Whilst religious organisations have a wide reach, influence and capacity to mobilise communities to respond to HIV/AIDS, their responses have lagged behind the challenges and their policies have shied away from conflicts with theological concepts. At the start of the pandemic, the religious community has given conflicting messages. Opposition from most religious denominations¹ hampered prevention efforts directed to condom use. Historical interpretations of leprosy or skin-diseases as the entry of an evil spirit reinforced stigma and discrimination. At first, many religious leaders interpreted HIV/AIDS as God's punishment of sinners and called for behaviour change or repentance. In general, this generated defensive behaviours, fatalism and self-stigmatisation among followers and other stakeholders.

Nevertheless, over time, many countries have realised impressive progress in the struggle against HIV/AIDS, and the case to be made for FBO involvement is strong. Though attribution is not straightforward, countries such as Senegal, Uganda, and Thailand, which have involved religious leaders early on in the planning and implementation of national AIDS strategies, have seen positive changes in the course of the epidemic. The contribution of FBOs and religious leaders to the United Nations General Assembly Special Session on HIV/AIDS (UNGASS, 2001) supports the argument for FBO involvement. Today, around the world many FBOs are involved in some form of sexual and HIV/AIDS education, care and support programmes.

The response of the faith sector

Faith-based programmes are especially renowned for their activities in the field of medical, pastoral and spiritual care, home-based care, and assistance to orphans. This is especially true for many Christian and Buddhist initiatives. Yet, many organisations and bodies have also developed policies, strategies and activities to prevent the spread of HIV and to fight stigmatisation and discrimination towards PLWHA. Since a few years HIV-infected clergy have openly attested their status and have organised themselves, which will prove invaluable in reducing stigma at community levels. A good example is the work of ANERELA+, an African network of religious leaders of all religions who are living with or affected by HIV/AIDS.

Increasingly, religious leaders advocate for human rights, address gender inequality and oppose harmful traditional practices. An important step is the recognition, e.g. by the World Council of Churches, that any references to "AIDS as a punishment of God" are incompatible with the Gospel and that a "theology of compassion" is needed to properly react to this pandemic. The Pan African Synod of Roman Catholic Bishops SECAM (Dakar 2003) adopted a plan of action that is not limited to care and moral behaviour change; a focus on poverty and the vulnerability of women and girls is essential to tackle the pandemic and a key notion in the Gospel as well.² Yet in this aspect there remains a big linguistic and conceptual gap to be bridged between secular professional and religious authorities: words like "gender" on one hand or "sanctity of life" on the other may not necessarily be recognized by the other partner as being a common motive for action.

At the institutional level, religious bodies,¹ mainly Christian Churches in Africa, have set up AIDS Desks and have hired specialised personnel to develop and implement HIV/AIDS strategies, develop sermons, workshops for pastors, theological reflection, educational materials, etc. Further, networks of FBOs have developed at national and international levels. Examples are the Ecumenical HIV/AIDS Initiative in Africa, the Jesuit AIDS Network and the Buddhist Leadership Initiative (see Boxes). There are also several interfaith initiatives, such as FOHAP in South Africa and ZINGO in Zambia. Some of these networks are described in this special issue.

The prevention controversy: from opposition to an "agreement to disagree"

FBO's contribution to prevention is valuable in terms of broader development issues such as education and social services to reduce vulnerability and to cope with impact, as well as an emphasis on abstinence and faithfulness as exclusive strategies for HIV prevention. Here however, in view of the reality of human sexual behaviour, prevention methods have been incompatible with the approach of secular stakeholders to HIV prevention. Indeed, in many countries, HIV/AIDS strategies focusing on condom promotion have faced tremendous opposition from religious organisations. At the local level some local clergy and FBOs have also felt constricted by these official positions, and occasionally act in pastoral situations according to their perception of social necessity.

Churches will not change their position on condom use completely, since in their view sexuality cannot be detached from core values of Christian love, marriage and procreation. A complementary approach, for example visualized in the "Fleet of Hope", describes peoples' choices related to HIV infection risks. Yet such an ABC approach may only be helpful if it respects the religious and moral teachings as well as the cultural values and socio-economic constraints underlying these choices, not if it prescribes or ignores them. Religious leaders necessarily will continue to advocate an ideal of restricted sexual activity instead of accepting any behaviour patterns as they are: this goes for sexuality as it goes for social injustice or violence and war. Intentions of collaboration between religious organisations (such as WCC, SECAM) and UNAIDS or national governments might be based on an "agreement to disagree" over prevention methods, taking into account the different responsibility of either partner for their mission, audience and mandate.

