Church is heavily involved in the HIV/AIDS struggle. A relief programme has been implemented in mobilising community financial resources. This programme is broadcasted by the Elikia Radio through a lively emission “Solidarity Channel” in favour of the infected and the affected.

· In addition, the Archdiocese of Kinshasa through the Day Care Centre managed by the sisters of “Mère Theresa Congregation” for people who are dying, is caring for about 80 children living with HIV/AIDS.

· Out of 4000 people living with HIV/AIDS counselled by the Archdiocese, nearly 70% have been convinced to identify themselves. They have been encouraged to live positively and to die with dignity.

AIDS and the Church

In 2000, the first seminar was held under the theme “AIDS and the Church”. This resulted in discussions on statements on AIDS, the aCCeptance of the Kinshasa statement of 1998 and the establishment of the Commission in the struggle of HIV/AIDS within the Archdiocese to organise and implement HIV/AIDS work. Furthermore, there was agreement reached on a programme to train trainers (clergy and laity), and to disseminate information, education and communication (IEC) on HIV/AIDS.

3.3.3.     Salvation Army

In DRC, the Salvation Army has been extremely proactive in their response to the HIV/AIDS crisis. The approach has been visionary as well as rooted in practicability and where a need is perceived, they have not delayed in responding. To their credit, their initiatives involve the community in almost all aspects of planning, implementation, monitoring and evaluation. This involves a holistic range of support, at every level, including spiritual support. In this approach, international and regional facilitation teams work together with local stakeholders to explore key issues such as participatory caring, community as belonging, change and hope.

In the fight against HIV/AIDS, the medical service of the Salvation Army focuses its efforts on prevention, counselling and care and treatment of opportunistic infections.

Prevention

Health centres, schools, hotels, pub and military camps are locations where information, Education and communication on HIV/AIDS and Sexually Transmitted Infections are delivered. Because of sensibility that surrounds HIV/AIDS issues, this subject is dealt among other health and development problems. The target population is given the option to raise the HIV/AIDS issues and to find out the community view points. This is done mainly in Masina area as well as in Bas-Congo Province. In 2000, 55 schools, 35 churches, 66 various associations, 22 people living with HIV/AIDS have been reached.

What is outstanding in the Salvation Army HIV/AIDS approach is the involvement of the community. In the slum of Masina/Kinshasa, young people have been able to identify areas where needy people who cannot afford hotels have sex. In addition, the military have been targeted for IEC and they were able to identify dangerous sexual behaviour such as multiple and oCCasional sex partners that are common practices among the military especially those of who are separated from their spouses for long time because of the war.

Counselling

Voluntary counselling and testing is part of the strategy used by the Salvation Army to help reduce the domino effect. It is done in collaboration with the family of the infected and affected where this is possible.

3.3.4.     Kimbanguist church

The Kimbanguist medical department of the Church of Jesus Christ on Earth in Kinshasa is eagerly involved in the struggle of HIV/AIDS especially in prevention and training, care of the infected and the affected people and safe blood transfusion.

Prevention

12 workshops have been held to sensitise the church members on the severity of HIV/AIDS and multiple consequences in 2000 alone.

Capacity building of 60 “cellules de prières” has been initiated to implement the behaviour change communication

20 focus group discussions have taken place at parishes level

Training

25 counsellors namely clergy and laity have been trained to care for people living with HIV/AIDS through information, education, spiritual and medical support.

Safe blood transfusion

A reliable and safe blood supply is still out of reach for many people particularly in rural areas. However, the Kimbanguist Hospital is one of few hospitals in Kinshasa where blood screening for transfusion is required.

Source: Kimbanguist M edical Department 2000-2001 reports

Comments

From 2000 to 2001 almost 10% of blood donors were tested HIV positive. If they had not been diagnosed these blood donors would have become inadvertent killers since they did not know their HIV infection status. This shows the importance of a comprehensive approach that is needed in order to suCCessfully control the HIV/AIDS infection even in church settings.

3.3.5.     Partnership between Government and FBO

In DRC, a strong partnership in the promotion of preventive medicine and the provision of care exists between Government and Churches mainly through SANRU project, BDOM “Bureau Diocésain des Oeuvres Médicales”, “Service Medical of Salvation Army” and Kimbanguist Medical Department.

The National AIDS Control Programme has recently organised a workshop “on the role of Faith-based Organisations in the fight against HIV/AIDS today” in collaboration with UNDP. 100 participants from Catholic, Protestant, Orthodox, Independent, Revival churches, Salvation Army and Muslim Community have attended the workshop. One of the most visible results of the workshop has been the establishment of a National Council of Interfaith-based Alliance comprising 8 religious leaders.

They have been set up to discuss HIV/AIDS issues and to lobby more resources. This has been done without segregation of any sort. In the meantime, the Director of UN system in DRC has promised to assist and collaborate with religious group to fight this pandemic. The immediate implication of the National Council Inter Faith-based Alliance is that Government cannot go alone and religious groups cannot work in isolation in the struggle of HIV/AIDS.

This shows the importance for churches to continue working closely with government structures in giving the right messages and support the communities. This concerted effort of the churches, government and other institutions is a milestone in the suCCesses that Uganda has achieved in the fight of the epidemic. This is an outstanding example of collaboration between government and religious groups to replicate elsewhere.

4.   HIV/AIDS and Youth

4.1.  Overview

ACCording to UNAIDS (June 2000), about 1.7 million are infected every year in Sub-Saharan Africa. Worldwide over half of all people who become infected are under the age of 25 years. In the DRC at antenatal clinic for pregnancy attendees, aged 20-25 years, 3 to 24% have been found to be HIV positive. Since the total population under the age of 15 years represent about 45%, DRC has a serious obligation, to target this “ window of hope ” in order to protect them from the risk of getting the infection.

What makes young people vulnerable to HIV/AIDS?

What makes young people so especially vulnerable is that adolescence and youth are times of discovery, emerging feelings and the exploration of new behaviour and relationships. Experimentation with sexual behaviour is an important part of this and can involve risks (UNAIDS Briefing paper 1999 “Young people and HIV/AIDS”).

