Confronting the AIDS Crisis in Africa
by Negura Feli Katho and Richard L. Starcher
How one African denomination, the African Inland Church of Kenya, assumed its God-given responsibility in confronting the AIDS crisis in Africa.
Sarah dropped out of school at the age of fourteen because her parents were dying of AIDS. Not only did they have no money for her school fees, but they also needed someone to take care of them. Sarah was their oldest child. Her parents had been part of a large, active local church, but fellow members and church leaders looked upon them as lepers. After her parents died, Sarah did what she could to bring in money to support her younger siblings. Sarah, now seventeen, is HIV-positive. In a few years, she too will die, leaving her brothers and sister to fend for themselves.
AIDS is the number one source of orphans in sub-Saharan Africa and the leading cause of death on the continent. In 2003 alone, 2.3 million Africans died of AIDS. Another twenty-nine million are living with the virus. Sub-Saharan Africa lays claim to eighty percent of all AIDS deaths worldwide. A recent United Nations report estimates the number of children in sub-Saharan Africa having lost at least one parent to AIDS will reach twenty-five million by 2010 (UNAIDS 2002). AIDS-related patients occupy as many as sixty percent of the beds in Nairobi’s government hospitals. Although anti-retroviral therapy exists, most infected Africans die relatively quickly because they cannot afford the treatment.
Christians and church leaders in the West frequently ask, “Is the AIDS problem as bad as it is reported to be?” When they learn it is, they appear to assume the situation is utterly hopeless. However, God’s people need not stand by helplessly.
Unfortunately, many African churches and denominations are still doing little or nothing to help. One concerned African leader summarized the reactions of many of the continent’s churches. They fall into three categories: (1) they display condemning apathy because they see AIDS as God’s punishment on sexually immoral people, (2) they reflect helpless resignation because they are overwhelmed by the immensity of the problem or (3) they are willing to get involved but remain idle because they lack the necessary skills, knowledge, resources and courage. For a long time, virtually every African church fell into one of these three categories. More recently, however, individual congregations and entire denominations have begun taking action.
This article tells the story of how one African denomination, the African Inland Church (AIC) of Kenya, assumed its God-given responsibility with respect to the HIV/AIDS pandemic. It is our prayer that this church’s example will encourage others to get involved. We will suggest transferable strategies to make this happen.
A STUTTERING START
AIC-Kenya has over three thousand local congregations. It is divided into forty-eight regions, each region being divided into a number of districts, each district into branches and each branch into local churches. The denomination has more than twenty Bible training institutions ranging from universities to lay leader training schools, as well as Bible education by extension. It sponsors nearly four hundred secondary schools, and has about three thousand associated primary schools, a nursing school, twenty children’s homes, five hospitals and fifty rural dispensaries and clinics. It also has a printing press, radio station and recording studios. Yet as late as 1996, AIC-Kenya had no defined strategy for mobilizing these substantial resources to fight the AIDS pandemic. Like many churches, AIC-Kenya tended to stigmatize AIDS and ignore its victims.
While individual Christians and isolated groups within the AIC began to take action in the early 1990s, denominational leadership lagged behind. For example, in 1994, leaders at Moffat Bible School in Kijabe attempted to initiate a denomination-wide AIDS awareness program but failed to get the bishop’s permission. Nevertheless, they worked with MAP International to produce a curriculum for their own students. The curriculum had two courses: one theoretical and the other practical. In the practical part, the Bible college students went into seventh and eighth grade classrooms to prepare teenagers to take responsibility for their lives and to encourage them to have a good self-image. The goal was to teach them about family, friendship, peer pressure, their bodies, the reproductive organs, the transformations taking place in their bodies, their feelings, AIDS and how to become an AIDS-free generation.
In addition to the curricular efforts of Moffat Bible School, various unofficial AIC groups emerged to care for People Living with HIV/AIDS (PLWHA), look after AIDS orphans and educate the community at large. These efforts produced positive results. In 1996, the bishop finally agreed to introduce AIDS seminars into the official program of the denomination, without yet creating a structure to coordinate the assorted unofficial programs.
Some of the unofficial efforts attracted foreign funding. Interestingly, it was donor organizations funding the disparate AIC efforts that pushed them to coordinate their ministries. Hence, in 1998, taking into account the commitment of the informal groups, the positive results of their work and pressure from donors, the bishop agreed to place the various AIDS-related efforts under AIC’s health ministry department. In so doing, he merged all the individual groups doing AIDS education and other AIDS-related activities. An effective structure emerged. AIC expanded these groups’ ministries and added new programs.
