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Foreign Policy Analysis
Two Possible Futures: Faith Action to End AIDS Panel 1

Two Possible Futures: Faith Action to End AIDS Panel 1

– Hello, everyone. Good morning. Thank you so much for
joining us at Georgetown, the Berkley Center for Religion,
Peace, and World Affairs. I always mix up the order. I hope everyone got some
coffee and some food. This is such a great room full of wonderful colleagues and friends, and so excited that you
joined us here today. My name’s Maeve McKean. I’m the executive director of Georgetown’s Global Health Initiative. I think that this event on
faith and AIDS is the perfect, it’s really emblematic of what
the Global Health Initiative does for Georgetown,
which is it recognizes that global health is a
multidisciplinary field that brings in many actors with many different skill
sets and backgrounds in order to address the most
pressing issues for our world. The intersection between
faith and global health is certainly that, whether you’re a Jesuit or a doctor or an advocate or a diplomat,
you understand that, in order to address the HIV epidemic, we need to all come together, and the leadership role
of the faith community is critical in that. I want to say that what really
brought us together today was this great book that,
it was just published, on “HIV and AIDS in 2013: A
Choice Between Two Futures” with Dave Barstow. He really looked at, where, I’m trying to find him in the crowd, really looked at where are
we going and how is the, in the HIV epidemic, and
how is the engagement of the faith community
going to get us there. And so, I encourage you
to look at this book. We actually have copies
outside that we’re, that everyone can get
if you can find Micah right across the hallway. We’re asking for a $10 donation. It’s going to go to
two great organizations that everyone knows. One is AIDS United and
the other is Common Voice. I think that this book
really sort of summarizes in a succinct way what are
the challenges that we, as a global health and HIV community, are looking to address in the coming years and what is that important
role that the faith has in ensuring that we reach those goals. With that, great welcome. I know no one wants to hear from me, we wanna hear from other
people in our incredible panel, so I’m going to turn it
over to my colleague, Mark, who’s going to moderate our second panel on “Looking Back: How Has
Religion Helped and Hurt “the Global AIDS Response?” With that– – We’re going to Sandy. – Oh, excuse me, we’re not going to the, (laughing) I’m sorry.
– That’s okay. – Turn it over to Sandy
Thurman who’s gonna lead us off before we get to our,
(chuckling) to our first panel. – Thanks, Maeve. (audience applauding) Good morning, everyone. – [Audience] Good morning. – Oh, that’s pretty good. Sound like church folk. That’s excellent.
(audience chuckling) I wanna thank you for
having me here this morning. Thank you, Katherine
and Maeve and the team, for putting this together in a
really, really important time in our work to address
HIV and AIDS in the US and around the world. We have, of course, the US
Conference on AIDS here, and I think some of you were involved in that meeting yesterday, a really extraordinary bunch of folks who’ve been working in this intersection of faith and HIV and AIDS
for a really long time and providing extraordinary leadership. There’s a lot of interest
and enthusiasm and excitement around the ending-the-AIDS initiative, mostly in the South, but around the US, and everyone’s, you know,
we’re really excited to talk more about that
in the next few days. And, of course, you
can’t come to the South unless you talk about religion, the intersection of religion and health, so it’s really important for us to be having these conversations now. We’ve made incredible
progress in our efforts to reduce the impact of HIV on
communities around the world. We’ve provided incredible prevention, care, and treatment services, and that success ought to be applauded. However, we shouldn’t get too smug, I get a little worried
about this these days, because the majority of our work and the hardest work we
have to do is yet to come. And I think that’s important
for us not to forget because a big question for us now is to consider who has been left behind. We’ve kind of reached and
picked the low-hanging fruit, and those we’ve been able to
get tested and on treatment. That’s all really great news, and in some wealthy
communities around the country, particularly in the US, we’re at the point where we’re talking
about ending the epidemic or ending the epidemic as we know it, and that’s really great news, but there are parts of the country where we now have to do much of this work whose demographics and health systems and cultures and political construct look more like the
places that we’re working in the global South than they do in New York and
San Francisco and Chicago and other communities. That’s certainly true with
the religious construct and those in faith constructs
in many of those places. So, we’re having this conversation at a really, really important time. When you look at who’s in the epidemic in this country and around the world who are still most affected, it’s increasingly the poor, it’s women, it’s people of color, it’s
men who have sex with men, and other key populations. So, what we see is what
we’ve seen all along, that poverty and racism
and sexism and homophobia continue to fuel this
epidemic in real ways. And, while we’ve made some great progress, we still have a lot more work to do. Today, the work, our work in HIV really is work in social justice, it’s work in civil rights,
it’s work in human rights, which really is a construct of all of our faith institutions. So, the more things have
changed over the time, the more they’ve stayed the same, so here we are back having
the same conversations. I was saying to someone last night, this is beginning to feel a little bit like the movie “Groundhog Day.” Do you remember that
movie where you wake up and you’re having the same
conversation every day? I’m like, “Oh my gosh, didn’t
I have this 30 years ago? “Didn’t I have this 10 years ago? “Didn’t I have this yesterday?” But I think it’s true, but
good for us to reflect on that. I was gonna talk a little
bit about the history of the faith-based responses
to the AIDS crisis, but most of you know that, that we started very early on with sort of dual responses,
one very negative, you know, particularly in the conservative
parts of the country, very, very unflattering
to those who were at risk and infected at the time, and then some incredible responses from the institutional church starting way back in, I think, 1983, when the United Church of Christ actually was the first
institutional church that came out with a statement saying we’ve got to respond to this, this is about compassion,
this is about acceptance, and then soon followed by
others, including the Catholics and the Anglicans and many others. But there was a tension
that went on for a while and still remains today. But we did have really
interesting and unusual responses that I wanna just, couple of them that I wanna pick out to highlight and then I just wanna tell
a couple of quick stories. My favorite, really, one of my favorites, is the story of St. Vincent’s
Hospital in New York. Have y’all all heard of
St. Vincent’s Hospital that was a Catholic-run hospital? Run by women religious
in the heart of New York that ended up being the
first really big hospital dealing with HIV and AIDS. It was a challenge for the women religious ’cause all of a sudden
they had these gay men coming in with their partners and friends and all of the sort of stuff
that ensued around that. But all of that was overridden by their compassion and commitment to serve all those in need and not to sit in judgment of anyone. It became an iconic place
to go for treatment. When they tore it down a few years ago, there was a wonderful
piece in The New York Times that talked about, and
there’s now a memorial there, but talked about that
interesting connection, where people’s barriers came down and this wonderful outpouring
of support and compassion evolved as an exemplar to
people all over the country. That’s a great, it was a wonderful story. There are stories like
that all over the country but this epidemic has called us to look at some of the places where we have biases and prejudices and to deal with them. That’s sort of the upside of, the silver lining in
something like this epidemic. This made us really respond
and grow and stretch to be better people and better servants in very significant ways. But I was reflecting this morning, I was gonna talk a little
bit about the history, but I woke up this morning
thinking about three people who I think are great exemplars to us as we have these conversations today, and I just wanted to
refer to the three of them and words of wisdom that they gave me that stick with me and
inform my work today and many of the rest of us who were at some of these
events where they spoke. The first one is Desmond Tutu. In 1999, when we were ready to announce the first global AIDS program,
called The Life Initiative, sort of the precursor
to the PEPFAR program, that was all-inclusive of all agencies, HHS and USAID and State
and Department of Labor and Department of Transportation,
Department of Justice, sort of a real comprehensive approach or the thought of a comprehensive approach to dealing with AIDS overseas. I was at the White House at the time. We asked Desmond Tutu if
he would come and announce, be with us for the announcement
of this big initiative. It was the first time we had
doubled the global AIDS budget. And so, he got up in this
room we call Room 450. It’s this fairly small
little theater room. Everybody was crammed in the front row and all of the people who
had been working on this, including the folks from the Office of Management and Budget, were sitting in the front row, and members of Congress and secretaries and so forth and so on. Desmond Tutu gets up, and for those of you who’ve ever seen him, you know he’s about this tall, but he’s very animated
in everything he does. And so, he got up. You think about people who get
credit and don’t get credit, and folks like the people at the Office of Management and Budget very rarely ever get any credit for what they do. And a lot of it is the heavy lifting that allows all the rest
of us to do our work, but no one ever sends
them a thank-you note. Desmond Tutu got up and he looked directly at the director of Office
Management and Budget at the time, Jack Lew, and his colleague, his deputy, looked at him straight in
the face and pointed at him and said, “You are an instrument of God. “That in your job in public service, “you are an instrument of God.” And then you could’ve
seen, I mean, of course, Jack Lew is a very good, practicing Jew, so he was kind of, I mean,
he was like, “Oh my gosh, “I can’t believe this man
is saying this to me.” It was really cute. But it was so great
(audience chuckling) because you, what Desmond
was saying at the time is you have to understand wherever you are and whatever your job is and
whatever you are called to do for the betterment of humankind, you are an instrument of God, regardless of what your faith situation is or what you believe or don’t believe. It was just such a beautiful moment and I remember it to this day, that wherever people are sitting and whoever I’m engaging with, whether it’s somebody I agree
wit or don’t agree with, when we’re trying to do something good, then that person is an instrument of God. I want us to think about that
in these very changing times where we are all trying to work better with those who disagree or with whom we have different ideologies or political context or religious
ideas or whatever that is. This is a time where it’s really important to see that in the people
that we’re working with, no matter whether we agree or not. That was the first thing. The second was another
interesting little story that I was, actually, the first
thing I was thinking about this morning when I woke up is Andrew Young, Reverend Andrew Young. Does everyone know who Andy Young is? Andy Young is a wonderful preacher who was a lieutenant to
Martin Luther King Jr. Was a great preacher,
was a great activist, still is a great activist. He came to be our
preacher in the year 2000 when we had our first big
religious leaders conference, global religious leaders conference, on HIV at the White House. We had a very interesting group of people. Andy Young was a preacher. Thich Nhat Hanh, who Martin
Luther King nominated for, the Buddhist monk who Martin
Luther King Jr. nominated for the Nobel Peace Prize, he didn’t get it but Martin
Luther King nominated him, is a great thinker on justice
and peace, was our lecturer. We had all kinds of
interesting cast of characters there at the service and at the meeting. The meeting was held on the
eve of the 45th anniversary of when Rosa Parks refused to sit down on the back of the bus. Andy Young got up and he, this is at St. John’s across
the street from the White House and he stood up to preach. It was really funny ’cause
he was a little bit nervous and I said, “Why are you nervous?” I was sitting next to him. He said, “I don’t know
what I’m gonna say.” And I thought, “Oh, Lord, “this is terrible.”
