Hope springs eternal
By Elizabeth Ellis
South Africa stands on the brink of a humanitarian crisis as HIV infection rates creep up to 6% of the population. The World Bank has estimated that the rate of infection will result in a 1% drop in the gross domestic product of South Africa and will consume 75% of the country’s health budget by 2005. At current levels, South Africa will lose the equivalent of two generations of people within the next 20 to 50 years.
These are the statistics that HIV/Aids treatment and prevention programmes are battling, and it’s a battle against the clock.
Fr Stefan Hipler, the chairman of the HOPE project, which provides treatment, prevention training and care to HIV positive communities in Cape Town, said, “We are facing the prospect of national failure. If our future fails, our country fails.”
The HOPE project tackles these problems by working with existing provincial government structures to provide support for the infected and affected.
“One of the biggest problems in the fight against Aids is adherence and compliance,” said Fr Hippler. Health care workers are discovering more and more that entire families use the drugs and vitamins meant for one person. All the drugs are vital to the maintenance of an HIV positive patient’s immunity levels. “Or alternatively we discover that they take a few tablets, feel better, then stop the course.” This lack of adherence is causing a stronger, more resistant, strain of HIV to emerge.
“The government cannot face this fight alone,” said Fr Hippler, emphasising that the HOPE project believes in a unified approach.
“Adherence training should go hand in hand with the roll out of anti-retrovirals. We employ health care workers dedicated to ensuring compliance and adherence among patients.”
Adherence training forms a pivotal part of the HOPE project’s approach to HIV/Aids prevention, along with education and workshops designed to increase knowledge of the disease and defuse the stigma that continues to cloud it.
This is where Fr Hippler and the Church begin to disagree on the approach needed to treat the pandemic.
The Catholic church is largest caregiver to Aids sufferers after the state.
“So the Church is partly keeping the country running,” said Fr Hippler, “but it contributes to the problem presented by HIV/Aids, particularly the stigma surrounding it, through its moral teachings.”
Fr Hippler maintains that this affects how the Church approaches those affected by Aids, and how they approach the Church.
Although Vatican II allowed the Church to read the signs of the time and respond accordingly, a new theology and approach has not been adopted to deal with the HIV/Aids situation.
“The Church is largely standing by and watching, which does not match the requirements of this situation,” said Fr Hippler. “Our convictions must match the challenges and demands we are facing.”
The HOPE project began in 1999 in response to a request for a dedicated infectious disease ward from Tygerberg hospital Initially a Rotary project, in 2001 the German Catholic community became involved. The community felt that they should make a social contribution and give back to the community they live in.
Since then HOPE has become a collaboration between the community, the University of Stellenbosch, Tygerburg Academic hospital and the Signal Hill Rotary club.
“The HOPE project builds nothing, we only expand on what exists, we ask what is not being done and provide it.”
Although it is a non-governemntal organisation, the project is run with a strict business orientation. “We never begin any programme without the minimum of three years funding. We have a responsibility to run a proper NGO,” said Fr Hippler.
The project is completely privately funded and receives no subsidies from the government. Instead it reaches out to private companies such as the Arabella Sheraton Hotel. The company’s contribution goes towards a specific project, such as paying for a community health worker.
“That makes it personal; it puts a face to their contribution and makes it a lot harder for them to back out.”
The project receives no funding or involvement from the Church, but is run as a Catholic organisation. They have also received interest from parish in Milnerton, who wish to contribute in some way, the first parish in the archdiocese to do so. The project also liaises with the Catholic Aids Network to exchange ideas.
The HOPE project’s involvement in the fight against HIV/Aids has come a long way since the opening of the Ithemba ward at Tygerburg hospital. This ward brought together the expertise and research for the treatment of infectious diseases under one roof. The project has developed from this base, where it worked with the family clinic and KidsCru, which specialises in researching diseases affecting children.
“It has been an enormous success and has showed us what can be achieved. Its success also brought an enormous sense of responsibility.”
The project then expanded its reach through its outreach programme, a series of day clinics in communities affected by HIV/Aids. The clinics employ dedicated community health workers, paid for and provided by HOPE.
“This is where we provide the community with what the government isn’t doing. We stop up the gaps, and at the moment that particular gap is compliance and adherence training.”
The biggest programme that HOPE is currently involved with is the traditional healers pilot project, a programme focusing on training traditional healers to provide counseling and testing to afflicted communities.
“The benefits of getting the traditional healers involved are huge,” said Fr Hippler. “More people, especially men, will come in to be tested and be more prepared to make the plans and adjustments necessary for a family with an HIV positive member.”
Fr Hipler hopes that this will be another step towards the elimination of stigma.
The HOPE project arranged three workshops that brought together traditional healers from the Eastern and Western Cape.
“They were happy and grateful that their points of view were being considered. It brought worlds together, and concepts of sickness, the disease and the limits faced by both traditional and western medicine.”
The pilot project, which will be monitored by the University of Stellenbsoch, will allow traditional healers to be trained to do pre and post test counselling as well as administering HIV tests.
The tests the healers will be using are the approved non-blood tests, which tests the patient’s sputum and delivers a result within 20 minutes. These test results will then be corroborated by a health worker at a day clinic, who will then refer the patient back to the traditional healer for counselling. This counselling will work hand in hand with the treatment regimen that is administered through the clinics.
“We have to own this disease. So far we have only been dealing with Western solutions, we need an African solution,” said Fr Hippler. Working with traditional healers will provide a holistic approach that could be beneficial, particularly in rural communities. “It will allow the clashes between traditions to heal, and allow appropriate adjustments to be made on both sides.”
However, the HOPE project operates on the theory that the biggest contribution that can be made in the fight against HIV/Aids is a change in attitude.
“We have to change the moral attitude of the Church and the political attitude of the politicians,” said Fr Hippler. In order to fight the spread of the disease people need to get involved, to see and experience the burden Aids sufferers live with.
“Lots to do,” he sighes, “we still have a lot to do.”
The Southern Cross
Catholic weekly newspaper