CHURCH OF SCOTLAND HIV/AIDS PROJECT GROUP May 2009 PROPOSED DELIVERANCE The General Assembly: 1. Receive the report, and thank the members of the Project Group and the Project’s partners around the world. 2. Instruct the Project Group, in consultation with other Councils, to develop material and resources that will help the church to reflect and respond appropriately to the issues surrounding HIV and Aids, and jointly with other Councils to consider the use of an ‘HIV-competent Church’ programme. 3. Instruct the Project Group to work together with the Ministries Council in exploring ways in which HIV and Aids education can be offered as part of the candidates training programme. 4. Thank the Very Rev David Lunan for his leadership in launching “The Moderator’s Challenge”, and encourage all Presbyteries to set up a fund-raising goal averaging at least £10,000 (according to size) for the Church of Scotland HIV/AIDS Project. 5. Invite congregations to observe Sunday 10 January 2010 as a day of worship, reflection and fund-raising on the theme of the Church’s response to HIV, and instruct the Project group to produce worship resources to enable congregations to hold “Souper Sunday” services and events. REPORT 1. Introduction “Stop AIDS. Keep the Promise.” – the campaigning slogan for World Aids Day 2008 and its theme of ‘leadership’ seems a good place at which to start this report. It is hard to believe that 2008 saw World Aids Day, established by the World Health Association in 1988, ‘come of age’. Individuals and organisations all around the world came together on 1st December to bring attention to the global Aids epidemic for the 21st time. The theme challenges everyone to demonstrate leadership and deliver on promises made in the response to HIV and Aids. Those making the promises and those making them, are not just governments, and organisations such as UNAIDS or the Global Fund but are you and me. The Church of Scotland HIV/AIDS Project, one of a wide range of Faith Based Organisations (FBOs) is involved in the continuing struggle to ensure justice and equity for those infected and affected by HIV and Aids. The 17th World AIDS Conference held in Mexico in August 2008 witnessed a dramatic sign of change in attitudes towards FBOs summarised in the words of Peter Piot, the retiring Executive of UNAIDS “when I started this job I saw religion as one of the biggest obstacles to our work…..but I have seen great examples of treatment and care from the religious community, and lately prevention.” UNAIDS recognises that as 70% of the world’s people identify themselves as members of faith groups, such communities play a major role in influencing people’s behaviour and attitudes and in providing care and support for people living with HIV. This is a major step forward. The Ecumenical Advocacy Alliance, of which the Church of Scotland HIV/AIDS Project is a member and contributor, has produced a resource called Exploring Solutions: How to talk about HIV Prevention in Church. This aims to help people in churches to talk openly, accurately and compassionately about why HIV spreads and what we as individuals and communities can do to help stop it in its tracks. For over two decades Aids has led to the deaths of millions of people and devastated families, communities, and the social and economic fabric of many countries. Although there is no short term prospect of any cure, today we know how to treat HIV and Aids and how to prevent the transmission of HIV. And yet the virus continues to spread because so many of us don’t talk about it. Much of the focus of the work of the Project Group in 2008/09 has been to build on the strength of being a FBO and the opportunity to work with and challenge national and international governments and organisations yet provide the tools necessary for presbyteries and congregations to continue the journey of HIV prevention locally and globally. 2. Strategic plan The newly developed strategic plan for the Project emphasizes the importance of theological reflection as we continue to raise awareness of HIV in Churches in Scotland. We recognise that Christ’s compassion and courage and acceptance of people as he reached out to them, and his dying on the cross for all, mean that the Gospel compels us both to challenge the stigma associated with HIV, and to offer practical care for people living with or affected by HIV. We plan to facilitate theological discussion relating to HIV and Aids by directing people to relevant worship and study resources, some of which will be informed by the experiences of our partners. We will develop targeted training resources for ministers and elders and we will produce resource material for Councils and Presbyteries and the wider Church. We aim to equip a group of volunteers throughout Scotland who will be able to lead workshops, worship or take part in awareness raising events. In our communication strategy we aim to help people understand the Gospel imperative to respond positively to people affected by HIV and the need for our Project to be a whole Church Project, engaging