(audience chuckling) But anyway, I mean, we all had faith that he would come up
with something to say. I mean, he is Andy Young. He got up and he gave
this wonderful speech and then he said to everyone, “You know, I’m leaving
first thing in the morning “to go to Montgomery to lead the march “in honor of the 45th
anniversary of when Rosa Parks “refused to sit down on
the back of the bus.” He said to the assembled group, he said, “The one thing I want you to understand “that we have learned in
the Civil Rights Movement “is that the road is long and difficult.” And he said, “The most important thing “you need to understand is you
have made a lot of progress, “but you can never lose your gumption “to continue to move forward, “because you do the easy part first “and the hard part comes last, “and that’s where you
have to stay the course.” I think the important thing
for communities of faith is that the communities
of faith are better at that staying the course
of about anybody anywhere. We see it in Africa and we
see it in the United States. Those religious communities, some people working in those communities were there before there was a PEPFAR or in the South before there
was a Ryan White CARE Act, and when all of us are gone, they’re still gonna be
there doing that work. They’ve got staying power and
longevity and sustainability that none of the rest
of us necessarily have. We just need to keep that in our thoughts as we begin to deliberate
on how we go forward and how those relationships work and how we garner that staying power. The third is another icon that I think had words of wisdom for us. The first is, there
are instruments of God, they’re everywhere. The road is long and hard in
civil rights, human rights, all the work we do, in
justice for all people. And then the last was an experience with Coretta Scott King, the
widow of Martin Luther King Jr. In 1989, she hosted the first AIDS 101 in Atlanta at the Martin
Luther King Center for the black community in Atlanta. She hosted it with AID Atlanta, which was the AIDS service
organization there. She got incredible pushback
from the black community about hosting this AIDS 101 because AIDS was not a
black community problem. This is 1989. I mean, incredible. People called her donors, her
donors called her to complain. The same thing happened at AID Atlanta, which was the largest
AIDS service organization in Atlanta at the time. The board of directors called to complain to AID Atlanta and to their board that this, what in the world
were they doing over here having this meeting in the
African American community, that that was not where
the epidemic was seeded. And so, everyone, there
was a lot of pushback. I remember (laughing) Coretta
Scott King saying to us, “You know, what we have to remember “is we cannot do them and us. “That if we want to do
the work of social justice “for people most impacted with, in this, “with his disease or any other situation, “it has to be about us. “We cannot perpetuate them and us. “It always has to be we.” I think that’s really important in the conversations we’re having now. It can’t be North and South, and I find myself fussing about
these people from the North don’t know anything about
doing work in the South. I say that to myself and
I have to check myself when I say that. It can’t be about this
group and that group or the rich or the poor or
San Francisco and New York or this or that. We have to be really careful that we don’t perpetuate segregation, that in our conversations, we perpetuate unity and not segregation It’s important that we be able to speak to the particular
communities most at risk, but it is more important
that we can end that context, that we never forget that we are all one. Again, that’s something that this, our faith communities can do for us better than just about anyone else. Let me just end by saying that I think those are
great words of wisdom by people who walked the walk in ways that none of
us will ever understand walking the walk, and good to remember as we
enter into our deliberations and conversations today
and in the ensuing days, because we have an
extraordinary opportunity right this minute to really turn the tide in the places most affected by HIV in this country and around the world, and an extraordinary opportunity to do what I think is even more important, and that’s transition the
leadership of these movements to a younger generation. I think that’s the key here. You wanna listen to
the words of the elders and take that wisdom forward, and then seed this work
to a younger generation and take an opportunity to support that in the way that the Andrew
Youngs, the Desmond Tutus, and the Coretta Scott Kings
all gave us a little nudge and some words of wisdom
to go forward with. I’ll end there and just
thank you all for being here and for having this conversation. Thank you for your incredible work in helping us think how
we might go forward, because we can go, you know, we can do it right or
we can not do it right, and this is a great
opportunity to work together to see if we can’t do better. Thank you so much and I look forward to our deliberations today.
(audience applauding) – I’d like to ask the
members of the first panel to come on up. – Dave’s gonna come here. – Welcome. We couldn’t have a better
person to start with after Maeve’s great
introduction than Sandy Thurman. That notion that we shouldn’t
have a segmented approach is important to think, even as politics has to do with this question of human rights and health on the one side and faith on the other, because we shouldn’t instrumentally, that we need to reach certain allies and certain implementers, and think about things in segmented ways. This is all about every
human being having value, including in mobilizing a response. We are inspired for today’s forum here
at the Berkley Center which really promotes
enriching discussions. Buy this book that Dave
Barstow has not only written but spearheaded as a project, a dialogue, for thinking about it being 2030 and two different futures, one in which many actors working together, including in the faith
community, did the right things and the AIDS epidemic
was brought to an end, and another future in which
we didn’t do the right things and the magnificent progress of moving from some two million
people dying a year in 2005 to some 900,000 now was subject to drift and
we didn’t finish the job, and the moral and policy failure
that that would represent. So, thank you for the book and it inspires our discussion today. This first panel will look
at lessons of the past and the next panel will
look forward to the future, particularly at the role
of the faith community. Let me all too briefly
introduce our panelists. We will be having three
segments of discussion. I’m gonna pose an opening question to each one of our panelists, then we’ll have some
follow-on conversation where I’ll ask some questions of multiple members of the
panel to engage each other and then most importantly, we’ll
turn to you in the audience for your questions and comments. Joining us today is Jesse Milan who is president and CEO of AIDS United, it’s a grant-making and
advocacy organization dedicated to eradicating
AIDS in the United States, has 30 years of experience in AIDS issues, and notably served for
five years as cochair of CDC’s Advisory Committee on HIV and STD Prevention and Treatment. Katherine Marshall, to my immediate left, is senior fellow here
at the Berkley Center for Religion, Peace, and World Affairs. She’s also a professor of the practice of development, conflict, and religion in the School of Foreign Service
at Georgetown University. I count her as a dear
friend and colleague, as a (speaks foreign language) myself. She had a long and respect-worthy career in the
World Bank, notably serving as the executive director of the World Faiths Development Dialogue, and someone standing right at the side of the head of the World Bank and looking at how it
engages the faith community. Ambassador Jimmy Kolker
is a visiting scholar here at Georgetown’s Center for Global Health, Science, and Security. He’s served in a number of
roles crucial to the movement, including assistant secretary
for global affairs at HHS and chief of UNICEF’s AIDS section and deputy global AIDS
coordinator at PEPFAR. But perhaps most relevant
to our discussion today, a pastor in Uganda as
PEPFAR was being stood up. We’ll be joined a bit
late by Gloria Ekpo who’s, the technology of the choo
choo train has failed her and she’s running late
(audience chuckling) from Baltimore but will
be slipping into the panel to join our discussion shortly. She’s senior technical
advisor for HIV and AIDS at World Vision and has a long career working in sub-Saharan
Africa for PEPFAR grantees and in public health roles. Last but not least is David Robinson who’s a consultant for
inter-religious action related to humanitarian
emergencies development, and in particular had a lengthy tenure at World Vision International and was senior advisor for operations focusing on public health, such as issues of Ebola and HIV/AIDS, and, interestingly, heading
up a number of efforts to bring Christian and
Muslim voices together. All right, without any further ado, I’d like to start with Jesse, if I might. Perhaps it’s fitting with a focus on the domestic
situation in the United States and from the perspective of
someone who’s lived with HIV. What do you see as the social drivers of the HIV/AIDS epidemic and how has the faith community addressed those social drivers? And how’s it failed to
address those social drivers? – Thank you, thank you so much, Mark. I just wanna take a moment to thank… Thank you. – You wanna hit the bottom to… – Okay, here we go. There we are. I just wanna take a moment to thank Dave for committing to AIDS United for the proceeds from this wonderful book. AIDS United, as you’ve heard from Mark, is a national organization
focused on ending the epidemic in the United States. Our philanthropy includes grant-making. Last year, we gave away about $8 million, and two years ago, we
gave around $2 million to support organizations treating people or supporting people with HIV who were affected by the hurricanes. So, we’re getting ready
for that right now. Our Public Policy Council is made up of 55 of the leading HIV/AIDS
organizations in the country, and together they advocate for
