The challenge of AIDS in Africa is one that undermines the very fabric of human life and as such, requires an unprecedented effort by committed Christians around the globe. Strengthening the link between communities of faith in the United States and countries in Sub-Saharan Africa is an effective mechanism for mobilizing more resources for AIDS prevention, support and care. We believe that the hands on involvement of Americans in the global AIDS crisis will both increase their awareness of this disease's devastation in the lives of millions, and stimulate an increase in their material and spiritual response.

As a result of the media coverage, involvement in international missions and personal travel, Presbyterians in the US are becoming more aware of the global AIDS crisis. We believe many Presbyterians are looking for opportunities to become more meaningfully involved in the response to the AIDS crisis in Africa. Several PC (USA) congregations in five states have approached the Worldwide Ministries Division (WMD), International Health Ministries (IHM) office in search of ways they can become involved by responding to the AIDS crisis beyond simply writing a check. They seek an opportunity to both fellowship and work with Christians in Africa who are already responding to the pain and hopelessness that AIDS has brought to their communities. At the same time, Presbyterian Churches in Africa have expressed their sense of frustration at being at the center of many suffering communities that are looking to the church for hope and help. Their belief in the faithfulness of God provides these churches with a reservoir of hope to draw from and share. But the needs for HIV/AIDS prevention education, orphan care, access to testing and medicines, and training (for pastors and lay-leaders) to provide counseling and care and support in the home, greatly surpass the resources in their storage house. These churches have also expressed interest in working side by side with churches in the USA. As a result of the expressed need from Presbyterians Partner Churches in Africa and the desire by Presbyterians in the US for involvement, WMD has developed Presbyterian AIDS Action. The two goals of Presbyterian AIDS Action are to increase Global AIDS awareness in Presbyterian congregations and to build links between PC(USA) Partner Church that is responding to the pandemic and Presbyterian AIDS Action Committees, which include congregations/presbyteries in the US. It is anticipated that the increase awareness of the Global AIDS crisis in congregations and clear opportunities for involvement will result in a greater response by Presbyterians to combat the suffering caused by this disease. The Presbyterian AIDS Action program is built on the belief that when Christians in the North and South bring together the many talents provided by God, each will be blessed by God and will be a blessing to others.

Program Description

Objectives:

• Increase knowledge of the HIV/AIDS crisis in Africa and expose 25% (2,795) PC(USA) congregations to Presbyterian AIDS Action.
  
• Establish ten country-specific Presbyterian AIDS Action Committees over two years.
  
• Increase annual giving to AIDS-related Extra Commitment Opportunity from $80,000 to $500,000. This increase in funding to AIDS related ECOs will be the result of the increased awareness among Presbyterian congregations and the funds raised by Presbyterian AIDS Action Committees to support their AIDS project.

Presbyterian Partner Church and Presbyterian AIDS Action Committee:

Over the course of 2002, Presbyterian AIDS Action will build links between five PC(USA) Partner Churches in Africa (CCAP Synod of Livingstonia - Malawi, EECMY - Ethiopia, CPC and CPK in the Democratic Republic of Congo and PCC in Cameroun) and five Presbyterian AIDS Action Committees in the U.S. The Presbyterian AIDS Action Committee will be composed of 2-10 congregations and/or presbyteries. These Committees will be initiated by the WMD AIDS Project Manager who will identify Presbyterian congregations and/or presbyteries in the U.S. that are interested in working on an AIDS project with a PC(USA) African Partner Church. We hope to develop 10 country-specific AIDS Action Committees. Interested congregations and presbyteries will be asked to create an International AIDS Committee, and select an International AIDS Committee Facilitator. The Facilitator will participate in a program orientation and training course specifically designed for the members of the Presbyterian AIDS Action Committee and will represent his/her congregation and/or presbytery at one of the country-specific Presbyterian AIDS Action Committee meetings. We expect that most Presbyterian AIDS Action Committee quarterly meetings will actually occur as conference calls. The WMD AIDS Project Manager will convene the first meeting and provide each Committee with organizational and operational guidelines. Group participants of each Committee will decide the actual structure and mode of function of the Committee. The WMD AIDS Project Manager and East/Southern and West/Central AIDS Field Consultants will act as consultants to the Committees. The WMD AIDS Project Manager will help organize the 1-1/2 day Committee training course for the International AIDS Committee facilitators and other Presbyterians interested in international AIDS.

Working in collaboration with the East/Southern and West/Central AIDS Field Consultants in Africa (2 PC(USA) missionaries), the WMD AIDS Project Manager will create appropriate links between each Partner Church and the associated Presbyterian AIDS Action Committee in the USA. The WMD AIDS Project Manager will help facilitate the creation of a 3-5 year contract which will describe the responsibilities of the Partner Church in Africa to implement the mutually agreed upon HIV/AIDS prevention, care and/or support project, and the responsibilities of the work group in the U.S. to visit, interpret, raise funds for, pray for and participate in other ways in the development of the project. There is no set financial contribution expected from either partner. Mobilization of resources (including funds) in Africa and the US to meet the tremendous needs, however, will be an essential activity for the successful implementation of the AIDS projects. We hope that involvement in the HIV/ AIDS work will be a walk of faith for each participating presbytery, congregation, and individual (in the US and Africa) and that this will result in mutually discerned and spirit lead participation between all parties.

Both Presbyterian AIDS Action Committee and the Partner Church, (PC), will be expected to complete an annual activity and financial report. They will also be encouraged to organize a bi-annual project review meeting with representation from both the Partner Church and the Presbyterian AIDS Action Committee. The report and meeting will serve as an opportunity for them to mutually review their progress. During this review the PC and country-specific Presbyterian AIDS Action Committee will be able to adjust the project objectives and implementation timetable based upon the previous year's performance.

Presbyterian Partner Church Training:

Training will be organized by the East/Southern and West/Central AIDS Field Consultants in Africa (2 PC(USA) missionaries).

Presbyterian AIDS Action Committee Training:

Over the past two years the IHM Program Associate has conducted international health training workshops for congregations and presbyteries that are actively involved in health mission projects overseas. In these workshops, mission committees learn to define a strategic mission plan and set goals and objectives and evaluation plan for their international health mission projects. At these workshops the participants have an opportunity to discuss the issues such as intercultural sensitivity and the goals of Christian partnership. The participants learn about the structure and work of PC(USA) Partner Churches around the world and how they can most effectively be connected to Presbyterian health missions overseas. The Presbyterian AIDS Action Committee training workshops will be based upon and benefit from lessons learned by Presbyterian congregations and presbyteries in the US who have participated in the IHM workshops and who are now working in health and development mission projects overseas.