every Council and every church member in its work. Our current strategic plan also reaffirms our priority to raise money to support partners as they respond to needs in practical ways. We will continue to support projects overseas and in Scotland which offer peer education, theological education and practical care and will support partners as they develop income generating schemes for people who are HIV+ to help them purchase nutritious food which is so important for the effective taking of ARV medication. We will work cooperatively with our current partners in Scotland and seek to develop ever more authentic relationships with our international partners. We aim for partnerships which are built on honest and open communication, the genuine sharing of ideas and on mutual understanding. 3. INERELA+ In following up from the General Assembly report of 2008 and the charge to the Project group to be represented on the steering group of Inerela+ Scotland, we are pleased to report that the formal launch of INERELA+, the international, interfaith network of religious leaders – both lay and ordained, women and men – living with or personally affected by HIV, took place in Mexico City on 2 August 2008. The 5 year anniversary of ANERELA+, the African Network was celebrated at the same occasion. Recognising the realities of the HIV epidemic in the rest of the world, it was decided to create 4 regional networks based on shared elements of history, language, culture and religion. Scotland would be part of the Europe/Central Asia region. At its February 2009 meeting, the INERELA+ Board completed its search for a new Executive Director who is expected to be in office by 1 May 2009. In just under five years, the two networks have grown to encompass over 3,500 members across five continents. It is hoped that within five years of INERELA+’s launch, the networks will increase their worldwide membership to over 6,000. These new members will mobilize their respective faith communities to provide accurate information and other services to an estimated 2.5 million people around the world, helping to reduce HIV-related silence, shame, stigma and discrimination and thereby reducing the number of new infections. Marion Chatterley, Chaplain to People living with HIV, Waverley Care, reports that at present, rather than having our own organisation, Scotland is to be part of INERELA+ UK and some progress is being made to ensure joined up thinking at an International level while recognising the specific needs of particular countries. 4. A Global Overview Perhaps the best overview comes in the form of the UNAIDS 2008 Report on the global AIDS epidemic. Published mid 2008, it marks the halfway mark between the 2001 Declaration of Commitment and the 2015 target of the Millennium Development Goals to reverse the epidemic by 2015, and is also two years before the agreed target date for moving as close as possible towards universal access to HIV prevention, treatment, care, and support. It is therefore a good time to assess the HIV response and to understand what must be done to ensure that nations are on course to achieve their HIV commitments. As a church, this report and the more recent UNAIDS – Letter to Partners, are important documents to influence our advocacy work. We must keep HIV and Aids at the top of the political and economic agenda and our government should be challenged to keep the promise they made in the setting of universal access targets for 2010. The Church must continue to be a voice for the voiceless. But has progress been made? There is no doubt that the nearly 4 million people on antiretroviral medication believe this to be so. The annual number of new infections worldwide dropped from 3 million in 2005 to 2.7 million in 2007, young people in many parts of the world are waiting longer to become sexually active and millions of children orphaned now have access to appropriate care and protection. What are the trends for some of our Project Partners? It is important to note that most epidemics in sub-Saharan Africa appear to have stabilised, although often at very high levels, particularly in southern Africa. In Malawi and Zambia there is some evidence of favourable behaviour changes and there are signs of declining HIV prevalence among women using antenatal services in some urban areas. The estimated 5.7 million South Africans living with HIV in 2007 continues to make this the largest HIV epidemic in the world. In parts of Mozambique, HIV prevalence among pregnant women is increasing and in some of the provinces in the central and southern zones of the country, adult HIV prevalence has reached or exceeded 20%, while infections continue to increase among young people (ages 15–24). In Asia, the epidemic is of a more disparate nature. In Burma/Myanmar and Thailand there is decline in HIV prevalence, however the epidemic in Pakistan is growing rapidly. New HIV infections are also increasing steadily, although at a much slower pace, in highly populated countries such as Bangladesh and China. As well as the variation in prevalence across the