appropriations and policies with Congress and the administration. Our capacity building to
240 grantees in 40 states make sure that other
organizations do better at achieving their mission. So, thank you so much, Dave. I appreciate this question,
as a person living with HIV who’s worked both in the
global and national arena, but a long-time member
of the faith community. I’m the past president of the National Episcopal AIDS Coalition, and Sandy Thurman was
a member of our board, so this is very personal. The social drivers, which are addressed in
Dave’s wonderful book, really are something
that the faith community should think about in
terms of where we failed. I think we’ve done a very good job, first, at addressing the social
drivers of poverty, particularly in the global arena. In the US, the poverty issue as it relates to the health
disparities and access to care, we’ve been very much on the forefront of the advocacy issues for those. Particularly in the global
arena, that has translated to advocacy for poor women
to have access to care for particularly maternal
and child health. In fact, we’ve eliminated maternal and child transmissions globally, well, substantially reduced them globally, and virtually eliminated them completely in the United States. That’s the good news, and
I think the faith community has resonated with help the poor, help the poor, access to care. But where have we failed? I think we failed to
recognize the power dynamics that are impacting people who are constantly at risk
for HIV or living with HIV and not having the support that they need. I wanna think about that
power dynamic in three ways. One, the agency of women, vis-a-vis men, around their
personal sexual health. Second, the human rights issues of particularly LBGTQ community. When we’re talking about
HIV, we’re talking a lot about the G and the T,
but not exclusively. And then third, the social drivers around the health disparities that are based solely
on race in this country. When we think about
where the Church has been on those three issues, I think we find that the Church has been, or the faith community, whether it’s a mosque, a church, a temple, has probably been very lacking, particularly on the domestic side. The LBGT community knows
that the faith community has stepped up at times
when someone was dead, but not necessarily when
someone was at risk. The faith community hasn’t stepped up merely in terms of power dynamics of how women, particularly in
global and domestic arenas, do not have true agency
over their sexual health. I think that the faith
community is still lacking. Despite the wonderful legacy
that we’ve heard from Dr. King and from Andrew Young and others, we’re still facing the issue
around the disparities of race. – Thank you, Jesse. We’re gonna turn to Kathrine in a moment. Katherine helped me figure out a book that I gave birth to here at Georgetown which was about agency and
recognition of all human beings as sort of touchstones for the work of global institutions and movements, and that was really resonant with me. I’m glad to start it with the domestic. We at Friends of the Global Fight, where I’m senior policy officer, we’re looking at these lessons to share between the domestic and the international that Sandy and Jesse have looked at. Well, Katherine. How is the faith community, or perhaps, better put, faith communities, inclined to take action on HIV/AIDS? Where was it positively leaning forward? Where was it not? How did it vary? And how’s it changed course over time? – Thanks. Let me start with how I got involved, because I got involved very early on through two people. One was a cousin who died of AIDS very early in the epidemic. He was actually the lover of Perry Ellis. I remember my family coming to terms with, first, the fact that he was gay, which I think most of them had not known, and secondly, this terrible disease that he suffered from,
I think, in silence. The second was my
secretary who was Ugandan, at the World Bank, who lived with one relative after another, going through these terrible,
really a terrible disease and the pain and suffering
that they went through. So, from very early on, my sense was that whatever
we could do, we had to do. But we faced early on, which
I think is the first answer, I have I think three parts,
if you’re gonna let me, we’ll see how I do with time.
(Mark speaking faintly) The first part is that we
were dealing with denial, widespread denial, which I
think we should remember. I heard once Bill Clinton
in a speech saying, “Denial’s not a river in Egypt,” which I don’t think was original to him but still, the… (chuckles)
(audience chuckling) The–
– I love it. (laughs) – For so long, it was so
difficult to deal with this. I remember one of my colleagues saying, “Well, you know, now we
have to learn to talk “about anal sex and so on.” But it was a problem that,
of course, dealt with sex. I remember another person saying, “Well, when the IMF has
conditionality on sex, “then we’ll really get somewhere.” But all of a sudden you had
to be thinking about issues, and it started to put, it
came roughly at the same time that we were starting
to think about the role of women in development, not
to speak of gay and what, how do religious
communities deal with issues that they didn’t want to think about, sex, role of women, et cetera. So, I think denial was
the first, overcoming it, and I think it still is an issue. It still is not the most comfortable issue for people to discuss. Second, I do contest talking
about a faith community because it obscures the
extraordinary diversity. First of all, we all use
the number all the time that Pew came up with. I don’t know quite what it means but 84% of the world’s population has a religious affiliation,
which is a big number. Very few other indicators are as big. So, it’s this enormously important but also phenomenally complex world where there are enormous differences. The differences within faith communities in the way that they have
dealt with these issues is something that we should never forget. The third point, I think,
is that this is an epidemic that has changed so dramatically
over, really, a generation. In the initial phases,
it was dark, mysterious, not understood what this was. The prospect of, I
remember 16 million orphans was one of the numbers that
people were talking about. And it was a death sentence. You’d be in Malawi, I was in Malawi once, where we were talking about
30% of the adult population. You would look around
a group of 10 people, three of them had a death sentence and probably didn’t know it. And it was a disease that was difficult for people to deal with
because the symptoms came late. It wasn’t like Ebola. So, you had these characteristics, so the denial was, our
society could never have this, of course we don’t, I mean, nobody ever has
sex outside marriage. It’s not possible. And then this has changed. First of all, people have
learned to talk about it. But in addition, you have seen the death sentence turn into something quite different with a possibility of
action, the prices came down, all of these other features
that I think we now, maybe the new generation has forgotten how much change there has been in the way that this disease is presented. Plus, we face the challenge
which, in some senses, is the first challenge that we face now, which is how does it fit
within the broader challenges of health disparities and gender relations and some of the other human rights issues that we’ve mentioned. And then the final comment that I think has already been alluded to is something we say frequently about dealing with religious aspects of development or of rights, that it’s part of the problem
and part of the solution. I don’t think we’ve ever
seen it as dramatically as in the case of HIV/AIDS, where you had terrible
things that people said, pastors said, imams said. First of all, this could never
happen in a Muslim community because, of course, we now have four wives so we don’t need to have
sex outside marriage. We can’t bury this
person in the churchyard. The wages of sin, which we
still hear time and time again. The cruelty that was
implicit in all of these are, in a sense, the worst
of religion and belief. At the same time, you had
the extraordinary compassion and caring that you had. Here, I’ll just mention three people that, for me, three people institutions that have done so much. Canon Gideon Byamugisha from Uganda was, I think, the first Anglican priest to be public about his HIV/AIDS status. I have watched Gideon change
people’s hearts and minds by telling his story, so his courage, his determination that the
ABC approach is stigmatizing, that stigma is the issue, that you have to have a broader approach, shows the power of individual
leadership in what he does. The second person is Father D’Agostino, the Jesuit who started
the Nyumbani Orphanage near Nairobi in Kenya. I was first introduced to
him at a huge conference, a Rick Warren conference,
I think, in the year 2000, in Washington, where he was
railing at the World Bank and how awful the World Bank was. That made me curious enough to follow up and to visit the Nyumbani Orphanage. But this was somebody who was a firebrand, who was just determined, he
focused on pediatric AIDS. The orphanage took in
babies that were abandoned, and so, that was, I think,
an extraordinary example. The third is the Community of Sant’Egidio, which is a lay Catholic movement, which I think has established a principle that we all care about, that people in Mozambique are entitled to the same standard of
care as people in Rome, that it’s not acceptable to
say that they deserve less. So, the remarkable examples of these people and
organizations, I think, has been an inspiration. – That was a great tour of the horizon of problems and important actors. Ambassador Kolker. Maybe particularly
because of your experience as ambassador in Uganda
when PEPFAR was launched, but your other roles at PEPFAR and HHS, could you talk a bit about
international diplomacy, those who are living with AIDS, those pursuing national strategies, the faith community, how does international
diplomacy play a role in getting implementing countries to include the faith community in part of the thinking and the response? – Thanks very much, and great that Gloria’s here.