A special AIDS curriculum will be developed and added to the Presbyterian AIDS Action Committee training workshop. The more specialized curriculum will address some of the issues particular to AIDS work such as the relationship between AIDS and poverty, stigma, the magnitude and the multi-factorial nature of the AIDS problem, death and dying, and the need for long term commitment.

Presbyterian AIDS Action Start-Up Activities

A Worldwide Ministries AIDS Task Team has been formed in order to increase the capacity of Presbyterians in the US, PC(USA) partners and other Christians overseas. The goal is to engage all in the global fight against HIV/AIDS through prevention, compassionate care and open discussion in the church and community. The AIDS Field Consultants and IHM Coordinator will work with the IHM Communication Specialist to develop appropriate awareness, promotion and educational materials. These materials will be disseminated through the members of the PC(USA) network (staffed offices, validated missions, Presbyterian advocacy, congregations and presbyteries) which have expressed interest in mobilizing support for our Partner Churches in their response to HIV/AIDS.

Description of the Presbyterian AIDS Action participants and their responsibilities

• Worldwide Ministries AIDS Task Team (WMATT): This task team consists of representatives from 11 functional PC(USA) offices including, South & East and Central &West Africa offices, Hunger, Development and Disaster Relief. It was established in 2000, in order to assure a coordinated response by PC(USA) to the Global HIV/AIDS Crisis. WMATT representatives will resource their constituencies in order to increase awareness of opportunities for involvement in and financial support of Presbyterian international HIV/AIDS activities.
  
  
• WMD AIDS Project Manager: will help coordinate activities and the dissemination of HIV/AIDS information and resources to all Presbyterians and to congregations and presbyteries participating in Presbyterian AIDS Action Committees in order to facilitate the interpretation of their HIV/AIDS projects. The Coordinator will also collect information from these partnership projects in order to promote them as examples of good trans-Atlantic Christian collaboration around HIV/AIDS.
  
  
• International AIDS Committee: This congregation or presbytery based committee will work with their Facilitator to disseminate information on their HIV/AIDS related activities.
  
  
• International AIDS Committee Facilitators: Facilitators will organize educational activities which focus on their congregation's and/or presbytery's involvement in the Presbyterian Action AIDS Committee project. They will also assist in the active incorporation of their International AIDS Committee in Presbyterian AIDS Action activities.
  
  
• South & East and Central & West Africa AIDS Field Consultants: These two PC(USA) missionaries working in Africa, will provide the IHM Communications Specialist with the information needed to develop materials which will explain the HIV/AIDS activities of the Partner Churches.
  
  
• Presbyterian Partner Churches and Presbyterian Action AIDS Committees (see above)
  

AIDS and Poverty

Effective responses to the HIV/AIDS crisis must ultimately address the poverty that fuels the epidemic in developing countries. Successful poverty reduction in these countries will require resolve by government and civil society to mobilize adequate resources to address the diseases of poverty (HIV/AIDS, malaria and TB). Faith based communities in the North and South can play an important role in alleviating the suffering from these diseases. The leadership of Christian organizations in Sub-Saharan Africa which (up to 50% of the health care to the rural poor is provided by theses organizations in some countries) and the support by Christians in the US and Europe can increase the international awareness of the global poverty. This international awareness should lead to strategies to increase resources to combat diseases which worsen poverty.

Vice-President Justin Malewezi opened the Africa Regional Consultation in Nov. 2001 on the Global Fund in Lilongwe, Malawi with the following words, "Every minute we have been sitting in this room, ten people have died of the three diseases: HIV/AIDS, Tuberculosis and Malaria. This translates to 15,000 people a day. This is not only appalling and tragic, it is scandalous. It is scandalous because we have the knowledge, the technology and the resources to address the challenges posed by HIV/AIDS, Tuberculosis and Malaria, but have not yet mobilized sufficient political will to prevent and treat these diseases in a comprehensive manner and on a scale commensurate with the devastation facing the human family." This year Vice-President Malewezi also participated in a workshop organized by our Partner Church in Malawi to mobilize pastors to respond to the HIV/AIDS crisis in their own communities.

Prepared by AIDS Action Team, International Health Ministries, Worldwide Ministries Division of Presbyterian Church (USA), 100 Witherspoon, Rm 3626, Louisville, KY 40202.

AIDS is a growing crisis around the world. In some parts of Sub-Saharan Africa up to 1 in 4 people have been infected with the HIV virus and there is concern that the infection rates in parts of Asia, Central and South America may also rise dramatically. AIDS affects not only the individual who has been infected by the virus but also his/her family and community. To date, more than 40 million people are living with HIV/AIDS and over 25 million adults and children have died from AIDS. The challenge of supporting those who are sick and those who have been left behind by the death of a loved one to AIDS, especially orphans and the elderly, is growing rapidly and urgently needs to be addressed. Local communities are doing the best they can but many are being overwhelmed due to the extent of the impact of AIDS on their communities.

As Christians, we have been called to be the expression of God's love for all humanity. We have been called to care for those who are hurting be it physically, emotionally or spiritually. We have been called to love our neighbor and to reach out to those who may be rejected by society. AIDS is challenging us to find new ways to live out our Christian faith.

As Presbyterians, we work in partnership with 164 partners in 92 countries around the world and support a wide range of activities initiated by our partners in the fight against AIDS in their communities. Some projects are based in local hospitals and clinics. Some projects work out of local churches where congregation members reach out to provide care, prayer, love and whatever else they are able for their families, friends and neighbors who are living with HIV/AIDS. Other projects emphasize the care of orphans, often through community-based orphan care projects.

While Presbyterians are already actively involved, there is much more that needs to be done to fight this pandemic. For this reason, the Worldwide Ministries Division has established an AIDS Task Team to develop a more comprehensive response. We continue to stay in touch with our partners overseas to see how we might best support them. We work with other ecumenical and secular organizations. Also, we are seeking the involvement of concerned Presbyterians in the United States. Involvement can be through learning and sharing information about the HIV/AIDS situation as it is being faced by our partners, and/or through sharing funds through WMD Extra Commitment Opportunity (ECO) gifts. Your help in any of these ways will make a difference to friends and neighbors in our global family.

To address the AIDS issue in the way that is most appropriate for us as a church, we, together with our partner churches overseas, realize that the needs are so great and so divergent that we cannot begin to address them all. Thus, together we have identified areas in which the need is greatest and which the Church is uniquely situated to share its gifts with the community. For this reason 4 primary HIV/AIDS related ECOs have been established.

• ECO#051674 AIDS Orphans and Vulnerable Children in Africa - Because the needs of orphans and their caregivers (often a grandparent or an older sibling) are so desperate, this ECO has been established as a separate ECO. Gifts to this account go specifically to projects working with children who have lost one or both parents to AIDS to help provide their basic needs including food, clothing, education, and medical care. Through the ECO people who work to care for the orphans are also trained in ways to best support these children.
  