continent, the modes of HIV transmission make Asia’s epidemic one of the worlds most diverse. Injecting drug use is a major risk factor in several Asian countries. And the overlap of injecting drug use and sex work is a worrying phenomenon particularly in India, Pakistan and China where an increasing number of women are injecting drugs and also selling sex. Many male injecting drug users also buy sex, and often do not use condoms. A high HIV prevalence has been found among sex-trafficked females who have been repatriated to Nepal, and also up to half of the females trafficked to Mumbai, India. Interestingly, Thailand’s epidemic has diminished but has also become more diverse, and HIV is increasingly affecting people traditionally considered to be at lower risk of infection. In Scotland, during the year since the previous meeting of the General Assembly, there have been a number of developments at both national and local levels. HIV now has a clear profile within Scottish Government priorities. Strategic positioning of HIV firmly within the remit of its sexual health team reflects the reality of the epidemic as it stands in Scotland. Ministerial lead of the National Sexual Health and HIV Advisory Committee (NSHHAC) places HIV at the centre of the health agenda. The progress is most evident in the work to develop a comprehensive and integrated HIV Action Plan. This is based, firstly, on a thorough Scotland-wide needs assessment of HIV treatment and care, and, secondly on the expertise of clinical services, community agencies and service providers. By the summer, Scotland will begin to see the first nation-wide social marketing campaign addressing sexual health and HIV awareness. Unlike the threateningly hopeless tones of the icebergs and tombstones of the 1987 campaign, this will take a positive approach to providing information and resources that support safer sex and wider health improvement. The Church and faith communities have a role to play at all levels in this respect. Emerging challenges have been identified. Reducing rates of transmission of HIV, making it easier for individuals to test for HIV, and improving the co-ordination and evaluation of our efforts encompass a number of other challenges. How to make condom use consistent and effective depends upon frank sex and relationships education. But it also requires awareness and support in relation to the effect of factors such as relationships, mental health, or alcohol related problems. Successes in tackling the spread of HIV among injecting drug users in the ‘Trainspotting’ years point us in the direction of pragmatic rather than dogmatic approaches to real life dilemmas. Collaborative effort across boundaries and borders is a force for change and delivery. Work shared between the Church of Scotland and partner agencies has developed steadily. HIV Scotland’s role in this includes Eunice Sinyemu’s membership of the Project’s Steering Group. Strategic lead at national level sees Rob Brown, the Kirk’s representative round the table with leading HIV experts on NSHHAC. On a daily basis, Waverley Care’s various support projects draw upon the deep seam of spiritual nurturing that’s to be found in parish ministry as well as through its chaplain, Marion Chatterley. Clarity, challenge and collaboration are crucial characteristics of any organisation with the needs of individuals and communities at their heart. We may often fall short or feel inadequate for the task, but our strengths lie in commitment and compassion. 5. Ecumenical Advocacy Alliance (EAA) and XVII International AIDS Conference, (IAC) 2008: MEXICO CITY The project group sent The Rev John McMahon, (Project Group member), Angus Adams and Catherine Hay (youth representatives) to represent the Church of Scotland in Mexico City, at both the EAA’s pre-conference and the IAC, in July and August 2008. The overall theme of the IAC was ‘Universal Action Now’ and this was reflected in the ecumenical pre-conference call: ‘Faith in Action Now!’ (Fe en Acción ¡Ahora!). For excellent reports and resources from the ecumenical pre-conference, please look at their website: http://iac.e-alliance.ch/. This was the first time the IAC convened in a Latin American country, where over 20,000 delegates gathered. High profile speakers, including Ban-Ki Moon, General Secretary of the United Nations and Mexico’s President Calderon, urged leadership as the key to achieving the action (now!) required to realise the UN commitment of reaching universal access to prevention, treatment, attention and support for HIV and Aids by 2010. Roy Kilpatrick, Chief Executive of HIV Scotland, reminds us that, “In Scotland, we need to ensure that the leadership which is the key to success is levered, supported and where necessary challenged.” The churches and other faith-based organisations have a significant role to play. If there is such a thing as inspired leadership, it’s equally true that most leadership qualities can and need to be worked at. Leaders sometimes need to be picked out from the crowd, encouraged, trained and let loose! The African HIV