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The Role of Religion in Asia’s Response to HIV/AIDS
March 30, 2006
Washington D.C. Center
Speakers: Marina Mahathir, Dr. Mark Dybul, Rebecca Shah
Moderator: Dr. Judith Auerbach
Asia Society: I see members of the Asia Society. Asia Society is a non-profit non-partisan private organization that is this year celebrating its 50 th anniversary. We were established with a double purpose to, the first one it to help Americans to better understand Asia and the second purpose is to bring Asians and Americans together. You will see through this program that we try to do both of those things. We have headquarters in New York City where we were founded 50 years ago. We have offices throughout the United States and in Asia including the most recent office which we just opened about ten days ago in Mumbai. The way we carry out our mandate is to do public programming. We are not necessarily a think tank per say we do not have in house resources but we do bring together resources from around the world on Asia and the United States to look at issues of importance. In terms of our partner organizations, we do not focus on just one area, we feel that anything that is happening in Asia is appropriate for our examination and illustration. We work with arts and culture. We have a wonderful art gallery at our headquarters in New York with magnificent Asian art collection. We do political issues we do economics issues we do business programming and we do social programming which is what we are doing today. We have an office in New York called the Asian Social Issues Program and this program is coming out of that office. If you are not members and find today’s programming interesting or the concept of learning as much as you can about Asia intriguing to you and you would like to look at the paperwork when you checked out on the way in, there are some materials. I urge you to join. We are a membership organization. We have very large membership here in Washington as well as corporate members. We are always looking for members, I urge you to consider membership.
Now for today’s program we have laid out – I believe you all have a chance to look at the biographies of all the speakers. I am going to just introduce to you the moderator for today’s program Dr. Judith Auerbach. Dr. Auerbach is Vice President for Policy and Program Development at the Foundation for AIDS Research. Prior to this position she was Director of the Behavioral and Social Sciences program and HIV Prevention Science Coordinator at the Office of AIDS Research with the National Institutes of Health. She has also served in the White House Office of Science and Technology Policy as Director for Social and Political Sciences. Dr. Auerbach received her Ph.D. in sociology from the University of California Berkley and in addition to her work in government and in the private sector, she has also been a teacher. She has published and presented on issues that deal with AIDS, research in science policy, and family policy in general. She is the author of a book In the Business of Childcare in addition to working for (inaudible). Her current research interests focus on two areas: developing basic and intervention approaches to health information and disease prevention, and the social organization of scientific knowledge. Dr Auerbach received the 2004 Federalist Activist Award for sociologist for women’s society and in 2005 (inaudible) Award for public leadership education network. It is my great pleasure to present to you Dr. Judith Auerbach.
Dr. Auerbach: It is really a pleasure to be here. That was much more of an introduction than I think I needed but thank you very much. I will be very brief about introducing the speakers because you do have their biographies on hand. What we are going to do is have three invited distinguished speakers present in various modes. (inaudible) and PowerPoint. It should be a nice combination. And then we will have a discussion among the panelists where I pose some questions, and then we will open things up to everybody here.
So we are going to go in no particular order, beginning with Marina Mahathir who has until very recently served as President of the Malaysian AIDS Council and the Chaired the Board of Trustees at the Malaysian AIDS Foundation. She has been very active in many scientific and civil society activities, NGO activities, related to HIV/AIDS in Malaysia and Asia more generally, including chairing the 5 th International Congress on HIV/AIDS in Asia and the Pacific (inaudible) in 1999, NGO’s in the Malaysian delegation to the UNGA. She has also been Vice President of the Asian (inaudible) in the Pacific and she is currently that society’s liaison to the 8 th International Congress on AIDS in Asia and the Pacific which will be held in Sri Lanka in 2007. She has been very active on issues related to women, gender, and HIV/AIDS and the role of Islam and religion more generally and in the fight against AIDS in Asia.
