At a mission church in Ivory Coast, AIDS victims receive front-row seats. Each Sunday the young congregation in Abidjan reserves its best view for those who may be too ill to appreciate it. Blankets and pillows are ready if they are too sick or too weak to sit or stand through the long singing and worship service. But the seats are usually filled because AIDS sufferers say it is that rare place where they feel socially welcome.
Out of that simple gesture the Abidjan congregation, with the help of American missionary physician Tom Edwards, operates a thriving home health ministry, where volunteer church members visit with and counsel AIDS patients.
AIDS may be killing Africa, but it is not out of the closet. Although 2 million Africans die of AIDS each year, and between 70 and 90 percent of all the world's AIDS cases are in sub-Saharan Africa, the illness remains taboo as either a topic of conversation or the subject of public-service campaigns.
In many areas, even cities like Abidjan with its population of 3 million, people with AIDS suffer on in denial or ignorance. "Often they don't even realize that they have it," said Dr. Edwards. Some believe they have tuberculosis and don't realize they carry a disease that can be transmitted through sexual contact or breastfeeding a child.
The dimensions of the epidemic, however, are unavoidable. During President Bill Clinton's August tour of Africa, meant to spur economic development, AIDS kept breaking into the agenda. Traveling with the president was Sandra Thurman, director of the White House National AIDS policy office, who told reporters on Aug. 27 in Nigeria, "We all are beginning to understand in a very real way that AIDS is a plague of biblical proportion. It's been declared the worst public health crisis since the bubonic plague. I think that's absolutely true."
It certainly seems that way in Africa, which more and more looks like a laboratory for the world's deadliest sexually transmitted virus. Political upheaval accelerates the disease. Women raped by invading militants during Rwanda's Hutu-Tutsi conflict in 1994 are now testing positive for AIDS. The same is true in the Democratic Republic of Congo. Economic upheaval breeds a similar trend. In Mozambique, men leave home for extended periods in search of employment. Finding prostitutes along with a job, they return to pass on AIDS to their wives. Holdover tribal customs, which favor polygamy and trading brides for cattle, plow a fertile ground for the virus.
When sickness finally comes, no safety net exists. A United Nations study in Ivory Coast found that families with an AIDS patient cut spending on their children's education in half and reduced food consumption by 40 percent. "When they have spent what they can on medical care," said Dr. Edwards, "there is nothing left for the family to do." So while AIDS patients in the West have ever increasing access to clinical trials and drug cocktails, in Africa their choices are fewer and more bleak: to waste away alone in an Abidjan shack or die slowly on the hard floor of an overcrowded Nairobi hospital ward. Rates of infection may be declining in the West, but AIDS in Africa is on a rocket-like trajectory. Over 22 million Africans are infected with HIV, the virus that leads to AIDS, compared to 1.5 million Americans.
Faith-based organizations that have been fighting AIDS for years are frustrated by its sheer demographics. Many countries have seen life expectancy drop by 10-20 years already due to the virus. And the epidemic is taking its greatest toll on young people: 80 percent of sub-Saharan Africa's population is between 15 and 49 years old. In countries like South Africa, half of its youth are infected with the virus. AIDS deaths have orphaned 13.5 million African children. AIDS orphans are expected to number 44 million by 2010. "We still have 30, 40, even 50 years to face in this epidemic," says Debbie Dortzbach, director of HIV/AIDS programs for World Relief.
Now, bipartisan legislation could put faith-based organizations to the test in Africa's battle against AIDS. The new law would create a World Bank trust fund worth $600 million in two years to fight AIDS worldwide. Most of that money would go to Africa, lawmakers say. It would also increase existing overseas AIDS relief through the U.S. Agency for International Development (USAID) to $300 million over two years.
The legislation is a boiled-down version of half a dozen proposals floating around Capitol Hill since January. This one received support from conservatives who normally shun mammoth public health projects, including Senate Foreign Relations Committee chairman Jesse Helms (R-N.C.). President Clinton signed it into law on Aug. 19.
Lawmakers inserted unprecedented language in the bill directing USAID to allocate "not less than 65 percent" of the funds to "voluntary organizations." Those are further defined as "U.S. and foreign non-governmental organizations, including private and voluntary organizations, for-profit organizations, religious affiliated organizations, educational institutions, and research facilities." Twenty percent of the funding is set aside to help AIDS orphans.
