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MAY 2007 PROPOSED DELIVERANCE The General Assembly 1. Receive the report, and thank the members of the Project Group, the Project Co-ordinator and the Project‟s partners around the world. 2. Instruct the Project Group to take appropriate steps to structure itself for its renewed period of work in 2008 - 2010 and report to General Assembly. 3. Commend to congregations, members and adherents of the Kirk the need for generosity in donations to allow the Project to continue financial support of its partners‟ programmes. 4. Renew its call to all people of faith in Scotland to work to address issues of HIV stigma and discrimination.

BREAKING BARRIERS A Report to the General Assembly of the Church of Scotland 2007 “People don’t die of AIDS – they die of stigma.” Pastor Patricia Sawo – World AIDS Day 2006 1. Introduction 1.1 The Stigma Deliverance The additional deliverance agreed at General Assembly 2006 has formed the backdrop for much of the Church of Scotland HIV/AIDS Project‟s work in the past year: Recognise that HIV stigma and discrimination continue to act as barriers to effective prevention and care within and furth of Scotland; confess to people living with HIV that the Kirk has been involved in unwitting and unthinking stigmatisation of them; and call on all Christians in Scotland to work to overcome ignorance and prejudice about people living with HIV wherever they may be. Pastor Patricia Sawo, our Faithshare partner, spoke at the annual Waverley Care Celebrate – Reflect – Remember event at St John‟s Episcopal Church, Edinburgh, on World AIDS Day. Responding to a moving drama presented by members of LGBT Youth and the inspiring songs of the Loud and Proud Choir, Patricia shared her own story as a person living with HIV and insisted: “People don‟t die of AIDS – they die of stigma.” Throughout her visit she underlined the message that the whole of society, but especially the churches, must address the issues of stigma and discrimination which continue to stop people going for HIV counselling and testing and discourage them from accessing treatment and care – in Africa and here in Scotland.

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1.2 Breaking barriers The Project has sought to act as an agent of change itself and a support to those who may be more actively involved in breaking the barriers so often thrown up by HIV and AIDS. Our report seeks to spell out some of those continuing barriers and how the Project addresses them by  giving an overview of HIV and AIDS in 2006 around the world (section 2)  and in Scotland (section 3)  reporting on the general work of the Project in 2006 (section 4)  describing how the Stigma Deliverance has been addressed (section 5)  offering a plan of action for 2007 (section 6)

2.

HIV/AIDS around the world

2.1 Worldwide statistics for end 2006
Adults and children living with HIV/AIDS 21.8 - 27.7 million 270 000 – 760 000 5.2 – 12 million 460 000 – 1.2 million 50 000 – 170 000 1.3 – 2.5 million 190 000 – 320 000 1.2 – 2.6 million 580 000 – 970 000 880 000 – 2.2 million 39.5 million (34.1` – 47.1 million) Adults and children newly infected with HIV 2.4 – 3.2 million 41 000 – 220 000 550 000 – 2.3 million 56 000 – 300 000 3 400 - 54 000 100 000 – 410 000 20 000 – 41 000 170 000 - 820 000 18 000 – 33 000 34 000 – 65 000 4.3 million (3.6 – 6.6 million) Adult prevalence (%)* 5.2 – 6.7% 0.1 – 0.3 0.4 – 1.0 < 0.2 0.2 – 0.9 0.4 – 1.2 0.9 – 1.7 0.6 – 1.4 0.2 – 0.4 0.6 – 1.1 1.0% (0.9 – 1.2%) Adult & child deaths due to AIDS 1.8 – 2.4 million 20 000 – 60 000 390 000 – 850 000 26 000 – 64 000 2 300 – 6 600 51 000 – 84 000 14 000 – 25 000 58 000 – 120 000 <15000 11 000 – 26 000 2.9 million (2.3–3.5 m)

Region Sub-Saharan Africa North Africa & Middle East South & SE Asia East Asia Oceania Latin America Caribbean East Europe & Central Asia Western & Central Europe North America TOTAL

* The proportion of adults (15-49 years of age) living with HIV/AIDS in 2006, using 2006 population numbers The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information.
Source for this table and sections 2.2 – 2.4 : UNAIDS/WHO AIDS Epidemic Update – December 2006

2.2 

Main global and regional trends Promising developments have been seen in recent years in global efforts to address the AIDS epidemic, including increased access to effective treatment and prevention programmes. However, the number of people living with HIV continues to grow, as does the number of deaths due to AIDS. This figure includes the estimated 4.3 million adults and children who were newly infected with HIV in 2006, which is about 10% more than in 2004.