AFRICAN INLAND CHURCH’S AIDS DIVISION
AIC’s AIDS division operates under its health ministry and has its central office within the church headquarters office. Seven people form the leadership team: a director, a coordinator, an administrator and four facilitators. Apart from the leadership team, each local program has its own team of workers corresponding to the nature of the program (coordinators, facilitators, educators, counselors, chaplains, nurses, doctors, workers and supervisors). Each region having gone through the training seminars has a coordinator and a supervisor. Each trained local congregation has two educators who facilitate ongoing training. AIC’s AIDS division is represented in the annual committee of the Church. They also give reports each year to the committee. The efforts of AIC’s AIDS division fall into three broad categories: (1) AIDS awareness, (2) AIDS prevention and control and (3) care of AIDS victims.
AIC-Kenya created AIDS awareness through church mobilization, education in schools and colleges and education of the masses (the community).
1. Church mobilization. AIC-Kenya mobilized its members through seminars and training sessions at various levels. The first target was church leaders. The first seminar was organized by AIC-Tanzania at Mwanza. The Kenyan leaders who participated in this seminar were so moved and motivated by the seriousness of the AIDS pandemic that they began inviting the AIDS trainers to teach in their respective regions. In each region, the team gave two seminars. The first provided facts and general information about AIDS in order to help people realize that AIDS was a dangerous reality. The second, six months later, allowed opportunity for feedback and provided greater detail about AIDS, self-protection, care of the PLWHA and planning for a program addressing the needs people had seen in their local churches.
Mobilizing local churches proved difficult. Some local leaders rejected the intervention of AIDS trainers and discouraged their members from getting involved. To overcome this obstacle, the AIDS division appointed a program coordinator who played the intermediary role between the central office and the local churches. He also planned activities and seminars in the various districts, branches or local churches. In addition, the AIDS division reported on community needs and regional successes at the annual gathering of regional church leaders. At these meetings, those who had not yet had seminars in their region often were persuaded to invite a team to make a visit. Hence, the church mobilization process was downward, from the central office to local churches.
2. Education in schools and colleges. AIC, in collaboration with MAP International, developed curricula for its Bible colleges, the nursing school and the children’s schools. It also promoted awareness in the community at large.
3. Curriculum for Bible schools and colleges. AIC’s Bible schools/colleges used the Choose Life curriculum for courses lasting two academic terms. The first term focused on the theoretical part of the training, and the second on the practical, whereby students went into local churches and/or primary schools to apply what they had learned.
a. The AIC nursing school. The nursing school also used the Choose Life curriculum to train students to provide pre and post HIV/AIDS counseling. AIDS trainers taught students to “enhance safe practices in respect to HIV/AIDS such as sterilization of equipment, disposal of sharp equipment, use of gloves, post exposure prophylaxis, management of S.T.I. [sexually transmitted infection] and issuing of condoms to spouses” (AIC Kenya 2004, 5).
b. Primary and secondary schools. AIC’s four hundred sponsored secondary schools and three thousand linked primary schools represented a wide field and required specific strategies. AIDS trainers first conducted seminars for the headmasters in order to convince them of the relevance of HIV/AIDS awareness as part of the school’s curriculum. They then trained teachers to use an AIDS curriculum entitled Why Wait? As in the case of certain church leaders, some headmasters rejected the program. In such cases, the AIDS division set up training centers or clubs for youth outside the school.
The AIDS division also used students from Bible colleges to teach seventh and eighth graders for one hour each week for ten weeks. This initiative had tremendous success, reaching thousands of children. The rate of pregnancy among primary pupils decreased. Some headmasters asked the team to return to their schools, while others asked them to provide instruction starting with fifth graders. Some students who had received this teaching in primary school introduced both the team and the program to their secondary school authorities so the training could continue at the high school level.
c. Community education. First, AIC reached out to the non-church community through a weekly AIDS educational program delivered by “Biblia Husema,” the AIC radio station. Second, wherever church leaders had AIDS seminars, they invited community leaders. Third, AIC hospitals contributed an important part to community education. They provided training for both sick people (HIV positive) and those who were well (HIV negative). AIDS teams working in hospitals taught people about cleanliness and disease (including AIDS) and how to take care of PLWHA without becoming infected. The same teams trained people to become community workers for PLWHA at home, especially those who were terminally ill. These community workers formed the team of a home-based care program.
