Thursday, February 28, 2008

The Future of PEPFAR Help in an African Context

Please read the following reflection from Fr. Terry Charlton, S.J. on his work with children who have been orphaned by HIV/AIDS in Nairobi. It's particularly helfpul to consider as Congress looks at PEPFAR (President's Emergency Plan for AIDS Relief) and its future funding.
Africa Needs an Effective Approach to AIDS

By Fr. Terry Charlton, S.J.
Jesuit Vocation Director, Kenya
National Chaplain, Christian Life Community, Co-founder and Chaplain, St. Aloysius Gonzaga Secondary School, Kibera

I work in one of the largest slums in Africa, Kibera, located in Nairobi, Kenya. Some years ago I started St. Aloysius Gonzaga Secondary School to educate young people who have lost either both parents to the AIDS-pandemic, or one parent and the remaining parent is infected. I am proud to say we now have 265 students, and we are supporting another 50 graduates to go on to college.

Kenya and several other countries have made real progress in fighting AIDS, with US support. On his recent trip to Africa, President Bush rightly received recognition for getting the ball rolling on expanding access to AIDS services in our region of the world, especially treatment and care for the sick and orphaned.

But, quite frankly, I am alarmed at how far removed from African reality his proposal is for the next five years of the program. Since Congress is now debating what direction to take this program, along with programs to address many health and development issues related to AIDS, I want to share what I have seen in Kibera and make a plea for realism.

We have learned a great deal about AIDS since 2003, when the U.S. first began its emergency response to the crisis in Africa. Anyone visiting us in Kibera would see that the AIDS issue cannot be viewed in isolation. My students, teachers and their extended families face inter-related problems rooted in poverty, issues of gender and a
broken-down health system. A smart U.S. response must address this context, including the dearth of qualified medical personnel and community health workers. And, to be effective, it would confront tuberculosis head on, since, as we have seen in Kibera, TB is what actually kills most people living with AIDS.

But the Bush approach, now taken up by the Republican leadership in the House, ignores these lessons. It does not seriously address any of these related issues and, worst of all, freezes funding at the current level for the next five years, even as the world is racing to meet the goal of universal access to all AIDS services by 2010.

This funding freeze would have a devastating impact on programs that serve the children I work with every day. So far, the U.S. AIDS initiative has provided crucial funding for programs that provide care for children, including school feeding programs, which have a broad impact. Yet, the President and his allies in the Congress would have these programs frozen in place instead of expanding them to meet the growing need.

Fortunately, an alternative is available. Congressman Tom Lantos, as chairman of the Committee responsible for AIDS programming in the House, understood that significantly greater funds are needed to fight AIDS and address basic capacity issues. One of the last things he did before he died of cancer was to propose five-year legislation which would update the U.S. response and provide $50 billion, not only for AIDS but also for children's programs, TB and malaria.

The Lantos proposal would also better meet the needs of women and girls. It would allow voluntary family planning services to women who are HIV positive and who do not wish to become pregnant. We can agree or disagree about the morality of contraception, but the truth is that helping women who may be weak and ill to avoid a dangerous pregnancy is about saving lives, and it would not promote abortion, as some pro-life groups have inaccurately stated.

The Lantos approach also eliminates the requirement that one-third of all HIV prevention dollars be spent on abstinence and fidelity. This funding restriction has been shown to not be workable on the ground. As someone profoundly committed to promoting abstinence and fidelity, my experience is that I can do my job most effectively when young people have the freedom to make moral choices. I am glad to see the Lantos bill still requires the U.S. to promote abstinence and fidelity as a part of a comprehensive approach.

Working in Kenya, I see people suffering and dying all too often from a disease that can be prevented. It is crucial that this program not become a political football, and I hope members of Congress of good will, from both sides of the aisle, can find a way to work together for the sake of Africa. Unless the U.S. AIDS program goes forward, together with programs that address the broader context of the epidemic, the ones who suffer the most will be the children I work with every day.

Terry Charlton, S.J.

Fr. Terry Charlton, S.J.
Jesuit Vocation Director, Kenya
National Chaplain, Christian Life
Co-founder and Chaplain, St. Aloysius
Gonzaga Secondary School, Kibera