Policy Network [in Scotland] recently ran a series of ‘Vital Voices’ leadership courses, an example that could be emulated. A key learning point from healthy respect was the value of local ‘champions’ in schools, churches and sports clubs. The ecumenical pre-conference was an excellent showcase of genuine, grassroots, faith-based involvement in the lives of those living with HIV and Aids. It was apparent that this faith-based response was so pivotal to the success of many HIV stories and yet, sadly, the voice of faith-based organisations was somewhat muted at the IAC, perhaps reflecting the scientific and clinical nature of IAC’s initial establishment. Clearly, however, alongside the need for prevention, research and treatment, the psycho-social support and care (much of which is provided, although not solely, by faith-based organisations) needs to be more evident on IAC’s programme. This requires action (now!) on the part of faith-based groups, submitting abstracts and presentation proposals for the next IAC (in Vienna, 18-23 July 2010), so that the good work evidenced and shared at the ecumenical pre-conference reaches a wider and, therefore, more influential audience. Of particular interest at the ecumenical pre-conference was a seminar on ‘Becoming an AIDS Competent Church’. Whilst the project group has celebrated success in working with our partner churches and agencies overseas, it might be true to say that much work remains to be done here, in Scotland, building upon what has already been achieved but helping the church, as a whole, to place HIV and Aids at the heart of our work and witness. Many of our partner churches and agencies are already HIV ‘competent’ and we have much to learn from them. The concept of “HIV-competent church” relates to the ability of a given faith community to deal with the challenges posed by the HIV and AIDS pandemic in an appropriate and compassionate manner. An HIV-competent church staunches the spread of HIV, improves the lives of those living with and affected by it, mitigates the impact of HIV and ultimately restores hope and dignity. The success, for example, of Eco-Congregations in Scotland is perhaps indicative that, through education and awareness-raising, congregations can be enabled to become more knowledgeable and involved, and the project group believes this approach to HIV ‘competency’ would present to the local church, and the communities in which we serve, an opportunity and a challenge. In other words, faith in action, now ! Crucial in helping the church and our congregations best understand the issues around HIV in Scotland, and the world, is to educate and equip our leaders at local, regional and national level. The project group, therefore, proposes to work with the Ministries Council in helping to develop a material on HIV and Aids education, initially for those in ministerial training but to be made available to the whole church. If there is no HIV leadership amongst our leaders, there is no leadership in HIV. We believe this response, in keeping with the IAC’s theme of ‘Universal Action, Now !’, will help the church to care and support more effectively. 6. Working with our partners – two snapshots. The United Mission to Nepal (UMN) is a co-operative effort between the people of Nepal and a large number of Christian organisations from 18 countries in four different continents. Established in 1954, it seeks to serve the people of Nepal in the Name and Spirit of Christ. The Church of Scotland has been a member of UMN since its inception. Since 2004, the Church of Scotland HIV/AIDS Project has been working with UMN in their overall aim of reducing HIV Transmission rate and improvement of quality of life of people infected and affected by HIV/AIDS in Nepal. UMN continue to support the prevention and control of HIV infection at the national and local level through partnerships and building the capacity of partner organisations. One example of such support is in the training and equipping of peer educators who work in their local community. Here is one of their stories… “Mamata is an extraordinary girl. She lives in the town of Itahari in Sunsari district and although only 21, she has been able to break the cultural barriers and openly speak about the spread of HIV through risky sexual behaviour. In Nepal, where the subject of sex is largely taboo and hardly mentioned in public, young people like Mamata are making a difference in their communities. Mamata confesses that at the beginning it was difficult to talk about sex and HIV, but after receiving HIV and AIDS training from Naba Jiwan Samaj Sewa, a faith –based UMN partner in Itahari, she gained the confidence to speak to her friends and others about the spread of HIV. She is now an active peer educator and has spoken to more than 150 students and also addressed church leaders in Itahari on the importance of speaking out and taking action. “Because of the understanding that I now have about HIV and how it is spread, I know how to protect myself from getting infected, but many of my friends and relatives do not. It