– Gloria, welcome. – Very timely.
– Thank you. – Thanks for joining the panel. It’s great to be here. I think PEPFAR, which I was a very unqualified person to head the largest AIDS
program in the world when I was ambassador to Uganda, the structure of the
President’s Emergency Plan for AIDS Relief put
ambassadors and country teams in charge of picking partners and being accountable for results. It differed from other
traditional development programs in that there was a commitment to sustainable high-level resources. It wasn’t the pilot program
or a center of excellence or a proof of concept. This was national scale-up. We were supposed to
help as soon as we could everyone who needed treatment and prevention care and support. It required partnerships, and it required partnerships
that require trust. This was something new
and these were not people who necessarily worked together before or had common purposes. Embassies are in very good
position to know in a country who’s doing what and who
has comparative advantages in what they do. The providers, faith-based
providers of religious services, advocates, certainly people
affected by HIV and AIDS, tended to be early adopters
and more innovative than some of the government systems that had a harder time
responding to emerging threats. And so, one of the questions that I asked anyone any, you know, we had the largest
AIDS budget in the world, if you were in global AIDS, you pretty much had to be
in Uganda in 2002, 2003, and the question I
asked every visiting NGO or partner, potential partner, was: Who in Uganda is already
doing what you’re doing and how are you gonna
add value to their work? It was interesting because some
very important aid partners and so on were pretty unable
to answer that question because they were very supply-driven. They knew what they were good
at, they had no idea what, how that actually could
add value in Uganda. There were a number of groups, including religiously based groups, that were very good at that because they had lots of local partners. And so, looking at something
from that point of view, of how, organically, you
have a comparative advantage to add value to something
that’s already going on or a need that’s already been identified, are ways that an embassy, I think, can be a very good doorkeeper
as well as resource-provider to organizations that do good work. We bring people to the
table and we try to, you know, if diplomats
are good at their jobs, and I think some us are, we help put our priorities
on to other people’s agendas. That is something that
also influencers do, and religious groups
are very much involved in changing behavior and
trying to get items crossed. You asked specifically
about national strategies and I’ll take just a minute on that. These tend to be public-sector-focused. These are governments writing strategies. The partners, for instance,
WHO is typically embedded in the Ministry of Health, so WHO strategy would have
the Ministry of Health in charge of things, and NGOS and particularly
faith-based organizations tend not to be very visible. Even if they’re providing perhaps half the health services in the country, it’s often the government clinics that are part of the national strategy. This is something that, if you overemphasize the public sector, you’re not actually able to
scale up in the same way you are if you’re trying to take
advantage of who’s doing what. Also, these national strategies rarely had people living
with HIV in the room, they rarely had key populations or others who were stigmatized there, and the question of how to deal
with criminalized behaviors is a huge dilemma for national strategies. It’s there that, what Jesse and
Katherine have already said, that the faith community can
be of enormous importance if they are enlightened
and looking at this from a point of view of how
can we be compassionate, who is it that we need
to open our tents to, but also if it is a narrow point of view, that these are sinners or criminals, it’s very difficult to
have a national strategy that actually reaches the people who most need that
strategy to deal with HIV. – Thanks for a
thought-provoking intervention. We will circle back to
a lot of these themes in the broader discussion. Gloria, I already introduced your great credibility as
senior technical advisor at World Vision, as OB-GYN, and someone who has worked
with the faith community in implementing countries. Could you speak to some of the roles of faith-based
organizations on the ground, and even beyond those important roles of advocacy, awareness,
affecting attitudes, but actually as service providers? – Thank you very much for having me here. It’s really a pleasure to share some of my experience in World Vision, how we’ve been working as a service, faith-based service provider to support efforts like
this in the HIV response. I know we’ve been working with
communities for 65 years now to tackle the root cause of poverty, of which HIV is one of them. We’re at the forefront of faith, we are still there, and
we continue to be there. I want to add that the
faith-based service providers are critical to the success
of ending the epidemic, current epidemic, and they’ve
been engaged all along. Research has shown that about
84% of the world is religious and also close to 40%
of healthcare delivery is by faith-based organizations. So, tapping into all this to
control the epidemic by 2020 is very, very critical. If we’ve been long in the
HIV epidemic response, I just want to share three
phases of engagement. During the emergency phase, which was the first
decade of the epidemic, the faith-based organizations,
service providers were there. They rallied around, cared
for the sick and dying through the various means, providing compassionate
care as much as they could. The next two decades was a bit passive for the non-clinical aspect as donor focused more energy and attention to the health facilities, training, building technical capacity, and ensuring that the
medications were available. I’m happy in this end
game, I will call it, that we are now refocusing our efforts in re-engaging the faith communities. And in the last five to seven years, the non community are now re-engaging FBOs to make sure that we
control this epidemic. The re-engagement is
becoming, is quite strategic because PEPFAR hard-lines
on the expectations based on the evidence that
have been provided so far. I’ll just share few of the areas they want the faith-based providers to continue to focus on. One of these is there are
advances in HIV prevention now and we want to encourage faith communities to talk about early
initiation on treatment and linkages to care
with viral suppression. They are able to thrive
if the virus is low and the new message is U is equal U, which is undetected is untransmissible. Those messages of hope are very critical. Need to address HIV violence among adolescents nine to 14 years old. Preventing them will really
be very, very important. Girls education is very, very critical to ending the epidemic. Not just girls education,
addressing gender norms, parenting roles that support these. Where are the men? Making programs to reach out to men, especially using self-testing
and linking them to care to be virally suppressed. The children and adolescents
are equally important, especially well children. We need to find them, link them to care. I know the faith community has been there in terms of the reducing
stigma and discrimination that are associated with
HIV and tuberculosis. So, continued engagement
on the faith community and service providers to do that becomes very, very critical. I think, lastly, looking at the advantage, the trust and relationship
of faith communities where they work. They are looking forward
to not just the message of advocacy and linkages to care, most of them are at the forefront
now leveraging platforms at their schools, at their communities, to ensure that comprehensive
HIV prevention and services are provided to their people. I think this is a roadmap, a good roadmap to end the epidemic. If this engagement is continued, we believe that a 2030
reality will be a reality. Thank you very much, yeah. – Thank you, Gloria.