In many church settings, prevention campaigns are reaching millions, but they are still missing too many young people. Recent surveys conducted in 17 countries show that half the adolescents questioned could not name method of protecting themselves against HIV/AIDS. (UNAIDS, 2001)

In addition, research findings indicate that people belonging to the various religious organisations are not less infected than the society at large. Therefore, one may conclude that the teachings about sexuality and moral values have not had the desired effect. This situation could be partially the result of young people who are exposed at the same time to double standards and receive mixed messages from media, advertising, culture and religious. There is no doubt that youth willingness either to participate in the control HIV/AIDS or behavioural change lies on the delivery of health education. Therefore, talking and learning about sex should be a vital part of any meaningful HIV/AIDS programme.

But in many societies including DRC, young people are failed by the lack of leadership of their elders. The ideology that HIV education lure adolescents into sexual activities has long since been disapproved and yet remains one of the many opposing factors towards finding effective solutions to the HIV/AIDS pandemic in most communities, based on the fact that these programmes violate the norms and cultural values of some.

By contrast, Denmark's peer Education for young people project is an outstanding example. Every week, trained peer educators hold meetings with other young people from sex to sexuality matters. With regard to that project reaching about 10 000 young Danes a year, there is no shortage of interest. (UNAIDS 2001, in together we can)

However, studies around the world confirm that even among well-informed young people, awareness about HIV/AIDS does not automatically translate into safe behaviour. Informing young people is not simply a logistical problem. It is process complicated by the fact that young people are not homogenous. In addition, there is lack of aCCess to youth-friendly health services and negative attitudes from health workers are often hindering youth and other from soliciting services from clinics.

Although these studies bring out mixed findings, their results indicate that there is a need for churches and other religious institutions to revisit their messages on sexuality including the use of condoms. Similarly, there is a need to assist parents with sex education for their children. Families are very often regarded as the cornerstone of the society and the safest place on earth. At the same time, the most horrifying things are taking place within families, such as physical violence and sexual abuse against women and children, contributing factors to the spread of HIV/AIDS.

Most effective prevention campaigns should therefore tackle the underlying attitudes, values and socio-economic conditions that prevent youth from protecting themselves. This could be done until young people actively participate in designing and implementing the campaigns. Therefore, young people should not only be involved in the decision making process, but also their positive endeavours should be recognised and incorporated into HIV/AIDS programmes wherever this is possible. The time to mobilise churches to be credible, and to fulfil Jesus Christ's given mandate “let children come to me” is now .

4.2.  Sex education in DRC

Every society has ways in teaching the young about sexuality, whether it is done by parents, aunts and uncles, or through sex education in schools. Traditionally, it is a taboo for biological parents to communicate any sex education to their legitimate children in DRC. In many cultures, sex education to adolescent is provided by aunts for girls and uncles for boys or any respected designated adults. However, urbanisation and changing family patterns have contributed to the demise of these traditional rules and procedures.

In consequence, young people are left in ignorance to find out about sexuality through misleading trials and sometimes fatal errors on their own, from friends, or from films, magazines, books and the consumerist messages of the advertising media. In general, sex education in school is lacking. A few schools provide a so-called sex education that consists only on basic lessons in anatomy and reproduction, and more recently, basic facts and information about HIV transmission and prevention.

Despite many good intentions to include HIV/AIDS education in the national curriculum, there is no evidence yet of its inclusion and there appears to be some resistance to its development and implementation.

It is very difficult to implement a national programme of sex education for young people when parents, religious leaders, policymakers, teachers and young people themselves have conflicting views and values regarding sexuality and therefore, about what should be taught by whom?

I asked a few questions to teachers in order to find out their opinion about the right person to teach sex education to schoolchildren. Half of them cited Health personnel because medical professional was seen to hold relevant information about the disease.

“The medical personnel should teach because we teachers just lecture it to pupils but the medical personnel are more knowledgeable than teachers so if they can teach that can improve health education”

Mbakata, schoolteacher.

¼ of them insisted that they should do it themselves because when it comes to academic staff they would do better than medical personnel. However, another ¼ of teachers reported that it would be better to do it both (medical and teachers) because of various reasons including collaboration and technical support.

“Both group should assist each other as it will be in a syllabus, a teacher can do it when it comes to teach in detail, I think medical personnel can do better”

Ramazani, Schoolteacher.

This shows how important it is to promote the multisectoral approach in the control of HIV/AIDS in order to allow community participation. If teachers knew that teaching health education to schoolchildren, who are parents of the next generation, they would be valuable contributors in the control of HIV/AIDS.

Since teenage pregnancies that could lead to the spread of HIV/AIDS both for mothers and their babies are extremely common in DRC, clergy should urgently address issues of sexuality as they pertain to youth. Churches can no longer shy away from the real issues that the HIV/AIDS epidemic presents to the world particularly in Sub-Saharan Africa. The time has come to face the problems and to deal with them within the context of fellowship. Uganda's suCCess in bringing down high HIV prevalence taught us that fighting HIV suCCessfully among the population at large and especially in youth is not impossible . Uganda's example must be emulated by the DRC and beyond.

4.3.  Secular Response to Youth and HIV/AIDS

In DRC secular response has been and is still widespread condom promotion, which has produced angry reactions from many churches believing that this encourages promiscuity and denial of personal moral responsibility. This has led to confused messages to the general population, in particular the youth. Subsequently, the inability to move beyond the condom issue resulted in the prolonged neglect of so many issues.

The social marketing and distribution of condoms in DRC to targeted population has taken multiple approaches, such as free, targeted distribution, community based distribution programmes, dissemination via health facilities, pharmacies and stores. Unfortunately, this strategy is not coordinated among the different outlet to achieve maximum availability of condoms. In order to bridge the gap between condom supporters and opponents, Youth Programmes are now set up and managed by the young people themselves to implement a comprehensive prevention strategy.

4.4.        Involvement of churches and faith-based organisations in HIV/AIDS Programmes

4.4.1.     “Carrefour des Jeunes”

The Youth Programme of ECC is heavily involved in the struggle of HIV/AIDS particularly on Peer educators and Counsellors training and the syndromic management of sexual transmitted infections.