  
• ECO#862706 AIDS Crisis Overseas - Gifts to this account support a broad range of projects throughout the world, primarily church and community based projects such as home-based care for people who are sick with AIDS, prevention education, and training pastors to be well versed in the spiritual and emotional care of people living with HIV. In giving to this account, you give us the ability to respond quickly to needs as they arise.
  
  
• ECO#051791 0.7 Initiative - A Practical Strategy for Presbyterians to engage in global efforts to aid the poor, particularly those caught in the vicious cycle of disease and poverty. Presbyterians are asked to prayerfully examine our own personal giving and commit at least 0.7% of our income to programs that contribute to the development work in poor nations. Donations to this account will be used for prevention, treatment and community-based care projects related to AIDS, Malaria and Tuberculosis. At least twenty percent will go specifically for AIDS work in Africa.
  
  
• ECO# 051700 Home-Based Care Kits in Africa - Family members struggle daily to care for a loved one with AIDS without even the barest necessities in the home. The message of Christian concern and compassion offered with each home visit will accompany and go beyond this provision of supplies in the Home-Based Care Kits. Funds will go to provide congregation initiated home-based care programs.
  

Gifts to these two accounts help support the work of two PC (USA) mission personnel as they work to be a caring presence, providing support and expertise as they walk with our partner churches that are struggling with the AIDS crisis and become more involved with AIDS work. These accounts provide the working budget for the consultants.

• ECO#051656 AIDS Consultant in Central and West Africa
  
  
• ECO#051673 AIDS Consultant in Southern and East Africa

If you have any questions or need advise on which projects are currently most in need of support, please contact Dorothy Hanson, the Project AIDS Manager, by telephone at (888) 728-7228 x5415 or by e-mail.

Thank you very much for your concern and interest because together,
we can make a difference.

The Impact of Religious Organizations in Promoting HIV/AIDS Prevention
(updated March 2002)

by Edward C. Green, Ph.D.
Consultant, Synergy Project and Harvard School of Public Health
e-mail: egreendc@aol.com ; egreen@hsph.harvard.edu

Revised version of paper presented at "Challenges for the Church: AIDS, Malaria & TB" (Conference Title), Christian Connections for International Health, Arlington, Va., May 25-26 2001. (Available in French) This material to be published in Green, Edward C., The AIDS Crisis in Developing Countries (Praeger Publishers, 2003).During the early years of the HIV/AIDS pandemic, many people who worked in HIV/AIDS prevention thought of religious leaders and organizations as naturally antagonistic to what they were trying to accomplish. In many minds, the stereotype of a religious leader was that of a conservative moralist who disapproved of any form of sexual behavior outside of marriage (especially male-male sex), as well as what was seen as the "only solution" to HIV infection, i.e., condoms.

Today we have convincing examples of so-called faith-based initiatives in which involvement of religious leaders and organizations in HIV/AIDS prevention has had major impact. (The role of religious organizations in care and support of those with HIV is well-recognized and not the issue here). This paper focuses on developing countries.

"Behavior Change"

"Behavior change" is a term much-used in AIDS prevention circles. It is often used narrowly to mean adopting condoms. But one could argue that the condom option is really a "harm reduction" solution for people who don't change their risky behavior.

This paper is concerned with what might be called primary behavior change. Examples of this are fidelity to a single partner, sexual abstinence, or young people "delaying" the age at which they begin to have sexual intercourse. It is useful to distinguish these behavioral changes from condom use or treatment of sexually transmitted diseases (STDs), both of which are "harm reduction" approaches. The latter are more passive than the former, and arguably involve less of a personal commitment to fundamental change of behaviors.

If we consider the simple ABC approach to AIDS prevention to which lip service has long paid (Abstain, Be faithful, use Condoms if A&B fail), it is clear that the vast majority of prevention resources have gone to condom promotion, and more recently, to the treatment of the treatable STDs. Few in public health circles really believed-or even believe nowadays--that programs promoting abstinence, fidelity or monogamy, or even reduction in number of sexual partners, pay off in significant behavioral change. My own view on this changed when I evaluated HIV prevention programs in Uganda and Jamaica, and conduced a national survey of behavioral change in the Dominican Republic.

Findings are now presented from three countries that seem to best illustrate the positive impact of faith-based organizations (FBOs), Uganda, Senegal and Jamaica. We will see a pattern of behavioral changes compatible with the prevention strategies favored by FBOs, as well as data showing stabilization and reduction in national HIV infection rates.

Uganda

Uganda is the country that has had the most dramatic decline in HIV infection rates. HIV prevalence declined from 21.1% to 6.1% among pregnant women between 1991 and 2000. In 1987, the major religious organizations in Uganda (Catholic, Anglican, Muslim) became significantly involved in AIDS prevention, with WHO/GPA funding, through the Ministry of Health. By 1992, HIV infections rates were still so high that USAID also decided to allocate some of its funds for FBOs to work in prevention, but on the FBO's own terms. The FBOs said that they wished to promote "fidelity" and "abstinence" rather than condoms. At the time, many working in HIV/AIDS prevention thought that fidelity and abstinence promotion would have few if any measurable results. However, this approach was and is strongly favored by President Museveni, who is credited with being the most activist African head of state in addressing the AIDS crisis. Museveni stated his views in a speech to the First AIDS Congress in East and Central Africa (Kampala, 11/20/91):

Sex is not a manifestation of a biological drive; it is socially directed…I have been emphasizing a return to our time-tested cultural practices that emphasized fidelity and condemned premarital and extramarital sex. I believe that the best response to the threat of AIDS and other STDs is to reaffirm publicly and forthrightly the respect and responsibility every person owes to his or her neighbor.

As for condoms, Museveni said in the same speech:

Just as we were offered the "magic bullet" in the early 1940s, we are now being offered the condom for "safe sex."... I feel that condoms have a role to play as a means of protection, especially in couples who are HIV-positive, but they cannot become the main means of stemming the tide of AIDS.

Beginning in 1991, we see a downward trend in both STI and HIV infection rates in Uganda. We also have numerous studies after 1993 documenting behavioral change. Most studies show that reduction in the number of sexual partners (which may be causally related to the "fidelity" message), and delay of sexual debut among youth (which seems to be related to the abstinence message), are the major forms of behavioral change that have occurred in Uganda, more than increased condom use. Condom ever-use is at about 20% nationally. The proportion of Ugandans who report one or more non-regular sexual partners is between 6-8.7%. And about 20-25% of those surveyed age 15-49 report complete abstinence in the past year, most of this attributed to youth delaying first sexual experience (Uganda MoH 2000, 2001 in preparation).