– Okay. – Dave. Let’s think about the
local faith communities and opportunities and
challenges over time, and in particular, gaps and divisions, intra-faith and interfaith
questions at the local level. – Thank you, Mark. Thank you, Dave and John O., for introducing me to
this topic a year ago, and Katherine, to the Berkley Center, where many meetings here on this subject and elsewhere across DC have been held. You hosted, in October of ’14, a meeting at the World
Bank with Adam Taylor, on lessons learned from
the HIV/AIDS response for the Ebola response. This is where it was kind of a capstone to my tenure at World Vision, working in interreligious relations in global health emergencies. The Ebola response and the meeting that you chaired along with Adam pointed out some of the opportunities and some of the obstacles. Religion, as you’ve already
said, is a double-edged sword in dealing with scary diseases that have to do with sex. My first encounter with
AIDS was in Mauritania where I was the operational
instructor for World Vision. We were in a child immunization program, child health program, and the Ministry of Health
sent some immigrants, African immigrants who were
traveling through Mauritania trying to get to Europe. They had AIDS. We were involved in evacuating them home. Several of these men,
they were young men, died as we were paying for cab
rides back to Sierra Leone or back to West Africa. It was my first encounter. Then World Vision, in 2000, under the leadership of Rich Stearns, got very, very active in advocating for supporting churches to deal with AIDS orphans and with grandmothers and
grandparents left behind, taking care of AIDS
orphans in Southern Africa. Christo Greyling, who’s a
mutual friend of many of you, with me on the phone
this morning reminded me that next week he will celebrate 32 years since he discovered he was HIV-positive. He is a hemophiliac, contracted HIV, and at his ordination admitted
to his church in South Africa that he was HIV-positive. He was kicked out of the church. Said, “We do not want clergy
who are HIV-positive.” He then went on to create Channels of Hope and create the CABSA, which is the Christian AIDS
Bureau of Southern Africa, which then became the Channels
of Hope wing of World Vision and was launched in Uganda in 2002. This is when I became aware of it, when Muslim leaders in Uganda complained that this program of alerting clergy,
mainly Christian clergy, on how to deal with stigma and
how to overcome the obstacles that the church actually was
putting in front of people who were infected and affected, that Muslim leaders began to come forward and said, “Look, we don’t know how to talk “about sex in our mosques. “It’s taboo to talk about it. “We don’t know how to
talk with men and women “in our mosques about this. “Are you going to share this?” Christo came to me. I was the advisor for
operations in Islamic contexts. We went through almost a
decade as an organization trying to figure out how to cope with the demand-driven side
from leaders of other faiths. Muslims were convinced we were there to convert them to Christianity because all biblical-based
principles addressed for, so they basically complained this is a Muslimized
Christian conversion agenda. There was the fear of
proselytism on one side. As we began to advance this and Ali Banda, Sheik Ali Banda in Lusaka, joined from ANERELA,
and others were involved in producing our material. Then our Christian staff began to say, “Dave, you’re,” Dave Christo,
“you’ve created Chrislam.” So, this issue of synchronism. The theological challenges of the interreligious dynamic of sharing what we had. The biblical principle from Jesus is where much is given, much is required, so the board of World Vision finally said, “We’ve gotta give this away. “We’re not gonna charge for it. “We need to give it to
a Muslim organization “because we do not wanna be
perceived as a Trojan horse, “using this catastrophe “for proselytism.” It was a very, very tortuous path. We can come back to this. But the trust and mistrust
became a huge issue that others have mentioned on the panel, and I think will remain
an issue into the future. The other is sustainability. Sandy, you mentioned the transition to a new generation of leadership. Almost everybody in World Vision who is in on the ground floor of working on developing
the interreligious approach have retired or moved on. And so, handing on to the next generation is gonna be key in the future. – Thank you, and I know a number of you, I can tell from the body language, that you want to comment
about each other’s things. I hope that my more generalized questions will give you opportunities to do that. I wanna ask some questions and I may identify a
couple of you to speak, but others who want to
jump in on the question, please go ahead. I wanna look at the faith community or faith communities, people living with AIDS, and
then also national strategies. In particular, start with Jesse and Jimmy. How have faith actors, if you will, done on engaging people living with HIV here in the United States
and internationally and them having a central
voice in the response? And if you’d like to talk about it also, how come they sometimes have
a voice in national strategies and sometimes not? – Happy to start off,
although I defer to others on the panel who are very much involved in community responses here. First, it does seem to me that the scriptural injunction
about widows and orphans was a very much a double-edged sword, that the hardest money we had, the money we had the hardest
time spending in PEPFAR was the earmarked 10% going to orphans and vulnerable children. That was in particular true because 95% of kids who
were affected by AIDS or had lost a parent to AIDS were being cared for by extended families. But there were, I have to say, a disturbing number of pastors in Uganda who went into the orphanage business because this was an easy
fundraising technique. Pictures of cute kids raise money. You had the constituency,
especially in the United States, but all over the world
as well as in Uganda, that institutionalized kids
instead of finding a way to support, even within
religious congregations, those families who were making
extraordinary sacrifices to take care of their relatives who were affect, HIV and AIDS. I think we still have that dilemma, that the responsiblity to
orphans is seen, in a way, as separating orphans from the communities in which they live, whereas we need to find
many more mechanisms. Some of the NGOs I’m
trying to work with now are ones that can strengthen
community organizations to deal with their own community members who are standing up but under great stress in dealing with the consequences of HIV in their own families. On a more institutional level, the Global Fund, with which
you’re so well familiar, has these community-coordinating, country-coordinating mechanisms. And who’s represented on those CCMs has been subject of enormous debate. I’m sorry Sandy isn’t here because I think they’re still going on in the Global Fund board
meetings and in the structures. But the idea that faith-based groups and people affected by the diseases are underrepresented in those groups and they tend to be
dominated by governments or by large organizations, by donors. And so, the question again
of how faith-based groups deal with those institutions
and how they’re, who represents, who speaks
for faith-based groups? Are they willing to have
someone who’s HIV-positive as representing the faith community rather than a clergyman or
an institutional leader, I think, is a huge question. Are they actually looking at
who’s affected by the issues? Just to add one more thing,
one of the principles that I think PEPFAR established in Uganda, we called no undermining, the question of, if one person was doing one intervention, for instance, distribution of condoms, we did not expect every
religious organization to be distributing condoms, but at the same time, the
sense that to yell out, “Condoms don’t work,” or to
have a rivalry with those groups that were distributing condoms really would undermine the program. It was a huge amount of trust and respect between different organizations
doing different things. I think that no-undermining
principle is important. Although when there’s strong evidence, we certainly had to bring
that evidence to bear, and the question of traditional healers, of attributing HIV to
witchcraft or to curses or to nonbiological factors was something that we did have to fight, but we tried to do that by
bringing the traditional healers into the conversation, making it clear that this was something
they could not cure with traditional methods, and how could their psychological and community-based practice be an asset in the referral system in which there was not undermining of the credibility of various people, but they really were
evidence-based solutions. – [Mark] Jesse? And feel free not to limit yourself to the US domestic front. – Oh, well, thank you. I think we have a problem when it comes to our
national response to HIV/AIDS and the role of the faith community, and I think it’s magnified
at the local level as well, and that is who represents
the faith community. I was AIDS director in Philadelphia and I was the first chair of
the Ryan White Planning Council for the entire nine-county region. That’s a difficult question. Who, when there are only
so many seats at the table that are constructed for the actual official planning bodies, and those planning bodies are empowered by our public health
authorities, by both the HRSA, the Health Resources and
Services Administration, for overseeing the Ryan White program and the $2 1/2 billion that go to states and communities across the country, and also the CDC, the Centers for Disease
Control and Prevention, local community planning for
how prevention money is spent. And now, with the Trump Administration’s ending the epidemic plan, with emphasis on 57 jurisdictions
in the United States that account for more than
50% of all new diagnoses, they are requiring all of
those public health authorities to do community planning. How do we engage the right
people to be at the table? For over 25 years, for nearly 35 years, we’ve had a construct called
“Nothing for us, without us” or meaningful engagement
of people living with HIV. It’s well understood, both
globally and nationally, that you dare not create anything that does not have people
living with HIV at the table for constructing what will be delivered in the communities on their behalf. One of the problems we’ve had with the Trump Administration’s
ending the epidemic plan is that the creation of that plan, at the highest levels, in the Oval Office and
with the Secretary of HHS, did not include people living with HIV. There was no representation. And now, when it’s being rolled out, they are requiring that jurisdictions, to get the money that will
be coming through that plan, do that kind of representation. So, there’s been a disconnect there. But who represents the faith community at either local or national levels is a complicated question. There have been times when
someone wearing a collar, as opposed to someone
who’s wearing something from another denomination or
another religious background, gets in the room, but do they really speak for
all those who are not there? In the Christian context,
if that person is white, can they speak for black congregations? If that person is Catholic, can they speak for
Protestant congregations? If that person’s Jewish? So, it’s terribly complicated. But I think what the chief message is, is that the faith community
needs to at least be aware that these conversations are happening and that the approach
that the administration and that local health
departments are implementing is really a multi-sectoral approach and that there are pathways
into addressing HIV/AIDS that any individual congregation, any individual denomination,
or any individual religion can actually access if they’re
willing to at least be aware that something is going on. – What I’d like to do
is broaden the aperture and then narrow things down
to a practical policy question before we turn to the audience. I wanna talk about trust. You brought up trust. There are lots of layers
of trust problems here in the vital role of faith communities. There is trust between those living with HIV
and those whom I call part of the HIV policy response community and the faith community, sort of trust issues working together. There are trust issues between
different faith communities, including on the ground. And then there’s the trust question for local authorities, local citizens, local faith organizations about international voices swooping in. Let me start with the other three of you but any of you want to go in. But Katherine, Gloria,
Dave, or any of you, are there some of those issues of trust you wanna dig into and shed more light on? – I think the trust
issue can’t be separated from knowledge and habit. One of the issues that
we’re dealing with here is the separation, the sense, the implicit assumption that religion would retreat
to the private space with modernization, and therefore was not,
quote, at the table. And as we know, if
you’re not at the table, you end up on the menu. But this was a very broad issue, right, that Wolfensohn at the
World Bank was confronting, of why are there no discussions, why is there no dialogue, why are these very