Peer educator training

In DRC, many provinces have benefited from this training. Figures written below are self explanatory.

ACCording to Emery Mpwate, the head of Youth Programme, despite the civil war that is prevailing in the East of DRC, resources are available to embark on the implementation of this programme in Bukavu, Goma and Kisangani.

Life-skills training

450 counsellors of whom 300 from Kinshasa and 150 from Mbuji-Mayi have been trained to acquire psycho-social skills that are likely to help them train youth and pastors.

4.4.2.     EVREJ-Congo

EVREJ stands for “Education pour une Vie Responsable et le Bien-Etre des Enfants et des jeunes au Congo”. EVREJ is a Christian Organisation with a vision to see young people fulfil their dreams and ambitions with respect for God and humanity. EVREJ has born from the fact that youth are fragile human beings. Without effective participation of adults especially parents, their development is quite impossible. Talking to these young people revealed that they had many goals, dreams and ambitions to achieve. Having HIV/AIDS meant to them that these aspirations would never be realised. For those other young people, living in the environment seemingly placed by HIV/AIDS, life was characterised by fear and a sense of bleak future.

In addition, young people are undergoing situation such as poverty, unemployment, poor or insufficient parenting, outmoded cultural beliefs and practices, gender bias, ignorance of life skills and Godlessness, all of which can cause increase in the spread of HIV/AIDS. They felt that some thing had to be done to restore hope where it might have been lost and to help young people develop a sense of purpose.

The objectives of EVREJ are:

· Education especially hygiene

· Biological determination of blood group, rhesus factor, G6PD, electrophoresis of haemoglobin and HIV testing

· Sexual education of children and youth in order to help them make informed decisions

· Syndromic management of Sexual transmitted infections

· Sensitisation of youth for blood donation.

Activities

Prevention activities

15 765 people of whom (3 153 parents) have been sensitised about the severity of HIV/AIDS. 3 000 young people have committed to abstain from sex. It seems that in communities where EVREJ is working, adolescent pregnancies would have decreased in 2001. However, a follow-up is needed to find out the effectiveness of the programme since it could be replicated elsewhere in DRC and beyond.

Voluntary Counselling and testing

In 2001, 1 699 young people were willing to undergo voluntary HIV test. 1 130 among them have been effectively tested and 11 have tested HIV positive. They have received pre and post-test counselling. 1 gentleman who tested HIV positive was taken fully in charge by EVREJ.

Blood donations

13 campaigns were organised. 1 699 blood units have been collected and distributed by the National AIDS Control programme.

EVREJ recognised that the above activities enable people to initiate change and sustain behaviour that promote a healthy state of mind, body, spirit and environment. EVREJ is not naïve, it recognised that behaviour change at individual and community levels in the present HIV pandemic is complex. However, an on-going process can bring the youth to the motto “today is time to act”.

4.4.3.     “Service Education à la Vie”

One method which “ Service Education à la Vie ” uses to help identify the project goals, purposes and strategies is to develop a problem tree after background information is collected. The problem definition or analysis requires an understanding of the context of HIV in the community.

Having gathered the information, the next step is to define the key problems that the community and the NGO want to address. “ Education à la vie ” has acknowledged that HIV prevention and care programmes are most effective if they are well planned and meet the needs of the community especially the youth. Last year, “Service Education à la vie” reached 1,250,000 people included parents and schoolchildren. 375 schoolteachers out of 800 have been trained in life-skills in Kinshasa.

Having recognised that messages are most effective when they are directed towards a specific population group and the behavioural options advocated should reflect the “ real life ” situations of the people to whom they are directed, “ Service Education à la Vie ” is working hand in hand with “Carrefour des Jeunes”, Muslim community, Catholic, Kimbanguist, Salvation Army and Protestant churches particularly in the areas of training of trainers and also in the implementation of HIV/AIDS youth programme.

4.4.4.     Union des Jeunes Catholiques

Union des Jeunes Catholiques and Union des jeunes Protestants (Carrefour des Jeunes) used to be working together during the nineties since funding agencies, HIV/AIDS Programmes and target populations were the same. At that time, the Catholic Youth message was based on the condom use as a mean of controlling HIV/AIDS and STI as promoted by secular organisations. But the Youth Programme insisted that the condom use does not protect people from sinful action. Therefore, young people were given information and opportunity to make informed decisions. In 2000, the Archdiocese of Kinshasa decided to transfer the youth HIV/AIDS Programme under the Auxiliary Bishop of Kinshasa. From that time up to now, the Union des Jeunes Catholiques has been weakened especially because of lack of funding and lack of physical infrastructure. The condom issue could have created this barrier that needs to be removed with another revolutionary approach to be shared within the framework of the Catholic network and beyond.

5.   HIV and Gender Issues

The discovery, that one is HIV positive is not only a major life crisis but also a very difficult fact to come to terms with. Many people living with HIV/AIDS especially women have indicated that it took them years to get in peace with themselves and personally aCCept the situation. People living with HIV/AIDS face stigma, even in countries known for their openness. In the context of HIV/AIDS, gender issues are insufficiently addressed in DRC church settings.

In DRC, it is said that traditional culture, customs and religion are two social institutions that have promoted the poor relationship between men and women. The church is said to be a male dominant institution that oppresses women. Therefore men are the main beneficiaries from that oppression. The key issue is what role the church of the 21st century can play to address these attitudes that jeopardise the status of women in the context of HIV/AIDS.

HIV/AIDS generally erupts in times of crisis. Central Africa in general and DRC in particular, like most other developing countries, are in the throes of economic and political turmoil. Per capita incomes are ranked among the world's lowest. For instance, the average is estimated at $:70 per year in DRC. Average figures mask wide disparities in wealth. Many families in Kinshasa eat only once a day and malnutrition is widespread.

Women are impoverished by the dominant social, economic and cultural orders that define their lives. Very often, women are forced into sexual relations with men in circumstances that deny them the right to protect against HIV infection. This is true both within and outside marriage. Because of wars and armed conflicts, the risk of sexual violence increases dramatically. There are large numbers of mobile, vulnerable and unaCCompanied women who become easy prey for rapists especially in Eastern part of DRC (UNDP, 1999).

