International Inter-Faith Conference on HIV/AIDS Prevention and Control Delhi, India December 1-2, 2004 Katherine Marshall Keynote Address This Meeting’s Special Significance Because today is World AIDS day, countless meetings and events centered on the pandemic are taking place in every corner of the world. All are designed to keep the focus on HIV/AIDS and to pay tribute to and mobilize support for those who are engaged in this epic global battle. It is difficult, nonetheless, to imagine any event that has greater potential importance than this one. That is because India is so much at a crossroads, with the threat of rapid increases in infection rates and human catastrophe for many millions of people in one direction, and the potential for a major mobilization that halts the pandemic in its tracks in the other. At this intersection of potential avenues, the role of faith leaders and communities has special and very great importance. That is why we have all come so far and worked so hard to make this conference happen. It is therefore a pleasure and an honor to be here with you today. I pay a special tribute to the heroes and heroines who have worked to organize the meeting and to bring us together here. You have moved mountains to organize this event, shifting the venue to Delhi only last week. And while the scale of the conference and its attendance are different from what was originally planned, the critical actors who are here and the topics on the agenda offer great promise that the core objectives of launching new partnerships and new processes of dialogue about HIV/AIDS will indeed be met. We all agree on the vital importance of the challenge of enhancing awareness of and joining forces to combat this terrible disease. Among the countless urgent global problems today, none is so demanding, yet also so elusive and complex, as the HIV/AIDS pandemic. Treacherous and difficult technical and ethical issues abound around HIV/AIDS. At their center is the issue of priority: this is calamity for the global community without rival, yet its treatment in many if not most global forums too rarely reflects this urgency and centrality. And this is not a problem that can or will be solved quickly. It is a marathon battle that will be with us through our lifetimes. What this calls for is the new kinds of partnership that bring together leadership and institutions from different parts of society in new alliances and forms. This meeting is thus about partnership and about commitment to action, action partnerships that span different sectors and that are both global and local in scope. It is about dialogue on difficult topics, honesty in the face of difficult realities, love and compassion in the face of suffering, and creative and energetic responses in the face of remarkable and new challenges. My remarks today focus on four topics. First, I reflect on some of the features of the HIV/AIDS pandemic that make it uniquely challenging for global and national communities. Second, I focus on some of the reasons why faith communities are so critical in the overall struggle against HIV/AIDS. Third, I advance some ideas on critical areas for common action. I close with two “messages” that I very much hope will emerge from our two days of dialogue together. The “Devil’s Disease”: Unique Challenges in the HIV/AIDS Pandemic We have, from the opening moment of this conference, been reminded forcibly about the stark and tragic quantitative dimensions of the HIV/AIDS pandemic. AIDS is a human and global crisis of unimaginable proportions. Over 20 million people have already died of AIDS. Millions of children have lost parents to AIDS. Over 40 million people today are infected. Each day brings over 18,000 new infections, more than 95% of them in developing countries; we estimate that 8,000 people each day die from HIV/AIDS and its side effects. It is estimated that 75 million people will be infected worldwide by 2010 and 100 million by 2020—if there is no effective intervention. India was not among the early countries affected by HIV/AIDS but today an estimated 5.1 million Indians carry the HIV/AIDS virus, the second highest number in the world, following South Africa. The stark reality is that the epidemic has clearly taken root in India and India is on the verge of a full-blown epidemic unless urgent action is taken. The situation of Delhi serves as an example. Many factors fuel the HIV/AIDS epidemic here. Some 40% of the 14 million population live in slums and there are approximately 35,500 street children. The population is estimated to include 10,000 are intravenous drug users and around 34, 000 female sex workers, of which 7,000 are brothel based HIV/AIDS is notoriously spread through truck drivers and 32,000 trucks are stationed per day in Delhi. The health status of women is poor, access to clinical facilities is limited, and there are well-known and wide gaps in both knowledge and awareness. All these factors underscore the potential for rapid spread of the pandemic. In reflecting on these mind-numbing numbers, for the world but also for India, the question must be posed as to why it has taken so long for the global community as a whole, and for country after country and community after community to come to terms with the challenge that emerges so starkly from the data. At least part of the answer lies in four insidious characteristics of this pandemic, such that I have come to term HIV/AIDS “the Devil’s disease”. First, HIV/AIDS is a new phenomenon, one that has arisen within the lifetimes of many of you who are present today. Twenty-three years ago the disease was not recognized by scientists anywhere, while today it is a global problem that has left no nation or culture unscathed. HIV/AIDS is a dynamic, fast-changing epidemic that has defied expert predictions time and time again. As the global effort to develop vaccines and drugs against HIV/AIDS has proved, it is a fiendishly complex disease that eludes ready solutions. What this means is that traditional tools for dealing with diseases and epidemics, developed over the centuries, have not worked in the face of this new disease. HIV/AIDS presents the human community with quite new challenges and they call