Five years ago I traveled to Nairobi to witness firsthand the devastating toll of the AIDS pandemic. I walked the streets of Kibera with a group of courageous and compassionate community health workers. We visited the dilapidated homes of the sick and dying, offering our prayers, blankets, and food, lacking the power of modern medicine to save life. At that time only the most elite and privileged of Kenyan society could access the drugs that perform a Lazarus effect among people in the advanced stages of the disease. With startling clarity I realized the degree to which AIDS exposes the deep fault lines of social inequity in our world.
In 2001 USAID introduced a rapid HIV test that provides a result within minutes instead of days. In a country in which an estimated 10% of the adult population is living with HIV, I was struck by the fact that this voluntary testing and counseling center was almost empty. My traveling companion (a Kenyan woman that worked for Action AID) and I agreed to take the test (with much less fanfare than the recent test taken by Senator Barack Obama). The inequality of AIDS permeated our pre-counseling session as we were both asked how we would cope with the disease if the results were positive. I thought about the friends and family that would respond to my status with love and acceptance, and about the medical care I would receive as a result of my health care coverage in the States (this scenario in the States is also shaped by my socio-economic status). For Susan, a positive result likely translated into both a physical and social death sentence. Due to the prohibitive cost and inaccessibility of AIDS drugs, a positive result meant that HIV would inexorably lead to a lonely and painful death. The pervasive stigma and shame surrounding the disease also meant that a positive status could lead to a social death, characterized by ostracism, rejection, blame, and at worst, violence from one's partner, spouse, or family.
Five years later, in November of 2006, I toured the same dirt roads that form a maze across the temporary housing structures that make up Kibera, the largest slum in Kenya with an estimated million residents. While the face of abject poverty remained hauntingly the same due to the widespread lack of access to clean drinking water, joblessness, and poor santitation- progress made around the crisis of HIV/AIDS provides an exceptional beacon of hope. Medecins Sans Frontieres (Doctors Without Borders) now operates three clinics in Kibera that provide free AIDS and tuberculosis treatment to thousands of Kibera's poorest residents. I visited one of these clinics and was heartened to see the practical revolution that had taken place since 2001.
Many countries across the continent are turning the corner in the fight against HIV/AIDS. The recently released annual report of UNAIDS cites encouraging evidence that in seven African nations the prevalence rate has declined. These reversals are thanks in large part to breakthroughs in political and civic will from African governments as well as wealthy nations - including our own. Despite some initial challenges, the President's Emergency Plan for AIDS Relief (PEPFAR) had placed 561,000 people on Anti-Retroviral (ARV) treatment across Africa, Asia, and the Caribbean as of May 2006. The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria has also served as an indispensable vehicle for mobilizing dollars where they are needed most for scientifically sound prevention and treatment programs. In two years, access to treatment has increased tenfold across sub-Saharan Africa. However, the epidemic finds a way to outpace even our most accelerated response. Only 1 in 6 Africans in need of treatment currently have access. Significant barriers remain to making second line therapies more affordable and accessible to those in greatest need.
While in Kenya I attended a conference on treatment literacy with over 40 Christian leaders from nine different African nations, which was sponsored by the Ecumenical Pharmaceutical Network. While parts of the Christian church are still awakening from what has been a devastating slumber, a majority of churches are now responding with greater compassion, charity, and even calls for justice.
The theme of this year's World AIDS Day is accountability. Targets such as the pledge made by world leaders last year to achieve universal access to treatment by the year 2010, and the Millennium Development Goal to halt and reverse the spread of AIDS by 2015, are in serious danger of being sidelined or ignored. While we should celebrate the corner that has been turned around AIDS treatment, the church must redouble its leadership and prophetic voice to ensure that these targets are realized and the battle around prevention is won. Through its leadership and action we can provide the answer to the timeless question, "is there a balm in Gilead?"
Adam Taylor is director of campaigns and organizing at Sojourners/Call to Renewal.