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In many regions of the world, new HIV infections are heavily concentrated among young people (15–24 years of age). Among adults 15 years and older, young people accounted for 40% of new HIV infections in 2006. Sub-Saharan Africa continues to bear the brunt of the global epidemic. Nearly two thirds of all adults and children with HIV globally live in sub-Saharan Africa, with its epicentre in southern Africa. One third of all people with HIV globally live in southern Africa and 34% of all deaths due to AIDS in 2006 occurred there. Declines in national HIV prevalence are being observed in some sub-Saharan African countries, but such trends are currently neither strong nor widespread enough to diminish the epidemic‟s overall impact in this region. Almost three quarters of all adult and child deaths due to AIDS in 2006 occurred in subSaharan Africa. In the past two years, the number of people living with HIV increased in every region in the world. The most striking increases have occurred in East Asia and in Eastern Europe and Central Asia, where the number of people living with HIV in 2006 was 21% higher than in 2004. Globally, and in every region, more adult women than ever before are now living with HIV. In sub-Saharan Africa, for every ten adult men living with HIV, there are about 14 adult women who are infected with the virus. Across all age groups, 59% of people living with HIV in sub-Saharan Africa in 2006 were women. In the Caribbean, the Middle East and North Africa, and Oceania, close to one in every two adults with HIV is female. Meanwhile, in many countries of Asia, Eastern Europe and Latin America, the proportion of women living with HIV continues to grow. Access to treatment and care has greatly increased in recent years, albeit from a very low starting level in many countries. Nevertheless, the benefits are dramatic. Through the expanded provision of antiretroviral treatment an estimated two million life years have been gained since 2002 in low- and middle-income countries. Focussing on risk

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The centrality of high-risk behaviour (such as injecting drug use, unprotected paid sex and unprotected sex between men) is especially evident in the HIV epidemics of Asia, Eastern Europe and Latin America. In Eastern Europe and Central Asia, for example, two in three prevalent HIV infections in 2005 were due to the use of non-sterile injecting drug use equipment. Sex workers and their clients, some of whom also inject drugs, accounted for about 12% of HIV infections. Paid sex and injecting drug use accounted for a similar overall proportion of prevalent HIV infections in South and South-East Asia. Excluding India, almost one in two prevalent HIV infections in 2005 were in sex workers and their clients, and more than one in five infections were in injecting drug users. A small but significant proportion of infections (5%) were in men who have sex with men. In Latin America, in contrast, one in four of the HIV infections in 2005 were in men who have sex with men, while 19% were in injecting drug users. Although HIV prevalence in sex workers is relatively low in this region, they and their clients accounted for almost one in six HIV infections. Although the epidemics also extend into the general populations of countries in these regions, they remain highly concentrated around specific population groups. This highlights the need to focus prevention, treatment and care strategies effectively on population groups that are most at risk of HIV infection.

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HIV and sexual behaviour trends among young people In 2001, the United Nations‟ Declaration of Commitment on HIV and AIDS outlined a goal of reducing HIV prevalence by 25% in young people in the most-affected countries by 2005, to monitor progress in preventing new infections. To assess progress towards this goal, countries in which national prevalence exceeds 3% were asked to participate in this process. HIV prevalence has declined since 2000/2001 in eight of 11 countries with sufficient data to analyze recent trends among young people. In Kenya, HIV prevalence among young pregnant women declined significantly by more than 25% in both urban and rural areas. Similar declines were evident in urban areas in Côte d‟Ivoire, Malawi and Zimbabwe, and in rural parts of Botswana. Less prominent (and non-significant) declines were observed in urban Botswana, Burundi and Rwanda and in rural Tanzania and Zimbabwe. There was no evidence of a decrease in HIV infection levels among young people in Mozambique, South Africa or Zambia. Using results from national surveys conducted at least twice in the same country during the period 1994–2005, trends in behaviours among young people were assessed. The proportion of young persons having sex with non-regular partners decreased in Haiti (men only), Kenya and Malawi (young men and women), and Zambia (women only), but increased in Cameroon, and Uganda (women only). Meanwhile, condom use rates with non-regular partners seemed to increase in some of the surveyed countries, including Cameroon, South Africa, Tanzania and Uganda (young men and women), Malawi (young men only), and Kenya and Zambia (young women only). In a few countries, most notably Cameroon, there appeared to be simultaneous shifts towards both safer and high-risk behaviours - with increases in the percentages of young people who engage in high risk sexual activities occurring alongside rising rates of condom use during casual sex with a non-regular partner. Relatively few countries were able to provide extensive behavioural trend data for young people and many countries had insufficient or no data on HIV prevalence trends among young people - including some of the countries with exceptionally high HIV prevalence in southern Africa. This reinforces the need to expand HIV surveillance activities as a matter of urgency. The future course of the world‟s HIV epidemics hinges in many respects on the behaviours young people adopt or maintain, and the contextual factors that affect those choices. Some recent, positive changes are evident among young people in parts of the Caribbean and sub-Saharan Africa, particularly in East Africa.