Marina Mahathir: First of all, let me thank the Asia Society for inviting me here to speak, once again, I think this is my third Asia Society event talking about AIDS and there might be a few more coming up. I was very interested in doing this because of the topic about the role of religion in Asia’s response to HIV/AIDS. Having worked in HIV for the past twelve years, particularly among vulnerable communities and doing a lot of advocacy work in Malaysia and the Asia Pacific region. I have no doubt through all of that that no response can be complete if they will not include religious organizations, religious authorities, religious leaders in the response, particularly in the developing world, particularly in Asia and the Pacific. And the reason is really very simple because religion plays a huge part in people’s daily lives. In our part of the world it is not something that they find once a week rituals, it governs the way they behave the way they interact with one another, it governs the way men and women treat each other. And that is very, very important part of the way society works and makes various people vulnerable. Also religious leaders are important community leaders they are extremely influential. If they say the wrong thing it is very hard to change attitudes, especially towards discrimination. If they say and do the right thing, it also has a positive effect. To give an example I have dealt with, last year, 2005, with a very publicity prone, I must add, muslim leader in Malaysia, one of the (inaudible) of the state said that people with HIV should be confined to an island. In 2005 people are still saying this and this is really, I had to take it seriously it would have been easy to poo-poo it off, but it is very important because people listen to him. They are not questioning and they think that this is a viable solution to the HIV problem. On top of that, he is not just influential on Muslim’s in my country but also non-Muslims. I was on TV talk show and there were call-ins and there was a Hindu man who called in and cited what he had said as something very good. So you know, the ramifications of this for people who are actually infected and their families is huge. It is not going to happen, I think, not practical, one of those people who likes to say things without thinking about the practicalities of it. But what it does is reinforces the stigma that is attached to AIDS and also the discrimination.
Also I think, and this is a current interest of mine on the issue of religion, particularly slum and gender, and women’s vulnerability to HIV that gender roles are often shaped by religious precepts. Where these tend to discriminate towards women, it makes women much more vulnerable to HIV. This is very important and I think you cannot address women’s vulnerability to HIV without addressing the religious basis for the gender dynamics within Asian society and my particular interests is in how that plays out in Islamic societies. I am not saying that Islam says that we should discriminate against women but certainly the way human beings interpret and then play that out in terms of personal laws, particularly, make a big difference to women’s vulnerability.
We can talk a lot more about that but I thought I would share with you some of the strategies that we have used in approaching particularly the Muslim leaders in Malaysia. Until last December I was head of Malaysia AIDS Council which is an umbrella body of right now about 38 NGO’s that are working in HIV in Malaysia. From the beginning one of out founding partner organizations was the Malaysia Consultancy Council on Hinduism, Sikhism, and Christianity and they have been training their leaders at the national level, at the state level. What was missing of course was the Muslim side of things which is a big gap because a majority of the people in Malaysia are Muslims and they were not involved and the fact that most people currently reported with HIV in Malaysia are Muslims. We have to deal with the Muslim religious establishment and it has been a real challenging learning process for us. We started off with completely the wrong track because we are so used to dealing with communities, particular communities, we had to tailor our programs to sort of target certain communities and all that, make sure everything is in a language that they understand. Religious leaders are the same way. We thought we had to speak with them in their own language, which in Islam means being able to talk about what the Koran says or what the Hadith says and all these sorts of things which sounds find in theory but when you try to do it practically and you are not an expert it really gets into a lot of trouble. You are really getting into lots of things you know nothing about. We started out like this and it all backfired in our faces so we tried it again. Basically we realized one thing: religious leaders are human beings. Just like anyone else they have the same fears as anyone else, they are just as ignorant about this thing as anyone else. We should address that. We started from scratch and we talked to them about what we knew, the facts about HIV/AIDS – this is what’s happening, this is how it is transmitted, what do you think we should do about this? And they were much, much more responsive because then it is clear we were not there just to tell them what to do, we wanted to ask them what to do.
We embarked on several consultations with the religious leaders and what we tried to do is, Islam as you may know, does not have priesthood. So in terms of leaders and such, they are all pretty much government appointed or self appointed. So in Malaysia for instance we have thirteen states, fourteen with the federal territory and each one has a government appointed head authority called a (??). He is not like a bishop or anything like that, in religious terms but he has just been given this authority. Mind you, once he gets it he acts like one. So when he says g (?>?) it makes things very difficult and Malaysians being essentially very feudal, once someone gets on top of you, you sort of start, and it is very hard to challenge. Anyways, we tried to select those that we felt had slightly more open-minded, open to listening and they were pretty responsive. We started out giving them the facts and then we thought, AIDS in Malaysia is very invisible still. We have cumulatively since 1985 about 70,000 people who have been reported HIV positive. But you basically cannot see them anywhere. It is hard for people to really believe that this is a big problem, this it is going to grow, that it is going to have an impact on our community. So what we decided to do is to make them see what will really happen to a country if AIDS really formed. We selected seven Muslim religious leaders and took them to Uganda because we wanted them to see a country where AIDS is in your face and you cannot run away from it. But not only that, but we wanted them to see a program where the Muslim community educated people about HIV. It is really well know, UNAIDS has called it a best practice and we also wanted them not to be fatalistic about it, not to feel like there was nothing to do. You can do something, you can be successful. There is something to be done in Muslim countries, in Muslim communities, by Muslim leaders. We took them there and they had the opportunity to talk to their counterparts there and observe their program. It is a wonderful one and I hope you all have the chance to learn about it sometime. And they also had the opportunity to attend an Islamic conference on HIV/AIDS where a lot of the African Muslim leaders came together to talk about AIDS in Africa. Again, they had the opportunity to interact with their peers. All we did was facilitate this. They got to talk to other people who had real life experience dealing with AIDS and were very realistic about it. The program for instance started out by refusing to talk about condoms at all. Fine. But a year later they had to because the realities of the situation warranted it. Plus one had lost his son to AIDS and regretted so much that he never had the opportunity to prevent that by talking about condoms.