important actors not there. There were a lot of issues involved, including the political,
which is part of the trust. The sense that proselytizing
is the real motive. The sense that faith communities are stuck somewhere in the past, that they’re not dealing
with the modern world and modern demands, et cetera. What’s, I think, interesting
about this history is that in many ways it was the tragedy and the challenges of
the HIV/AIDS epidemic that opened many, that forced people to open new kinds of relationships and dialogue. Of course, it also came
down to another element of the trust issue, which is money. That such a substantial part of public health funding
has, internationally, has gone to the HIV/AIDS, disproportionate, we all I
think know, in many ways, given the many other demands, but it has changed the whole conversation. That was what was interesting
about the Ebola situation, was to force ourselves to
look at what have we learned, what have we not learned, where is this very complicated question of who’s at the table. I mean, one of the leading issues, in looking at faith communities, is (chuckling) how do you bring
women into the conversation when most people with
collars are not women? How do you bring youth
into the conversation? So, in many ways, the very
complex, fascinating history of the HIV/AIDS epidemic has transformed or has started to
transform that discussion. – [Panelist] It’s a trigger. – Gloria? – Yes, I’ll just add to that conversation. That is really true. In our work, just like
we’re discussing earlier about the Channels of Hope we use to mobilize faith communities, issue of proselytizing was an issue, I mean, was a concern. There’s a lot of myths,
there’s a lot of mistrust and misunderstanding with various faiths. But I experienced is that as
we come to dialogue with them, sit face to face, talk
about bring holy scriptures from whatever their religions are and examine the context and the content as it relates to the person at the center. These are women, children,
they are congregation members who are affected by HIV or other disease. By examining these holy scriptures, it gives people a safe space to do that in order to achieve the common goal of delivering the healthcare services. I think, like in one of our programs, in one of the countries, about
90% of religious affiliation, bit high, but there’s a
particular Christian sect that refuse their members
to go to health services. What they did was, is always praying and other methods, alternative methods, and the people were dying. In our recent program of
using Channels of Hope and what we also call Health
Kiosk, we mobilize them. We didn’t go straight forward, so there are strategies
of getting people of faith to buy into, to dismiss the
trust, believe in each other, and build relationships
to achieve health goals. We had to walk with them where they are. They were more comfortable
with water sanitation, they were more comfortable with sexual reproductive health issues, before they took on HIV and AIDS. And that relationship-building takes time. It’s not one month, it’s not two months. Sometimes could be six
months or even two years. But as soon as that trust is built, ability to walk together, communicate, and navigate the issues that concern the various congregations becomes very, very necessary. And for World Vision, we had to, through the Channels of
Hope and other program, we’ve been able to walk
with Muslims, Hindus, but now with a lot of other
religious organization, I think that dialogue, be inclusive and bring everybody to lay
all the cards on the table. We’re not proselytizing. You have your faith, we
believe it, we respect it. But here we have a common threat and we have to find common grounds in order to solve those. Thank you. – Dave.
– Thanks. Just to add, there are a
couple other dimensions in the trust dynamics. The Ebola crisis revealed to me, working with interreligious
councils in West Africa, at the very end there was
a lessons-learned meeting in Freetown with the
Inter-Religious Council of Christian and Muslim leaders. They all said, “Look, we’re too old. “We’re too old for this. “We started around resolving the war, “the civil war in Sierra Leone, “and we’re all past retirement. “We gotta hand it over to a
new generation of leadership.” But one of the dynamics there was, the joke (chuckling) in Sierra Leone was: In the capital, you eat; in
the bush, we wash our hands. That was, basically, the money that comes
from external sources, whether it’s the Global Fund, whether it’s UNICEF, whether it’s WHO, it ends up in the capital
and it ends up with those who are at the table in the capital. The Muslim councils were saying they were not getting any of the money. The money’s staying in Freetown. So, where’s our piece of the action if this is where we gotta
stop it, out near the border, with Guinea and Liberia? So, there’s this local, there’s the bush, the capital dynamic, and that’s shared power. Can we trust the people in the capital to share their power with us in the field? There’s the theology issue,
internal as well as external, which I said earlier. And then there’s the power dynamic. The power inside the
theological structures. The Muslim community was saying, “We don’t have everybody at the table. “We have these independent actors.” The Christians were saying, “We don’t have everybody at the table. “Where are the Pentecostals? “Where are the independent churches? “Where are the African
independent churches? “We’re not getting the message to the,” and it comes back,
Jesse, to your question. Who represents the faith community? Because it is very diverse
and convoluted, complex, and often divided over power and money. So, that has to, I think,
come in to the question of how do we overcome those obstacles? And the opportunities, there are opportunities embedded in this, but those are the obstacles. – If I may, I’d like to
just ask a couple of, I won’t say lightning-round questions but short questions if
anybody wants to add something before we turn to the audience. Some of you have said things about PEPFAR and the Global Fund. Do any of you wanna add any insights about how well PEPFAR or the Global Fund have done to incorporate faith voices, faith actors in changing people’s minds, and as implementers? And let’s speak freely
about the good and the bad. Anything further, beyond
what Jimmy spoke to on the country-coordinating
mechanisms of the Global Fund? – Yeah. You want?
– No, no. – Okay, I just want to say that, to the section I had alluded earlier, PEPFAR, Global Fund have really tried bringing voices together. I think they had a New Partners Initiative where they brought all partners together, CBOs as well as faith-based organization, to tap into resources
for the HIV response. They also had the faith-based initiative that also brought more
faith-based partners to the table. This enabled the faith-based
partners to gain more capacity to implement the HIV response the way they felt will make impact. Last year, they also engaged faith-based by giving 100 million
faith-based engagement fund, investment fund, and that’s through solicited
and unsolicited opportunities, reached out to faith-based organization to help drive this message to
bring an end to the epidemic. I think they’re encouraging
more local partnership so that the international
NGOs could continue to build local partnership to be prime, to be able to run with those projects and make it more sustainable. I think those are the
way they’re engaging. For us, within here in Washington
and even internationally, they have quarterly meeting with CSOs, civil society organization, where they share their concerns and we share what we are
doing and the approaches. So, I think these levels of engagement have really been very, very helpful and, if continued and empowered, could really help in the agenda. The messaging between
Global Fund and PEPFAR, I know that international
donors are really synchronized so that it’s the same message, it’s the same adolescents we are targeting with cost-effective best
practices and interventions. I think having that common
voice within the donor community really helps push the agenda forward. Thank you. – Anybody else? – I was just gonna say I’m left-handed and if I really concentrate on it, I can write with my right hand but it’s kind of hard and
it doesn’t look as good. I think that’s the way
both the US Government and the Global Fund dealt first with faith-based organizations. It’s not instinctive, it’s
not the usual partners. Both USAID and CDC had very
well-developed structures of partners with whom
they traditionally worked. You mentioned New Partners Initiative, the faith-based initiatives. By having set-asides of money
to attract new partners, our eyes were opened and we were able to work
out good relationships. As the PEPFAR partnerships
became localized, and this is an increasing trend now within the country-operating plans, that the partners need
to be locally based. This was a dilemma for
many of the original, what they call Track 1, new
partners, initiative partners, because these were
inside-the-Beltway people who got a congressional
earmark, essentially, for their own money. I think PEPFAR gained
from having those partners but I do think that it
put them into a category of how are we gonna be
traditional USAID or CDC partners when that isn’t our vision of ourselves? So, that’s it. Global Fund had even more problem because, again, you had to
deal with national strategies, and I think it’s been
very hard for Global Fund to insist in any way that
there be a fair shake for faith-based partners. – Before I turn to the
audience, and now’s your time, I’ll be asking you to identify yourself and to ask a question, is there anything any
of you would just want, have a burning desire to raise something about something you’ve heard so far or particularly the issue of stigma, and faith actors either
helping get rid of it or perpetuating it? – If I can add quickly
something we haven’t mentioned. I think the AIDS crisis has opened a whole set of
discussions about the role of the faith communities broadly in public health and in other sectors that opens up questions of what’s important for
monitoring and evaluation. Is this just some mumbo jumbo from the international community
or is it actually useful? And dealing with issues of corruption that I think is critical. Second thing, that this comes
less from the AIDS issue than from some work we’re
doing on family planning. That there are some areas
that you need to recognize that are particularly difficult. Adolescent sex is clearly one of them. There is a tendency in the
family planning community to think that it’s a good idea to have faith leaders and
youth on the same platforms. I’m not sure whether they think the scales are gonna fall off people’s eyes and either the youth are gonna say, “Sex is bad before marriage,” or whether the religious
leaders are gonna say, “Well, you know, it’s all
fine, norms have changed.” (panelist chuckles)
But the real possibility is that things are gonna
get a whole lot worse, particularly, for example,
in Muslim communities, there is this narrative that all this is a plot by the Western world to limit the size of
the Muslim populations. So, let’s be a little bit
more wiser and more sensible about the way that we handle
some of the difficult issues. – Any burning interventions,
including on the stigma? – I really have to weigh
in because I do feel that this faith community
is 25 years behind. I’m just gonna say it. Millennials, Gen X, do
not know anyone with AIDS. And even we on this panel have
used the word AIDS too often when we really should be
talking about HIV disease and transmissions for
HIV and living with HIV, because soon, 50% of all
people in the United States who are living with HIV
will be 50 years old, and by 2030, 70% of us will be over 50. So, we’re gonna be living in
a world of chronic disease and 25 years ago, we were,
as a faith community, focused so much on sickness and death and burying people and burying people, we haven’t made the transition to helping people live
healthy, well, and long. That transition must happen now. We’ve gotta become conversant with the words viral
suppression and what that means, we need to understand what undetectable means
untransmittable means, and how that’s a joy that
we’ve all been praying for for 40 years. Now it’s here, we should celebrate it. (audience chuckling) And frankly, if we’re
not talking about prep in the same way that we might help in family planning conversations or in marital counseling
conversations around birth control and ways in which you don’t get pregnant, we gotta talk about ways
in which you don’t get HIV. I think the faith community
needs to have leaders within it who are holding up how modern
education about HIV/AIDS, health and wellness,
sexual health and wellness is where the future is
for ending this epidemic, both globally and nationally. – I should turn to the audience. Do any of the other three of you have something you’d
like to add right now? Okay. Please, there are mics in the back. If you just identify who you are and have a question in the form of a question, and perhaps pose it best
to one audience member. Right here. – Thank you, good morning. My name is Francesca Merico. I work for the World Council of Churches’ Ecumenical Advocacy Alliance
but I do not have a question. I have several comments (chuckling) because you made in your– – If you could be brief. – I cannot. (laughs) I will try.