If sizable numbers of men and women reduce their number of sexual partners, can this have significant impact on HIV infection rates? Recent studies by N.J. Robinson and others that have modeled the impact of different interventions on HIV infection rates in east Africa suggest that reduction in number of partners can have great impact on averting HIV infections, in fact greater than either condom use or treatment of STDs.

Decline in infection rates is greatest among the 15-19 age group, and a UNAIDS analysis shows that this was mostly due to the rise in the median age of first intercourse by 2 years, increasing from age 15 to 17. Rise in age of sexual debut among females is particularly important because of the increased biological vulnerability of young females to HIV infection.

It is noteworthy that male condom user levels were only 3-5% in Uganda before 1992. And this refers to the proportion of men who reported "ever" using a condom, not those who claimed regular use. It therefore seems unlikely that condom use contributed to the onset of decline in STI and HIV infection rates, even if increased condom use in subsequent years helped this process. Condoms were not widely available in Uganda until after 1993, and then mostly in urban areas. By 1998, 20% of Ugandans reported ever having used a condom (average national male rate, rural and urban). Some reports continue to claim that the world's great success story in AIDS prevention, Uganda, owes its achievement to condoms, but this is not true.

It is also worth noting that apart from delay of sexual debut, about 7% of women and 10% of men aged 15-50 reported that they have adopted complete and sustained abstinence for HIV protection in the previous year by the mid-1990s. This rose to over 20% in 2000.

Has involvement of faith-based organizations impacted behavior in Uganda? There is some evidence from impact studies, such as a UNAIDS "Best Practices" study of the Islamic Medical Association of Uganda (IMAU) which shows that AIDS prevention activities carried out through religious leaders has had significant direct impact on particular populations targeted. The Anglican Church of Uganda has also implemented special prevention programs aimed at youth, carried out in Sunday schools and primary schools. Moreover, religious organizations put emphasis (sometimes sole emphasis) on primary behavioral change, on what they called abstinence (or "delay") and fidelity, and these are the very changes that resulted, or were most likely to be found in surveys and studies. True, FBOs were not the only groups promoting primary behavioral change, but this was their intervention of choice and they probably helped promote this approach with other groups.

Finally, as behavior has continued to change and HIV infection has continued to decline, the number of religious leaders and groups involved in AIDS prevention has expanded under district Ministry of Health AIDS prevention activities (funded by the World Bank's STI Project). As a result, there is now a high level of involvement on the part of religious organizations and leaders. How high? By 1995, only two years into the first FBO project, over 2,745 trainers and peer educators as well as 5,629 community volunteers in the Muslim IMAU project had reached 193,955 households and had counseled or sensitized 1,059,439 sexually active people, according to the external evaluation of the USAID-funded project that supported the first FBOs. In the Anglican CHUSA project, the project trained 96 diocesan trainers and 5,702 community health educators and had sensitized 736,218 members of the community, also by 1995. There was also a Catholic-run project.

In 1998, I evaluated HIV decline and behavioral change evidence in Uganda for the World Bank. I reviewed district workplans between 1995-98 and conducted interviews with relevant informants. I estimate that an average of 150 religious leaders (ministers, imams, deacons, elders, etc) were being trained in each of Uganda's 45 districts per year, resulting in some 6,750 religious leaders trained in HIV/AIDS per year. Even if there may have been over-reporting of training numbers, we can reduce figures by a third and there would still be 4,500 trained per year since 1995. "Training" here refers to religious leaders being educated about AIDS and what they could do to help prevent it, usually in brief workshops. Those trained in this way then function as peer educators and group discussants or leaders, talking to others in their religious group or broader community about AIDS and how to prevent it.

Taken altogether, the foregoing amounts to at least suggestive evidence that religious organizations and other more conservative opinion leaders in Uganda (e.g., school authorities, traditional healers, and local political leaders such as chiefs) that have advocated abstinence and fidelity have had a significant impact on overall infection rate decline.

Senegal

Senegal is another country widely recognized as an AIDS success story. Like Uganda, it was one of the first countries in Africa to acknowledge AIDS and to begin implementing significant AIDS prevention and control programs. According to UNAIDS, Senegal currently has one of the lowest HIV seroprevalence rates in sub-Saharan Africa. Data from antenatal clinics complied by UNAIDS show that HIV infection rates were 1.1% in 1990, and only 0.4% by 1997. A UNAIDS document reports, "In Dakar, the major urban area in Senegal, HIV-1 prevalence among antenatal clinic women has been 1% or less for all years up to 1998." Prevalence rates range from zero to 0.8% outside Dakar.

As in Uganda, we find evidence of primary behavioral change in Senegal, that is, partner reduction and rise in age of sexual debut. For example, researchers, compared two cross-sectional surveys using standardized questionnaires conducted in 1990-1992 and again in 1994. Even by 1994, "The proportion of men who declared casual sex partners in the past 12 months decreased from 39% to 21% (P = 0.01). Condom use ("ever used) was 3.6% in 1993, almost the same low level as Uganda at that time. In a 1997 UNAIDS survey of women in Dakar, where condom use might be expected to be the highest, 23% of women age 16-50 reported ever using a condom.

According to Demographic and Health surveys, the median age of sexual debut has risen in Senegal, from 16.4 in 1993 to 17.5 in 1997. For age-specific comparisons, median age of debut for females 20-24 rose from 17.5 in 1993 to 18 by 1997. For females age 45-49, debut rose from 15.8 in 1993 to 17 by 1997. DHS data seems lacking for males before 1997, but by 1997 age of debut ranged between 18 and 20, depending on the age group. Many or most countries in east and southern Africa seem to have sexual debut median ages of 15 or less.

As in Uganda, FBOs became involved in HIV/AIDS prevention from early in the epidemic in Senegal. A conservative Muslim organization, Jamra, approached the national AIDS program in 1989 to discuss prevention strategies. Also as in Uganda, there was initial disagreement about the role of FBOs in condom promotion. The government conducted a survey of Muslim and Christian leaders to better define a role for them in AIDS mitigation. The survey found that religious leaders needed and wanted more information about HIV/AIDS, so that they in turn could educate those in the respective religious communities. According to UNAIDS:

In response, educational materials were designed to meet the needs of religious leaders. They focused in part on testimonials from people living with AIDS-the human face of the epidemic, often hidden where prevalence remains low. Training sessions about HIV were organized for Imams and teachers of Arabic, and brochures were produced to help them disseminate information. AIDS became a regular topic in Friday sermons in mosques throughout Senegal, and senior religious figures addressed the issue on television and radio.

