Changing Our Outlook About HIV

Dear Friend,

As we commemorate World AIDS Day, I am struck by how our outlook has changed over the years that we have been fighting this pandemic.

I recall returning to Kenya in 1992 after a seven-year absence and hearing that so many of the Kenyans I had known had died. When I asked why, I was told it was tuberculosis, or pneumonia. When I probed a little deeper, I found they had died of AIDS. It was absolutely shocking. Back in those days, AIDS was a death sentence.

It was during these early days that Catholic Relief Services began to respond to the pandemic – within the complex context of Catholic teaching – with our first HIV project launched in Bangkok, Thailand, in 1986.

Our first efforts to respond to AIDS focused primarily on community-based care. The development of antiretroviral drug therapy, the so-called AIDS drug cocktail, was still a long way off. And even when it did become available in 1996, it was too expensive to be a viable option for resource-limited settings.

Then, Cardinal William Keeler, the archbishop of Baltimore, recommended that I speak with Dr. Robert Redfield of the University of Maryland's Institute for Human Virology, which had done groundbreaking research in the area of HIV and AIDS. Dr. Redfield met with a group of us at CRS in 2003 and made a powerful case that we should get involved in antiretroviral therapy. He made quite an impression. We just needed the right opportunity.

That opportunity arrived later in 2003 with the President's Emergency Plan for AIDS Relief (PEPFAR), historic legislation that pledged $15 billion over five years to bring antiretroviral therapy to the poorest nations around the world. CRS embarked on one of the most intense project planning and design exercises in memory in drafting our bid for the PEPFAR grant.

A CRS-led consortium was awarded a grant, but that was only the beginning. We still had to carry out what has become one of the most complex initiatives in CRS history.

It has also been one of our most rewarding experiences – to see miracles happen before our very eyes. I'll never forget the first time I saw our antiretroviral clinics in the field. Some years ago, I visited St. Mary's Hospital in Durban, South Africa. I met a woman who had come to the hospital to die. She had sold off everything she owned. She had said goodbye to her young children. And she had come to St. Mary's, prepared to accept her fate. But at the hospital, she was put on antiretroviral therapy. And when I met her, her fate had changed – dramatically. She was about to be released from the hospital, to start her life again. She was to be reunited with her children. And she had a set of issues she never thought she'd face: like how to restart her life, how to support her family. That she was alive and facing these issues was a miracle.

This miracle is being repeated thousands of times. Antiretroviral therapy is bringing hope to people where there was none. Families are being reunited. Fathers and mothers are able to resume working. Children are returning to school.

A recent study that got a bit of press called into question the effectiveness of antiretroviral therapy in very poor countries that have been wracked by HIV. The study said that only 60 percent of AIDS patients in Africa still took the drugs two years after starting treatment. But that has not been our experience. CRS' two-year retention rate is over 80 percent across the nine countries where we provide antiretroviral therapy, and is more than 90 percent in Nigeria and Rwanda.This flies in the face of conventional wisdom, which said that people from impoverished countries would not be able to follow such a strict drug regimen.

Next year, this lifesaving PEPFAR program will reach the end of its initial five years of funding. In the next six months, Congress will be making decisions to reauthorize this highly successful initiative.

With your support and prayers, we are confident that PEPFAR will continue for the next five years and beyond.

Ken Hackett

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