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3. HIV/AIDS in Scotland 3.1 Scottish statistics
Heterosexuals presumed infected outwith UK (%) Greater Glasgow & Clyde

Year

Total

MSM (%)

IDU

Lothian

Tayside

Grampian

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

175 169 182 168 156 154 171 250 258 364 405 347

15 14 12 17 25 27 29 35 37 44 36 34

46 49 43 45 40 42 39 36 38 36 39 40

28 30 39 26 19 15 19 12 11 15 26 21

62 63 73 60 49 61 54 77 80 114 135 100

55 39 37 41 41 34 45 90 99 123 135 111

17 21 23 19 7 11 16 18 14 27 19 25

13 14 19 18 14 13 22 16 26 25 34 24

Source for this table and section 3.2 : HPS Weekly Report 24 January 2007

3.2 Scottish Trends   In 2006, 347 newly identified cases of HIV were reported to Health Protection Scotland. This figure compares with annual totals of 364 and 405 in 2004 and 2005, respectively, and an annual average of between 150 and 180 during the 1990s. The 14% reduction in cases between 2005 and 2006 was due, principally, to decreases in newly identified infections in Lothian, Greater Glasgow and Clyde and Grampian; the exception to this trend being evident in Tayside where the number of cases increased from 19 in 2005 to 25 in 2006. At a risk group level, 12% and 16% reductions among men who have sex with men (MSM) and non-Intravenous Drug User (non-IDU) heterosexual men and women, respectively, were observed; the former being particularly pronounced in Glasgow and the latter in Lothian. The decline in cases of HIV among MSM is encouraging though it is too early to say if this observation reflects any change in the incidence of infection among this group. Indeed, data generated through the unlinked anonymous HIV testing of syphilis specimens from MSM attending Glasgow genitourinary medicine clinics during 2001-2005, suggest that the incidence of HIV among this population probably increased during this period. The incidence of syphilis among MSM shows no sign of decreasing despite considerable health promotion efforts to increase awareness and access to testing. Of even greater concern is the increase in cases of rectal gonorrhoea among MSM between the January – September periods of 2005 and 2006. These observations indicate that unprotected sexual intercourse, and thus risk of HIV acquisition, among MSM continues to constitute a major public health challenge. The decline in newly identified cases among non-IDU heterosexual men and women is principally due to fewer detections among infected men and women who probably acquired their infection in African countries. It looks as if 2004 was a peak year for cases with

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an African connection. This observation may reflect i) a decline in the number of migrants from African countries coming to Scotland, ii) a decline in the prevalence of HIV among such African migrants, or iii) a combination of i) and ii). The second hypothesis is supported by observations among persons with risk exposure in sub-Saharan Africa, undergoing HIV testing in Scotland. HIV prevalence among this population declined from 12% in 2004 to 8% in 2005. In 2006, the number of newly identified cases of HIV among IDUs decreased slightly from that evident in 2005. Of the 21, nine were probably infected elsewhere in the UK or abroad and, of the remaining 12, 11 were aged over 30. These observations, together with the continuing low prevalence of HIV among IDUs undergoing attributable HIV testing in Scotland during 2005, indicate that HIV transmission among this population is rare. Encouragingly, data from the Scottish Drug Misuse Database revealed a considerable reduction in needle/syringe sharing among IDUs in Scotland. The proportion sharing at least once in the previous month decreased from 31% during 2004/05 to 27% in 2005/06. Universal antenatal testing continues to detect HIV infection among pregnant women. Of 12 HIV infected women, undiagnosed prior to pregnancy, who gave birth during the first six months of 2005, 10 (83%) were diagnosed antenatally. The number of HIV infected individuals in specialist care (as indicated by the number of persons having a CD4 count test to establish how well their immune system is functioning) rose by 72% from 1311 in 2000 to 2272 in 2006. The latest figure will probably increase as reports for late 2006 are collated by HPS in the first quarter of 2007. Approximately 70% of those in care were on triple therapy or higher and of the 1575 receiving such therapy during October 05 – September 06, 83% had an undetectable viral load at most recent test. There is no evidence to indicate that access to care and treatment in Scotland is restricted by exposure category, country of origin or geographical area of residence. With the continuing increase in the numbers of persons in specialist care and on therapy in 2006, one of Scotland‟s most pressing HIV challenges is to ensure that all infected persons needing treatment and care receive it.

