Release date
October 17, 2009
Michael Hill
Communications Officer, Sub-Saharan Africa
Baltimore, MD

Forum Highlights Progress in Combating HIV

October 17, 2009, —

By Michael Hill

Dr. Joe O'Neill began his talk on the progression and

successes of HIV care by paraphrasing one of Christianity's most revered saints.

Dr. Eric Goosby

Dr. Eric Goosby, the U.S. global AIDS coordinator, addresses attendees at the CRS HIV Continuum of Care Forum. Photo by Jim Stipe/CRS

"St. Francis said a long time ago that you start out

doing what's necessary, then you do what's possible, and someday you're doing

the impossible." O'Neill is considered the architect of the President's

Emergency Plan for AIDS Relief (PEPFAR), the Bush-era initiative that is

responsible for saving millions of lives around the world, particularly in Africa.

He was addressing Catholic Relief Services' forum on continuum of care for

people with HIV, held in Washington, D.C., over two days in September.

"If you think back to where we were 10 years ago,"

O'Neill said of the days before PEPFAR when AIDS was ravaging Africa, when a

diagnosis of HIV was considered a death sentence, "what we

are doing is the impossible."

Indeed, a decade ago, the idea that so many people in Africa

would be alive and living normal lives even while HIV-positive seemed beyond impossible.

But that is what PEPFAR funding, in the hands of agencies like CRS, has


Continuum of Care

The forum, which attracted nearly 200 people, showed that

doing this impossible work is not just a matter of handing out the lifesaving

antiretroviral pills that PEPFAR provides and expecting patients to take them.

That approach doesn't work anywhere and is especially ineffective in the

developing world where patients might be desperately poor. They barely find

enough to eat to stay alive. Gathering the extra food necessary to make their antiretroviral

drugs safe and effective is often impossible. Some with HIV are crowded in

horrific urban slums; others are spread out over a hardscrabble countryside.

For many, access to health care services can be limited at best.

CRS is part of AIDSRelief, a consortium of five institutions

that administers a $500-million PEPFAR grant in 10 countries, eight of them in

Africa. Using the knowledge of health care practitioners, the experience of

dedicated aid workers and the reach of the Catholic Church, AIDSRelief has a

very high percentage of HIV-positive patients who stay on their antiretroviral

treatment regimen and survive once they are on the medication—more than 90

percent. In fact, the percentage is higher than for similar programs in some

U.S. cities.

Focus on the Whole Person

The forum documented AIDSRelief's work in a series of panels

that showed how basing care in communities, paying attention to details, and

keeping the focus on the whole person—not just this deadly virus—can lead to

tremendous success.

Christina Kateyaka and Danny Lundu

Christina Kateyaka and Danny Lundu are both living with HIV and attended the CRS HIV Continuum of Care Forum in Washington, D.C., in September 2009. Photo by Jim Stipe/CRS

In his welcoming remarks, CRS President Ken Hackett said

that Catholic social teaching informs all of CRS' work in the HIV area and is

fundamental to its success.

"We look at the economic, the social, the physical, the

cultural, the psychological and the spiritual dimensions of people, and we plan

our interventions with this complex reality in mind," Hackett said.

The respect for CRS' work in the HIV arena was evident from

those who came to speak. O'Neill was preceded by Dr. Robert Gallo, the

co-discoverer of HIV whose work provided the first results that showed that HIV

was the cause of AIDS. As director of the Institute of Human Virology at the

University of Maryland School of Medicine—one of CRS' partners in AIDSRelief—Gallo

continues to lead some of the most cutting-edge research in the field.

Gallo called the PEPFAR-funded work that CRS, AIDSRelief

partners and others are doing, "as noble and successful and historical a

program that I know of in the history of medicine."

'Voice to the Voiceless'

On the second day, welcoming remarks were given by Dr. Eric

Goosby, who as the U.S. global AIDS coordinator is essentially in charge of the

PEPFAR program that last year was renewed for another five years and $48

billion. Goosby called for using the PEPFAR model and funding to go beyond HIV

and AIDS treatment and build the ability of governments around the world to

take care of their own health care needs.

