8.Synopsis.Religious.Based.Initiatives

SYNOPSIS
HIV/AIDS Prevention and Control Series
Religious-Based
Initiatives
Series Editor
M. Ricardo Calderón
Latin America and Caribbean Regional Office
AIDSCAP/Family Health International
Project 936-5972.31-4692046
Contract HRN-5972-C-00-4001-00
The AIDS Control and Prevention
(AIDSCAP) Project, implemented by
Family Health International, is
funded by the United States Agency
for International Development.
2101 Wilson Blvd., Suite 700
Arlington, VA 22201
Tel: (703) 516-9779
Fax: (703) 516-0839

Family Health International (FHI) is a non-governmental
organization that works to improve reproductive health around
the world, with an emphasis on developing nations. Since 1991,
FHI has implemented the AIDS Control and Prevention
(AIDSCAP) Project, which is funded by the United States Agency
for International Development (USAID). FHI/AIDSCAP has
conducted HIV/AIDS prevention programs in 40 countries, and
the Latin America and Caribbean Regional Office (LACRO) has
implemented interventions in 14 countries within the region.
November 1997
For further information, contact:
2101 Wilson Blvd, Suite 700
Arlington,VA 22201
Telephone: (703) 516-9779
Fax: (703) 516-0839
Graphic Designer: Deborah Clark

The HIV/AIDS Prevention and Control SYNOPSIS Series
RELIGIOUS-BASED
INITIATIVES
Series Editor:
M. Ricardo Calderón
Arlington,VA, USA
Prepared by:
Magdalena Martínez
Anna Dulaney
MAP International–Latin America
Quito, Ecuador
Project Coordinator:
Mary L. Markowicz
Arlington,VA, USA
Published by the Latin America and Caribbean Regional Office of
The AIDS Control and Prevention (AIDSCAP) Project
Family Health International

The opinions expressed herein are those of the writer(s) and do not
necessarily reflect the views of USAID or Family Health International.
Excerpts from this booklet may be freely reproduced, acknowledging
FHI/AIDSCAP as the source.

T A B L E O F C O N T E N T S
Acronyms ii
Acknowledgements iii
Prologue v
Holographic Overview ix
Introduction 1
Social and Religious Context of HIV/AIDS in Latin America 5
Overview of HIV/AIDS in Latin America 5
Social Context: Gender, Policy,
Political and Economic Issues 6
Religious Context of the Region 11
Mainstreaming RBIs: Benefits at Low Cost 17
HIV/AIDS and the Church’s Mandate 17
HIV/AIDS Challenges the Church 25
Models of RBIs in Latin America 31
NGO Programs: Local Capacity Building 31
Church Congregation or Parish Programs:
Participatory Approaches 32
Network-based Programs: Collaborative Action 33
Hospital-based Programs: Care and Management 34
International Programs: Coalition Building 35
Achievements of RBIs in Latin America 37
Lessons Learned 41
Recommendations 47
References 49
TABLEOFCONTENTS

ii Religious-Based Initiatives
A C R O N Y M S
AIDS acquired immune deficiency syndrome
AIDSCAP AIDS Control and Prevention Project
CBO community-based organization
FHI Family Health International
HIV human immunodeficiency virus
LAC Latin America and the Caribbean
LACRO Latin America and Caribbean Regional Office
MAP-ESA MAP International–East and Southern Africa
MAP-LA MAP International–Latin America
MOH Ministry of Health
NACP National AIDS Control Program
NGO non-governmental organization
PAHO Pan American Health Organization
PVO private voluntary organization
RBI religious-based initiative
STI sexually transmitted infection
USAID United States Agency for International Development
WHO World Health Organization