Even in church settings, given the low status attached to women, they are ill-equipped to negotiate safe sex and to deny sex to an unfaithful partner. Behavioural change is essential. Fidelity is not considered a virtue among men, and it is estimated that between 60% and 80% of women currently infected with HIV in sub-Saharan Africa have had only one sexual partner (UNDP,1999). It is known that churches condemned prostitution from the pulpit, but bearing in mind that it is an economic choice and the income derived feeds children, churches should use neutral and unbiased language to address sexual issues particularly for sex workers who are abandoned by the churches in order to save from getting infected.

Neutral language will help lead to more open discussion. Sex means different things to different people, and its meaning often varies by culture. In DRC, sexuality can be used to show feeling, have children, provide physical relief, gain a sense of closeness or attractiveness, or be a mean of getting money or fulfilling an obligation. With an open mind, churches can develop an understanding with each person that can likely lead to a free discussion about sex and gender issues and plan meaningful actions aCCordingly.

Interesting programmes that target men and women to confront their role in the marginalisation of people living with of HIV/AIDS are “ Femmes PLUS and Papas PLUS”

Femmes Plus

In DRC, women living with HIV/AIDS face isolation, rejection and discrimination. They are aCCused of being the source of infection within households even if the opposite is very often true. The general public ignore and blame them as they are regarded as useless people with short life span.

In addition, options of health care, relationship, and career development are greatly restricted. For instance, PLWHA lack treatment and option thus even die early from a curable disease. Employment chances are few, and if chosen, fellow workmates discriminate against them and end up losing jobs through unfair dismissal. Even one's personal life in terms of relationships becomes affected, friends run away, and families give no support.

To overcome these difficulties, Femmes Plus methodology includes: Counselling, food supplement, Information, Education and communication, treatment of opportunistic infections, referral system and Training of volunteers'. 22 Women living with HIV/AIDS are encouraged to live positively within the project.

Femmes Plus is seeking additional resources to expand its programme to all provinces and is calling upon men's involvement in the fight of HIV/AIDS. What is encouraging, is that Femmes Plus is to be found in some provinces particularly in the oCCupied territories (rural areas) which are often neglected with regard to HIV/AIDS. Therefore, Femmes Plus is meeting a real need.

Papa Plus

Denial, blind panic and victim-blaming have been among the men's worst responses in DRC. In addition, there is a lack of relevant structures that are likely to give social support to men though DRC is a male dominant society. The objective of Papa Plus is to encourage men to reflect critically on themselves as many of the practices of men contributes to the spread of HIV/AIDS. Papa plus is distinguished by its determination to act, innovate and to lead through examples and encouragements:

5 antenna have been established in some clinic settings in Kinshasa.

15 awareness campaign of social mobilisation and testimonies of people living with HIV/AIDS have been held

6 social assistants have been trained in guiding reproductive health and rights, which is being handled by two sectors of life skills training and health education (counselling) for HIV positive people

The spirit of volunteerism is compounded in the project for sound strategies of restoring lives of the people threatened with HIV/AIDS

This organisation has adopted a very practical approach to involve men to contribute to the decline in the spread of HIV/AIDS within their own forum. Monthly meetings are held where men who are HIV positive give testimonies. This is unusual in DRC. Initially, Papa Plus encountered increasing resistance from some men feeling their gender threatened. However, the growth of the organisation and the interest that has been aroused among the general public contribute to the de-stigmatisation process.

6.   Involvement of Churches in Training Clergy and Laity in Counselling of HIV/AIDS Infected and Affected

HIV/AIDS continues to be a major issue and the prevalence is on the increase despite some efforts to contain it in DRC. It is clear that many challenges lie ahead in the fight against HIV/AIDS and renewed multi-sectoral efforts to include religious organisations become imperative. Religious organisations are mostly community based. No other organisations gather thousands of people at least once a week. If religious institutions are inspired to reach out their members and talk openly about HIV/AIDS, we would have an enormously powerful tool in advocating preventive measures and care.

However, clergy are ill equipped to deal adequately with HIV/AIDS in a counselling set-up. On one hand, many of them acknowledge having insufficient knowledge about the disease and its impact on affected families. On the other hand, clergy admit having ambiguous personal feelings about the dreadful virus, the disease and the sufferer. The question is how they can manage to be effective in the struggle of HIV/AIDS given their emotional feelings and their insufficient know-how.

Most of clergy who are currently in leadership position were trained before the outbreak of HIV/AIDS. Therefore, they were not given training in pastoral counselling for HIV/AIDS and care giving for the people they serve. Although, HIV/AIDS requires a pooling of energy and creativity from every society, very often clergy lack empowerment and knowledge. A large number of clergy claim never to have seen an AIDS patient even though they bury friends and relatives who died from AIDS. What is termed denial may be simply misunderstanding imposed by lack of education. That is why perhaps they partially work in isolation. Subsequently, many churches are reluctant to speak out about HIV/AIDS and they fail to be in the forefront in breaking the silence.

Doctors and nurses need help to increase their tolerance and compassion to people they are unable to heal. People living with HIV/AIDS should be treated as full human beings rather than statistics . Health professionals often hide their inadequate care towards people living with HIV/AIDS behind their so-called busy schedule. To overcome these shortcomings, “ Holistic Approach to Health and Healing ” is required.

This programme has been implemented in Vanga Hospital, Bandundu Province. The programme involved a considerable amount of counselling and seeks to involve both health and community workers to work hand-in-hand. It enabled counsellors to be trained in DRC and beyond. Communities involved felt empowered by the process. Unfortunately, the project ceased when donor funding ended and in addition, the American medical doctor who was the person responsible for the project went back home.

The Salvation Army operates a training camp near the International Airport of Ndjili. War displaced people namely young girls, widows and women living in difficult situations are given psycho-social support. Youths who benefited from the programmes are encouraged to become peer educators as they are more likely to sympathise with them. 200 women out of 700 have left the refugee camp since they are able to sell crops etc. because of the micro-credit that they received from the Salvation Army. This is an interesting programme worth recommending.