AIDS PREVENTION AND CONTROL
Immorality was the first enemy AIC attacked. Through the above mentioned educational ventures, as well as through less structured efforts, the church promoted behavioral change, focusing both on young singles and married couples who were still HIV negative.
1. Denominational instruction and counsel. For singles, AIC upheld abstinence until marriage. No other option was entertained. During pre-marital counseling, couples were encouraged to take a voluntary HIV test. For married couples, AIC promoted purity and faithfulness in marriage, discouraged couples from living apart for extended periods of time and advocated monogamous marriages (in a society that condoned polygamy). The church promoted condom use in cases where one partner was infected and strongly recommended an HIV test if the cause of the death of a marriage partner was uncertain, especially if the remaining spouse was considering remarriage. AIC also opposed certain local practices, rites, rituals and ceremonies that might cause the spread of HIV, including wife sharing, wife inheritance, sexual cleansing and cutting the skin with non-sterile instruments.
2. Inadvertent infection prevention. Although AIDS facilitators taught that every individual needed to take responsibility for keeping free of HIV/AIDS, they also encouraged measures to avoid inadvertent infection, particularly in hospitals and health centers. They aimed at training at least “fifty percent of nurses and laboratory technicians in order to enhance safe practices in respect to HIV/AIDS such as sterilization of equipment, disposal of sharp equipment, use of gloves, post exposure prophylaxis, management of S.T.I., issuing of condoms to spouses [and] screening of donated blood” (AIC Kenya 2004, 5). AIC facilities also promoted Prevention of Mother-to-Child Transmission (PMCT).
3. Testimonies of people living with HIV/AIDS. Despite the massive publicity on HIV/AIDS in Kenya, many churches and individual Christians appear to live in denial of the magnitude of the problem within their own circles. One AIDS training facilitator described the attitude still prevalent in the churches:
AIDS is known as a dirty thing to be talked about—judgment from God, sickness of sinners; in this situation, who can say that he or she is [HIV] positive? Yet as long as people are keeping quiet, there is no way of having any help. The hard task we have is to help people overcome the stigma and show up.
AIC’s AIDS division developed a PLWHA network and appointed a coordinator to help PLWHA overcome the stigma of AIDS and empower them to testify in churches and at seminars. As teams traveled to give seminars, the coordinator arranged for one or two PLWHA to go along and share their experiences. The coordinator reported, “Through those people we can teach so powerfully…. As they testify, leaders are now realizing that AIDS is among them. We want them to know this reality that their members can be [HIV] positive as well as their children.”
CARE OF AIDS VICTIMS
AIC not only sought to prevent the spread of AIDS but care for infected and affected persons. The infected were people who were HIV positive or who had fully developed AIDS. The affected included family members of PLWHA, and, in particular, AIDS orphans.
1. Treatment and care of the infected. While no AIDS cure exists today, with proper care PLWHA can live substantially longer and healthier lives. AIC hospitals provided pastoral counseling, free treatment for PLWHA and affordable antiretroviral treatment. Many PLWHA took advantage of these services. As PLWHA were visiting hospitals, the AIDS team members taught them how to take care of themselves, how to live with their family members without contaminating them, what to do at home when they were sick and when to come back to the hospital. Moreover, the hospitals trained community workers to care for and support PLWHA at home.
2. Assistance for the affected. Regarding affected people, AIC focused particularly on orphans. First, the church helped patients dying from AIDS prepare wills and decide how their children were to be cared for. After the parents’ death, the church sought to ensure parents’ wishes were respected and their orphans were not exploited or abused. Second, the church sought to help the extended family or older siblings care for children left behind. Third, AIC ministered directly to orphans. One facilitator reported, “We start giving money for children who were in need. As we go to schools we identify the most needy, the orphans. We take food to them.”
LESSONS FROM AIC’S AIDS MINISTRY EXPERIENCE
While far from perfect, AIC-Kenya’s AIDS initiatives are nonetheless commendable. Its successes, failures, strengths and weaknesses all contribute to a better understanding of how African churches and Western friends can get involved in fighting this modern plague. We offer the following three tips for developing an effective AIDS ministry.