Acknowledgements iii
A C K N O W L E D G E M E N T S
We would like to acknowledge and recognize the contributions,
work and efforts of the Implementing Agencies — NGOs, PVOs,
CBOs, NACPs/MOH, Social Security Institutes, and private sector
enterprises — with whom LACRO has worked and for all that we
have learned and accomplished together in HIV/AIDS prevention
and control.
We are especially grateful to Magdalena Martínez and Anna
Dulaney of MAP International-Latin America for writing this
booklet. They, in turn, would like to express their gratitude to
the following MAP International personnel for their editorial
and research assistance: Lic. Mauricio Solis, Latin American
Regional Director; Ms. Ndunge Kiiti,Associate on study leave
from MAP East and Southern Africa; John Butin, Director of
Program Planning and Coordination; and Susan Reeves, Director
of Grants Funding. MAP International is a non-profit relief and
development organization that promotes the total health of
people living in the world’s poorest communities. MAP
(Medical Assistance Programs) works alongside others in com-
munity health development, disease prevention and eradica-
tion, relief and rehabilitation, and global health advocacy. For
further information, contact: MAP International, 2200 Glynco
Parkway, P.O. Box 215000, Brunswick, GA 31521-5000
Telephone: (912) 265-6010.
We take this opportunity to also thank all the staff members
of AIDSCAP/LACRO, including former staff members, for their
overall support and assistance to LACRO activities: Joseph
Amon, Lee Arnette, Mimi Binns, Oly Bracho, Marianne Burkhart,
Rebecca Coleman, Mark Chorna, Genie Liska, Cathy Mamedes,
Mary L. Markowicz, Robert Martínez, Mary Kay McGeown, Steve
Mobley, Manuel Mongalo, Polly Mott, Sara Padilla, Marvelín
Parsons,Amparo Pinzón, Luis Rodríguez, Melissa Rosenberger,
Diana Santos, Isabel Stout, Molly Strachan, and Oscar Viganó.
In addition, we express our appreciation to the AIDSCAP LAC
Resident Advisors: Catherine Brokenshire, Jamaica; Martha Butler
ACKNOWLEDGEMENTS

iv Religious-Based Initiatives
de Lister, Dominican Republic; Eddy Genece, Haiti; Gale Hall,
Jamaica; Jorge Higuero Crespo, Honduras; and Maria Eugenia
Lemos Fernandes, Brazil; and other AIDSCAP staff for their
insights and contributions.We are grateful to Peter Lamptey, FHI
Senior Vice President of AIDS Programs and Project Director of
AIDSCAP, and Tony Schwarzwalder, Deputy Project Director of
AIDSCAP, for their continued support of LACRO activities.
Finally, we wish to extend our gratitude and appreciation to the
USAID Global Bureau’s HIV/AIDS Division, field Missions in Latin
America and the Caribbean, and to the Population, Health and
Nutrition Team in the Office of Regional Sustainable
Development of the USAID LAC Bureau, particularly James B.
Sitrick, Jr., for the support and funding of the Information
Dissemination Initiative and other LACRO programs.

P R O L O G U E
The HIV/AIDS Prevention and Control Series, SYNOPSIS, is a sum-
mary of the lessons learned by the Latin America and Caribbean
Regional Office (LACRO) of the AIDS Control and Prevention
(AIDSCAP) Project. AIDSCAP is implemented by Family Health
International (FHI) and funded by the United States Agency for
International Development (USAID). The series is a program
activity of the LACRO Information Dissemination Initiative and
was created with several goals in mind:
to highlight the lessons learned regarding program design,
implementation, management and evaluation based on five
years of HIV/AIDS prevention and control experience in
LAC countries
to serve as a brief theoretical and practical reference
regarding prevention interventions for HIV/AIDS and
other sexually transmitted infections (STIs) for program
managers, government officials and community leaders,
non-governmental organizations (NGOs), private voluntary
organizations (PVOs), policy and decision makers, opinion
leaders, and members of the donor community
to provide expert information and guidance regarding cur-
rent technical strategies and best practices, including a dis-
cussion of other critical issues surrounding HIV/AIDS/STI
programming
to share lessons learned within the region for adaptation
or replication in other countries or regions
to advance new technical strategies that must be taken
into consideration in order to design and implement more
effective prevention and control interventions
to advocate a holistic and multidimensional approach to
HIV/AIDS prevention and control as the only way to effec-
tively stem the tide and impact of the pandemic
Prologue v
PROLOGUE