So those are the real life experiences that we felt would be good and those seven people came back quite changed I guess. One of them would talk on TV, he was very often invited on TV talk shows on religious matters and he would get up and talk about his trip to Uganda and what was happening there. He was excellent and that was really good. Plus we then were developing a manual on training religious leaders on Islam and AIDS and again them involved from the very beginning and worked through every single issue. We got them to look at the religious backing for the things that we wanted to do. It was a very interesting process because they were very involved, it was a very good interaction. We were able to get the NGO side, ask the NGO side, ministry of health, and the religious leaders. After which we had a memorandum with the UNDP actually, the UNDP funded it, then we went around the country and conducted regional workshops with grassroots religious leaders and trained them on HIV and talked about all of these issues. It was really amazing what we found, that Malaysia has a big drug problem and with it follows the HIV problem so in fact there is grassroots level religious leaders were already facing HIV and they did not know what to do because they had no knowledge and know they were not really providing the service they needed to provide. They did not have the knowledge so they were falling back on the same old things which they knew were not very useful. They really welcomed this training and they wanted more in fact. For budgetary purposes we were doing grouping people from different states together and they wanted to do state level workshops and then even smaller ones so more people had the opportunity. It has been really amazing. In one state we had 29 of these religious leaders (men and women) we count also village heads who lead prayers, people who teach the Koran to kids, male and female. In this one session there was a big debate about condoms. Finally my staff, after a long while, they were going on and on about how condoms cannot be used. Finally asked them, have you ever seen one? And all of them very shamefacedly said no. so I ran out to the nearest 7/11 and bought one each for all of them brought them back, got them to open it, take it out and look at it. At the end of it, they said, “we were afraid of this little rubber thing.” They realized it was just a tool for prevention, it is not the thing that makes people go bad. That really demystified and undemonized the whole thing. It was very useful.
Since then unfortunately it has come to a halt, which is rather unfortunate. We are hoping to revive it. The problem is always the bureaucracy. The response at the grassroots level was great. The problems we have are with the people sit in the office at headquarters. Those who never get to meet people with problems and they are the ones who make the decisions and the ones who sign the checks. Also, it is a revolving door you get all the civil servants coming in and out. Every time we have a new one come in and they look at the manual and do not understand the history, that it was developed with the religious leaders input. They look through it, they see the word condom and they go “stop” and that is it. It is very hard for us to restart the whole lobby, the whole process of getting them to sign it again. That is a bit unfortunate. For the limited run it did have, I think it was quite successful. People were so responsive and very keen and they understood that it was an issue.
There are so many other issues that are related to religion and AIDS in Malaysia which I think might be too long to go to. That is just an example of the strategy we used and some of the countries want to emulate it. It’s hard to translate, I know, because in Malaysian. The other thing they are trying to do right now we just started a harm reduction program with methadone and needle exchange. This is fully backed by the government but the religious leaders are not very happy with it. Partly because the whole thing was just dropped on them and the public, just like that. We did not have the opportunity to educate people first to close the door. Again, unfortunately the educating of the religious authorities is not in the hands of us, the NGO’s, it is being done by the government. So all the experience we had originally has not been put to use. The strategy, we advised them was to take a few leaders first and work on them and then get them to work on the others. Unfortunately they have decided to go big and have a seminar for one thousand people and predictably enough with different levels of HIV understanding also some things it was a bit of a disaster. We are trying to get that rectified in one way or another because it has to be done.
Dr. Auerbach: Thank you very much. That was a very nice introduction to your particular (inaudible). I would like to introduce our next speaker who is Dr. Mark Dybul who is the Deputy Director Global AIDS Coordinator and Chief Medical Officer of the Office of the Global AIDS Coordinator of the US Government. Of course means he is involved in leading the implementation of PEPFAR. Two steps before this position probably was at the NIH (inaudible) where was the Assistant Director for Medical Affairs at the NIAIE (inaudible) and he has also been very instrumental in the group that formed the treatment guidelines for HIV and AIDS out of the (inaudible). So without further ado I would like to introduce Mark Dybul who will talk about the ways in which governments and donors interact with big institutions.