for quite new approaches and new means. That applies as much for the challenge of looking to social responses as it does for medical practice and research. Second, HIV/AIDS in a very practical sense is a disease that is deceptive and deceives in community after community. Its characteristic lengthy latent phase means that infected people spend many years with the appearance of good health, showing no evidence of disease, even as they can and do infect many others. Most people who are infected with HIV/AIDS do not know that they carry the disease, and many die without the disease being recognized. This means two things: first, that denial of the presence of HIV/AIDS is a very common response, as it can be invisible, unseen for so long. Second, it contributes to the tragic phenomenon that full recognition of the grip of HIV/AIDS in a community comes when it is essentially too late to halt its spread. When large numbers of people are dying and funerals become the norm for many, the disease is deeply ensconced and incredibly hard to fight. Third, HIV/AIDS brings into the public domain issues that are normally very private and personal; it brings into the open the existence in communities of practices and realities that many view as embarrassing and shameful. The fact that HIV/AIDS is spread largely through sexual contact makes it difficult to discuss and to address. Similarly drug users may be among the first affected and may spread the disease to others with whom they are in contact. The fact that HIV/AIDS normally takes hold in communities in groups that are marginalized, considered “at risk” and excluded, makes it easier for leaders to believe that it cannot spread beyond these limited corners of society. The private face of HIV/AIDS thus contributes to the phenomena of shame and denial that in turn allow it to spread and undermine the lives of people and communities. Many of us in the development community have had to learn to confront topics that we had never discussed so openly, with new tools and approaches. And fourth, HIV/AIDS presents new and very difficult ethical challenges to the global community as well as to individuals. At the global level, the pandemic challenges us to translate commitments to confront the pandemic into practical action, and to keep the focus on a problem that is a continuing, dispersed crisis that is so often barely seen. The changing nature of the pandemic and responses to it present ever-changing challenges also. Only a few years ago, the staggering cost of treatment with antiretroviral therapy and the complex and risky treatment regimes suggested that, however tragic, there was no realistic option but to accept that most people infected with HIV/AIDS would die untreated. Today, though, that equation is changing rapidly and, with lower drug prices, simpler treatment regimes, and evidence that even very poor communities can manage treatment programs well, access to treatment is starkly posed as a human rights challenge. How, we are asked, can one allow babies to be born infected with the HIV/AIDS virus when a known, simple treatment can largely avert infection? How can we save a baby with treatment, yet allow the mother to die when, again, known treatments are within our grasp? The Community of Sant’Egidio is an example of an organization committed to working with the world’s poorest communities that has pioneered the way in showing what can be done in treatment in the poorest communities and which starkly presents the challenge of providing the best care techniques for HIV/AIDS patients as a leading human rights issue for the global community. On the other hand, the costs of treatment still far exceed those of prevention, and the best course of action is to prevent infection. HIV/AIDS presents us with agonizing issues of tradeoffs and choices among difficult options. HIV/AIDS presents difficult and stark realities and we know, from experience in many different situations, that they can only be confronted with knowledge and information. Without a clear understanding of the disease people cannot protect themselves from it. Without knowing where and how HIV/AIDS is moving in a community, any strategy to combat it will be feeble. That is why the very first and critical step in confronting the pandemic is open and honest discussion of HIV/AIDS, its causes and its path. There are inspiring examples of leaders from many walks of life – politicians, business leaders, faith leaders from many different traditions, artists and entertainers – who have demonstrated that with courage and compassion they can pry open the doors to discussion, dialogue and understanding. Yet another dilemma and irony of HIV/AIDS is that these same leaders must also be able to offer hope, because without hope action is difficult to muster. It is hardly surprising that some national leaders seem reluctant to admit the stark realities of HIV/AIDS in their country out of fear that this will deter investment or discourage their citizens. The HIV/AIDS pandemic thus calls for a special brand of leadership, one that can look the anguish of the disease in the face yet which can also hold out the hope that it can be overcome. Faith Leaders and Communities and HIV/AIDS This conference focuses on the role that faith leaders, institutions, and communities can play in the fight against HIV/AIDS. In sum, the experience of many countries which confront the pandemic is that faith organizations have tremendous potential to play critical roles in the partnerships and coalitions that are needed to confront the pandemic. Indeed, in the all too few success stories where countries have succeeded either in sharply reducing levels of HIV/AIDS infection or averting a threatened pandemic, faith communities have played a critical part. Since faith communities have such special importance in India, this exploration of how they can be part of the strategy to combat HIV/AIDS is of central importance. Case studies of Uganda, Thailand and Senegal, three countries which stand out for their courageous and effective efforts to confront HIV/AIDS, all highlight the part played by faith leaders. In each case, leaders from different faith communities have put aside differences, among