Later that day, a panel highlighted CRS' successes in

turning over control of our HIV programs to local partners.

"We should be doing all we can to make these projects

sustainable in local hands," said Ruth Stark, CRS' country representative in

South Africa. Stark had just overseen the handoff of the $50-million AIDSRelief

effort to the local partner, the Southern African Catholic Bishops' Conference.

South Africa is the first of the 10 AIDSRelief programs to make that


At the end of the forum, Michel Sidibé, executive director

of the Joint United Nations Program on HIV/AIDS (UNAIDS), greeted

participants at a closing reception. "You reach the unreachable," he

said of CRS' work on HIV. "You give voice to the voiceless."

Three beneficiaries of CRS' work in Africa, all living with

HIV, spoke at the forum. Christine Kateyaka and Danny Lundu told of their meeting

at an HIV counseling program in Zambia, getting on treatment and eventually

getting married. Their daughter, nearly 2 years old, has tested negative for

HIV. Tich, a 19-year-old from Zimbabwe, told of surviving his diagnosis and

going on to use his art to speak of his determination to lead a full and vital


Equal Access to Good Health Care

In other welcoming remarks on the second day, Dr. Robert R.

Redfield, who cofounded the Institute of Human Virology with Gallo,

emphasized how the work of AIDSRelief reflects Catholic social teaching's call

for "health equity"—the ability of all people of the world to access

good health care on an equal basis.

Redfield said that it is only faith-based organizations like

CRS—which has its foundation in the Catholic Church—that can make the

commitment to reaching health equity because doing that requires the type of

long-term view and long-term commitment that comes from faith.

Sample of Tich's artwork

Tich told of surviving his diagnosis and going on to use his art to speak of his determination to lead a full and vital life. Photo by Jim Stipe/CRS

"Today, most people don't believe that health equity is

an obtainable goal," he said. "You need organizations committed to

it, who see it at the end of the tunnel, even if that's 200 years from now."

Redfield said this would be a long struggle. "I believe

we need very effective partnerships of governments, faith-based organizations

and academic institutions if we are going to move toward the goal of health

equity," he said.

"We will not see it in my lifetime, or in my

grandchildren's lifetime," Redfield said. "But we do see it now in

the sacred faces before us, in one life at a time."

Commitment to the Whole Person

Michele Broemmelsiek, CRS' global director for AIDSRelief,

gave an overview of the consortium's work and said that its strength is due to

its faith-based approach. "This gives us a very strong commitment to the

community, to the whole person, the whole family," she said. "This is

a critical factor in our success."

O'Neill said that in the early days of formulating PEPFAR,

when he was in the Bush White House, he was determined to get faith-based

organizations involved, not because he wanted to push any faith—which he noted

would be improper for a government official—but because he wanted results.

During a visit to Zambia, he had seen the commitment and effectiveness of a

hospital run by the Salvation Army.

"Using faith-based organizations was the smart way to

get things done," he said, referring with pride to getting AIDSRelief—with

CRS as a major player—fully funded.

'They Said It's Impossible'

It all seemed to go back to that statement by St. Francis

that he quoted at the beginning of the two days, about moving from the

necessary to the possible to the impossible. O'Neill recalled his days working

in a San Francisco-area hospital in the early 1980s when patients with AIDS

first began appearing. Most survived only a few months.

"They said there was nothing you could do for those

people, that it was impossible," he said, then pointed to all the progress

that was made keeping those with HIV alive and healthy.

O'Neill then moved to an inner-city clinic in Baltimore

where most of those with HIV were poor African-Americans. "They said maybe

you can do something with people in San Francisco and Greenwich Village, but it's

impossible with this population," he said. But he got to work and success


Then the focus moved to the spread of HIV in Africa. "They

said maybe you can do something in developed countries, but it's impossible to

do anything in Africa," O'Neill said.

"Guess what? We did it."

Michael Hill is CRS' communications officer

for sub-Saharan Africa. He is based at the agency's headquarters in Baltimore.