4. The Project in 2006 4.1 Funding and policy £49,970 was added to the fund during 2006 bringing the total to £527,366 as of 31 January 2006. Income fell compared to 2005. We continue to depend largely on congregational giving to Communion Sundays, Harvest, World AIDS Day and Christmas special collections, Guilds, as well as the generosity of individuals. We are ready to enable more congregations to link their giving to learning and praying for specific projects, within the limited staff resources we have. It remains essential for the Project to meet its strategic aims by having the freedom to determine how it prioritises its grants. However, there is scope to informally „link‟ individual congregations with some of our partners to enable a focus of prayer, giving and information. The Project Co-ordinator welcomes enquiries from congregations who may desire to explore such links. As a result, new or renewed grants were made in 2006 totalling £118,646 to the following: Bangladesh - Church of Bangladesh HIV Prevention India – Andhra Pradesh - SACRED India – Hyderabad – Health for Peace Project India – Tamil Nadu – DEAR Foundation India – Tamil Nadu – HEADS Prevention Counselling & Support India – Tamil Nadu – GGPS Community Programme India – Tamil Nadu – TEMT Awareness & Prevention Malawi – Livingstonia Synod Youth Advocacy Malawi – Nkhoma Synod Programme Thailand – CCT Sangklaburi Community AIDS Project Zambia – LIWOMADI Women‟s Programme Zimbabwe – Home-based Care 6

Scotland – Barnardos Riverside Project Scotland - HIV-AIDS Carers & Family Service Provider Scotland - ImpactAIDS – Civicus Conference Workshop Scotland – Living Well with HIV Peer Support Group Scotland - Positive Voice - Complementary Therapies for People with HIV Small Educational/Training grants to seven workers in partner projects (eg paying registration fees for the International AIDS Conference) Following the decision of Assembly in May 2006 to extend the life of the Project for an additional three years to the end of 2010, the Project Group immediately set up working groups to address (1) policy (2) fund-raising and (3) future staffing. In September the Project Group was able to accept the recommendations of the first two. The policy group‟s work is incorporated in the Project‟s revised Guidelines and Procedures, which can be downloaded at http://www.churchofscotland.org.uk/appeals/hivaids/downloads/hivgrantappguidelines.pdf The fund-raising group worked on imaginative ideas for a major campaign early in 2007 to secure a capital base on which to base a budget for grant-making for the following three years. Disappointingly, this proposal did not meet with Council of Assembly‟s approval (stewardship and new initiatives for funding the work of the Church have been under consideration by the Council‟s Funding Forum). A period of consultation ensued, which resulted in Council of Assembly agreeing in December that a sum of up to £25,000 per year over the next three years should be made available to match money raised by the Project. This additional funding, which will come from the reserves of the Mission and Renewal Fund, is to be used to further the practical work of the Project. This very welcome gesture of support from Council of Assembly does not, however, remove the urgent need to raise more funds to allow us to respond to urgent requests from our partners. Although our partners serve people of many faiths and none around the world, we ourselves are regarded as a denominational project and hence excluded from consideration by many of the grant-making bodies and trusts that other agencies approach for funding. This underlines the necessity of regular, committed giving from Church of Scotland congregations, members and adherents. Because we have very limited staff resources to put into larger fund-raising efforts, we are grateful to those who take local initiatives to raise funds for the Project. We are hopeful that the Family Cycle Ride to Falkland Palace on 23 June will raise at least £10,000 with sponsors from across the country. 4.2 Partnership and networking 4.2.1 The Toronto Conference In August, the Project Co-ordinator was privileged to attend the 16th International AIDS Conference proclaiming 'Time to Deliver' in Toronto, as well as the Ecumenical Advocacy Alliance‟s faith organizations' pre-conference. Both conferences had grown since Bangkok 2004 – the pre-conference from around 200 to nearer 500 and the main conference to something well over 20,000. Among those huge numbers it was good to meet with some of our „own‟ partners and take forward our joint understanding and commitment. Growth in numbers at the pre-conference prevented delegates from engaging with one another at the same level as 2004. There were distinct groups from para-church agencies like World Vision and TEAR Fund – both organizations are to be commended on sponsoring so many delegates from affected countries. Also present for the first time were pastors from mega-congregations like the Saddleback Church in California. This much larger evangelical presence led to more theological diversity. As a result, there was not enough space to engage with some of our divergences and differences. The International AIDS Conference itself was a masterpiece of planning, though the physical venue – separated into two main buildings on three floors each, connected by many escalators 7

