“Prioritizing Children in the HIV Response”

 “Prioritizing Children in the HIV Response”

Archbishop Thabo Makgoba

Communities of Faith Breakfast: Building Partnerships for a One-Community Response to HIV

Thursday, 21 September 2023, 7:45 am

My warm thanks to UNAIDS, PEPFAR and your faith community partners for the invitation to join you. In an era when world attention has been distracted by Covid, and then by war in Europe, keeping a focus on ending the scourge of HIV/Aids is of critical importance.

Especially tragic is the way in which the coronavirus pandemic and international tensions have taken attention away from the plight of children in this health crisis.

Now I know we have made huge strides in the fight against HIV/AIDS and TB, among children as well as adults. As the preparatory papers for this meeting tell us, in the 12 years from 2010 to 2022 there was a 58% drop in the annual number of new infections in children, and the number of AIDS-related deaths was reduced by 64%. Those figures are impressive.

But nevertheless, last year the number of children who acquired HIV still numbered 130,000 – a rate of two-and-a-half thousand new infections a week. About 84,000 children died – an average of 230 a day. While children comprised 4% of people living with HIV in 2022, they accounted for 13% of AIDS-related deaths.

Nearly nine of every 10 children living with HIV in 2022 live in sub-Saharan Africa. It is especially alarming that of the world's one-and-a-half million HIV-positive children, four in every ten of them – about 660,000 – are still missing out on anti-retroviral treatment. Can you believe it? Can you believe that is how we treat – or fail to treat – our children, who represent our future? It is unconscionable, especially if you consider how we were able to roll out countless millions of Covid vaccines at breakneck speed. We should not be able to sleep at night while this persists.

In South Africa, we have had a particular passion for the plight of children ever since the 1990s, when an extraordinarily articulate young boy named Nkosi Johnson seized the country's imagination. The country was scandalised when a public school refused to enrol him because he was HIV-positive, despite the fact that our Constitution forbids discrimination on the grounds of medical status. He went on to become a powerful advocate, doing more than anyone else at the time to highlight not only paediatric HIV, but the disease as a whole. He even appeared as a keynote speaker at the 13^th International AIDS Conference, before dying at the age of 12.

As people of faith, we believe – and this is common to all faiths – we all believe that our Creator created us in our Creator's image, and that we are all valuable in our Creator's eyes; we are all intrinsically worthy of dignity and respect – no matter what our circumstances. God's intention is that all of us should have a life in abundance, healthy lives, lives in which poverty and vulnerability are overcome.

Our faith therefore demands of us that our worship should drive us from our knees, and send us out from our churches, our mosques and our temples to engage the world and ensure that our Creator's intention is fulfilled.

As faith communities, we are deeply embedded in communities across the globe, and our presence in most of the world as independent institutions can be deployed to fill in gaps and strengthen campaigns to improve the lives of people.

Faith communities can also play a vital role because HIV and Aids is of course not merely a medical issue. It affects all aspects of human life, our mental and physical well-being, such as in societies where there is already a lack of food security and high levels of poverty.

The founding “Magna Carta” of the World Health Organization says “health is a state of complete physical, mental and social well-being and not merely the absence of diseased or infirmity” and its constitution recognizes responsibilities for “the improvement of nutrition, housing, sanitation, recreation, economic or working conditions”.

We can overcome HIV and Aids only if we move beyond medical interventions to deploy the networks of caring within communities which are central to the work of local institutions of faith. Those who provide pastoral care are uniquely placed to identify and address situations which inhibit successful medical care, such as why those to whom they pastor are not adhering to the regimens prescribed by the medical professionals.

In the Southern African context we have found that addressing economic and social challenges is critical to the success of treatment programmes: without support for young mothers and families, ensuring food security, and pastoral, mental and social support, they remain vulnerable. The tragic fact, which was recently highlighted at South Africa’s latest National Aids conference, is that young people and children are dying in special shelters for Aids patients where treatment is available, often because of the lack of good support mechanisms or networks.

A 2019 study of the challenges facing current PEPFAR interventions concluded that there are “significant limitations in facility-based models” and that there is a growing consensus that building “community-based alternatives is necessary”.¹ And a 2020 action plan produced by UNAIDS cites among the strong points of faith communities that they are locally based and community-driven and have a holistic approach to address physical, mental and social needs. ²

So as faith communities, we can and must work together closely with governments, multilateral organizations and development agencies, to finally overcome the burden of HIV and Aids, with a special focus on paediatric HIV. But as I have said previously in forums such as this, we need carefully to review our models for joint action, and especially how we establish partnerships and formal collaborations.

To deploy the resources of faith communities most effectively, I urge you to include our networks alongside the epidemiologists and medical experts, not only in the implementation of programmes but in the design of grant priorities. It is, for example, important to engage faith communities in the design of HIV and AIDS programmes to avoid ethical conflicts that can tear communities apart, such as the dilemma of helping feed a child with HIV/Aids but denying food to a hungry child who does not have HIV/Aids but suffers stunting.

In South Africa, churches and faith communities were amongst the first to implement prevention, treatment and adherence programmes supported by PEPFAR. So we in the faith communities can testify to the importance of the investments countries such as the United States have made in enabling access to treatment which has saved millions of lives. I know I speak on behalf of all South Africans, and I make bold to say, of people throughout the continent, when I say we honour and thank you for your commitment to fighting this scourge.

But the challenge is not over. We still have to address desperate needs, especially of the children who are infected or at risk. Right now, the main focus in relations between the world's most powerful nations on the one hand, and the countries of Africa on the other, is on that which is negative: on military interventions, on the export of weapons and mercenaries to Africa, and on the economic exploitation of our raw materials.

When President George W Bush introduced PEPFAR, with bipartisan support in Congress, he promoted the image of Americans as caring and compassionate people, people who saved millions of lives in Africa. No American programme has saved more lives of mothers and babies than PEPFAR. There is nothing more pro-life than PEPFAR.

But that image of the United States now threatens to be replaced by one which in which you present yourselves as primarily a military power, only interested in Africa as a battleground in your fight against international terrorism.

But you and your partners in the G20 nations in Europe and Asia can turn this around. If the economic powers of the world wish to improve their image in Africa, they could do no better than boosting their aid in the health arena. Specifically, the United States should reauthorize PEPFAR, and their European and Asian counterparts in the G20 group should follow their example.

So let us join hands and form new partnerships to empower local networks and coalitions to build capacity and strengthen national health responses, globally, regionally and on a national level. Let us put into practice what we are – instruments in the hands of our Creator.

I thank you, and may God bless you.

1 See the article by M. Kavanagh & V. Dubula-Majola, “Policy change and micro-politics in global health aid: HIV in South Africa”, in Health Policy Planning, 2019, 1-11, Oxford University Press.

2 Produced by UNAIDS, the Global HIV Prevention Coalition, 30 July 2020; https://www.unaids.org/en/resources/documents/2022/prevention-2025-roadmap