Mark Dybul: Thank you Judy and good afternoon to everyone. Thank you very much to the Asia Society and for inviting and for your leadership in highlighting the importance of HIV/AIDS in Asia and around the world. And particularly this afternoon for highlighting the importance of faith-based organizations in the fight against AIDS which we believe is an essential component in any response. Perhaps I could give you a brief background on the President’s Emergency Plan for AIDS Relief, for those who are not overly familiar with it. It is a five year fifteen billion dollar initiative. It is the largest international health initiative in history dedicated to a singe disease, which as a public health official is something that is still mind boggling to me. It is extraordinary. The President set very specific goals for us, it was not just fifteen billions and let’s hope something happens. It is fifteen billion dollars with very specific goals: to support treatment for two million people, to support care for ten million HIV infected people, orphans, and vulnerable people, and to support prevention to try to avert seven million new infections. Pretty sizable bite to take but an essential one. The leadership of the American people is now clear on HIV/AIDS. Unfortunately the American people are providing a lion’s share of activities globally for HIV/AIDS, something that hopefully will be corrected in the near future. But is essential that we take these tasks on, in part because of what is going on in Asia but also in Africa and around the world. There is some misunderstanding about PEPFAR, it is not only in 15 countries. We have a focus in 15 countries. We have bilateral programs in a hundred and twenty countries, including many in Asia. One of those 15 focus countries is in Asia, Vietnam. But in addition to that we are still the largest contributor to the Global Fund for AIDS, TB, and Malaria. The US government, the American people, are currently providing 30% of all the resources in the Global Fund. So a third of all the grants in Asia from the Global Fund come from American people and that is an integral part of PEPFAR. Overall in Asia, through our bilateral programs, we are current, the US, supplies around 140 million dollars a year. Again, a third of all the Global Fund grants come from the American people.
That is somewhat an overview of PEPFAR. The topic for today though, is something we believe is critical and that is the role of faith-based organizations in the fight against of HIV/AIDS. We are concentrating on Asia here, but I would not that this is essential throughout the world, in Africa, Latin America, Eastern Europe. All over the world faith-based organizations are critical for reasons that have already been discussed. I would like to highlight two of them. One has been extensively discussed which is the credibility and importance of faith-based institutions in the communities. They are the guiding force in many communities throughout the world. If we are not engaged with faith-based organization, we cannot possibly have a credible response to AIDS. The second reason is as important to us. This is that faith-based organizations have a reach that nobody else has. In many rural communities you will go to in any part of the world, the only organization out there is a church or a mosque. They are the only organization providing services, they are the only organization that pulls the community together. If we do not engage faith-based organizations we cannot combat this epidemic. That is true for prevention care and treatment.
In prevention the leadership of the churches in the actions of its people are essential and involving them are essential. I will talk about some specifics and we have had some examples already where the moral compass in the society is provided by a group of individuals and if you do not engage those individuals the actions of that community cannot possibly change. I will give you an example from Africa. I was recently in Zimbabwe where a church which accounts for about ten percent of the population endorse polygamy for all of its existence and in fact there was a great deal of HIV/AIDS in their community because of it. As a result of HIV/AIDS and a lot of education, the church has reversed itself and is now opposed to polygamy and is teaching its membership not to engage in polygamy because of the risks of HIV/AIDS. That is just one example of these cultural issues that need to be talked about and dealt with among the churches and faith-based organizations if we are going to respond.
The importance of the faith-based community in care and treatment is as important as in prevention. The majority probably of home based care for the dying is provided by faith communities, particularly in rural areas. Most of them are already caring for HIV infected people, but do not know it because they do not do HIV/AIDS tests. We are not going to reach all of these in their homes and their communities unless we engage the faith community. In treatment, forty to fifty percent of parts of Africa, for example, health care is provided by faith communities, mission hospitals. If you are not involving those hospitals and facilities in the care of HIV infected individuals you cannot possibly reach all the HIV infected individuals in the country. As we move to national coverage for prevention, care, and treatment the only avenue to do that is in a multi-sectoral approach which involves all aspects of the response, including the faith community. Whenever I speak on this topic, I always go back to critical document in development which unfortunately is being forgotten and that is the Monray (sp?) Accord. A key principle of which is multi-sectoral involvement, involving all sectors: faith community based, public-private, everyone in the response to development including HIV/AIDS because it was recognized there that only through this multi-sectoral and multi-disciplinary approach could we possibly tackle the problems not only of HIV/AIDS, but development in general.