(all laughing) I will try, though. The first point is I really
appreciated when Katherine spoke about the differences in faith communities and ways in which we
address and approach HIV. But I also want to add that it’s not only
about the different ways different faith communities address HIV. It’s also within the same
faith we have different ways to approach and deal with HIV. I want to give you one example. I was once, in 2005, in Thailand with the Daughters of
Charity and very young, and I remember a scene
that really changed my view of how Catholics can deal with HIV. The Daughters of Charity were
working with sex workers. I went into a room and
the sisters, the nuns, were on the top of the sex workers teaching them how to do massage. This was because they found
out that the best way for them to work with the sex workers, to talk and to teach them
about prevention methods, was to use the same, to help them to address their needs, their needs was to work
better with their clients. And that was really powerful for me. So, really, also within the same faith, different approaches. The other thing was about, we have, someone said we have
learned to talk about HIV. I think that we are really good at talking about HIV among us. We are terrible at communicating
and talking about HIV to young people and to
the outside community. And it’s not only to
blame the faith community. We are really not good
at finding good ways to talk with young people
but also to others, the general population and key population, and engage with them. This leads to the fact that
in Europe, for instance, there is a lot of ignorance around HIV, which is bringing a raise in HIV infection among young people. This leads me to what you said about the dialogues with
faith leaders and the youth. I think they are actually very important. But faith leaders should
be in dialogues with youth and talk about sex, not just
faith leaders and young people. We should do this in partnership with other civil society organization and other organization. That’s the best way to build
this capacity of faith leaders to deal around issues related to sex. (chuckling) And then the
last point, I promise, and it’s about the question on how do faith communities engage with people living with HIV and who represent the faith communities. I am sorry but I think
it’s the wrong question. Because what Sandy said at the beginning was about we should talk
about we and it is about us. There are people of faith
who are living with HIV. I remember once when the
UN Political Declaration on Ending AIDS was adopted in 2016, there was a beautiful panel at the UN when this question was raised. There was on the panel a sex worker, an injecting drug user, and transgender, and all they said, each one of them said, “I am a person of faith. “I go to church, I go to the mosque.” So, this divide is really not
helping us to work together. – I agree. What I’ve, we bring in other questions and if you want to speak to
some of those great observations in some of your other
answers, that you do so. – [Man] Over here. – Hello, I’m Reverend Mike Schuenemeyer with the United Church of
Christ, based in Cleveland, Ohio. My question is reflecting on the past. In 1988, the AIDS National… (audio system beeps) Sorry. In 1988, the AIDS National
Interfaith Network was created. Out of that, there were
some 2,300 HIV ministries in the United States
that grew out of that. Out of that also came the Council of Religious AIDS Networks. In 2000, we had a change
in the White House, significant change in
political and the ideology and the kind of religious ideologies that then became favored. AIDS National Interfaith
Network went out of existence. Funding for the Council
of Religious AIDS Networks also was redlined. And since that time, the
capacity of the faith community to work in the United States
has been greatly hampered. There just hasn’t been
a significant mechanism for being able to respond to HIV. I wonder if you might be able to reflect on how the influence
of religious ideologies in our political systems also affects and interferes oftentimes with the capacity of
faith to work effectively in the HIV response. – [Mark] Might you pick one
or two people on the panel you’d especially like to hear from? – Love to hear Jesse respond to that and I’d like to hear Ambassador Kolker respond to that, if you would. – I do believe that we do a great job of helping the sick and dying. In the last two decades,
at least domestically, HIV has been a lot less
about the sick and dying, and domestic religious communities have turned their attention, I think, more to the global pandemic
because of sick and dying but not to health and wellness and certainly not about
sexual health and wellness. In a world where 50% of Americans are going to experience divorce, and where Grindr and social media are the way in which
people are hooking up, straight and gay, Christian
and non, et cetera, the opportunities for us to actually break open the conversation around sexual health and
wellness is necessary, and I think faith leaders,
both lay and clergy, have got to get to the reality
of where we are in 2019. These are conversations
that have not been had and youth are thirsty
for someone to help them. But unless we’re willing,
as institutions, to do that, we may very well fall into a place that we don’t wanna be once again. And it’s not just HIV. It may be all the other 26 sexual diseases that we don’t talk about
that can live with you for the rest of your
life as well, (chuckles) herpes, et cetera, et cetera. So, that conversation has got to happen and I think it means that we
need to break the silence. – Jimmy or… – Sure, I’ll just add a couple things. First, the good news, I think, that PEPFAR really has been an exception to that rule, that what we’ve done globally
was by design separated with a separate budget,
a separate hierarchy, an ability of contributing funds, and has maintained the bipartisan support for 15 years now, which
is really exceptional. Having been an Obama appointee in HHS, it was very clear that
one of the frustrations of having worked in PEPFAR was that the domestic AIDS
response was so fragmented, very much subject to all politics as local people who wanted to recognize certain constituencies and not others and that the money was never consistent or that the vision was at the same level that I think we felt,
those who worked on PEPFAR, we were carrying out. What Dave’s book talks to
us about is complacency. The fact that we succeeded in many ways, that we don’t have
mother-to-child transmission, that many of these real
heartstring-tugging parts of the response are now done, makes the harder parts much more subject to ideologies and politics. If we’re complacent about
this, we are gonna lose. We have to realize the commonality of what we’re talking
about, just as Sandy said. – Other questions? Over here? – [Len] Yes, I’m Len Sperry from– – Um, okay. You and then the young
women in front of you – from Florida Atlantic
– to whom I was pointing. University where I’m a professor and director of clinical training. Our community is the largest home to individuals with HIV
in the United States. I’m talking about the Southeast Florida. We get the most Ryan White
grant funds anywhere. We’ve done some research
in our university. The first thing it showed
is that spirituality is a significant protective factor in individuals maintaining a healthy life status, which means viral load
that’s well controlled. Now, one of the things that is also of interest to us is that there’s a difference
between spirituality and religious affiliation
and religious behaviors. Many of the individuals in South Florida are not part of faith communities. But those that are have very quickly determined that some houses of religious practice are basically friendly toward them and they’ve quickly identified those that are not friendly, and the majority of faith communities in South Florida are not HIV-friendly. – [Mark] Could you arc towards a question for a panelist?