Within the Christian community, there is some recognition that sexual contacts may transmit a deadly virus rather than life. In this case, the commandment: "Thou shall not kill" prevails, especially in the situation where one of both spouses is HIV-infected. Similar reasoning is done by many Muslim religious leaders, who acknowledge the use of condoms within marriage to preserve life. An example of a Muslim FBO that is not opposing condom use is IMAU (Islamic Medical Association of Uganda) although it argues that condoms should be only promoted as protection after the failure of the first two lines of defence: abstaining from sex and having sex only within marriage.

In conclusion, while the work of FBOs in prevention is important, collaboration with secular stakeholders may remain problematic. Yet there are some useful entry points. Firstly, FBOs can be effective in helping young people learn how to avoid STIs and HIV transmission before they become sexually active. Secondly, religious organisations have always focused on values. In the face of the HIV/AIDS pandemic, value education, with an appropriate focus, can be a powerful tool.

Opportunities for involvement

FBOs have displayed a number of strengths compared to government institutions and development NGOs. For example, in many parts of Africa they are clearly the most effective in service delivery in relation to care and support for PLWHA. FBOs have a solid record in alleviating human suffering and potential for outreach to the poor in the most remote areas of the world, including humanitarian crisis and conflict situations. Their limitations are manifested mostly in the areas of collaboration with other stakeholders in prevention issues, and in their lack of opportunities for participation in the design of national policies and strategies.

On the other hand, significant opportunities exist to enhance the debate and the involvement of religious organisations, and the effectiveness of their HIV/AIDS-related projects. To be able to expand and widen their programmes, they cannot do this alone. They need information, training, opportunities for networking, funding, and technical assistance from international FBOs, religious bodies, (international) NGOs, governments, and other actors. Some recommendations from a 2003 desk review on the response of the faith sector in sub-Saharan Africa conducted by the Dutch Royal Tropical Institute³ are:

Government-FBO relationships – The main priority is to create a better understanding between religious/FBO leaders and governmental policy makers at national and international levels. This would involve greater communication and professional discussion. Also, the extent to which mechanisms are in place for effective participation of FBOs in HIV/AIDS programmes should be reviewed. This includes reference to the national and global AIDS control programmes coordination, other institutional relationships, and coordination around FBOs' strategies and work.

Financial and technical support – If FBO projects are to be improved and scaled up, international FBOs and donors must show greater commitment to supporting local FBO initiatives. They should be supported in their very effective practical work at the grassroots level, regardless of differences of opinion on international levels over theoretical concepts.

Training and skills building – Training is needed to ensure increased skilled human and financial resources for the treatment, care and support activities in which FBOs have demonstrated a strong commitment and potential. This would include support for skills training and initiating community development activities.

Prevention support – FBO care and support activities need to be complemented, not overruled, by public health activities that support prevention. It should be acknowledged that not all FBOs are in a position to promote condom use. Their work in their areas of comparative advantage should be respected. In this way the work of other stakeholders may be adequately complemented, and the deadlock over prevention methods overcome. Nevertheless, FBOs should be encouraged to give young people access to HIV prevention services, along with expressing their messages. In their own religion classes, FBOs should be supported in teaching young people how to negotiate sexual relations. Such life-saving skills are especially important for pre-adolescents who want to practice abstinence.

Networking and communication – Religious leaders and FBOs should actively seek information and exchange and avoid isolation. They should pursue regional, national and international networks at every opportunity. Secular stakeholders should facilitate contacts and discussion with religious leaders. Communication at the higher levels is important to keep religious leaders and FBO workers informed.

The need for sustained collaboration

The donor community has become increasingly active in funding FBOs, after years of hesitancy. In addition, UNAIDS has opened the policy dialogue to include all stakeholders in the fight against HIV/AIDS, including religious leaders. Since 1996, several regional and national conferences gathering religious leaders and FBOs have been organised with the support of UNAIDS and bilateral agencies. It is important to listen to religious leaders' statements at these conference and elsewhere and appreciate their commitment to fight stigma and discrimination. It is time to lay down the arms in the condom battle with the Churches and concentrate more on what they can do. As stated by Calle Almedal, a UNAIDS senior staff, "Would it not be a good programme if preachers address the stigma attached to AIDS and PLWHA 52 Sundays a year for three years? And it would not cost a cent, but might change something."⁴

1. In this edition FBOs are defined as organisations that have one or more of the following characteristics: affiliation with a religious community, a mission statement with explicit religious references, receiving financial support from religious sources, selection of board members or staff based on religious beliefs, and use of religious beliefs in decision-making. FBOs may operate out of individual churches or other faith structures, or they may be independent organisations. Religious bodies or denominations are faith structures that are organised in one way or another at the national and international level. Examples: the Catholic Church, the Sunni Islam, the Anglican Communion, the Evangelical Churches of West Africa (ECWA) and the Baha'i Faith.

3. Tiendrebeogo, G., and Buykx, M. Faith-based organisations and HIV/AIDS prevention and impact mitigation in Africa, Royal Tropical Institute, The Netherlands, 2004.