is because of this that I need to speak out” says Mamata” UMN, through its partner organisations also gives courage and hope to people infected and affected by Aids. Radhika Pun became infected through her husband who was a seasonal migrant worker. She says… “I lost my job and was shunned, neglected, persecuted and depressed. I gave up all hope of life. Then one day, at a social event, I noticed everyone behaving differently towards a group of people. These people were HIV-infected. I immediately felt pity for them and started talking to them. Eventually in 2005 we formed Sakar Samuha Nepal (SSN), a self support group. During an HIV and Aids workshop, we came into contact with UMN, who took an avid interest in our group. Through our partnership since mid 2007, UMN has not only supported us but also inspired us to realise that being HIV-positive does not denote the end of life but the beginning of a new one” Joel Gijinthi, UMN’s HIV/AIDS Technical Advisor, who had opportunity to meet with the moderator during his recent visit to Nepal, Maggie Lunan spoke of their meeting, “It was a real delight to meet with Joel Gijinthi and his family when we were in Kathmandu; the first impression was of the warmth of his welcome and his appreciation that we might spend time with him. When he began to tell his story it was we who were humbled; initially he had come to Nepal for two years, leaving behind his wife and children in Kenya – it’s a sacrifice I can hardly contemplate. His ongoing commitment to HIV and Aids work with UMN and his professionalism was evident. We were proud to be associated with World Mission Council who had had the foresight to fund his post, recognising the skills and experience he brought.” Ida Waddell, a Church of Scotland Mission Partner with the United Church of Zambia, working in Mwandi Hospital as the Aids Relief Coordinator tells the story of one of her colleagues who is HIV+ve. “Peter has been married for 2 years to Mary who is HIV –ve and practices safe sex using condoms. He and his wife wanted children so came to the clinic for advice. Peter’s blood was checked to make sure he was taking his antiretroviral medication properly and the virus levels in his blood were as low as possible. Mary’s monthly cycle was monitored to work out when was the best time to conceive. They had unprotected sex on only one occasion but it was enough to give them a healthy baby boy 9 months later. Both Mary and the baby remain HIV –ve.” 7. Promoting the Project in Scotland. Children’s Assembly 2008 It was a real pleasure for the Project to be involved in the second Church of Scotland Children’s Assembly, staged at Aviemore in November 2008. While the subject of HIV and Aids is one which might not seem ideally suited to an audience of 10–12-year-olds, we were keen to play our part in making a difficult issue come alive in a reasonable and responsible way for young church members. Staging six workshops, each involving around 20 assembly participants, the Project team highlighted key issues involving nutrition as they affect people who live with the virus. The aim of each session was to provide the youngsters with an understanding of what antiretroviral drugs achieve and the importance of regular nutrition in making this medication work to its fullest potential. The feedback received from participants and organisers was very heartening, including several of the children taking the message back to their own congregations, raising awareness there and also raising funds for the project The Moderator’s Challenge Working closely with the Right Rev David Lunan during his moderatorial year has been a great privilege for our Project, not only because of his deep understanding of the issues involved in HIV and Aids, but also because of his personal commitment to keeping the Project in the Church’s attention. In particular, we were very pleased that the Moderator took the initiative in stimulating awareness-raising and fund-raising at presbytery level. During the autumn, Rev Lunan (himself a Presbytery Clerk) launched his “Moderator’s Challenge” to each presbytery, in the hope that each might commit itself to raising an average of £10,000 for the project. The focus of the launch was a World AIDS Day Reception at the Moderator’s Residence to which all Presbytery Moderators were invited. There they were told of the good news from the work of the Church of Scotland HIV/AIDS Project and its partners worldwideó stories of hope and challenge in a situation which all you often hear about is pain, vulnerability and despair. The Moderator said: “It is together with our partners that we are able to make a difference over the last 6 years we have been able to support projects financially with over £600,000 raised by the people of Scotland. The challenge now is to continue to support partners by increasing their capacity and self sustainability, but we cannot do that without committed funds……Why not challenge your Presbytery to be innovative, and let us seek to reach that first £1,000,000”. It is our hope that all presbyteries will, indeed, rise to