A Catholic NGO, SIDA, also became involved in prevention as well as counseling and psychosocial support. In 1996, A meeting on AIDS prevention was held for Christian leaders; every bishop in Senegal attended and consensus was reached that AIDS prevention was an important national priority. The following year, Senegal hosted the First International Colloquium on AIDS and Religion, held in Dakar in late 1997, was attended by some 250 persons from 33 countries, including Muslim, Christian, and Buddhist religious leaders and the ministers of health of five African countries. The impact on Senegalese religious leaders of all faiths seems to have been to empower them "to act freely in the promotion of prevention strategies" Yet there was much to overcome before this was possible. A local researcher notes:

During the first stages of the AIDS epidemic the majority of religious (leaders) condemned those infected with the virus, calling the illness a divine curse. This attitude made AIDS shameful and a positive diagnosis difficult. Religion systematically condemned certain modes of prevention as well as certain individual and group behaviour.

A recent LA Times article describes the role of FBOs and religious leaders today:

While the religious leaders insist that they encourage abstinence over the use of condoms, they acknowledge the importance of dispelling myths about the disease, such as the common theory that AIDS is a curse or a punishment by God.

It may be argued that sexual behavior in Senegal is conservative by general sub-Saharan African standards, therefore perhaps it is pre-existing norms and values rather than the impact of any interventions that have kept infection rates low. Furthermore, widespread male circumcision among Senegalese men certainly helps prevent heterosexual transmission of HIV. It may even be that the presence of HIV-2 limits the spread of HIV-1. But these considerations fail to explain why HIV-1 infection rates have risen in countries neighboring Senegal, countries comparable with regard to the factors just mentioned, including religious profiles. They do not explain why Senegal is unique in West Africa.

It should be noted that both Senegal and Uganda stand out in Africa as countries where governments supported AIDS prevention efforts boldly and strongly, at a relatively early stage. There is agreement in both countries that this support has made a major difference and has allowed prevention programs to have maximum impact. It is probable that one of the factors inhibiting a strong government response to AIDS elsewhere in Africa and beyond is fear of negative reaction from religious authorities. This only strengthens the argument for involving religious leaders and FBOs as early as possible.

At least the argument cannot be made in Senegal that behavioral change, followed by serprevalence stability or decline, was caused by fear, by simply seeing so much death-the argument often made to explain what happened in Uganda-since IV infection rates never exceeded about 1%, one of the lowest in sub-Saharan Africa.

Jamaica

Risk factors are found in Jamaica that would predict relatively high HIV infection rates: an early age of sexual debut (median age of 14 for boys and girls), multiple sexual partners, a robust sex industry linked with tourism, lack of male circumcision, presence of chancroid, age disparity between partners (a pattern of older men having transactional or coerced sex with younger girls), relatively high levels of alcohol and drug use, and related factors such as poverty, labor emigration and male absenteeism, violence, homophobia, and major stigma associated with AIDS. Yet Jamaica has low HIV infection levels by regional standards: 1.6% or lower among the general population in 2000, down from 2% in 1996. This seems to be because of programs of STD case finding and syndromic management (resulting in declining infection rates of virtually all STDs); and behavioral change programs that have resulted in substantial reduction in number of sexual partners, a slight rise in the median age of sexual debut, and-unlike Uganda-- high rates of condom use.

Jamaica is another country where there has been emphasis on promotion of "fidelity" and "abstinence," as well as condoms and treatment of STDs. This has come from the national HIV/AIDS Control program, through its BCC (behavior change and communication) program. Notable among the vehicles for BCC have been schools and FBOs. As in Uganda, Jamaica's BCC program has emphasized face-to-face approaches and the use of peer educators.

Sexual Behavior Change in Jamaica

Has promotion of "fidelity" and "abstinence" resulted in behavioral change? The causal variables have yet to be sorted out, but a recent national population-based KAP survey of Jamaicans age 15-49 shows that the proportion of both males and females who reported 2 or more partners for the previous 3 month period declined sharply in 2000, compared to 1996. There was significant decrease among all age groups with the exception of females aged 15-19 (4.5% vs. 3.8% existing at time of a 1996 survey).

Furthermore, the median and mean age of sexual debut rose from 13 to 14 for males between 1996 and 2000; it remained 14 for females. Earlier population-based, quantitative evidence showed that 50% of females aged 15-19 had had sexual experience, down from 59% in 1993. Therefore, the age of sexual debut seems to be rising overall since 1993, albeit slightly.

There is also evidence from a recent qualitative study that some young people believed that 15 or 16 is the earliest that Jamaicans should begin to have intercourse. A focus group of "suburban" boys (those from higher-income neighborhoods) believed that age 18-25 is "ideal" for first sexual experience. Yet sexual debut is at an earlier age. This means that there is a gap between beliefs, values and behavior, a gap that FBOs can do even more to focus on in BCC interventions. The same study showed that boys who delayed first intercourse tended to be "raised in a Christian home" suggesting the influence of religion in delay of sexual debut.

Community Peer Educators interviewed by a recent USAID evaluation team reported that "mainstream" Jamaican churches have been particularly cooperative in their AIDS education efforts. With some churches, there was resistance at first. But it took only pointing out that members of a particular church were becoming infected with HIV to change these attitudes. The result is that Jamaica has had good, supportive relations between FBOs and national AIDS efforts in both the public or private sector, for many years.

The USAID evaluation team was unable to find direct evidence of any clergy or religious organizations opposing the work of the National AIDS program. There were occasional allegations that fundamentalist or Pentecostal churches criticized the promotion of condoms, but no real evidence of this emerged anywhere. On the contrary, individual clergy and faith-based organizations were cited virtually everywhere as helpful not only in the care, support and counseling of people living with HIV/ or AIDS, but also in AIDS prevention efforts.

It is important to mention that FBOs in Jamaica have been relatively open about condom education and promotion. The government's condom social marketing program was even able to promote condoms among church groups on several occasions, and it encountered no church opposition to such efforts. Condom user rates in Jamaica are high by any country's standards. Over 90% of sex workers regularly use condoms with clients, and some 77% of men, and between 57-79% of women (depending on age group) reported using a condom during their last sexual encounter with a non-regular partner. Even condom use among regular partners is high by international standards, increasing from 47% in 1996 to 52% in 2000, using the same measure: whether or not a condom was used in the last sexual encounter.

In sum, Jamaican FBOs have been active in AIDS prevention (as well as in care and support of those already infected), just as we see in Uganda and Senegal, two other countries that have experienced stabilization and even decline of HIV infection levels at the national level.

Conclusion

In view of these findings, as well as the modeling studies cited, it would seem that there ought to be greater equity in resource allocation between HIV/AIDS prevention programs promoting primary behavioral change --such as delay of sexual debut and reduction of number of sex partners--and the far more familiar programs that promote and provide condoms. There should also be more involvement on the part of faith-based organizations, and more AIDS prevention resources allocated to them-not because this is part of any political agenda, but because it works.

