Until recently, many faith-based organizations have been slow in acting on their responsibility to help prevent the spread of HIV and care for those who are already infected or directly affected by this disease. Discussion of sexuality in Africa carries a heavy taboo, and because the most common mode of HIV transmission is through sexual intercourse, many faith-based institutions remain stuck on issues of stigma and judging others. Many churches are further constrained by a lack of programmatic experience, administrative capacity, and accountability.

A near-universal theme among churches in Namibia is that, to varying degrees, they disapprove of the use of condoms. Historically, this has pitted government-led prevention campaigns against the ideology of the church, with the result that — rather than argue with their government leaders — many churches preferred to do nothing at all on the subject of HIV/AIDS. For many years, the theological and ethical concerns that churches had about condom use served to block any other discussion of prevention, care, or the destigmatization of HIV/AIDS.

The underlying issues are more complicated than may first appear. Sub-Saharan Africa is marked by a multiplicity of cultures and nations, which means that strategies or even model solutions cannot simply be transferred from one culture to another. In wrestling with the problems of HIV/AIDS, these various worldviews must be considered. In the African context, spirituality and religion play a decisive role in the way life is structured. Up to this point, experience shows that a purely scientific-oriented approach to solutions in the battle with AIDS is not sufficient to achieve the desired success.

Many African churches have begun to intensify their battle against AIDS. Two years ago, the All African Council of Churches (AACC) called on all of its church-related partners to actively participate in building awareness about HIV/AIDS and helping those who are HIV-positive. The AACC called on member churches to create networks, develop behavior-change (prevention) groups, and especially care for women and young people. The AACC is promoting a holistic approach as the most effective one, involving both prevention and care.

Similarly, an initiative of the World Council of Churches, supported by the Evangelical Church in Germany, will soon establish an HIV/AIDS advisory and coordination office in West, South, and East Africa. The World Council of Churches also coordinates the Ecumenical Advocacy Alliance (EAA) whose thematic focus is "The Ethics of Life — HIV/AIDS." As part of this, the World Council of Churches is advocating that churches work cooperatively to undertake national campaigns to

• Increase resources for prevention, care, and treatment;
• Encourage churches to practice solidarity with those infected with HIV;
• Orient prevention toward basic causes of HIV infection in the various target groups; and
• Increase access to treatment.

HIV/AIDS prevention can be promoted through the distribution of information and sex education material, as well as through media campaigns, lectures, peer-education seminars, discussion groups, retreats, experiential workshops, and testimonies from those affected. Historically, the substantive points of emphasis have been either the communication of values within the African cultural context, such as fidelity and abstinence, or a call for "safer sex" — especially the use of condoms.

But more importantly, preventive measures should call for a change in behavior, both for youth not-yet-infected and for those who are infected, with an emphasis on positive living (i.e., including care and support). Information programs about the means of infection and the course of the HIV/AIDS illness should not be handled separately. An effort must be made to work against stigma, and the individual needs of both sexes and various age groups should be addressed. In this regard, culturally relevant sex education methods such as drama or songs play an important role.

Namibia Moves Forward

Fortunately, the willingness of local churches to get involved in the fight against HIV/AIDS in Namibia has improved in recent years. Pastors are burying more people than ever before, and even if no one officially says that half of these deaths (or more) are due to HIV/AIDS, everyone is whispering this anyway.

In 1998, Catholic AIDS Action was launched and has grown into the largest nongovernmental response to HIV/AIDS in Namibia, with 13 regional offices and over 1,250 volunteers. The Evangelical Lutheran Church in the Republic of Namibia has made a similar commitment, modeling its work on Catholic AIDS Action with a formal memorandum of cooperation between the two. While more and more churches are expressing interest, the initial focus has been primarily on caring for people already infected and affected by HIV/AIDS, in large part because this is less controversial theologically than issues of HIV-prevention.

At Catholic AIDS Action it is often said, "Care is the best prevention, and prevention is the best care." This is because each activity provides an opportunity to reach out and do the other. For example, with the rapid increase of orphans in Namibia (more than 82,000 estimated in 2001), prevention and care must be targeted to this group, for fear that their vulnerability will otherwise lead to high risk behaviors and a continuous spread of this disease.

An important means of presenting prevention messages is through peer education. The most widely known HIV-related peer education program in Namibia is the 10-session behavior-change course, "My Future is My Choice," which UNICEF first introduced in 1997. Also used by Catholic AIDS Action for the country's Roman Catholic affiliated schools, hostels, and congregations (with a slight adaptation for a church-based setting), this curriculum was absorbed within the school system by the Ministry of Basic Education, Sport, and Culture in 2002.