vi Religious-Based Initiatives
AIDSCAP (1991-1997) was originally designed to apply the
lessons learned from previous successful small-scale prevention
projects (1987-1991) to develop comprehensive programs to
reduce the sexual transmission of HIV, the primary mode of trans-
mission of the virus.AIDSCAP applied three primary strategies —
Behavior Change Communication, STD Prevention and Control,
and Condom Programming — along with supporting strategies of
Behavioral Research, Policy Development and Evaluation.
The success of this approach, based on the combination of strate-
gies and targeted interventions, has been widely documented.
The AIDSCAP Project, in fact, has been recognized as among the
best and most powerful international HIV/AIDS prevention pro-
grams to date.1
AIDSCAP has worked with over 500 NGOs, gov-
ernment agencies, community groups and universities in more
than 40 countries; trained more than 180,000 people; produced
and disseminated some 5.8 million printed materials, videos, dra-
mas, television and radio programs, and advertisements; reached
almost 19 million people; and distributed more than 254 million
condoms.2
However, the pandemic continues to escalate at a rate that out-
paces our successes. Thus, we need to build upon these suc-
cesses, learn from our experiences, and determine what has
worked and what is missing in order to respond with added
effect in the future.The magnitude and severity of the HIV/AIDS
pandemic calls for boldness, flexibility, wisdom and openness.
The world cannot afford to continue to fight HIV/AIDS only
with current thinking and tools. We must look toward new
thinking and strategies that complement and carry the current
state-of-the-art approaches forward in the fight against HIV
infection.
Therefore, LACRO endorses, promotes and elevates Gender
Sensitive Initiatives (GSIs), Civil-Military Collaboration (CMC),
Religious-Based Initiatives (RBIs), and Care & Management
(C&M) as the new prototype of technical strategies that must be
incorporated on par with the strategies that have been imple-
mented to date. Walls, barriers and biases have to come down in

Prologue vii
order to unlock the strengths, benefits, potential, synergy and/or
resources of GSIs, CMC, RBIs and C&M.
More importantly, approaches that compartmentalize strategies
can no longer be justified. Despite the efforts to integrate and
coordinate amongst and between technical strategies and differ-
ent sectors of society, prevention programming is barely scratch-
ing the surface of what a real comprehensive effort should be.
One of the most important lessons learned about HIV/AIDS is
that it is not only a medical problem, nor is it exclusively a pub-
lic health problem. Rather, the pandemic is in addition a socioe-
conomic problem and, as such, threatens both the sustainable
development of developing countries and challenges the ethical
foundations of the developed world. HIV/AIDS has become a
challenge to health, development and humanity.
For lasting success, a genuine multidimensional approach is
urgently needed. One that demands new forms of wealth distri-
bution, educational opportunities and development; attempts to
resolve the inequalities in gender and power; acknowledges the
individual, environmental, structural and superstructural causes
of and solutions for the pandemic; and aims to balance the dis-
parity between the “haves” and the “have-nots,” resulting in more
sustainable, equitable, effective and compassionate efforts.
Therefore, the SYNOPSIS Series reaffirms that current HIV/AIDS
prevention and control strategies work, and contends that new
technical strategies are needed and can be effective and com-
plementary. The Series also strongly advocates for, and will dis-
cuss in a separate issue, the Multidimensional Model (MM) for
the prevention and control of the pandemic. This model must
guide national, regional and international planning and program-
ming in order to achieve measurable and significant gains that
can truly effect changes at the individual, societal, environmen-
tal and structural levels.
We trust the reader will be open to our futuristic thinking and
will contribute to the further development of the strategies pre-
sented here as well as others. We hope the SYNOPSIS Series

viii Religious-Based Initiatives
will stimulate discussion and reflection, propel continued dia-
logue, and encourage the pioneering of new combinations of
innovative approaches.
M. Ricardo Calderón, MD, MPH, FPMER.
Regional Director

Holographic Overview ix
H O L O G R A P H I C O V E R V I E W :
This SYNOPSIS booklet discusses the importance of religious-
based initiatives (RBIs) through a holographic approach.
Holography is a special photographic technique that produces
images of three dimensional objects. This photographic record is
called a hologram, and one of its main applications is that any
fragment of the hologram can regenerate the entire image, even if
the fragment is extremely small. In other words, if a negative
from an ordinary picture is cut into two, the print from each half
would only show half of the picture. Conversely, if a holographic
negative is cut in two, the print from each half would show the
entire picture. If these halves are cut again, the print from any
one of the pieces will reconstruct the whole picture.3, 4, 5
Utilizing the holographic model, this booklet was written such
that any one of the sections (holograms) will provide the reader
with an understanding of the whole subject matter. First, we
describe the entire strategy or topic of discussion in one sen-
tence, the widespread definition and/or our own definition of the
subject (Hologram 1). Next, we present a one-paragraph abstract
of the topic (Hologram 2), expanding upon the original defini-
tion. Then, we present the topic by providing a summary or reca-
pitulation of the main points of each of the sections of the book-
let (Hologram 3). Finally, the entire strategy is again presented by
virtue of the complete text of the booklet (Hologram 4).
We anticipate that the Holographic Overview of Religious-Based
Initiatives will benefit both the seasoned professional and the
novice. It provides a quick, general overview of RBIs as well as
context and background. It also directs the reader to specific sec-
tions that may be of greatest interest or that the reader would like
to review first or at a later date. Thus, we hope this approach will
enable the reader to make fuller use of the booklet as a reference
guide, as it provides a simple and concise definition of RBIs, a
brief description of the topic, a summary of the discussion, and
finally, the complete text — all in one document.
HOLOGRAPHICOVERVIEW