Of course, it is very difficult to attribute behavioral change in Uganda, Jamaica or anywhere to any one, or combination of, specific interventions. It is very hard to control for confounding variables. And few studies have looked specifically at the impact of FBOs. Indeed, very few countries have even supported major, national-level faith-based initiatives in AIDS prevention. The contribution of faith-based organizations has therefore not been recognized by national and international HIV/AIDS donor organizations, at least outside the countries discussed here. Yet there is now enough suggestive evidence to encourage FBOs to play greater roles in HIV/AIDS prevention, and for donor organizations such as USAID, the World Bank and UNAIDS to support more faith-based initiatives.

In conclusion, the following propositions are submitted for consideration and indeed for far more extensive empirical testing:

1. FBOs are best positioned of any group to promote fidelity and abstinence; this is their "comparative advantage." The behavioral change results of such efforts are measured as partner reduction and delay of first sexual experience, to use the language of public health.
   
   
2. These behavioral changes tend to be overlooked, yet we have highly suggestive evidence from a least three the few countries that have experienced national-level success in reducing HIV infection rates that they do occur when promoted, and that--according to recent modeling studies--such behavioral changes can have major impact on HIV risk reduction.
   
   
3. Religious organizations ought to be given more support in doing what they do best, namely promoting fidelity and abstinence. If FBOs also want to promote condom use, so much the better.
   
   
4. It is reasonably well-established that consistent condom use protects against HIV transmission, therefore condom use should be promoted. Yet FBOs should not be forced to emphasize or even necessarily include condom promotion in their HIV/AIDS programs. There are enough other organizations in international AIDS prevention already doing this, and there are insufficient programs directed at partner reduction and delay of sexual debut among youth.
   
   
5. Until recently, little international funding has gone to FBOs. There have been few evaluations of FBO AIDS prevention programs; existing evaluations results have not been much discussed or well disseminated; and religious organizations tend to be involved in care and support programs more than in HIV/AIDS prevention. Thus FBOs remain a great untapped potential in the global fight against AIDS. As new FBO programs are initiated, these should be carefully monitored and evaluated for lessons learned.

The Presbytery of New Castle overtures the 214th General Assembly (2002) of the Presbyterian Church (U.S.A.) to do the following:

1. Direct the program areas such as Hunger, Peacemaking, the Washington Office, the UN Office, Stewardship program, the Woman's Unit and other appropriate offices to
   
   
1. give leadership in support of the 0.7 percent initiative, so as to encourage and enable the denomination through its individual members, congregations, presbyteries, synods, and the General Assembly to study and adopt the 0.7 percent giving goal in support of our denomination's international development programs with an appreciable portion of this funding targeted for HIV/AIDS education, prevention, and care; and
   
   
2. provide guidance to each level for the appropriate remittance channels for such funds.
   
   
2. Call upon the United States government to
   
   
1. direct 0.7 percent of GNP to international development assistance;
   
   
2. adopt a combination of policies to bring relief to poor countries, including changing trade rules and canceling unpayable debt, in addition to economic development assistance; and
   
   
3. target aid funds repairing and building healthcare, education, and social welfare institutions and program, giving priority to small-scale, community-based organizations; and
   
   
4. use its influence to ensure that African nations are able to obtain HIV/AIDS medications at a reasonable price.

Rationale

The Presbytery of New Castle believes that in the current crisis time in our own national life when major attention is focused on domestic and global terrorism, we run the risk of losing sight of the equally important need for our nation to demonstrate its values and leadership by strengthening our support for struggling underdeveloped nations, and that as the Presbyterian Church (U.S.A.), we also face the urgent challenge and great opportunity to display an increased level of financial commitment to the ongoing healing ministry of our Lord Jesus Christ, and that one of the most urgent arenas for such a witness today concerns the pandemic devastation of HIV/AIDS.

The HIV/AIDS virus affects the entire world, killing more than 8,000 persons and infecting some 15,000 daily in 2000, 95 percent of which lived in developing countries.

Africa has borne the brunt of this scourge as revealed by the fact that the 36.1 million people globally infected by this disease, 25.3 million of them (70 percent) live in sub-Saharan Africa-a region that accounts for but 10 percent of the world's population! [from The Dakar Declaration of April 2001].

The Office of International Health Ministries of our General Assembly has indicated that from 40 percent to 60 percent of health care in sub-Saharan Africa is provided by our partner churches, and that the PC(USA) is committed to support these partners within their own distinct scenario of AIDS ministry in unique and supportive ways, including the establishment of two HIV/AIDS Consultant positions for Africa so that our support will be coordinated on the ground in assessing and planning with our partners directly.

All of our PC(USA) programs in support of HIV/AIDS ministries are hampered by funding that is insufficient to meet the ever widening global pandemic.

The 2001 United Nations General Assembly Special Session on AIDS incorporated in its final declaration the call for the long-standing target of the concept of giving 0.7 percent of Gross National Product by all countries to provide the funding required by the global HIV/AIDS pandemic.

The Worldwide AIDS Ministry of our own Worldwide Ministries Division has called for the endorsement and support of this concept, as this 0.7 percent initiative can be directly tailored to challenge our denomination as individual church members, congregations, presbyteries, synods, and the General Assembly.

"The international community must rise to the challenge of helping Africa. It is simply unacceptable that while the developed world enjoys unprecedented prosperity, one in seven African children will die before his or her fifth birthday. It is time that politicians and voters in rich countries realized that without a bright future for the poor, the future cannot be bright for the rest of the world," . In 1970, the UN General Assembly set the international aid target for Organization for Economic Cooperation and Development (OECD) at 0.7 per cent of the Gross National Product (GNP). Currently the average across all OECD donor nations is 0.39 per cent but across the wealthy G8 countries (excluding Russia) it is 0.19 per cent.

Not only does government need to put more funding into development, but the Christians must closely re-examine our individual, congregational and denominational responsibilities to the poor .

In June 2001, the 213th General Assembly of the Presbyterian Church (USA), unanimously called for Presbyterians to engage in advocacy efforts such as the World Health Organization's Massive Effort Against the Diseases of Poverty and to increase related funding. The goal of the ME campaign is to decrease malaria deaths by 50%, TB deaths by 50% and AIDS deaths by 25% over the next ten years. The 0.7 Initiative was subsequently embraced as a very practical way for Presbyterians to accomplish both these goals.