Since we are focused on Asia I would just like to give a couple of examples, following up on some examples of where the US government and the American people are supporting faith efforts in Asia, to give a flavor for what can be done. In Southeast Asia, in Vietnam, which I mentioned is one of the focus countries for the emergency plan, there are a couple of things I would like to highlight. One is the catholic churches involvement in palliative care. In an extraordinary way, the government of Vietnam, which I think most people are aware is a communist state, is actually actively partnering with the Catholic Church because of HIV/AIDS. It is one of the first times something like this has happened. It is a good example of the importance of involving faith communities. The church there is mostly involved in palliative care at the moment but is branching out more and more. Another example is a program we are supporting where medical doctors are working with Buddhist monks to promote behavior change among youth and encourage care and comfort for those living with HIV. Right next door to Vietnam, in Cambodia, a large Buddhist temple there, Kian Khest (sp?) serves 70 villages. In those seventy villages support for the emergency plan is allowing the temple to support care for persons living with HIV/AIDS and up to two thousands orphans and vulnerable children this year. Again, the reach into those 70 villages is of the temple. In Thailand, Mercy Center employs persons living with HIV/AIDS to provide anti-retroviral therapy and palliative care, orphan care, prevention, stigma reduction in Bangkok slums. I think most people who have been in some of the slums, whether it is outside of Nairobi or in some parts of Bangkok, are the faith based community. We are not going to get into these communities unless we are engaging the faith community.
Moving to South Asia, I am not going to talk too much about India because the next discussion will be heavily on India, just to highlight a couple of things. The Salvation Army is implementing care and support for persons living with AIDS in Mumbai. There is an interfaith conference with people of the Hindu faith, Muslims, and Christian organizations that have developed an action plan for interfaith activities on HIV prevention and care. Getting the churches, all of the churches, and all of the faith communities involved, Young Women’s Christian Association works with OVC’s and adolescents in Delhi and Tamil Nadu. This is just an example of a list of about fifteen I have of faith based communities being engaged in HIV/AIDS in India. I will leave that mostly for the next speaker. In Bangladesh, through support from the American People, the Bangladesh AIDS program is working with religious leaders to reduce stigma and promote counseling and testing, promote abstinence and fidelity behavior change, community change and social norm change. The program seeks to reach fifty percent of the general population over the next three years, and only the faith community would be able to have such a strong reach. They will eventually reach fifty five thousand people through their Friday sermons alone which give a great example of what is needed. I will give an example from Africa where the Ethiopian Orthodox Church is going to reach forty million people, half of the population, through their sermons as well. Great examples of how the churches and faith communities can be engaged.
In the South Pacific and Indonesia, the women’s branch of Indonesia’s largest Islamic organization has over 30 million members. They are working with the US support with female prostitutes along the country’s main east-west highway. The women from the Islamic community bring information to the prostitutes and male travelers at truck stops to teach women job skills such as sowing to try to move them out of prostitution with alternative employment while working with their potential clients to emphasize the importance of abstinence and fidelity. Another Islamic organization in Indonesia produced a series of twelve sermons to be read at Friday prayer services throughout the country. These sermons provide information to men and families on HIV/AIDS, to promote abstinence and fidelity as well as combat the stigma and discrimination, dealing with some of the gender issues that were discussed, which can be both promoted but also broken down by the faith communities. In Papua New Guinea, one of the Islamic communities is developing and implementing HIV/AIDS curricula focused on youth that will be rolled out extensively through its networks.
This is just a sampling of the types of programs that the US government is supporting and we must support if we are going to achieve results because these communities have such deep roots and such deep reach. You can see, I think, that PEPFAR partnerships with faith-based organizations are very diverse, both in terms of the countries they work in but also in the work they do. We plan to expand on these as much as possible. Overall this year, in the 15 focus countries, about 24 percent of our partners are faith based organizations, demonstrating the importance of this reach. Eighty two percent of our partners are local organizations and I think it is important to emphasize the necessity of country ownership in all of these countries. We will not win this battle by the American people going in and doing things. We will win this battle by the American people partnering in transforming countries and an essential component of that is local organizations and that means in many of these places, faith based organizations. With that I would be happy, when we get to that, to discuss any of the specifics and talk more generally. Thank you again to the Asia Society and for raising such an important topic.
Dr. Auerbach: (inaudible) Our final speaker is Rebecca Shah, Director of Transforming Development Associates which is an independent consulting firm that specializes in international development. She also serves on the boards of a couple of organizations that are involved faith based community development activities and micro-enterprise, HIV/AIDS related enterprise development throughout the developing world. She has previously served as (inaudible) at the World Bank in the development network and she has authored several works including a chapter in related to faith community and development. Without further ado, I am going to ask Rebecca to talk about HIV/AIDS activity from faith based organizations.
Rebecca Shah: Thank you Asia Society for organizing this event, I would like to echo my colleagues, this is a very important issue. I understand I have ten minutes so Madam Chairmen, I would be open to you warning me when I go over. I just ask you do not warn me like Maggie Patter did during cabinet meetings where if her cabinet staff drowned on too long she started tapping a pan on the table very loudly (taps pen on table). This is straight from one of the ex cabinet members mouth. Ok, thank you.