7.   Care and Prevention Services

7.1.  Voluntary Counselling and Testing

Prior to 1999, no government centre offered voluntary counselling and testing services to the community outside the medical facilities. Testing was offered at the Blood Transfusions centres for donors. In many instances, private laboratory testing after referral from a private Medical Practitioner was extremely very expensive 10 US$.

In 2000 a collaborative effort between Government, PNLS and GTZ launched 4 health centres for testing. Previously testing was only performed with ELISA test. Recently the rapid test was also introduced.

In antenatal clinic, group counselling on Mother-to child transmission is given to all pregnant women in the form of health education during antennal visits. A notable example is Kingansani health centre , most of the nurses were trained by the GTZ staff during 10 days within the health centre premises (2 hours per day especially in the afternoon when they are less busy). The aims of this training were:

· to uproot the fear attached to HIV infection

· to familiarise them with various kind of problems that are found in HIV infection

· To develop empathy for people living with or affected by HIV/AIDS

The following sub-themes were developed:

· How HIV is and is not transmitted?

· HIV and safe medical practices

· Child nutrition in the context of HIV/AIDS

· Confidentiality and stigmatisation issues

· The importance of VCT

There is an apparently low uptake of counselling which is assumed to be due to the heavy workload of the nurses, lack of privacy during counselling, stigma both within and outside the clinic and a lack of aCCess to low-cost infant formula.

During the recent workshop organised by PNLS with UNDP support, it was recommended that testing services should be introduced at all mission hospitals. This is being currently considered, as Christian medical facilities would be the right places to offer such services. Some Mission hospitals have already suCCessfully initiated VCT.

In Binza Health Centre, the Catholic sisters who are responsible for the health centre recommended for training 2 social assistants who have already been collaborating with them as volunteers in the family planning programme. Subsequently, they received a 3 weeks training on HIV and STI counselling in specialised clinics organised by “Médecins Sans Frontrières” in Kinshasa. In addition, a gynaecologist went on the ground in order to work closely with midwives for 2 weeks in order to help them strengthen their capacities to promote safe motherhood.

VCT is increasingly integrated in routine activities of the above two health centres. Nurses are encouraging pregnant women to be tested. However, the programmes are not yet fully integrated in pre-school settings where girls of childbearing age could be targeted.

7.2.  Prevention of Mother-to-child-Transmission (PMTCT)

As mentioned elsewhere, In DRC the HIV prevalence among pregnant women varies between 3-11% and the mother-to-child transmission stands at 25-30% in the context whereby breastfeeding is the cultural norms. ACCording to the National AIDS Control Programme (PNLS 2000), the number of children suffering from AIDS has increased from 8 to 16%. Therefore, PNLS estimated at 42,000 the number of infected children per year. The routes of transmission are presented in the table below:

Table 8: Routes of Mother-to-child Transmission

Source: UNICEF, 1999

“The prevention of mother-to-child HIV transmission should be part of the minimum standard package care for women who are known to be HIV infected and their infants. Implementation of any of the anti-retroviral prophylaxis regimens shown to be effective in randomised clinical trial can be recommended for general implementation. There is currently no justification to restrict use of these regimens to pilot project or research settings.”

WHO Technical Consultation on behalf of the Inter-Agency Team on MTCT of HIV
Geneva, (October 2000)

With GTZ support, MTCT project has started in Kinshasa with mandatory of offering PMTCT therapy. Examples are from Kingansani and Binza maternities , which are densely populated slums where Catholic sisters operate.

Source: GTZ report from 1 st December 2001 to 31 May 2002 (unpublished data)

Apart from the two Mission health centres, very few churches have been involved with the provision of MTCT. These two health centres are doing a good job since nearly 45% of all pregnant women who went for antenatal clinic aCCepted to be voluntary tested within a country where people are still reluctant to speak openly on HIV/AIDS.

ACCording to Dr Richard Matendo, (GTZ, PMTCT), the dire social consequences of VCT on pregnant women are:

“Although many pregnant women who attend antenatal care aCCept to be tested, a few of them can easily tell their husbands or any other relatives that they did so unless they are told to be HIV negative afterwards. In so doing, they feel proud to know how to improve their own sexual behaviour in order to avoid HIV infection. On the contrary, (when they test HIV positive): how is my husband going to react? This is the usual question. Most of them fear divorce, stigmatisation and discrimination within the family and beyond. For instance, one of the HIV+ women followed recently by GTZ in Kinshasa has been rejected not only by her husband but also by her own family. She would be homeless and ready to commit suicide right now if a local Church had not been compassionate and given her all the social support that she needed.”

It has to be mentioned that this PMTCT programme is only based in Kinshasa. There is a great need for these services to be extended into the rural areas, where most of the population live and where the churches settings are well placed to take up this challenge. Therefore, the need for national coverage is documented and the voice of church related institutions to advocate and lobby for these services should be taken into aCCount. Hopefully, PNLS, UNICEF, UNAIDS and SWAA are looking forward to initiating and implementing PMTCT programme in Bas Congo Province.

7.3.  Christian Hospital Care

7.3.1.     Kimbanguist Hospital

FRASKI (Simon Kimbangu Fraternity) and the Medical Department are caring for 30 people living with HIV/AIDS and 20 affected. Food, spiritual and psycho-social supports are provided by trained counsellors.

Comments

Many clients, especially women who tested HIV(+), find it difficult to discuss HIV/AIDS and STI issues with their partners because partners do not believe they have a disease particularly if they have no symptoms. In consequence, they refuse to come for treatment. The Kimbanguist Hospital has earned a good reputation for maintaining HIV confidentiality that is why many clients use its health services for testing, treatment and counselling.

7.3.2.     Centre Bomoto

Reproductive tract infections and sexually transmitted diseases are an important public health concern particularly in Kinshasa. It is well known that people who have STI are at increased risk of becoming HIV or transmitting HIV to their partners. ACCording to the Director of Centre Bomoto , many people, particularly women, who have STI do not receive proper care and treatment for the following reasons:

They may have symptoms, but they do not identify themselves as such. Many women lack information about normal vaginal discharge. Some women have had an infection for so long that they think symptoms are normal.