The 0.7 Initiative challenges individual Presbyterians and Presbyterian congregations to give a minimum of 0.7 of their income to international aid. After making this commitment, Presbyterians are encouraged to become involved in advocacy activities which pressure the US Government to commitment 0.7 of the GNP to international aid. It is hoped that by 2007, fifty percent of PC (USA) congregations will subscribe to the 0.7 principal and by 2010, the USA will increase its overseas aid budgets to 0.7 per cent of its national wealth (GNP).

DISEASE AND POVERTY

"Poverty is the underlying obstacle to human well-being. Despite the unprecedented prosperity and quality of life enjoyed in large parts of the world, 1.2 billion people survive on less than one dollar a day and another 1.3 billion scrape out a living on less than two dollars a day. Being poor is bad for your health. But being ill also reduces your chances of getting out of poverty." So being poor increases your likelihood of being sick and being sick increases your likelihood of being poor.

Recent data such as the December 2001, Report by the Commission on Macroeconomics and Health (CMH), Jeffrey Sachs, Harvard University argues that improved health is a critical requirement for economic development in poor countries and that malaria, HIV/AIDS and tuberculosis significantly obstruct economic growth. "The burden of disease in some low-income regions, especially sub-Saharan Africa, stands as a stark barrier to economic growth and therefore must be addressed frontally and centrally in any comprehensive development strategy." The World Health Organization (WHO) subsequently launched the project entitled "The Massive Effort Against the Diseases of Poverty". The campaign stress that for the first time in history, we have the knowledge and financial resources to reverse the toll of these diseases. The question is, do we have the political and moral will to achieve this goal?

TB, malaria and HIV/AIDS are all made worse by poverty - they thrive wherever people are poor. Of the 36.1 million people living with HIV/AIDS, 95 per cent are living in poor countries. One-fifth of the world's population is at risk of malaria- mostly in developing countries. Every year there are 8 million new TB cases and the poorest and most vulnerable are at highest risk. TB thrives in conditions of poverty and overcrowding . In order to tackle these diseases it is essential also to tackle poverty itself. But in order to tackle the poverty, we are told that by the CMH group and others, we must tackle the diseases.

People in some of the poorest countries are living with, and dying prematurely from, HIV/AIDS, malaria and TB because those countries are burdened with debt and are spending too little on basic healthcare and education. In the meantime, wealthy countries have for thirty years failed to meet their commitment (0.7% GNP) on aid. The Christian Aid report 'No Excuses - Facing up to Sub-Saharan Africa's AIDS Orphan Crisis' (June 2001) began with the words "AIDS is not just a health issue. AIDS is fueled by poverty.' Diseases such as HIV/AIDS, TB and malaria thrive in the world's poorest communities precisely because those communities are poor". In facing up to the crisis of HIV/AIDS in sub-Saharan Africa, and other poor regions, the world must face up to poverty itself. These diseases both thrives on and worsens poverty in three ways:

1. Diseases of Poverty are transmitted more rapidly in poor countries. Extreme poverty, malnutrition, lack of clean water, lack of education vulnerability to disease, low levels of schooling, crowded living conditions and ignorance about the diseases all contribute to their rapid spread.

2. Sick People in poor countries are not able to get medicines and/or the other basic essentials required for healthy living. In most poor countries, health services are disastrously underdeveloped. People who are sick in these countries desperately need Essential Medicines. These Essential medications are frequently not available in local communities. Many cannot afford the essential medication even when they are available in the local pharmacies.

3. The existence and spread of HIV/AIDS, Malaria and TB in poor countries further deepens poverty. WHO reports that these diseases both reduce the productive capacity per worker and the number of productive workers in Africa and other poor regions of the world. An example of this problem is TB that strikes people during their most productive years. Three out of four deaths occur between the ages of 15 and 54. As breadwinners die, incomes fall and remaining family members, primarily the young and the elderly, must struggle to subsist on the substantially reduced financial resources. Although these are diseases of poverty, HIV/AIDS in particular has also had a devastating effect on the urban professional people (in the middle and upper income levels of society). As they die prematurely, teachers, doctors, nurses, civil servants and clergy persons will need to be replaced to lead the future generation that must tackle the cycle of disease and poverty. HIV/AIDS has also had a particularly devastating toll on the society leaving over 13.1 million children orphaned by the end of 1999. As the pandemic grows, this number will certainly increase, subsequently burdening the minimally functional social systems in these poor countries. The reduction in the work force due to illness and death associated with all the diseases of poverty will result in lowered tax revenue that will mean even lower levels of government expenditure on basic services.

Current Plans for Massive Effort Funding for AIDS, Malaria and TB is NOT enough. Plans for a global fund to tackle HIV/AIDS, TB and malaria were originally hatched at the G8 summit in Japan in July 2000. The G8 committed to the Massive Effort goal to cut cases of malaria and TB in half and reduce by one-quarter the number of young people becoming infected with HIV by the year 2010. A year later a global fund to fight HIV/AIDS, TB and malaria has emerged as the main initiative to bring about the reductions pledged by the G8.

While the UN Secretary General, Kofi Annan, and others appeal for at least US $10 billion per year to combat HIV/AIDS, TB and malaria, the fund looks likely to fall short of any meaningful injection of money. The USA has promised US $200 million - one-three-hundredth of what it is planning to spend on the so-called 'Son of Star Wars' missile defense shield. The fund itself is likely to raise less than US $2 billion, with no guarantee of further money to follow. The question has also been raised as to whether these funds are new funds or if they are only the redistributing of funds that have already been allocated.

If the 22 Organization for Economic Cooperation and Development (OECD) donor countries honor their 30 year-old commitment of giving 0.7% GNP, an extra $100 billion annually would be available both for specific disease initiatives such as anti-retroviral drugs, HIV prevention programs and orphan care, mosquito net programs and TB DOTS (Directly Observed Treatment Strategy) in addition to resources to tackle the failing infrastructure and underlying poverty.

WHAT WEALTHY COUNTRIES GIVE
The average contribution for countries in the European Union is 0.33 per cent of the GNP. The average contribution for G7 countries (USA, UK, France, Italy, Germany, Canada and Japan) is 0.19 per cent. The two countries giving least in proportion to their wealth are Italy (0.13) and the United States (0.10). It is interesting that these are the two countries that most openly assert their Christian tradition.

1.) Organizations such as Christian Aid have stated "there is a moral imperative for wealthy countries to provide aid to poor countries. That imperative is even stronger now with a global HIV/AIDS crisis. Had wealthy donor countries met the target of giving 0.7 per cent of national wealth in overseas aid thirty years ago, the large scale of the HIV/AIDS pandemic might have been prevented".

2.) The historical links between Christian denominations in the USA and Europe with their partner churches in the developing world, and the credibility of religious institutions both positions and mandates the Church to play a major role in encouraging donor nations to honor their commitment.

3.) The 0.7% Initiative provides an achievable and measurable opportunity for the church to make a significant difference in the health and well being of people living in the world's poorest communities.