Well, I have my PowerPoint presentation, if you cannot see it I was wondering if you could come over, but if you can, it is over here. I apologize for the title, I am not really a Tina Turner fan, but I do think it is rather catchy. I come to this set of issues as a demographer and someone who has worked with faith based organizations over the last ten to fifteen years both in India and in the United Kingdom, as well as here in the US. I also worked with the World Bank, which many of you know is not a faith based organization and fairly resistant to faith – a different kind of faith. Well, faith based organizations bring a lot to bear on the work of prevention, treatment, and care of people living with AIDS in India. I have highlighted two points as to why I think that is. I think faith based organizations have a holistic and an elevated view of the human person. They see them as people with dignity, with self worth, and with a hope in the future. I think this view is particularly important for a disease that ravages and decimates the physical body such as AIDS. In a culture such as mine in India, we have a historical and an entrenched culture of exclusion and stratification. You all know about the caste system, the exclusion of untouchables, of widows, of women who are menstruating, of women who have just had children, of orphans. Now we have a new constituency, of those with AIDS. In India, they already are isolate a vulnerable and hurting group of people through social stigma.
Faith based organizations, as Dr. Dybul has already said, have a vast amount of skills, experience, and very effective institutions and networks. In fact, George Deacon of the mission directed in India for USAIDS called the role of faith based organizations in India and some of the skills they have are unparalleled. So what is the context? Here comes my next slide. Most of you, unfortunately it is impossible to talk about AIDS in Asia without talking about India. And sadly it is impossible to talk about AIDS in the world without talking about India. India is second only to South Africa in the number of people living with AIDS. These estimates are from the National AIDS Control Agency organization in India and some actually – I mean I have read somewhere too that their estimates are serious underestimates because they are part also of a government organization which tends to underestimate the dangers of AIDS. Heterosexual sex accounts for 88 percent of HIV transmission in India. The highest prevalence of those contracting HIV in India is between the age groups 15 and 44 and in 2005, NACO found that 37 percent of new cases were diagnosed were people under the age of 30.
In addition to higher populations such as commercial sex workers, in India most of the transmission is through extra-marital sexual activity. We see that married women are increasingly vulnerable in India. In Andhra Pradesh which is one of our six high risk states in an ante-natal clinic in Vijayawada they found that one out of every ten women that came for the ante-natal testing were tested positive and they did not even know it. Much heterosexual transmission is to a great extent linked to dysfunction, I call it, which is this high level and strong correlation with domestic abuse. Of course domestic abuse is related to sexually transmitted diseases, many of the people we have met and worked with in our organizations in Bangalore were victims, women who were victims of domestic abuse and they had at least one incidence of a sexually transmitted disease. Gambling again found to be strongly correlated with domestic abuse and extramarital sexual activity also is linked with gambling and thus in turn with STI’s.
What is interesting and sad is what most people do not know this, I am sure many experts do, is that sixty percent our infections are in rural areas and forty percent in urban areas. Men leave villages, go out to the urban areas, work and come back and infect their wives. In turn the wives then infect their children. We have a rising number of natal infections too in our high risk states. Another terrifying and very, very deeply sad characteristic of HIV/AIDS in India is the number of orphans. We currently have 1.2 million orphans and there have been projections of the number of orphans rising to 4.3 million by 2010. This is a country that completely lacks any type of safety net for orphans, for children. In Bangalore where I work and live there is a rising number of child prostitutes and child headed families. Here too, this is unfortunately an aspect of HIV/AIDS in India which really has not been very well looked at or indeed dealt with at any level by the government.
I ask you, can faith be part of the solution? About five years or ten years ago, faith and solution would not be in the same sentence. I mean faith was often assumed to be part of the problem. There seems to be this historical conflict, this perception at least, of a conflict between the progressive development agenda by our friend down the road and by in many cases secular development, western organizations and what is often perceived as the moralistic religious agenda. So there is a conflict. I can give two examples: in the Beijing women’s conference and the Cairo population conference often Muslim countries and catholic countries were on the defensive. Mary Ann Glendon (sp?) who I am honored to know was one of the people who helped to co-author some of the work for the population conference, spoke out strongly about this and felt that as a catholic she was constantly having to defend her position and could never speak with any sort of authority on this. Up until a few years ago at least, in India faith based organizations either had to conform for the amount of money that was rushing into India, they either had to conform to the western development organizations agenda or be on the defensive about their position. So they either gave up their unique perspective, their unique status, or sat on the sidelines and became defensive.