and a long walkway, must have proved exhausting for those living with HIV or other disabilities. Every AIDS conference is marked by local culture and there seemed to be many more North Americans present this time, including considerable numbers of gay men living with HIV and associated illnesses, some walking with canes because of CMV (an associated virus that may lead to blindness), others in wheelchairs. While many Africans present were witnessing to living well on anti-retrovirals (ARVs), it was sobering to be reminded of what HIV can still do in developed countries among so-called 'marginalised' groups like men who have sex with men, injection drug users and commercial sex workers. There was less call on the chaplains this year, though a prayer room was set aside with a daily timetable of Pentecostal prayer meeting, Catholic Mass, Protestant worship, Buddhist prayer and several rounds of Muslim prayers (it was also used by Jews, Hindus, Syrian Orthodox – and First Nation people). Unfortunately this room was way off the beaten track, so did not attract the passing trade or opportunities to chat informally to people as at Bangkok, though those who found it and used it really appreciated it. One of the times I was 'on duty' a Muslim woman from Morocco was almost in tears when she came out from making her salat - "This room shows what our faiths should be about - praying and fighting evil and injustice and AIDS together." It was noteworthy that key themes emerging at the pre-conference as part of the challenge for faith-based organizations (FBOs) and churches internally – and for others in dealing with FBOs were similar to priorities at the main conference, where there was fundamental agreement that HIV prevention and treatment are complementary: • Stigma and Discrimination • People living with HIV involvement • Gender inequality • Poverty and food security • Condoms • Harm Reduction programmes • Sexuality • Sex Workers • Injection Drug Users • Re-emerging epidemics among men who have sex with men • Orphans and vulnerable children • Emerging and growing epidemics in eastern Europe, central Asia, etc • Healthcare systems and workers • Sustainability • Accountability Peter Piot of UNAIDS emphasized the vital need to continue arguing the exceptionality of HIV politically, even if it can be normalized in other ways (eg being seen increasingly as a totally preventable and treatable illness medically and standing alongside other Millennium Development goals). Especially in Africa, Piot pointed to the double bind of HIV and AIDS both preventing the achievement of Millennium Development goals on health, poverty and education, and those same developmental deficiencies contributing to the further spread of HIV, eg food security, poor healthcare provision, disempowerment of women. On the scientific and medical front, there was good news about a range of new drug therapies well down the research and trials pipeline, as well as encouraging microbicide trials and other possible prevention measures for women to use. It was, however, pointed out repeatedly, that these would depend on their being universally accessible and women's empowerment! A vaccine seems as far away as ever. Bill Clinton, who as US President had called for a vaccine before the end of this decade, now admits we are unlikely to have one before 2020. All this research, development and distribution demands, of course, huge resources and funding. There is already a huge shortfall in what the world community has committed to the Global Fund and the goal of

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providing universal access to prevention and treatment to all who need it by 2010 (as promised at the Gleneagles G8, etc) looks increasingly unlikely to be met. The June 2006 United Nations General Assembly Special Session on AIDS was criticised for failing to address adequately the huge HIV prevention task that lies ahead. In particular, it failed to name the specific groups among whom infection is growing fastest in some of the emerging epidemics in China, Indonesia, Central Asia or Eastern Europe: sex workers, injection drug users and men who have sex with men. There was no such reticence at the Conference. Toronto 2006 seemed more inclusive than Bangkok 2004. There was criticism of what some regarded as too much political rhetoric at the conference. Among them was the Canadian Prime Minister, who had failed to attend the opening ceremony and then was more than a little disingenuous in complaining that the Conference had become too politicised! But to get scientists, clinicians, NGOs, FBOs, activists all pretty well agreed on what can and should be done to address both prevention and treatment is remarkable. It's arguable that all of these groups are ready to deliver. What the world needs is for politicians and governments to demonstrate similar commitment to deliver, not least in addressing the huge funding gap as, year on year, the number of new infections grows. 4.2.2. Continuing partnerships The Project Co-ordinator continues to be involved in a representative role at various regular or occasional forums in Scotland and beyond, including  The Ecumenical Advocacy Alliance http://www.e-alliance.ch/ Membership of the EAA continues to encourage and inform much of our advocacy work. Their supply of worldwide resources and contacts makes us aware of new developments, training material, etc, which can then be shared with our own partners. Their work in facilitating the pre-conference and inter faith chaplaincy (4.2.1) every two years is invaluable.  The NHS Lothian–Zambia Partnership The LZP is rooted in a desire to facilitate better linking and learning between statutory and voluntary services so that HIV health care and support is improved for Africans living in Lothian and to encourage international linking. It has been encouraging that the Project has this year made a grant to the LIWOMADI women‟s programme, which Waverley Care has made a focus in its own Zambia connection.  Cross-Party Parliamentary Groups on Sexual Health and International Development Both these CPGs have proved useful for learning, networking and advocacy and for demonstrating the Kirk‟s commitment to their overall concerns, especially in the field of HIV and AIDS.  Lothian HIV/AIDS Agencies Coalition The Project Co-ordinator has now completed a second year as chair of the Coalition, which is working towards a re-branding as the Coalition of HIV and Hepatitis Agencies in Lothian.  CHAA – the Christian HIV/AIDS Alliance http://www.chaa.info/ CHAA sees its mission as to facilitate compassionate, strategic Christian responses to the global HIV/AIDS pandemic by working together as an Alliance to educate, inform and challenge the UK Christian community. At present the Alliance tends to be London-centric, but is seeking to find ways to be more inclusive of the whole UK.  Short conferences and consultations this year have included HIV and the Law (issues around criminalisation of HIV infection) Changing the Focus (prevention issues among men who have sex with men in Scotland) The biennial Church of England/Church of Scotland consultation 4.3 Awareness-raising and advocacy „Compassion fatigue‟ is a major challenge to all engaged in seeking to raise awareness about worldwide HIV and AIDS and advocating for more resources, whether from individuals, organisations or groups. People are overwhelmed by the statistics and the appalling scale of 9

