Antiretroviral therapy is a relatively new issue to most communities in Africa. The main barrier to accessibility has been the high costs involved. Nevertheless, through technical advances and lobbying by various stakeholders the costs have been reduced and funds are being mobilised to increase accessibility to antiretroviral drugs. However, there is a big issue of stigma associated with HIV/AIDS and use of the drugs, which needs to be addressed by faith-based organisations (FBOs).

One of the causes of stigma in AIDS is that HIV is sometimes transmitted by behaviours which are regarded as sinful as taught by various faiths. For example sex outside marriage is regarded as a sin by most faiths, and it is one of the routes through which HIV transmission can occur. Therefore, PLWHA have sometimes been stigmatised as of lower moral character who cannot control their sexual behaviour. As a result there is a tendency to hide HIV infection and consequently reduce access to HIV management. On the other hand most faiths teach about the imperfections of human beings who constantly need to ask for forgiveness from God. An example of this from the Islamic faith is in the Qur'an (39:53): "O my servants who have transgressed against their souls! Despair not of the Mercy of Allah for Allah forgives all sins for He is Oft-forgiving, Most Merciful."

The faiths also teach charity and compassionate care of the needy who include those afflicted by diseases. For instance, the Qur'an (2:177) says: "It is righteousness to believe in Allah and the Last Day and the Angels and the Book and the Messengers; to spend of your substance out of love for Him for your kin, for orphans, for the needy, for the wayfarer, for those who ask and for the ransom of slaves…"

Another reason why AIDS is stigmatised is that it is associated with early death. Therefore, people with AIDS are sometimes regarded as of low value since they are on their way to death. To avoid this perception there is a tendency to hide HIV status. However, most faiths teach that death is close to everyone and that it is inappropriate to stigmatise those who appear close to death.

Faith-based community mobilisation

In Africa, a significant proportion of health care is provided by faith-based health units. These units were established in response to faith teachings that call for the care of the needy. With appropriate capacity building, many of these could deliver antiretroviral drugs and support PLWHA in their treatment. Since antiretroviral therapy is relatively new especially in Africa, many FBOs have not yet fully utilised their potential for advocacy and education of the community on this issue.

However, there are some FBOs that are beginning to build their capacity to address antiretroviral treatment-related issues. An example is the Ugandan project "Community Mobilization Model for Prevention of Mother to Child HIV Transmission (PMTCT) and Antiretroviral Therapy (ART)" of the Islamic Medical Association of Uganda (IMAU).

In Uganda it is estimated that about 1 million people are living with HIV/AIDS. Of these, about 100,000 have symptoms of AIDS and are in need of antiretroviral therapy. This number is expected to increase every year. It is estimated that only about 10% of those who need the drugs are actually using them and most of these people are living in urban areas. They meet most of the treatment costs privately. The IMAU project was designed to complement government efforts to increase awareness and utilisation of PMTCT and ART services. This pilot project was started in 2002 in Kampala District. A rapid appraisal was first done to assess the knowledge of the communities on PMTCT and ART. The knowledge was found to be low. A curriculum was then designed to address various issues related to PMTCT and ART. The topics in this curriculum included: Voluntary Counselling and Testing, infant feeding, PMTCT and ART. Twenty-five trainers were selected from Christian and Muslim faiths depending on their competence and availability to train the community educators. The main objective of the education was to increase awareness and promote demand for ART services. A total of 750 community educators of both Muslim and Christian faiths were trained together. These community educators included religious leaders and their assistants. These educators then started educating their communities about PMTCT and ART issues through sermons, group talks and home visits.

Demanding services

The educators record their activities on monitoring forms which they return to IMAU staff during monthly meetings. According to these records, they have so far educated over 100,000 men and 150,000 women. They report that their communities are demanding services including PMTCT and ART to be brought nearer to them at more affordable costs. They also report that their communities are now looking out for opportunities to get low-cost or free antiretroviral drugs. They believe that increased availability of antiretroviral drugs will be an incentive for utilisation of other services including VCT and PMTCT. They say that the project has contributed to increased openness and reduced stigma around HIV/AIDS. Some community educators have reported that people are more willing to go for VCT in clinics because antiretroviral drugs to help them are becoming available. One community leader said: "AIDS is becoming a chronic treatable disease like diabetes and hypertension. There is no need to stigmatise people anymore."

There is increasing demand to expand the project to other parts of the country. This will require more resources to train more trainers and community educators. The project was funded by CDC in collaboration with UNAIDS and UNICEF. Plans are underway to look for resources from both within and outside the communities to sustain and scale up the project activities. The estimated cost for educating an individual regularly so far is about 1 US$ per year.

In conclusion, faith-based organisations have a great potential to deliver ARV-related services through their health facilities and religious establishments. This potential needs to be utilised by forming partnerships with FBOs and building their capacities to deliver these services. The example from Uganda shows that this can be done.