4.) The 0.7% Initiative provides an opportunity for Christians in high-income countries to critically assess our individual, congregational and national response and responsibility toward a world increasingly polarized between rich and poor nations.

5.) The 0.7% Initiative provides an opportunity to demonstrate Christian concern and determination, as a community bonded by love for God and God's people, to improve the living conditions particularly of the poor and well being for all human beings.

6.) Christian community development programs, educational institutions and health facilities continue to be significant providers of services in the world's poorest countries. Our participation in the 0.7% GNP advocacy activities will increase the flow of resources to our partners in low income regions such as sub-Saharan Africa while highlighting our continued commitment and involvement in activities that close the gulf of economic and health disparities between rich and poor nations.

HOW DOES THE 0.7 INITIATIVE WORK ?

Presbyterians are being asked to make a personal commitment to give 0.7% of their own income towards alleviating the burden of international poverty. They then find other groups of individuals within their congregation who are also interested in making this commitment and join together to learn more and support each other. In the congregation there are several groups which can provide leadership for the 0.7 Initiative. Groups and committees within the church that might be interested are:

Christian Spiritual Discipleship committee - the most radical response to world poverty will ultimately be grounded in our personal spiritual discipleship and our understanding of personal Christian stewardship

Women's groups - this is an issue of health and well-being especially for women and children around the world. Frequently the women associations become particularly interested when they learn of the close links between gender inequity and poverty which increase the vulnerability of women to HIV/AIDS.

Missions committee - this is a group that is formed specifically to look at and address the needs of people living overseas. Those who should be most affected by the giving of 0.7% are people in countries with the greatest economical and development needs.

Peace and justice committee - as this is at its roots also a justice issue regarding the unequal distribution on wealth within the world and the responsibilities of those " to whom much has been given...."

Health committee - as poverty strongly and adversely affects people's health. With the additional aid from the 0.7 Initiative communities will be able to not only better identify their health needs but to work to bring about changes in this area.

Stewardship committee - as the ones responsible for assuring that the congregation's financial resources are used to build the Kingdom of God.

Once interested individuals, groups and committees have made a commitment to the 0.7% Initiative they bring the Initiative to the congregation as a whole to educate and encourage the congregation to adopt the 0.7% Initiative as a form of stewardship of its own resources. Interested members of the congregation are challenged to develop creative ways to incorporate those who are not involved with any of the groups mentioned above and who may have little knowledge of or interest in the issue of poverty. In some congregations this "uninterested " group may represent the majority of the church membership.

After the congregation has made a commitment to the 0.7 Initiative they are encouraged to address their Elected Officials from the perspective of a body that is already giving 0.7% to international development and demand that their government keep its commitments and do likewise.

Conclusion

The health status and living conditions of people in poor countries today is in need of many changes. Christians, as congregations and as individual citizens of high income countries in the global economy, have it within our power to make a difference in supporting and walking with of our brothers and sisters who live in poor countries and are working to improve their lives. Once we have established thoughtful stewardship of the many resources provided to us by God, then we can say without hesitation or stumbling ."… let justice roll on like a river, righteousness like a never-failing stream! " Amos 5:24. By participating in the 0.7 Initiative, we can take a position of leadership in our communities and in our country. We can become God's Light that shines and illuminates the path to justice, hope and well-being for all people. In doing this, we "let (our) light shine before others, so that they may see (our) good works and give glory to (our) Father in heaven." (Matthew 5:16)

Information Boxes:

a) Recommendations

The following are more specific recommendations as to what individual, congregations can do and what to call on the US government to do.

Individuals

1.) Educate our congregation and neighbors about:

• The problem of the growing gap between rich and poor nations
  
• The 0.7%GNP Appeal by the International Monetary Fund and World Bank
  
• The USA performance
  
• The implications for the growing gap for Christian stewardship

2.) Lead by example
After assessing your pattern of giving, challenge your Christian church members and friends to determine if they are allocating at least 0.7% of the financial resources provided to them by God, toward activities which will close the gulf between rich and poor nations.

3.) Facilitate your Congregation and other Christians who have already reached the 0.7% target to take the next steps:

• Educate others through personal testimony, minute for missions, literature distribution, and presentations at Christian conferences
  
• Write to your congressperson and urge others to write their congresspersons in order to promote the US Government recommendations (below).

Presbyterian Congregations

1.) Direct at least 0.7% of your income for international Christian health and development work.

2.) Resources should be targeted at repairing and building up Christian health care, education and social welfare projects that address both the physical and spiritual needs in poor countries.

3.) When allocating resources be sure that community members have been included in the creation and implementation of the projects to ensure that effective, low-tech, low cost and local solutions are given priority and that substantial funding goes primarily to community-based organizations.

4.) Direct funds toward strengthening health care and education services in poor countries, giving priority to small-scale organizations rooted in the community.

US Government

When writing to congressional representatives, direct them to ensure that the US Government:

1.) Direct 0.7% of the GNP for international aid

2.) Adopt a combination of policies, including changing trade rules and canceling unpayable debt.

3.) In addition to economic development, aids funds should be targeted at repairing and building up health care, education and social welfare in poor communities.

4.) Direct funds toward strengthening health care, education, and social services for poor communities, giving priority to small-scale organizations based in the community (programs that tackle the root causes of poverty as well as the common diseases).

Related Issues

b) Debt
The HIV/AIDS crisis must also serve as a final wake-up-call to G8 leaders, the World Bank and International Monetary Fund (IMF) on the cancellation of unpayable debts of poor countries. The paying-off of external debt is one of the factors that have critically weakened health care and education in the countries that are now worst affected by HIV/AIDS. The setting up of a US $1 billion global fund makes little sense while the 23 countries that have hitherto had some of their debts canceled are still repaying over US $2 billion every year. The same 23 countries, including many in sub-Saharan Africa, among those countries hardest hit by the HIV/AIDS crisis and are together only able to spend US $1.4 billion per year on health care.

c.) Trade
. The terms of trade for poor countries must also be addressed through rewriting the World Trade Organization (WTO) agreements to benefit the poor. In the short term, many countries can reduce the number of people living in poverty through using aid and debt cancellation. But while the rules of international trade are stacked against them, they are unlikely to be able raise growth rates, expand basic services and eradicate poverty. ('False Dawn: A Christian Aid Policy Brief', June 2001)

i. Kohler and Wolfecsohn, International Herald Tribune, 14 March 2001
ii. Dr. Gro. Harlem Brundtland, Director-General, World Health Organization, October 5, 2000
iii. Health a Key to Prosperity, WHO/CDC, 2000
iv. J.D. Wolfensohn, World Bank President, WHO/CDC, 2000