deaths, new infections or numbers of orphans needing cared for. Given the difficulties for many church folk of engaging with a pandemic largely related to sexual behaviour, the Project has a major task in seeking to present the facts about HIV, encourage people to reflect on what they have learned both socially and theologically and then respond in practical action, whether by donation or advocacy. At the Toronto Conference (4.2.1), Bill Clinton was asked at a packed news briefing if people with HIV and AIDS could count on him (and his multi-million dollar Foundation) to be around for the long haul? Clinton said: "Even my worst critics never accuse me of being a quitter. I tend to be a sticker. I can't conceive of anything that would divert me from this commitment, short of a lifethreatening illness or success (in defeating HIV and AIDS)." The Project continues to seek to use its limited resources to enable people to understand the facts and the need to engage with HIV for the foreseeable future. The Church of Scotland, having embraced HIV, has to stick with it. So this year we have sought through various media to present the facts and invite reflection and action. We have always eschewed over-using heartstring-tugging images of people, especially children, to generate an emotional response. We aim to be careful with our language so that our straplines and slogans do not mislead or raise unreasonable expectations. While we do look for a response from the heart, it is essential as Christian people that we engage responsibly with our heads. A major revision and update of the website (www.churchofscotland.org.uk/hivaids) was undertaken in July, including information about all our supported projects and there is a monthly news page. Regular news of our supported projects overseas also appears in World Mission‟s weekly UPDATE (http://www.churchofscotland.org.uk/councils/worldmission/wmnews.htm#update). There, for example, we were able to break the news of the disturbances in Pune, India, which prevented HIV agencies, including our partner Deep Griha, from carrying out their World AIDS Day programmes. The Project Co-ordinator‟s forthcoming visit to South India has been highlighted with news from the several projects supported in Tamil Nadu. An „action‟ page seeks to offer guidance for follow up – for several months readers were encouraged to access material about HIV stigma and discrimination in order to understand the issue. This was to reinforce the messages coming across during Patricia Sawo‟s visit (5.2) and was backed up by a special page of downloadable resources for World AIDS Day. These were also made available on a CDrom. In more recent months the action page has encouraged readers to understand more about access to HIV medicines (anti-retroviral drugs) and take action by writing to pharmaceutical companies, using the Ecumenical Advocacy Alliance‟s resources and campaign. The Project seeks to be proactive towards press, radio and television by issuing news releases – as well as reactive to their enquiries – but finds that we are most successful when working with partners who may more readily have the ear of the media, eg Waverley Care. While continuing to respond to the many speaking requests from congregations and church groups, we are seeking imaginative ways of contributing to particular areas of other Councils‟ work and look forward to closer collaboration on some of them. The Project may also indirectly facilitate events like the Glasgow Schools Global Forum when upwards of 200 sixth-formers were challenged to become peer educators using the Christian Aid/Church of Scotland model. An impressive training manual is now available for teachers and youth leaders.

