Christian faith communities and HIV in humanitarian settings: the cases of South Sudan, DRC and Kenya

Faith-Based Communities (FBCs) provide 40% to 50% of healthcare in developing countries and contribute greatly to HIV responses. One in five organisations working on HIV programmes are faith-based. Yet, during large-scale emergency responses, humanitarian actors have not realised the potential of FBCs to undertake HIV programming, nor have they utilised it by supporting or partnering with them. This may be due to humanitarian organisations’ preconceived ideas about FBCs’ capacity and their approaches to HIV services.

A collaborative study between ODI, World Vision and Tearfund in 2009 aimed at understanding the role of Christian FBCs in responses to HIV in humanitarian settings, and the nature of the collaboration between FBCs and humanitarian actors. This article is based on the findings of this work. Fiona Samuels, Rena Geibel and Fiona Perry, Collaboration Between Faith-based Communities and Humanitarian Actors When Responding to HIV in Emergencies, ODI Project Briefing 41 (London: ODI, May 2010).

HIV in emergencies

The growing number of disasters, often linked with displacement, food insecurity and poverty, increase vulnerability to HIV and negatively affect the lives of people with HIV. The spread of HIV in fragile states and humanitarian emergencies depends on many factors, including HIV prevalence and service avail­ability, the main modes of transmission, the duration and nature of the emer­gency, the level of disruption to basic services and the coping strategies people use during the emergency. Fiona Samuels, HIV and Emergencies: One Size Does Not Fit All (London: ODI, 2009).

Women and children are the most vulnerable to violence and HIV in these situations. Children are greatly affected by violence and crime in an environment without role models, moral leader­ship or understanding of social interactions and behaviours which could contribute to the prolific level of sexual and gender-based violence in post-conflict and fragile state settings. F. Perry, Research Concept Note: Post-Conflict Sexual Violence – An Expected Cultural Norm in Fragile States? Can CoH Gender Training Change Attitudes and Behaviour of Youth and Make a Difference? (Nairobi: World Vision, 2010).

The study showed that violence against women increased during periods of insecurity. Many women use transactional sex (sex in exchange for basic necessities) to survive, both dur­ing and after a crisis. Respondents also spoke about increases in consensual sex in camps for internally displaced people: ‘People were looking for a place to comfort themselves’, accord­ing to a focus group discussion in Kenya. Meanwhile, stigma about HIV and AIDS is high and deters people from disclosing their HIV status and seek­ing treatment and support. ‘Resources were scarce and families did not want to be burdened by a chroni­cally ill family member’, said a respondent in the Democratic Republic of Congo (DRC).

Methodology

The study consisted of a review of literature from Liberia, Haiti and Zimbabwe followed by qualitative field studies in DRC, South Sudan and Kenya. Eighty-four in-depth interviews and 20 focus group discussions were conducted with participants selected using opportunistic and snowball sampling, and including people affected by the emergency, people living with HIV and members of FBCs.

Key findings

Faith communities’ niche areas

Participants in all three countries expressed the view that churches are often the first port of call for the most vulnerable during emergencies. FBCs could use their structures and net­works to obtain emergency funds and have the potential to provide good-quality and consistent HIV preven­tion and treatment services for rural or marginalised communities in emergencies.

FBCs can maintain projects during periods of insecurity because their staff tend to be local vol­unteers. There were reports in all three case studies of mission clinics and hospitals staying open when other facilities, including government hospitals, had shut.

The research showed that the continuous presence of churches during conflict builds trust amongst local communities. Churches acted as mediators between communities and aid organisations; helped to mobi­lise groups to implement activities; and negotiated safe passage for humanitarian actors. In Kenya, for instance, the local faith community mobilised youth, who were perpetrating many crimes at the height of the post-election emergency, by involving them as gatekeepers, security guards and relief distribution monitors.

Churches can provide spiritual care and refuge; they preach love and encourage kindness; and they can mobilise limited local resources to support vulnerable children, people with HIV and families. As one religious leader in South Sudan put it: ‘The community has con­fidence in the church. More attend VCT (voluntary counselling and testing) managed by a faith organi­sation than the government. They trust we will stay confidential.’

Lack of HIV training and misconceptions about HIV

The study found no systematic HIV training for clergy, alongside a wide spectrum of faith-based approaches to HIV, ranging from denying its existence and condemning those infected to establishing home-based care, initiating associations of people with HIV and offering church premises for mobile HIV testing and HIV campaigns. According to study respondents, the opinions of religious leaders have changed substantially in the past five to ten years, though rural parishes lag behind as fewer HIV aware­ness campaigns and training reach these areas. There were reports from the DRC and Kenya that some leaders are misinforming congregations on HIV and encouraging members to stop taking anti-retroviral drugs (ARVs) and allow God to heal them.

Few pastors have been trained in HIV-related counselling or trauma recovery techniques. In addition, religious leaders may disapprove of family planning and the church often prohibits sex outside marriage, making it difficult to help young people who are already sexually active.