Centre Bomoto stressed that many clients suspect they have STI, but they do not seek care because:

· They dot not recognise the seriousness of STI

· They are too embarrassed to attend clinic

· STI carries a social stigma.

· They have not aCCess to treatment

· They cannot afford treatment

· Most clinics are not youth-friendly

Centre Bomoto was created to gain clients' confidence particularly women and youth, for discussing problems related to sexual and reproductive health. Since most clinics where Bomoto is used for referral systems were found not youth-friendly because of health worker's judgemental attitudes towards sexually active youth that have contributed to poor uptake of reproductive health services among young people. Currently STI management including treatment is delivered in Centre Bomoto premises in order to break down barriers to youth that prevent early diagnostic and treatment. In 2001, 1,046 adolescents attended the clinic using syndromic management approach.

7.3.  Care of AIDS Orphaned Children

7.4.1.     AIDS ORPHANED CHILDREN IN DRC

ACCording to the National AIDS Control Programme, the Democratic Republic of the Congo has an estimated 811,000 orphans whose one or both parents have died of AIDS. In a recent report, the programme said that the pandemic has increased the number of street children in the vast country urban centres. With the all socio-politico-economic problems that this country is facing the need for strong action is urgent and must be country-wide.

The DRC made early gains in the fight against AIDS. In the 1980s programmes were started to educate the people and promote the use of condoms. Targeted programmes were started with prostitutes and high-risk groups. As a result of these programmes, the HIV positive rate was held down in the urban areas and reduced in some high-risk group populations.

In the 1990s many of the programmes started in the 1980s closed down or greatly reduced their activity. It is not clear what is happening with HIV/AIDS at this time. With the level of poverty the highest it has ever been in DRC and the extreme decline in health services, it is assumed that HIV/AIDS is much worse than estimated. Additionally, children who survive from wars end up as orphans with no skills to face the challenge in life. Prostitution becomes the most likely way out especially for girls and the vicious circle of HIV/AIDS spread is perpetuated. This is why Bethsaida Centre and Amo-Congo are aiming to break the vicious cycle.

Bethsaida Centre

Reverend BIANSIMA LALA has set up an orphan programme in the suburb of Kinsuka.

Main activities

Advocacy:

The project is helping 100 orphaned children who are given school fees from a German Mission. Without this financial support, most of these children would be vulnerable to HIV/AIDS since they could not be able to embark on training. However, the project should foresee mechanisms of sustainability once the foreign aid is gone.

Prevention

Bethsaida Centre has trained locally 5 teams of counsellors. From January to April 2002, they sensitised 2'470 persons in many ways. They have been welcomed by most host-families since these visits were done purposefully for the follow-up of orphans in their home environment.

Care and support

Health cares have been provided to orphans who are suffering from opportunistic infections.

AMO-CONGO “Avenir Meilleur pour les orphelins”

In order to mitigate the impact of AIDS on poverty and to reduce to some extent the impacts of AIDS on households, publicly funded programmes to address the most severe problems are needed. However, the political will and commitment to address this issue is lacking.

Amo-Congo (a private NGO) has included home care for people with HIV/AIDS, support for the basic needs of the households coping with AIDS, foster care for 5000 AIDS orphans, food programmes for children and support for educational expenses. Amo-Congo is helping families particularly widows and children survive some of the consequences of an adult AIDS death that oCCur when families are poor or become poor as a result of the costs of AIDS.

Recent Amo-Congo activities included the development and provision of free voluntary counselling and testing services, free treatment protocols for sexually transmitted infections, promotion of comprehensive training and income generating scheme. However, Amo-Congo should assess what it would cost for the benefits of the project to continue beyond donors' involvement. I reminded the project manager to reflect on how funding will be obtained to meet these costs if for one reason or another the project is to be handed over to local community.

It makes no sense at all to expect that pharmaceutical and diagnostic companies in developed countries should produce medical devices and drugs for free. The fight against HIV/AIDS must be a sustainable business for every one involved in terms of economically viable arrangement which is long lasting and self sustaining.

Street Children

DRC has been the hardest hit country due to lack of adequate HIV/AIDS control measures, buttressed by war and poverty. This has lead to increasing street children who are well known in DRC. In vernacular language, Street children are called “ chegge ”, “phaseurs” and “ Londonienne.”

The first category of street children are those who decided to make streets their living rooms for several reasons including financial hardship, poverty, family breakdown etc.

The second group is those who drift to the street during working hours. The money earned helps them partially assist their families with whom they remain in touch somehow. Sometimes, phaseurs come from extended families where life conditions become so unbearable that the hardships and potential dangers of the street are the only option to be chosen.

The third group consists of vulnerable young girls and women who have to sell themselves and their sexual favours as a coping strategy. However, I should say that the above categorisation of street children is complex. By experience, I saw some children running away from fairly respected and middle class families in order to join street children probably because of peer pressure. This warrants further exploratory studies.

The needs of street children are vast and growing. The experience of malnutrition, lack of education, marginalisation, inadequate supervision, and increased poverty and reduced opportunities will have decades-long impacts on street children in the societies in which they live in. To overcome these difficulties, some street children programmes provide basic services.

On one hand, Catholic Relief Services make sure that basic needs are met for them e.g. schooling, medical care, immunisations, love, warmth, etc. On the other hand, most NGOs working under UNICEF's funding are offering services that aim at facilitating reunification and reintegration of street children from the street into the communities from where the children have come from.

It is grounded and driven by the conviction that children and adolescents living in AIDS-affected communities have the right to protection, and appropriate care and support. In DRC, the responses to date have been fragmented, uncoordinated, and small scale. There is an increasing need for a sound principle guide for an effective action at local, district, provincial and national level in the development and implementation of expanded and comprehensive initiatives that meet the needs of vulnerable children and adolescents.