Rev Lunan’s challenge in the months to come, so playing a vital part in our work. “Souper Sunday 2009” One presbytery-wide activity which should be noted is the Lothian Presbytery event entitled “Souper Sunday”, which was staged in many of the congregations across Midlothian and East Lothian on Sunday 11th January. Each congregation had been equipped for the day with an order of service which could either be used, word for word, by congregational elders, or else adapted to reflect local needs and interests. Hymns, prayers, readings and three short addresses on the theme of “new beginnings” were offered in the worship resources, which were enthusiastically adopted by many Kirk sessions. Following the services, worshippers were invited to stay in church for a simple soup-and-bread lunch, with donations invited to benefit the work of the Church of Scotland HIV/AIDS Project. As a result of the services and lunches, £5,600 has been raised towards the Presbytery’s £10,000 goal. Such was the enthusiasm for “Souper Sunday” across Lothian Presbytery that the Project is proposing its adoption across the Church of Scotland as a whole (see Deliverance, section five). Mothering Sunday This year’s Mothering Sunday Starters for Sunday material was developed by the Project, following an instruction from last year’s General Assembly. In considering HIV and its impact on family life throughout the world, it is impossible to ignore the fact that so many young lives have been lost as a result of the virus’s devastating effects. This, in turn, means that many households are cared for not by mums and dads, but by grannies, grandpas and even children. The HIV/AIDS Project asked the Church to pause on Mothering Sunday, giving thanks to God for mothers the world over, but also remembering that in many parts of the world today there is a “lost generation” of parents, whose families do not know the kind of family life many of us take for granted in Scotland. Faith and HIV in Action. At the time of writing the report plans are well under way for a training workshop for Christian Faith leaders at which Waverley Care will offer the opportunity for faith leaders to learn how to use a toolkit called ‘Breaking the Loud Silence of HIV’. This resource, developed for use in church activities, explores ways to tackle the stigma and discrimination experienced by people living with HIV. The Project supported Waverley Care’s Celebrate, Reflect and Remember event in St John’s Church, Edinburgh, part of the World Aids Day activities, 2008, and around this time Waverley Care distributed a flyer with the ministers mailing bringing the needs of people living with HIV to the attention of every church in Scotland. 8. Project Management At the time of writing, the process of interviews is taking place for the position of full time Project Co-ordinator and a part time Project Administrator. It is hoped that both positions will be filled by the time of publication of this report. Despite a period of more than a year with temporary staffing for the project, the project Group have continued to drive forward the work including the process of taking the project to the next stage of its life, post December 2010. Consultation has begun with the Council of Assembly Governance and Budget Groups and with the Council Secretaries of the various Councils in regard to this. It is planned to report to the General Assembly of 2010. Conclusion Although potentially the past year could have been a fallow one for the Project, it has in fact been one when there has been much activity. It has been an opportunity to reflect and respond. The prospect of a new beginning – looking forward to the future beyond 2010 – working together with each partner to enable it to respond to its particular situation is challenging but hugely rewarding. During the recent US election campaign, President Obama’s “Yes we can” approach is perhaps one that we as a Church should emulate. As people of faith we must have the courage to be leaders as we continue to “Stop AIDS. Keep the Promise”. In this way we can play our part to empower our global community to treat all people, including our sisters and brothers living with HIV, with love and respect. In the name of the Project Group ROBIN HILL, Convener CAROL FINLAY, Acting Co-ordinator Webography Global campaign to promote “HIV-competent” churches http://latin-america.waccglobal.org/lang-en/noticias-/11-Global-campaign-to-promote-\ HIV-competent church (WCC) http://www.oikoumene.org/en/programmes/justice-diakonia-and-responsibility-for-creation/health-and-healing/hiv­competent-church.html Exploring Solutions : How to Talk about HIV Prevention in the Church http://www.e-alliance.ch/en/s/hivaids/publications/exploring-solutions/ Universal Access Now. http://www.hivscotland.org.uk/index.php?controller=Default&action=ShowContent&pageid=39 Leadership is the Key: an article for World AIDS Day http://www.hivscotland.org.uk/index.php?controller=Default&action=ShowContent&pageid=44 Report on the Global AIDS Epidemic 08 http://viewer.zmags.com/showmag.php?mid=wwfwwq#/page0/