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5. Addressing the Stigma Deliverance 5.1 The process The need to address issues of stigma and discrimination as major barriers to effective awarenessraising, prevention, care and support has been recognised by the Project Group since its inception and has informed its grant-making decisions. In the UK context, a range of research reports have highlighted the concern eg Outsider Status, Public Attitudes towards HIV, HIV becomes your name (see References below). Our consultation with partners at Limuru in early 2006 and the input of Pastor Patricia Sawo of ANERELA+ (the African Network for Religious Leaders living with or personally affected by HIV and AIDS http://www.anerela.org ) challenged Scottish delegates to address those issues particularly as they affect African people living with HIV in Scotland. As a result, Patricia was invited to visit Scotland around World AIDS Day. World Mission Council agreed to fund her as a short-term Faithshare partner. A small planning group was established with Waverley Care to plan her programme, in particular a major conference which would address the specific concerns around African people. The Project Group was represented on this group by the Co-ordinator and Eunice Sinyemu, who is the African and Ethnic Minorities Officer for HIV Scotland. Other key stakeholders like Greater Glasgow & Clyde Health Board were involved in the detailed work of planning the conference, which was funded by grants from the Scottish Executive, the George MacLeod Trust, HIV Scotland and the Scottish Episcopal Church. Aberdeen, Edinburgh and Glasgow presbyteries were all invited to be involved. Preparing for the visit formed the major part of the Co-ordinator‟s workload in the last few months of the year and World AIDS Day resources were designed to complement the programme. 5.2 Pastor Patricia Sawo’s visit (24 November - 8 December 2006) Patricia flew into Aberdeen airport, where in her lengthy immigration interview she was asked to spell „Glasgow‟ as a test for entry! In Aberdeen, she worshipped with an African fellowship, experienced Church of Scotland family worship at Kintore and engaged in discussion with folk from across the presbytery in a hectic weekend‟s programme. Then in Edinburgh she had the opportunity to visit a wide range of HIV services with colleagues from Waverley Care and HIV Scotland, including the Solas Centre, Milestone Respite Care Programme and the Regional Infectious Diseases Unit at the Western General Hospital, meeting and talking with a range of people living with HIV. Leading Time for Reflection in the Scottish Parliament, Patricia shared her own experience of receiving support as someone living with HIV and told MSPs: “As we approach World AIDS Day I want to challenge each and every one: you can make a difference in someone‟s life just by a small action! Your efforts could help prevent a child from being infected, postpone one death from AIDS by availing ARVs or nutrition, help an orphan have a better quality life.” A transcript of Patricia‟s reflection is available at the Scottish Parliament website: http://www.scottish.parliament.uk/business/officialReports/meetingsParliament/or-06/sor112902.htm#Col29737 On World AIDS Day itself, Patricia did a number of media interviews (including the Scottish Catholic Observer) and met for tea and discussion with staff at the Church of Scotland offices before sharing in the annual Waverley Care Celebrate – Reflect – Remember event at St John‟s Episcopal Church. Her contribution there – referred to in 1.1 above – was much appreciated by the very diverse and representative congregation of people living with or affected by HIV locally in the Lothians. Sunday worship included a special service at St George‟s West, poorly attended despite an open invitation to the whole presbytery. Moving on to Glasgow, a similar programme of agency visits organised by Waverley Care‟s African Outreach team included the Brownlee Clinic at Gartnavel Hospital, where Patricia was also able to 11

undergo a number of tests and receive advice – she had been unwell for much of her stay. A prayer breakfast was poorly attended but brought out useful discussion – as had a similar event in Edinburgh the previous week. Useful links were made with some of those working with asylumseekers in the city. The final event of the visit was the Keeping the Promise: Faith, Health and HIV conference at the Royal Concert Hall with 100 delegates from a wide range of backgrounds and nationalities – one senior official from the Executive described it as „the most diverse health-related event I‟ve attended in Scotland‟. The conference was chaired by the Moderator of the General Assembly, Rt Rev Alan McDonald and several leaders of other Scottish churches were present. Patricia gave the keynote address calling the churches especially to a real commitment to the challenges of HIV and AIDS, with health and voluntary sector professionals speaking about HIV testing and treatments, prevention and awareness. Young Malawian peer educators from Ekwendeni and Mulanje – visiting Scotland as Christian Aid Faithshare partners with the peer education programme initiated by the Project – shared some of their lively methods of HIV communication through song and dance. Workshops followed in the afternoon and the conference has been actively followed up since, especially through HIV Scotland‟s African and Ethnic Minority Network. We continue to be grateful to the leadership of ANERELA+ for releasing Patricia from her responsibilities as their East Africa Co-ordinator to make this Scottish visit. We are also grateful to all those involved in preparing and executing the programme at the local levels. 5.3 Outcomes The Project Group noted that Patricia‟s visit  challenged us with her gospel directness, her pastoral warmth and her personal courage as someone living with HIV  gave good press, radio and TV coverage  showed the rewards of partnership working, especially with Waverley Care and HIV Scotland  exposed the theological and practical challenges in accessing African-led congregations around Scotland  revealed differing expectations of her visit (with some church folk willing to learn and give to overseas but uncomfortable at addressing Scottish or personal issues around HIV)  demonstrated a continuing lack of basic understanding among many people about HIV and how it is transmitted The visit and the Glasgow Conference in particular underlined the need to listen to people‟s stories – the reality of living with HIV in Scotland today – and act on them. At the time of writing a meeting to review the Conference has been held and various priorities established, including training to address stigma, work with young people and the setting up of a network in Scotland of religious leaders living with or closely affected by HIV. 6. Getting the message right 6.1 Further work on stigma and discrimination The 2006 deliverance allowed us to begin addressing stigma and deliverance, particularly through Patricia Sawo‟s visit. But this must be taken forward. Patricia herself made three clear statements which point to particular challenges. 1 “I am at risk because I am a human being” The challenge for the church to get the HIV (and the related sexual health issues) message and share it with others. A survey commissioned by the National AIDS Trust concludes that “there is a declining knowledge among the British public with regards to HIV infection and 12