So what are faith organizations? Let me briefly tell you from the grassroots perspective what faith organizations. When I talk about FBO’s I talk about established churches, established religions as well as grassroots organizations. The Hindu’s: India is predominantly a Hindu nation. The Hindu Nationalist Party, not to be confused of course with the all Hindus, the Hindu Nationalist Party, as exemplified by the BJP, the government that was previously in power up until the Congress Party of Indira Gandhi had a strong emphasis on abstinence and faithfulness. In fact, Seshma Suaraz (sp?) was a very strong proponent of abstinence and really opposed any condom use in AIDS or even in AIDS education ads. What are our Muslims doing in India? Well they are very disorganized, any efforts are sporadic. (TAPE ENDS)
(NEW TAPE) Personally quite happy to see more and more religious organizations engaged in HIV work. I am still very disappointed at the level of Muslim organizations involvement in HIV. It is still very far behind other religions and that is particular disappointment for me being a Muslim myself. But I think as both my colleagues here have mentioned, religious organizations, particularly the Christian ones and the Buddhist ones, have been very, very good about care and support. They do hospices, orphanages, all sorts of things. It is really excellent. I do agree all of this is very necessary, very important. But two years ago in Bangkok, there was a big satellite meeting on religious leaders on HIV/AIDS because they were going to bring out a leadership statement. I went there and really made a plea to all of the religious organizations, they had to emphasize also prevention. In emphasizing prevention they also had to address, not just stigma and discrimination, but their role in stigma and discrimination, which unfortunately – they have played a big role. Whether it comes from religious precepts or wherever, statements and things like that leaders have made, really against particular groups of people are most horrible to HIV. I mean across the board, not just the particular religions, have really increased their vulnerability by making them more invisible, by making unable to access prevention because they cannot admit to what they are doing, all sorts of things. It has made women vulnerable to HIV by really reinforcing the patriarchal attitudes in society. I spoke about the UNGASS where for days and days and days countries with very strong religious backgrounds, a lot of Muslim countries as well as the Vatican and the US, fought to exclude this thing of the most vulnerable groups in our country, whether it is homosexuals or drug users or migrant workers, just exclude them completely from the document. As if they do not exist at all. This to me I thought was criminal, the fact that they spend days and days and days while people were getting infected and dying, the very same people were getting infected and dying. All of these bureaucrats and diplomats in New York were trying to obliterate them from the world. I think, I am glad to say that those religious in Bangkok did not take that to heart and the statement that did eventually come out I think addressed that and acknowledged the need to get over it. Because when you emphasize care and support totally all the time, yes that is great and it is very much needed, yes it is all about compassion and all that, but you are also saying that until you get infected we do not care about you. And I think that is really wrong from every point of view. You have to care about people before they get infected. And you have to care about the situations that make them vulnerable to HIV.
I think there is a lot more that religious groups can do to address these vulnerabilities, to address people without judgment. I will give you an example, it is a tiny example, some said today there are lots of good examples but they are tiny and unfortunately they do not add up to enough. This one example that I am rather proud of, simply because it happens to be a Muslim example, there is a wonderful (inaudible) in Indonesia just outside of Surabaya – ostab (sp?) is like a religious teacher and he and his wife have been working, administering, a community of sex workers, and he lives among them and has his mosque right in the center of the sex worker community. He gives them religious classes but on top of that he also gives them things like English lessons and computer classes. If they want to go on the Haj, he helps them save money to go and all that. He makes no judgment whatsoever at what they do and understands that for many of them, they have to do it out of poverty. He has actually been very effective in finding ways naturally for these women to get out sex work. I am less concerned about the end result which in fact is very good, he says that out of a community of six thousand, six thousand sex workers in one community, over the past fifty years, it has gone down to thirty thousand. But the approach, the completely non judgmental approach is something that I think should be emulated. He cites the prophet himself, the prophet Mohammed, who he said moved Mecca to Medina (or maybe it is the other way around) because he went where the problems were, meaning that you cannot live in an ivory tower, you have to go down to where the problems are and work there. Only there you can – I thought he was an excellent example, particularly for his colleagues in the – the other area that I really must mention, to come back to women’s vulnerability, and that I think in every religion unfortunately they are very, very patriarchal and this has not helped women at all. Married or un-married, their vulnerability is completely link to their status in society which is really dominated by men. How they can say no, how they can find ways out of infection, how do you – if for example in Muslim communities, you are always obliged to be sexually accessible to your husband, how do you say no when you suspect he is HIV positive? If he refuses to use a condom, what do you do? Where do you get help to turn this around because there has to be exceptions to this? It is not always clear to women, it is not always clear to men. There is a responsibility to not transfer the virus to others. Unfortunately this problem is recognized in many communities, many religious communities but the response is always, as far as I can see, almost always mandatory testing. In Malaysia we have been fighting a movement we are against, premarital mandatory testing, which is supposedly used to protect women from HIV by knowing who they are marrying. Usually, what I have found from people who decide to get married and then have to do the test, you cannot really change your mind about the man you want to marry presumably there are many qualities to him. There are many flaws with this. One of the flaws is that it is not supportive of the women, it does not include counseling, it simply does nothing at all. Most importantly for me is that is does now empower, it takes the decision out of their hands completely. Whether they want to marry—and also it does not actually change the power structure in the marriage. It does not stop the man from getting infected five or ten years down the line. Then he infects her. In fact, that is what we are seeing, women not getting infected at the beginning of their marriage, but much later on when they have had several children already. Testing by itself does not solve it, particularly mandatory testing. I will stop there.