In addition to Sen. Helms, sponsors of the legislation-Sen. Bill Frist (R-Tenn.) and Rep. Jim Leach (R-Iowa) in the House-say USAID bureaucrats encouraged them to specify eligible organizations. In other words, the officials seemed to be admitting, the most effective treatment for the epidemic must address the moral and behavioral patterns that lead to AIDS.
"There is only one 100 percent effective way to stop the spread of AIDS, and that, of course, is abstinence and faithfulness to one's spouse," said Sen. Helms. "And it is through churches that this message will be effectively promoted and accepted, not through government bureaucracies."
The bill's passage signifies that liberals and AIDS activists are ready to hear that message, too (see sidebar). "This is a calamity that is unprecedented in human history, and it is time to put our political, ideological, and religious differences aside," said Cleve Jones, founder of the AIDS Memorial Quilt project. "We have to work together."
For many Christian agencies, that simply means growing what they have been doing. A gathering of missionaries and Christian relief workers, led by SIM International, developed a position paper on "a compassionate response to AIDS" in 1993 that has been guiding the work of churches and several agencies ever since. "AIDS brings us to our knees," said SIM's Paul Hudson. "Church denominations that once saw each other as the enemy now are gathered around this single problem."
World Relief HIV/AIDS coordinator Debbie Dortzbach told WORLD the agency's focus includes "embracing the church's endeavor to be the church and respond to orphans, to promote godly sexual behavior, and to alleviate a plunge into deeper poverty in areas most affected by AIDS." In Mozambique, the Wheaton-based relief agency is looking to finance microenterprise businesses as one way to halt the spread of AIDS.
Why business development? Because, the group discovered, AIDS was spreading fastest in areas where breadwinners crossed the border into South Africa and spent extended amounts of time away from family in order to work. Fathers indulged in extramarital sex, and returned to infect wives with the virus. Keeping the family intact by creating homegrown business opportunities is a way to discourage bad sexual behavior while promoting thrift.
Mrs. Dortzbach said World Relief is also looking to support African churches as they respond to the growing problem of AIDS orphans. Children belong in families, she said, not orphanages. Churches are converting church sanctuaries into schoolrooms during the week, tutoring children left parentless by AIDS, helping them plant food, and lobbying to protect their rights in land inheritance following a parent's death.
In Ivory Coast, the church-based clinic Dr. Edwards helped was actually able to reverse the AIDS trend. The clinic began screening pregnant women on a voluntary basis, and found 12 percent were HIV positive (while showing no symptoms of AIDS). By administering AZT during the last months of their pregnancy, clinic workers were able to drastically reduce the number of babies ultimately born with the virus.
Governments like to support "community-based development," said Ken Isaacs of Samaritan's Purse, and "there is no larger community-based network than churches in Africa." The North Carolina-based Samaritan's Purse will not "chase the money" offered in recent legislation, he said, but would use government funding, if it is available, to expand existing work among the 3-million member Kale He Wet Church in Ethiopia, where Samaritan's Purse is already supporting one clinic: "We are interested in trying to work with people through the churches-monogamy, abstinence, and fidelity-not just in prevention of AIDS but how to live, treat, care for, and love family members with AIDS."
The African AIDS epidemic, in a culture in which male promiscuity is often a prerogative, has pushed Christian experts into rethinking how they teach abstinence.
"It is parallel to the gun [control] situation in the United States," explained Ndunge Kiiti, who helped write AIDS educational material for MAP International. "Everybody wants to face it as a security issue, something to be controlled, rather than an issue of behavior, something to be changed. It is easier to make policy that way, and it is the easiest way to decide what to do in our hotel meetings."
MAP International, based in Brunswick, Ga., has focused on producing AIDS training manuals-for pastoral counseling, home health care, and teaching young people about AIDS with abstinence at the core of the material. Recently MAP material was adopted by Florida state health officials for stateside training and counseling.
Until now, even the best faith-based efforts faced two-way obscurity. First, effective programs languished while government-to-government funding spawned bloated health bureaucracies (Kenya's is a prominent example) that did nothing to reduce the rate of HIV/AIDS. Second, Christians in the United States have not pushed the efforts of these groups because they tend to view the AIDS crisis overseas through domestic debates led by homosexual activists.
Dr. Edwards said sustained changes require deeper involvement. "These people have to be brought into a community where others are doing the same thing. We face this all the time in church evangelism. The church needs to be a community where those people are welcomed in and then want to change their habits."
World Relief president Clive Calver, while welcoming government help, emphasized that "the evangelical church in the United States will stand indicted and guilty before the throne of Christ if we fail as churches to take action on behalf of our African brothers and sisters in this hour of greatest need."