personal risk. The proportions able to identify all the possible ways HIV is transmitted from person to person have declined since 2000.” One member of the Project Group, who hosted Patricia Sawo during her visit, told how she had been asked by a church member whether she had not been concerned to have someone living with HIV stay in her home? Some folk at a meeting were astonished and upset to be asked by Patricia whether they knew their HIV status. If the Kirk is to have any credibility in addressing broader societal issues, its members must know and understand the facts about HIV transmission. 2 “Sexuality is a sacred gift from God” The challenge to work on the theology of HIV. Whether we like it or not, God created us wonderfully as embodied beings. Both the publication of the report of the Working Group on Human Sexuality and the Guild‟s imaginative discussion topic „Body Image‟ will help us all in this task. Mature reflection and discussion on these issues will be welcomed by civil society. As Health Minister, Andy Kerr, comments in his foreword to the Sexual Health Strategy Annual Report: “I‟m also pleased to see that local authorities, NHS Boards and others are taking a true partnership approach to implementing the strategy and action plan. The report outlines excellent examples of joint working, including partnership with the voluntary sector and faith groups.” But that will demand of us the kind of powerful humility demonstrated by Patricia Sawo, when she reflected on her early attitude to HIV: “I quoted the Bible wrongly and out of context”. 3 “We must address the faults in society which feed HIV” The challenge to be holistic in our approach to HIV. This involves understanding that “sexual health and wellbeing do not happen in isolation. Economic, cultural and social influences all have an impact on sexual wellbeing and can be implicated in inequalities. For example, evidence suggests strongly that people from more deprived backgrounds are more likely to have sex at a younger age.” That again is from the Executive‟s report about Scotland, but it applies in every land around the globe. HIV is a key component in the Millennium Development Goals (4.2.1 above). HIV is a justice issue. So, if we wish to speak out about moral and ethical issues involved in family breakdown, perceived promiscuity, abortion and other issues, we must also speak out about poverty, debt, deprivation, consumerism, globalisation, etc. Breaking some barriers of HIV stigma can raise new barriers, as Patricia again reminded us. In addressing the very particular issues of African people living with HIV in Scotland and how and where they find both medical and other support, we have to avoid associating a whole community in ways that could be perceived as racist. We may also be implying that other groups are somehow less at risk. A casual reading of some church-related literature suggests that men who have sex with men do not figure so highly in our pastoral concerns, yet it is still such men who are most at risk of becoming infected within the UK itself – including Scotland. 6.2 From barriers to bridges So the Project will continue to work with our partners not just on breaking barriers but also building bridges. Reporting on research from a sub-Saharan African perspective, the African Religious Health Assets Programme (ARHAP) notes that “Religious entities are perceived as contributing to health, wellbeing and the struggle against HIV and AIDS through tangible and intangible means. It is this combination that distinguishes them and gives them strength. Leading tangible factors comprise compassionate care, material support and health provision; leading intangibles are spiritual encouragement, knowledge giving and moral formation.” As the Church of Scotland HIV/AIDS Project moves on from its initial five years, we would affirm this further comment from the ARHAP report: It is clear that there have been tensions around religion and public health, especially when it comes to HIV and AIDS and matters to do with sexuality, condoms and stigma. 13

The findings of this research suggest that this tension is part of the past, and that the sheer human impact of the pandemic is drawing religious entities into new and significant contributions to health and wellbeing. Indeed, our confidence in respectful dialogue is strong given that in Zambia and Lesotho we have uncovered a large and diverse range of religious people and organizations who are doing significant work, and who are committed to partnering with health practitioners in the struggle for health and wellbeing. What is clear, however, is that this dialogue needs to be undertaken in a way that is respectful of all partners, and this does mean dealing with the suspicions on both sides. Given the way in which religion and health are intertwined in Africa, public health practitioners need to ask: “How can we expect to understand and help people if we miss the very thing that they consider to be the most important thing in their lives even if it may not be so in our own?” At the same time, religious leaders need to ask: “How can we expect to make a real difference in the health and wellbeing of our communities, if we do not draw on the wisdom and experience of those dedicated to and trained in these fields?” A mutual appreciation of the assets held by both the religious and public health sectors is necessary.

In the name of the Project Group SHIRLEY BROWN, Convener NIGEL POUNDE, Secretary

References: ARHAP/WHO, Appreciating Assets - The Contribution of Religion to Universal Access in Africa: October 2006 Christian Aid, Is HIV a concern for churches in London? June 2006 Health Protection Scotland, Weekly Report: 24 January 2007 National AIDS Trust, Public Attitudes Towards HIV: March 2006 Scottish Executive, Respect and Responsibility – Sexual Health Strategy Annual Report: November 2006 Sigma Research, Outsider Status – Stigma and discrimination experienced by gay men and African people with HIV: December 2004 UNAIDS/WHO, AIDS Epidemic Update: December 2006 Waverley Care, HIV Becomes your Name – Issues facing Africans living in Scotland who are HIV positive: June 2005

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