8.   Other

AJIC,” Association des Jeunes vivant avec le VIH/SIDA au Congo”

The youth represents an increasing percentage of HIV infections globally. The impact on young people is proving far worse than anticipated. In 2000 alone, some 53,000 children under 15 were infected with HIV in DRC (UNAIDS, 2000). But young people are also among those who act first and most decisively. Among 220 tested HIV positive in a local hospital after VCT, 32 youths trained to date are living positively under AJIC. 5 of them would have killed themselves after HIV testing. They have been hopefully saved by their colleagues. They are committed to support the design and conduct behaviour change activities targeting them. In addition, they are sharing experiences, concerns, curiosities and solutions for reducing their own sexual behaviour risks. Meaningful involvement of youths in peer counselling is critical in creating an enabling environment for traumatised youths. It also provides a supportive environment for sharing and learning.

ALPI+ “Association pour la Libération des Personnes Infectées”

ALPI's concern is to provide replies to exclusion, solitude, and despair and restore the social link of patients. Meetings are organised between people living with HIV/ANDS so that they get to know each other, break out isolation and share their experiences. The objectives of ALPI+ have several components as follows:

· Promoting the dignity and self sufficiently of people infected by HIV

· Promoting early screening for HIV/AIDS

· Educating women and young in the prevention of HIV/AIDS

· Promoting income-generating activities to improve economic aCCess to health care

· Promoting psychosocial and medical care of people living with HIV/AIDS

· Distributing food and clothes to people in great need

RCP+ “Réseau Congolais des personnes vivant avec le VIH/SIDA”

In many communities, people still blame circumstances or others for being the cause of their suffering. Such statements like “it's the government”, “it's my wife or my husband”, “it's peer pressure”, “I was bewitched” are common. People are still pointing fingers. In its efforts to prevent further infections, RCP has set up the space for people living with HIV/AIDS to receive medical attention, counselling and support, pastoral care and possibly financial assistance to be able to cope with the situation.

Conclusions

My first conclusion is that the involvement of churches and church related institutions in the struggle of HIV/AIDS is a brave effort to raise clergy and laity awareness in order to help them contribute in the control of HIV/AIDS. However, the clergy is currently ill-equipped for an effective HIV/AIDS control. Clergy end up with inaCCurate data and only half of the message partially because of the reluctance to break the silence on sex and sexuality issues.

Since HIV/AIDS is a development issue that has damaged economic and social aspects in DRC, it is helpful that the necessary messages are aCCurately given. Clergy should play a crucial role in the control of HIV/AIDS if in service-training about the disease is provided and if they fully understand that teaching HIV/AIDS is a key part of clergy's duties in this HIV era. It is imperative that the church employs a holistic approach to address the problem.

In addition, currently individual churches are trying to implement HIV/AIDS activities. The major focus has been awareness raising through public campaigns. Much can be gained through the commitment of churches to expand, integrate and intensify response of all churches and church-related institutions to take actions, increase resources and build up their capacity to sustain their efforts to slow down further spread of the epidemic.

Next, church leaders can play a very vital and prominent role in influencing attitudes and behaviour of the general public in order to reduce the stigma, the shame, the rejection and blame that are attached with HIV/AIDS and that add extra layer of sufferings to the already infected and affected by HIV/AIDS.

Moreover, HIV infection in many church settings has not been taken seriously for a long time, so I find it most salutary that some churches are now determined not to repeat the mistakes of others especially the current situation in which many people have no knowledge of their HIV infection status. This means that many millions are falling prey to the virus every day. Indeed, churches can assure that the knowledge of the individual HIV status is provided to every citizen on a voluntary basis, but in a completely confidential context that eliminates any chance of stigmatisation.

Furthermore, as is evident from the statistics provided elsewhere, the HIV/AIDS epidemic now kills many family breadwinners, undermines business, creates orphans and decimates the workforce. It is an illusion to assume that wars and natural disasters will vanish from the earth. Therefore, the new streams of AIDS related refugees and orphans must be added to those already existing.

Finally, during the mapping exercise I found that most of churches policy-making organs are clergy dominated with minimal involvement by professionals even from their own congregations. However, AIDS is a technical issue calling for a professional approach. Therefore, the church should look beyond its traditional structures and approaches in order to become an effective player to combat the disease. Subsequently, a decisive response will not only call for theological input, but for social and medical skills in a vigorous and holistic manner through positive and effective prevention and curative measures.

Even though most churches have reacted against the condom, it has to be mentioned that they failed to vigorously teach and promote abstinence holistically. The churches have been silent when it comes to talking about human sexuality with or without AIDS. To repeat simply the commandment “thou shalt not commit adultery” is not enough without theological rationale of human dignity and sexuality as purposeful gift of God. Therefore, theological and ethical thinking is needed for church leaders and their congregations to speak honestly about HIV and AIDS and to act practically in response to it.

In the light of the findings, the following issues need to be made to improve the church based HIV/AIDS control:-

Clergy/Church leaders or church policy makers

Policy

· Prior to embark on any HIV/AIDS project, a situational analysis with community participation is required to make sure that the project will belong to the community since it is socially and culturally aCCepted

· HIV/AIDS related stigma continues to inform perceptions and shape the behaviour of people living with HIV/AIDS. Churches should develop policies to combat discrimination and rejection

· Each congregation should develop its own policy in the light of its beliefs within the context of Christian fellowship

· Too much time has been wasted in discussing condom issues and too many lives have been lost. A realistic compromise of the condom issue should be adopted

· Every church leader must personally break the silence about the norms and practices that fuel HIV/AIDS epidemic. A church leader seminar is needed!

· Clergy are ill prepared to deal with HIV/AIDS in a counselling set-up. Training in HIV/AIDS needs to be incorporated in theological and biblical colleges.

Congregations

· Clergy need to teach on the biblical verses that encourage and support people infected or affected by HIV/AIDS rather than criticise and condemn

· Congregations should look at the social, cultural, traditional and theological understanding of HIV/AIDS issue in the light of God's grace

· Congregations need to be equipped in pastoral care and social ministry

Communities

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

· Should be involved in a common struggle to overcome HIV/AIDS, with actions and strategies that combine all members and component parts of the community resulting in a true partnership

· Emphasise men's responsibilities towards women and girl children

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

· Need to be trained in counselling and home based care approach

· Need to understand that the struggle against HIV/AIDS will be won by communities; in every family, village, township and settlement across DRC partially if volunteers and caregivers are given community support

· Should understand that people living with HIV/AIDS are human beings in full possession of their human rights. Therefore, they must be valued as a resource and as crucial allies in the struggle to overcome HIV/AIDS.