Planning and capacity to respond to HIV in emergencies

The study found insufficient preparedness for HIV responses during emergen­cies among FBCs. Few local religious initiatives have contingency plans or enough funds for emergency responses. Churches are also reticent about traditional gender roles and harmful traditional practices. Addressing these issues is often overlooked. This could partly be due to the under-representation of women among Christian leaders. Many respondents felt that the church has a role to play in addressing gender discrimination, which leaves women and girls vulnerable in general, and particularly in emergencies. According to the religious leaders interviewed, gender is difficult to address within the church. However, as one religious leader in Nairobi said: ‘We need to address gender, HIV challenges, and build our capacity to deal with early child marriage and female genital cutting’.

The potential advantages of inter-denominational collaboration such as sharing of funding and training was limited in all three countries; network umbrella organisations exist, but do not reach their full potential due to lack of resources.

Collaboration with humanitarian actors

There are examples of collaboration between interna­tional humanitarian actors and local Christian com­munities. In DRC, for instance, the Catholic Church has developed an HIV national plan, and are planning to be supported directly by humanitarian actors (e.g. the World Food Programme) or through Catholic development agencies (e.g. Cordaid). However, churches rarely have the neces­sary human resources to build relationships with international agencies. Skilled church leaders may also be overstretched and humanitarian actors may see churches as obstacles to services such as condom distribution, sex education and measures addressing traditional practices. While humanitarian actors have some level of reporting against their accountabilities, churches tend to focus on activities rather than results, according to respondents, and lack project management, monitoring and documentation.

During the launch of the findings of this study in Nairobi on 1 December 2010, a panel was set up to facilitate a discussion on the lack of collaboration between humanitarian organisations and the Church when responding to HIV in emergencies. A number of possible causes were cited:

• Humanitarian actors often do not take the time to fully understand, gain common ground with and get to know potential partners before an emergency happens. During an emergency there is little time to build these relationships. In addition not all FBCs and churches are the same and humanitarian actors need to be prepared to take time to understand the different approaches between them.
• It seems that theological misunderstandings are the main obstacle to humanitarian actors working with the church. Gender inequality and lack of youth participation in programming were also cited as problems.
• Humanitarian organisations tend to have short-term programmes which are not conducive to the more developmental nature of FBCs. There is a need for long-term partnerships with FBCs to develop more sustainable programmes and sufficient skilled and well-equipped staff, and for FBCs to access adequate long-term funds.

Recommendations for humanitarian organisations

Long-term partnership

Humanitarian organisations should work with FBCs in their disaster management activities, from local emergency preparedness and capacity-building through emergency responses and beyond. The position FBCs have within the wider community and the resulting trust and relationships mean that they are uniquely placed to lead an HIV response, a capacity that humanitarian actors should recognise and build upon in humanitarian emergencies. Assistance can be given with proposal and report writing, funding and monitoring and assessment. These partnerships should extend beyond the initial stages of the emergency, so ensuring sustainable programming and increasing the skills and capacity of the organisation.

Initiate HIV emergency preparedness and dis­aster risk reduction initiatives

Humanitarian organisations could help to build the capacity of FBCs on disaster risk reduction. Training for FBCs should include disaster risk reduction, emergency preparedness and how to incorporate HIV and AIDS into humanitarian planning responses.

HIV, gender and GBSV training

Humanitarian actors and govern­ments need to support more HIV training for Christian leaders, particularly in rural health zones. International faith-based organisations can help to build the capacity of local churches, using proven Christian-based facilitation tools to tackle miscon­ceptions of HIV, address stigma and discrimina­tion towards people living with HIV, enhance family dialogue and improve relationships with humanitarian actors. Donors and humanitarian actors need to advocate for longer-term social change, protection and skills-build­ing programmes for women and girls.

Assist FBCs to initiate participation of youth and children in HIV and emergency programming

Humanitarian actors should work with FBCs to develop a comprehensive strategy for children and youth, focusing on their rights to survive, be safe, belong and develop. Components could include life skills training, peer education, mentorship, family dialogue, basic education, vocational training and adolescent-friendly reproductive health services.

Recommendations for FBCs

Unbiased and scientific HIV awareness for all staff

All staff of FBCs including the leadership need to have adequate HIV knowledge that is theologically acceptable and does not allow for misconceptions or misunderstandings, so preventing stigma and discrimination in the community.

Mobilise FBCs to address stigma and det­rimental cultural practices

FBCs and in particular the local church need stronger skills and resources to address gender dynamics, domestic violence, tribal reconcilia­tion and the involvement of men in HIV testing and treatment.

Mobilise FBCs to tackle GBSV

Some FBCs provide medical and psychosocial support for women who have been raped. Yet prompt reporting for medical and legal purposes remains lacking and most funding for gender and sexual violence in crises focuses on short-term immediate response rather than prevention, social reinte­gration and female empowerment. Trusted members of the local faith-based community are well-placed to initiate dialogue on gender roles and social norms, work with households to pro­mote rapid response to and report violence against women  – and become a voice for women.

Invest in faith-based youth teams and commu­nity outreach

FBCs need to ensure that they provide HIV services that are closer to those that need them, reaching remote areas. Building local skills in HIV prevention, care and counselling is possible through religious networks. Faith-based youth outreach workers will create an interface between health facilities and communities, and local human resources to call upon during crisis.

Fiona Perry is Global HIV advisor for emergencies, World Vision.