themselves and with other sectors of the society including political leadership, to work together in new forms of dedicated partnerships. They have led the way in speaking openly and widely about the disease. They have been open to a wide range of interventions, yet kept the focus on the critical need for changes in behavior to prevent disease and compassion for those who are affected. They have demonstrated flexibility in the face of changing circumstances and new evidence. They have been able, because of their special communications means and gifts, to reach huge communities. They have demonstrated a staying power they have attained over the centuries. They have been able to build on the special trust that many communities, especially those that are poor and marginalized, hold for their faith leaders. They have been able to bring to bear their ethical and moral leadership in confronting difficult realities that emerge in confronting the pandemic. Above all, faith leaders have brought forth the finest qualities of faith traditions in showing their breadth of love and compassion for all who are affected. Yet the faith community leadership that has emerged in the “success stories” has not always been the case in many countries. Indeed, in many parts of the world the sad reality is that faiths and religious communities must been seen as “part of the problem” in the HIV/AIDS pandemic. In many instances, faith institutions, faced with the insidious characteristics of the HIV/AIDS pandemic, have contributed to denial of the importance of the pandemic, convinced that it “could not happen” to their community, shunned many affected by HIV/AIDS, stunted open discussion of the disease, and stood in the way of some programs aimed at preventing its spread, including the education and information that have always proved to be a central ingredient of success. What we hope to see is a situation where faith leaders are instead “part of the solution,” helping to lead the way in fighting HIV/AIDS. Faith leaders are often uniquely positioned to open discussion of the more sensitive dimensions of the HIV/AIDS pandemic, to mobilize communities, to demonstrate the love and compassion that are an essential part of addressing the pandemic and caring for those affected, and to confront the complex ethical and moral issues that arise. Faith communities, we are convinced, can bring the positive action-oriented, moral, and compassionate forces of their faith traditions to fight this terrible disease. At a global level, we are witnessing today in faith after faith, parish by parish and denomination by denomination, a rise in concern and compassion in confronting the HIV/AIDS pandemic. In this vast sub-continent of India, the roles that faith communities are playing and can play in fighting the HIV/AIDS pandemic are extraordinarily diverse. Some examples of innovative programs led by faith communities are already part of the “best practice” from which people all over the world are learning. There is, nonetheless, a consensus that the surface of potential action has barely been scratched. We look to you to explore how to move forward in exploring new avenues to mobilize the potential, for each community individually, for interfaith efforts which join the experience and efforts of different traditions, and for faith institutions and communities working in partnerships with development institutions of many stripes. There are three “dimensions” of HIV/AIDS strategies where, we suggest, faith leaders and communities can play particularly important roles. The first is in helping to navigate in the complex ethical and moral waters that the HIV/AIDS pandemic entails. This is no easy challenge, yet the foundations of our ethical systems owe so much to faith traditions that it makes eminent sense to look to faith communities for wisdom in confronting the issues that arise. Teachings about compassion, love, and caring have never had greater significance than today but so too are those around making difficult choices and adapting to changing realities. Second, faith leaders and institutions have critical roles to play in finding ways to work in different communities. Since every action to fight HIV/AIDS needs to translate to the level of a community and individual, faith institutions which are the quintessential community organizations have vast resources to offer. Third, there is a very practical and demanding challenge ahead in confronting the HIV/AIDS challenge: ensuring that promises are translated into action and that funds dedicated and committed to the fight against HIV/AIDS are well used. The importance of transparent and efficient use of funds has critical importance and we look to faith communities to serve as allies as well as watchdogs in this effort. Action and Dialogue on HIV/AIDS HIV/AIDS presents an extraordinary range of challenges, medical, scientific, social, economic, political, moral, and financial. HIV/AIDS is much more than a disease that affects the body. It is a major development problem, which turns back the clock on social progress by undermining social infrastructure and ravaging productive individuals (nurses, teachers, truckers, and farmers included) and communities. It fosters instability and threatens peace and security, with repercussions at community, national, regional and global levels. This conference offers the opportunity to pursue the multi-sector and multi-stakeholder dialogue that this unique set of challenges entails. In each area, the inputs of quite different perspectives and insights are critically needed. On each topic, we are convinced that the faith leaders and communities represented here have vital contributions to make. Four topics embedded in the conference agenda highlight the need for and importance of continuing dialogue looking towards joint and concerted action. These include women and HIV/AIDS, special approaches to youth, the links between science and faith, and the importance of communications. The focus here on women reflects a conviction first that women are at the forefront of the fight against HIV/AIDS, both as leaders and because they are most deeply affected, and second that faith communities have special potential and need