Counselling

· In many church settings, there are no counsellors per se , but several different staff members such as clergy, laity, health professionals etc. share in the counselling process. Therefore, all staff members and community workers who provide counselling on a regular or oCCasional basis should be provided with appropriate training on counselling and basic communication skills.

· There will be an increased need for counsellors, especially if anti-retroviral drugs become available for those testing positive

· Wherever counselling takes place, whether at the home or in the clinic, it must be held privately and confidentiality should be given priority since the major barrier of VCT is stigma.

· Counselling is part of the education process: VCT should be encouraged at every opportunity

· Promoting VCT for behavioural change as a prevention strategy alone will have limited impact without quality and/or referrals for those who test HIV positive

· Pre-marital counselling and testing is highly desirable with appropriate counselling

· For discordant couples, there is no place for divorce except in case of infidelity. Enrichment courses for couples to maintain marriage are needed

· Pre-counselling, on-going and post-test counselling are essential

· Ongoing counselling is known to help individuals to aCCept their HIV status and develop positive attitude. Disclosure, however, is still a very difficult process. Therefore, psychosocial support should be provided at clinics, schools, and communities and in church settings.

Advocacy

· Peace is an essential pre-requisite for effective programmes against HIV/AIDS. The extent of ongoing war in DRC seriously undermines any realistic programmes to combat HIV/AIDS especially in the oCCupied territories. It is imperative that church leaders in collaboration with Government take decisive steps to create and maintain peace and security in DRC and the Great Lakes Region

· Leaders of faith-based institutions should be effective in calling upon government for openness and political commitment to the promotion of preventive measures and the provision of care.

· It is the duty of religious institutions to inspire and mobilise other institutions such as local, foreign funding agencies and religious institutions in the North to assist and support their brothers and sisters in the South. Therefore, the church should have a united voice to lobby for more resources.

· The church should lobby for the promotion of national conscience to reduce stigma hence helping people to take Voluntary Testing and Counselling

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

Networking

· The National Inter-faith Council Alliance that has been recently created should be strengthened with the right leadership and the required resources in order to make the fight of HIV/AIDS by FBO their top agenda

· There is a need for better quality information ( aCCurate and timeous) for churches to collaborate with the Government and UN agencies

· Best practice (on what works, how, why and so forth) should be shared among churches and church related institutions etc.

· One particular challenge to address is the tendency of governments and churches to regard each other with suspicion, which often hinders opportunities for collaboration.

Social services

· To date, the response to Orphans and vulnerable children has mostly come from women and NGO who respond by visiting orphan household, establishing income-generating projects and sending children back to school. Adapting and replicating many of these initiatives in church settings can help protect and support greater number of vulnerable children.

· Orphan care should be in response to community action undertaken with local resources. This type of targeted assistance goes hand-in-hand with community capacity building.

· The target population should include child-headed households, widows, grandparents, orphans and youths. The goal is to develop the capacity to be self-supporting

· Church and church related institutions should reach HIV positive children with adequate medical attention to alleviate their suffering and reach adolescent with information about infection prevention and actions they take to manage their HIV infection.

Donor community

An NGO can achieve wider impacts in many ways including expanding its operations; introducing or developing technologies which spread, developing and using approaches which are then adopted by other NGOs and/or by government, influencing changes in government and donor policies and actions; and gaining and disseminating understanding about development.

Robert Chambers

· Although churches are truly constituency-based organisations which are committed to working with their communities, churches will find it difficult to meets the needs of infected, affected by HIV/AIDS and uninfected within their own congregations. Church should act as conduits, monitors and evaluators in HIV era. However, the challenge that most funding agencies are facing is finding out a reliable and aCCountable conduit!

· The traditional partnership between churches and ecumenical organisations of the North and the South does not seem to take into aCCount the new dimensions of HIV/AIDS control measures. A variety of country or regional HIV funding programmes exist locally. However, many churches have the tendency to turn to their traditional donors with their church alone. To suCCessfully resolve a problem of high HIV/AIDS prevalence, churches need to open new avenues for additional potential donors and resources.

· The customary attitude of international organisations and donor countries that still requires that all developing countries should follow the donor's prescribed guidelines without taking into aCCount the local HIV/AIDS context should be replaced by an open and fruitful dialogue between the North and the South in mutual respect and consideration.

· Research should be encouraged and sustained in order to get a better picture of people's knowledge, attitudes and practices about the HIV/AIDS realities in DRC and beyond in order to plan and implement strategic interventions.

Abbreviations

AIDS            : Acquired Immune Deficiency Syndrome

ANC              : Antenatal care

AJIC             : Association des Jeunes vivant avec le SIDA au Congo

ALPI             : Association de Libération des personnes infectées par le VIH

BDOM           : Bureau des oeuvres médicales

DRC              : Democratic Republic of Congo

ECC              : Eglise du Christ au Congo

EVREJ           : Education pour une vie responsible et le Bien-Etre des enfants et des Congolais

FBO              : Faith-Based organisation

GDP             : Gross Domestic Product

GTZ              : German Technical Cooperation

HIV              : Human Immune Virus

IEC              : Information Education and Communication

IST              : Infection Sexuellement Transmissible

MTCT            : Mother-to-child transmission

NACP            : National AIDS Control Programme

NGO             : Non Governmental Organisation

PMTCT          : Prevention of Mother-to-Child Transmission

PNLS            : Programme National de Lutte contre le SIDA

RCP              : Réseau Congolais des Personnes vivant avec le VIH

SANRU          : Santé en milieu rural

SWAA           : Southern Women African Association

TB                : Tuberculosis

UN               : United Nations

UNAIDS        : United Nations Acquired Immune Deficiency Syndrom

UNDP           : United Nations for Development Programme

USAID          : United States Aid International Development

VCT              : Voluntary Counselling and Testing

WCC             : World Council of Churches

WHO            : World Health Organisation

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