– Yes. Specifically, if Jesse
would respond to this, we have very little, and I
know very little research that’s being done at the federal level. I was at one of the CAIR center, the Center for AIDS Intervention Research, and those five centers have shrunk over the years. I’ve also been on the NIH committee on religion and HIV/AIDS, and we haven’t had an
RFP go out since 2005. So, we have essentially
– I’m sorry, I’m gonna have – no government money
– to ask you to pose your, I’m gonna have to ask you
to pose your question. – It is, right now.
– We need you to– – Why is it that these research funds are being cut off, Jesse? – The research budget at NIH has been flat for a while, and one of the great opportunities is for the increase of new
funding for NIH for research, as being proposed in
the president’s budget. I think that’s a great thing, and the opportunities for
more innovative research, including on the role
of the faith community, I think, is present. There has been some research, particularly among people
who are aging with HIV, done by New York City and
AIDS Project Los Angeles, that shows that people who
are aging with HIV over 50, 50, 60, to 70, one in four feel depressed, one in four feel isolated. And so, I think what you’re
describing around spirituality is very important because
the faith community can actually be a community where people can feel hope and support. I know that’s true for
me and I know that’s true for so many others who are living with HIV who are in faith communities. But if you’re newly diagnosed and over 50 or even if you’re newly diagnosed at 23, how can you find those pathways in if the faith community isn’t, once again, as we were doing with all the funerals, making it clear that you’re welcome here? But we haven’t done those in 25 years. So, how can we make it possible for people to feel that they are welcome
to be part of a community where spirituality is common
and where hope is provided? – I thank you for that because that really gets at
this key theme of this book of stigma and all human beings treated as being of value. It’s crucial to the response on HIV/AIDS, domestically and abroad, but it is where the faith community can really have open
arms and change minds. Right here, you had a question? – Thanks. My name is Gayatri. I’m actually in the
Georgetown-NIH partnership so I think this question about NIH funding is really interesting. My question is more so along the lines of how we can stop the new
forms of HIV transmissions, specifically among injection drug users in West Virginia and Appalachia where we’re seeing these
new forms of outbreaks that we’ve never seen before, and potentially using faith networks to mobilize support there, where there really is no
other type of infrastructure. I guess, what have been your experiences in kind of reigniting these
conversations in communities that have not seen these
problems for some time? And I guess, Jesse, and
I was wondering if Sandra could also comment on this because I thought you had
some great comments earlier. – Well, I’d welcome, in
asking Sandy to speak to this, that we talk about it at home, but maybe think also about any comments about the faith community with particular stigmatized populations where we know there is a high
vulnerability to HIV/AIDS, whether it’s the G and the T in LGBT or sex workers or drug injectors. – Yes. That’s a very important question. Increasingly, in our work, we have linked that anybody
that comes to our services have the right to receive those services as well as linkages. I think this new message of hope, caring not for the dying
but for the living, has really come, and having open dialogue, like the health talks we
have at church services, having people after church services to stay and counsel on things. Like the program I talked about, we implemented it in Zimbabwe. The entry point was HIV and AIDS, but the need of the
community was beyond that. The men were lining up for circumcision. The women were lining
up for cancer screening. Men were even looking for
screening for prostate cancer. So, comprehensive care
for that congregation. I felt that that’s a message
that every faith community should hear and let them pick
with what works best for them. For those communities, talking
about it makes it lot easier. Putting everything on the table or the pastor finding the right language to talk to his teenage or
teenagers in the congregation is a tough thing for them to do. But the good thing is that
we have other health workers who are there who have the right language and can communicate the right language in the right slogan for
these different age groups. We rally with them. Like the cancer screening,
it wasn’t done by the pastor, but they collaborated
with the health facility, came to these five, four congregations, mobilized women and men, the church volunteers mobilized women and women for those services. They expected 80 people
but 300 people turned up, and the services were not enough, all because the church was well-informed. And I think, even for
marginalized population and key population, we
need to talk about it because it’s real and it’s within us. Thank you. – Answering this good question,
we could hear from Sandy. – [Sandy] Sure. – Maybe from Jesse about
the West Virginia aspect. And hear from Katherine as
well on those getting reached. – Sure, that’s a really, really, oop. Oh dear, what happens, okay. That’s a really good question
and I appreciate that. I think one of the places where we’re really missing the boat as communities of faith at the moment is around this issue of addiction. And particularly in places like where we were normally not working, like West Virginia and rural parts of the, you know, in Indiana and all these places that we haven’t, we don’t
have a large presence. Part of that is attributed to
what Mike was talking about, that we used to have
much stronger networks around the country than we do now, and now we’re seeing that
we really need that again because we have a new epidemic, not the epidemic we had before, and figuring out how
we advocate for funding for these kinds of programs, and to educate people and work with religious
leaders on the ground. I mean, there are a couple things, and I’d love to talk more about this, around things like
addiction and sexuality. Nobody teaches that in seminary. So, these people, we keep
calling up religious leaders to talk about stuff that they have no capacity to talk about, and quite frankly we
haven’t done a good job of educating them. And you don’t get it in
your divinity schools and you don’t get it in
your working pastoral care. We don’t talk about these things that we’re calling on
people to talk about. So, it’s our job, as intermediaries and people who are in the
middle trying to do this work, to figure out how, if they’re not getting
it at the university, how we go out and actually provide people with the information that they need that’s difficult to talk about for them in their religious context, about, you know, around sex and addiction and so forth to do that. So, I think, what is this? What are you showing me? I’m old, I can’t see.
(Gloria chuckling) Oh. “People who use drugs are beloved by God.” We can always depend on you people to be out front with this.
(audience chuckling) (chuckling) Anyway, I think
that’s really important and something that we
all should talk about in the course of these next few days. – We could elicit an answer
from Jesse and Katherine to close out before we go to our break. – Thank you for raising that
because there are 220 counties in the United States that are
hotbeds for an outbreak of HIV based on injection drug use. But this is also an opportunity for us to stop talking only to the
left half of the faith community and to the right half
of the faith community, because Donald Trump has a
base of evangelical voters that live in those counties, and there are congregations
in those counties of multiple backgrounds that
have ignored their opportunity. Those of us who are involved for years in HIV/AIDS from the faith communities, we have the opportunity to talk to those public health authorities to say, “Have you thought about raising those?” Because, as Sandy just, we
can be the intermediaries. We don’t necessarily have to be those evangelical congregations, but we can be the intermediaries
to the health department to urge them to bring them to the table, and they might be more
easily brought to the table when they’re invited by us. – Katherine? – I think the discussion has highlighted that the HIV/AIDS challenge, epidemic has led us into new ways of thinking about
a lot of different issues, much broader issues, that relate to the role of
religion in society, et cetera. Clearly, one of the issues
that I think we’ve touched on but should highlight is sex education and the whole challenge around
what should people be taught in schools as well as in seminaries, and how do we get over some
of the fraught debates, the implication that teaching
people about their bodies, going to encourage promiscuity,
and some of the other myths. I think we also have touched
on some of the special issues of vulnerable communities,
clearly drug injecting. We haven’t mentioned people in prisons, which is clearly a big issue. Another area that I think we
need to be concerned about is refugees and migrants, where these are clearly
big issues and challenges. Finally, one of the myths in dealing with HIV/AIDS, even in the most pandemic countries, has been the assumption
that this had more to do with homosexuality and Western
approaches and whatever, all the myths around homosexuality, whereas, in fact, it’s a
disease that affects young women more than anyone else. Therefore, the issues of
rape, domestic violence, and basic understandings of relationships that involve women and their agency, which was one of the points
that we started with, is still, and it still is a major issue. You said some faith communities
are 25 years behind. This concept that men
and women are truly equal is one that still needs a lot of work. The HIV/AIDS epidemic has put that issue much more squarely into our consciousness but it’s not one that
a lot of organizations are dealing with in a practical way. – We’re gonna move to a break and we are pivoting to the question of looking forward to the future, which I hope we’ve laid
the groundwork for. I just wanted to note something. I’m with Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria. We cosponsored a report
with amfAR and AVAC, “Translating Progress Into Success “to End the AIDS Epidemic.” The faith community and hard evidence-based insights about what works are
not mutually exclusive. They are deeply connected. There are lessons from many
places around the world about what works and what vulnerable populations and methods for saving lives or helping people live long, healthy lives are being left on the table. I’d encourage you to grab one outside. We’re gonna have a break until 11 or so. You might have coffee and nibbles further. I really wanna thank
this rich array of people I have had the privilege
to join in this panel. (audience applauding)

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