Forum Highlights Progress in Combating HIVBy 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.
"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 accomplished.
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.
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 transition.
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 life.
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.
"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 followed.
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.