Dr. Auerbach: We are actually close to running out of time all together, aren’t we? But I do want to give other two speakers an opportunity to add anything they would like to and then maybe we can take another question or so.
Dr. Dybul: I think it is a very good question, and sometimes a very difficult issue. But to be honest I think it is often a more difficult issue at the (inaudible) then it is on the ground. Not always, but often. You can reconcile public health with faith beliefs and the faith based communities’ beliefs. A good example is in prevention, young children are generally taught abstinence and fidelity and so the churches can concentrate there where they do not as much deal with people engaged with sexual activity. Again everyone needs to be engaged in this response and different communities can respond in different ways with their beliefs. That works quite well and is working in many places. It is also true that realities influence the teaching. We visited a small, small, small evangelical church that was about the size of this stage in deep world Mozambique, it had about thirteen very conservative evangelical pastors. We asked them what they teach their flock about prevention, they said, I teach sexually active youth to use condoms but I do in a context of abstinence, fidelity, and condoms and our faith teachings. The realities on the ground are frequently much different from the realities we hear about back here, not always that is the case, but is not infrequently the case. I think there is an awful lot of misunderstanding often sometimes from the faith community to the secular community, but often from the secular community to the faith world and not understanding what is understood in those communities. I think a very good example of that is the faith communities across the board are founded in the basic principles of compassion, hope, and love. There is a sense of compassion and love in the care and treatment of individuals that transcends teaching. There are many examples of this. The Catholic Church which has been dealing with prostitution for centuries, literally centuries, in very compassionate and caring ways. In this very city, the first hospice for HIV infected people was opened by the catholic cardinal at the same time that he was talking about men who have sex with men and the teaching of the church; he opened a very caring environment for those very people because of the compassion. There is a difference between moral teaching and compassionate care for those whoa re engaged and our own policies reflect that. We are opposed to prostitution on certain grounds but at the same time both in law and policy we understand the need for compassionate care for those people which is separate from their activities. Compassionate care welcomes them as individuals, recognizes how they become prostitutes because of economic and other reasons and works very much with them. Following up on the last comment which was made, which is how I will end – Michael Gersun (sp?) who is the person on many of these issues who is a very wonderful person and a devout Episcopalian uses the term, “meet people where they are” which I think is how most faith based communities deal with this. They meet people where they are. There are issues and we do need to deal with them, and they are dealt with for example the polygamist trial which I discussed where they actually changed their teaching, these things happen but we need to keep pushing them. There are real issues there. I do not want to gloss over the real issues there. But there are ways to deal with them and the way not to deal with them is to throw arrows from each other on the fringes and not try to understand where people are coming from in both directions.
Dr. Auerbach: Thank you.
Rebecca Shah: Need I say more, but um
Dr. Auerbach: Ok (laughter)
Rebecca Shah: Just to say that faith based organizations and faith organizations, the Catholic Church, the church of India, are not enemies of change. They have their own problems, they are not perfect, they have a long way to go. The churches teachings on discordant couples that is something that needs to be worked out, whether condoms can be used among discordant couples. Things like that, there is discussion. I would like to emphasize where I come from come, form where I am sitting in India, there is no culture war. It seems to me that a lot of time the culture war is in imported form here. We don’t fight. (inaudible). The USAID and there secular NGO’s work happily with us. We all work together because the situation is often so dire we don’t even have time to think about what our differences are. So I just want to end with that.
Dr. Auerbach: In the interest of time (inaudible)
Asia Society: Yes, first of all, let me apologize – I shouldn’t apologize, this is an absolutely wonderful presentation. So good. (clapping) I don’t think we have a chance to ask questions from the audience but I think it is extraordinarily illuminating. Let me thank you all, Judy, Marina, Mark and Rebecca. And unless you are rushing out, perhaps we could let people come up and talk to you for a few minutes. I know we said we would be over at two, but if you have a few minutes, perhaps some people would like to come up and talk to you. Thank you so much (applause)
END.
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