to address gender issues as they affect HIV/AIDS. The “feminization” of the HIV/AIDS pandemic has become increasingly evident over the past two years, with sharp increases, across many very different countries, in the share of women affected by the disease. Beyond this, women carry the largest share in providing care to others who suffer and in struggling to keep families affected by HIV/AIDS intact. The panel dedicated to the topic of women will explore the many dimensions of these issues and propose specific avenues in the search for action. A major point to highlight here is that the HIV/AIDS pandemic has highlighted in new ways the consequences of gender disparities in many societies. It presents the challenge to confront and address these disparities in more forthright ways. For faith communities, which highlight the central importance of the family, the realities that the pandemic brings forth, including on issues such as gender-based violence and the treatment of many girls, calls for dialogue and reexamination of many traditional assumptions and practices. The focus here on youth stems from the heavy concentration of HIV/AIDS among young people. Only by addressing issues for youth, and by reaching out effectively to young people can the pandemic be stopped. Thus, the panel on youth reflects the desire to focus on the special challenges for youth and the roles that faith communities can play in this regard. Discussion of the links and disconnects between science and faith has a long history in India. The challenge of HIV/AIDS presents these issues in new and stark form. The dialogue on the impact of HIV/AIDS and the search for new solutions and new alliances thus needs to be anchored in and build on this long-standing dialogue. Finally, with the critical importance of knowledge and information as a central vehicle in combating HIV/AIDS, we need to keep the focus on communications. Here, the conference might focus on two particular dimensions. The first is sharing information about what is happening, what different communities are doing, and what can be learned. The second is bringing to bear in new ways the gifts and tools that faith communities have developed to communicate in the struggle against HIV/AIDS. Concluding Thoughts The AIDS pandemic is in many senses a parable of our times, with its fast pace and constantly changing and expanding demands. Twenty-three years ago, none of us had any inkling that HIV/AIDS would so dominate the global scene. The pandemic overwhelmed the development community, always with surprises and new demands, and that is likely to continue into the future. HIV/AIDS forces us to constantly to look at basic development issues—the very essence of humanism—in different ways. AIDS may be the greatest test of our lives: how will future generations view how we, as individuals, communities, institutions, governments, and organizations, have responded to this pandemic. As we explore our respective responsibilities and possibilities of response, we should always call to mind the extraordinary demands that the pandemic presents. For us who are meeting here, there are two practical and immediate challenges. The first is to explore our own responsibilities and the means we can bring to discharge them. The second is to explore, beyond our individual roles and resources, how we can engage more effectively with others in new forms of partnerships. More specifically, we can explore how to we can work to bring together institutions and individuals, secular and religious, to save our sisters and brothers from sickness and death by a preventable, treatable disease. The specific ways in which India’s faith communities in response to HIV/AIDS will be yours to create. You, who are trusted by your communities, understand in a deep way their needs. We, who are development practitioners, can offer you our advice and partnership in going forward to serve your communities in ways that take stock of what has already been learned in the fight against AIDS. We can learn from your experience in your communities and improve our work serving the poor and those suffering from HIV/AIDS. You have a special capacity to understand deeply how people think, feel and work. There is a great deal of shame surrounding HIV/AIDS; “stigma” is how we talk about this shame in the development community, when individuals feel alienated or embarrassed about their HIV status. Stigma around HIV/AIDS is enormous and comes in many forms—to those individuals who are HIV positive or have AIDS, and to their families and friends. We are hopeful that you can and will engage actively with civil society and relay to your communities that HIV/AIDS is a disease affecting people across the globe and that behavior that stigmatizes and shames its victims is itself shameful and harmful to the community. We need to be more open about the pandemic and care for those with the disease or the families and loved ones of those also affected. You know well how to mobilize your communities and to care for them; in many cases this is your daily and life work. Many here are experts in healing. The complexity comes in finding a balance between the healing work that comes most naturally to you and the scientific technology that has become quite advanced in responding to HIV/AIDS. Many of the speakers here today speak to drug treatment programs and vaccine research underway. A partnership between those who are experts in both the scientific and religious realms is critical, and potentially fruitful. I am honored to be part of this remarkable gathering and the continuing effort that it represents. I and my colleagues in the World Bank are part of a global partnership to combat the challenge of HIV/AIDS, and nowhere is this challenge more important and more stark than here in India. All of us here and elsewhere need to engage in open dialogue and form creative, dynamic partnerships to fight this crisis together. We need to pool all of our resources and wisdom so that the sum of all of our efforts can really make a difference. Let us learn from each other and use each other’s expertise to put a stop to this devastating disease. Thank you |
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