1. Encourage individual initiatives. While it would be easy to criticize denominational leaders for not seizing the initiative, AIC-Kenya did well not to hinder its members and institutions from getting involved. Without these individual efforts, AIC-Kenya’s AIDS ministry may never have gotten off the ground. Other denominations not yet ready to organize AIDS-related activities should not hinder their members from getting involved or operating among their constituencies. Further, Western donors did well to encourage the coordination of AIDS-related activities. Their efforts resulted in a more efficient operation and, eventually, in denominational engagement.
2. Develop appropriate structures. While individual efforts within the AIC constituency were praiseworthy, the magnitude of the AIDS challenge demanded a concerted response. One individual’s experiences illustrate this need.
Martha had a vision for training people for home-based care of PLWHA. She presented the idea to the pastors so that they could mobilize believers to participate in a training seminar. This is what she had to say about the presentation:
The church was not ready to get involved in the project. The sensibilization [publicizing] was not enough, thus only three people showed up for the seminar. I was discouraged and canceled it. With the pastor’s wife, we immediately started visiting sick people. Because there were many, we went the next day too. I deviated from my goal of training people to care for the sick. I started to care for the sick myself.
By the end of the day she had trained several people. However, they were not from the church; they were from the community at large. Together they visited and helped the sick. The team consisted of people from various background and beliefs, many of whom expected to get paid. When this did not happen, most of them abandoned the project. As a result, Martha was unable to meet the PLWHA’s needs and was forced to abandon her vision. She concluded by saying, “My advice is to have the church involved in whatever AIDS project you are starting. Don’t take it as a personal business, share the vision with others in the church, train church members and make sure you do what you planned to do.”
An effective, church-based AIDS ministry requires three basic elements: a policy, human resources and a budget. The policy defines the ministry’s parameters and priorities, which, in turn, determines the needed human and financial resources.
While laudable, AIC’s ministry to AIDS victims, in particular AIDS orphans, appeared underdeveloped in comparison to its educational efforts. The rapidly growing number of AIDS orphans demands a comprehensive response. The Church can help meet the demand for an increasing number of orphanages. At the same time, it is important to recognize orphanages are not the only (or necessarily the best) option for helping children of AIDS victims. In many cases, it would be more appropriate and cost effective to provide financial and other support services to extended family members and others willing to welcome AIDS orphans into their homes. Further, projects targeting orphans should take into consideration school fees, clothing, health care and food.
3. Involve local church pastors. In Africa, pastors are usually well respected, both inside and outside the church. Church members are reticent to take initiative, but respond well to pastoral directives. Hence, AIC-Kenya’s strategy of mobilization “from the top down,” that is, leaders and pastors first (starting with the bishop), proved effective. Pastors were exposed to the reality of AIDS before most of the members. Furthermore, AIC introduced the Choose Life curriculum into the Bible schools and colleges where new pastors were being trained. Hence, these church leaders were sensitized before entering full-time ministerial service.
The HIV/AIDS pandemic threatens to destroy Africa. African churches, along with their overseas partners, need to know that they have an important role to play in fighting this plague. Indeed, all across sub-Saharan Africa, churches have a massive audience, an enormous influence and the true message that can overcome the ravages of HIV/AIDS. Every church on the continent must wake up and take action. Some churches, like AIC-Kenya, are doing their part. Others, who are still watching from a distance, need to follow in AIC-Kenya’s footsteps and get involved.
AIC Kenya. 2004. The Africa Inland Church: HIV and AIDS Policy. Nairobi: AIC Kenya.
UNAIDS. 2002. “Children on the Brink: A Joint Report on Orphan Estimates and Program Strategies.” Accessed February 5, 2007 from http://www.unicef.org/publications/files/pub_children_on_the_brink_en.pdf.
Negura Feli Katho and her husband teach at the Institut Supérieur Théologique de Bunia in the Democratic Republic of Congo. She also helps local churches reestablish and strengthen their Christian education programs, which recently were disrupted by war and ethnic strife.
Under the auspices of the Evangelical Free Church of America, Rich Starcher served for twenty years in three African countries, most recently as dean of extension studies at the Nairobi Evangelical Graduate School of Theology. He presently consults with EFCA partner churches as Equip Leader for Africa.
Copyright © 2007 Evangelism and Missions Information Service (EMIS). All rights reserved. Not to be reproduced or copied in any form without written permission from EMIS. All rights reserved. Not to be reproduced or copied in any form without written permission from EMIS.