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South Africa. Aids: there still remains much to do

The Catholic Church has played a pioneering role in fighting the HIV/AIDS pandemic in South Africa. We talked with Sister Alison Munro, Director of the Southern African Catholic Bishops’ Conference AIDS Office.

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What is the situation of HIV/AIDS in South Africa?

We still have about 6.4 million people HIV infected, and as a result, more than 3 million orphans and vulnerable children in the country. In the last few years we have seen that the rates of infection have come down in certain parts of the country, but in other parts and among certain age groups there’s still a high rate. Across the country, there’s still reason to worry and be concerned because although we have made progress, there’s still a long away to go. Now fewer people are dying than was the case 10 years ago.

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Is there any association with poverty?

The poor remain the most vulnerable to HIV infection. Although it is a disease of poverty, it is not only related to poverty. We have wealthy people, people living in very affluent situations, who are also infected. One does not necessarily see them easily because they are able to look after themselves.

What exactly has been the role of the Church in fighting the HIV/AIDS pandemic?

In some places, we actually began before the government; the government hadn’t yet trained the nurses and doctors to go into those particular areas and the infrastructure wasn’t there – but what we have noticed over the years is that the Department of Health has opened clinics providing antiretroviral treatment in many places. As a result, the Church has been able to withdraw from some of those treatment programmes because it doesn’t make sense to have two running next to each other. In some cases, the Church’s programmes have been taken over by the government so that the treatment is being provided in a Church healthcare facility but supported now by the government. One has to recognise that there are not always evenly delivered care services, in the sense that we have pockets of excellence and pockets of poor service delivery – where not everybody is committed, not everybody is trained and the infrastructure doesn’t allow it, or health-care workers do not always order the correct amounts of drugs (for new patients and those already on treatment). But generally, in treatment services we have seen a huge change.

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When did the Church really start its intervention?

In 2000, the bishops re-opened the AIDS office that had been closed for some time, and I was appointed that year. Small diocesan responses to AIDS were already in place across the region. Around that time, people were dying. It was really dreadful. The pandemic was raging. Some of the Catholic donor agencies (two of them in America and three in Europe) were willing to support the Church’s response through the Bishops’ Conference. For the first time, major funding came in. Before that it was so little that one couldn’t do very much with it. At that time and for a number of years, I estimated that about 70% of what the Church was doing was related to home-based care – visiting people in their homes, keeping them comfortable and letting them die with dignity.

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When did the treatment begin?

We began the Church’s treatment programme towards the end of 2003. We started in five places. We couldn’t go anywhere else because there was not enough money. Then we worked on a PEPFAR (The United States President’s Emergency Plan for AIDS Relief) treatment grant under Catholic Relief Services (CRS) until 2010 at which time PEPFAR started giving us the grant directly. That grant will end in May 2015. What we have been doing over the last few years now is transferring those patients into the government health system. In some cases, the Department of Health is providing drugs to patients in Catholic facilities. In the majority of cases, the patients have been absorbed into the Department of Health facilities, meaning that the total number of people in treatment include those who were initiated in the Catholic facilities. Currently, out of the 22 original treatment centres, we have six remaining. The Church’s programmes are also helping to identify the people who need to be on treatment and accompanying them to make sure that they take their drugs (something the Department of Health is not successful in doing: they give the drugs but do not ensure that the person takes them). We have some money from the Global Fund: it is for home-based care, TB screening and orphan and vulnerable children care.

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What about orphans ?

There are estimates of about three million children in South Africa. They are not all infected. We are working on what needs to be done for these children because if they are not supported, they are not going to thrive or survive. There’s no way orphanage programmes can take care of them because there’s simply not the space and it is too expensive to run all those residential care facilities. Although there are orphanages, most children are being taken care of either in their extended families or in the communities from which their parents came. There are many successful stories around that, but there are also sad cases where children keep falling through the cracks: they become vulnerable a second time or are not helped by anybody. Those are the main areas of concern in the country and those in which we are fully involved. (J.R.)

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