In 2001, Catholic AIDS Action introduced and adapted two additional youth-oriented prevention programs for Namibia, called Stepping Stones and Adventure Unlimited. Both of these have been very well received, in large part because of their integration of Christian values with issues of behavior change, self-esteem, and decision-making. The demand for training of peer-educators in these curricula has increased, so Catholic AIDS Action has trained youth leaders from other church organizations including the Evangelical Lutheran Church in the Republic of Namibia and the SWAPO Youth League. Even without advertising, the demand for more training has increased dramatically since the program's launch in 2001, limited only by staff time and money.

Several gaps emerged from a review of the curricula and the implementation of these programs, including issues of gender empowerment and human sexuality. Separate initiatives for women and girls may be required due to their special needs, including general health conditions, women's rights within the family, inheritance laws, school access, the work environment, strengthening of their sexual self-determination through women's groups and empowerment programs, and improvement of their socioeconomic status through income-generating measures or small loans.

Parenting education is another gap in the curricula. However, this has proven to be a complicated issue. When Catholic AIDS Action youth-leaders attempted to introduce an HIV education group to parents and other adults in the community in 2000 and 2001, they failed. Two theories have been offered by the staff at Catholic AIDS Action: (1) that it is difficult for young people to organize groups of adults, because doing so runs contrary to cultural norms, and (2) that parents say they want to have the same HIV education experience as their teenage children but in reality are too busy or fear that others will mistake their interest as personal vulnerability.

Other concerns about youth include the impact of alcohol and domestic violence on HIV-transmission. It is not clear whether these issues are best dealt with in a youth-led curriculum or by direct government intervention such as putting higher taxes on beer and hard liquor and instituting additional criminal penalties.

It has also become increasingly clear that in preventive work, men must be addressed in a special way. The attention given to men on World AIDS Day 2000, "Men Make a Difference," brought to light that the main means of infection worldwide is heterosexual intercourse. In work with men and male adolescents this means, for example, that risky sexual habits, tradition-bound role models, and behavioral patterns must be made a subject of discussion. Also, the idea that women and girls are expected to prove their loyalty and/or fertility to their occasional partner by having unprotected sex with them must be discussed not only with women, but also with men.

In addressing specific age groups, it is especially important to create programs geared toward young people, such as anti-AIDS clubs, role-plays, residential camps, videos, and theatre and music groups. These kinds of programs can deal with the subject in a relaxed manner without stigma and provide an opportunity for children and young people to express themselves in their own way. Here too is a chance for adolescents and young adults to address HIV/AIDS issues with other young people. The problem with such activities in the past in Namibia is that without ongoing support and (at least periodic) supervision, most of these activities cannot be sustained — and do not last more than a short while. In addition, the incentives introduced by the UNICEF-led "My Future is My Choice" program such as tee-shirts for the participants and a per course fee for the facilitators have seemingly made it impossible for any peer education group in Namibia with less than these incentives to succeed.

Next Steps

The goal of all interventions is to strengthen the community's social, political, and economic competence, so that when interventions end, the following will have been achieved:

• Positive changes in behaviors such as avoiding infection risks, accepting the sick, and diminishing the taboos surrounding HIV/AIDS. This requires a focus on self-esteem and peer-group support to reinforce what was learned.

• Communities that care for those at risk of or affected by HIV/AIDS — including AIDS orphans — to protect them from abuse and exploitation. Issues of hope, sustainability, and self-sufficiency are crucial here. By contrast, if young people feel hopeless or depressed about their own future (i.e., "AIDS doesn't matter anyway, because I don't have much of a life worth living for…"), then virtually any prevention program will fail.

• Improvement of advocacy and empowerment skills, whereby people will stand up for their own rights at an interpersonal, community, and national level. This means, for example, that government agencies will also be pushed to fulfill their tasks in the areas of medical treatment of HIV/AIDS, legal assistance, and the care of those living with HIV/AIDS and their dependants.

Though impact is maximized when young people take ownership -- and leadership -- of whatever activities they are involved in, there are limitations to what young participants are independently capable of doing. Despite their enthusiasm, they should not be overloaded with adult responsibilities and roles. Thus, technical support must be provided to those involved in both prevention and care programs. Young program staff or volunteers typically need the following:

• Training in developing and disseminating information; making presentations; and developing and implementing strategic information, education, and communication plans
• Access to databases and wider information networks
• Understanding of group dynamics and conflict management
• Community mobilization skills
• Monitoring and evaluation
• Feedback about their work, assistance in how to solve problems, encouragement, and emotional support.

Lucy Y. Steinitz, Ph.D.
Options Consulting — Windhoek Namibia