x Religious-Based Initiatives
The reader should note that while we have tried to include the
key issues surrounding RBIs in this SYNOPSIS, the booklet is not
meant as an exhaustive discussion of all of the issues regarding
the strategic role of the church in the fight against HIV/AIDS.
T h e W h o l e S t r a t e g y
Hologram 1: The Definition
Religious-Based Initiatives (RBIs) in HIV/AIDS prevention and
care represent the efforts of religious institutions to work
together with individuals, families and communities, as well as
multilateral, governmental and non-governmental organizations,
to transform the conditions that promote, in a sustainable way,
their physical, emotional, economic, social, environmental and
spiritual well-being.
Hologram 2: The Abstract
Religion plays a critical role in the lives of Latin Americans. The
strong influence of Church leaders in politics and society, the
presence of Churches in most communities, and the approxi-
mate 88 percent of Latin Americans who identify themselves as
Catholics (75 percent) or Protestants (13.7 percent) make reli-
gious-based initiatives a uniquely effective and needed partner
to combat HIV/AIDS. RBIs fill a strategic niche in the struggle
against HIV/AIDS globally. When properly supported and coor-
dinated, they can be some of the most strategic prevention and
control vehicles through which to slow the spread of the pan-
demic. Some sectors of the Church will undoubtedly continue
to be challenged to overcome their prejudice against people
with HIV/AIDS. However, the magnitude and severity of the
pandemic is pressuring both religious and secular institutions to
modify their ways of responding to HIV/AIDS; to effect changes
within their structures, beliefs and practices; and to find their
commonalities and complementarities. The involvement of the
Church in HIV/AIDS prevention and care is critical not only for

Holographic Overview xi
society but for the Church as well. The Church has the infra-
structure, means and mandate to combat HIV/AIDS, yet much of
its vast potential and resources remain untapped to date.
Multilateral, governmental and non-governmental organizations
working in HIV/AIDS must escalate to a new level of partner-
ship and collaboration for enhanced effectiveness and wider
impact. Moreover, failure to mobilize and utilize this foundation-
al institution of Latin American society would almost surely
mean failure in the struggle to promote truly effective preven-
tion and control efforts within the region.
Hologram 3: The Summary
Social and Religious Context
of HIV/AIDS in Latin America
HIV/AIDS is spreading consistently and rapidly in all countries
in Latin America. It does not discriminate by sex, age, occupa-
tion, religion, geography or economics. Although only 13 per-
cent of the number of people currently living with HIV/AIDS
worldwide are found in Latin America, the fact that this number
is growing by 25 percent each year is of grave concern.The
increasing incidence of transmission among the general popula-
tion demands that everyone become involved in responding to
HIV/AIDS. However, the social context of HIV/AIDS in the
region is complicated by gender, policy, political and economic
issues. Cultural, biological, religious and economic factors
strongly impact the vulnerability of women to HIV/AIDS within
the region. Open discussion towards just and rational policy-
making around HIV/AIDS has been difficult. Scarce resources
for prevention and care have been the rule rather than the
exception. As more members of the Church are living with
HIV/AIDS, the Church is increasingly being challenged and moti-
vated to develop prevention and care strategies and to include
these individuals in the life of their congregations. Rather than
condemning others, the Church is studying how HIV/AIDS can
be a “chance to express the grace of God.”

xii Religious-Based Initiatives
Mainstreaming RBIs: Benefits at a Low Cost
RBIs are pivotal to the success of prevention and care efforts in
Latin America as well as globally. Churches are found in nearly
all communities in the region and wield a significant level of
cultural, political, social, educational and economic influence.
The Church can be viewed as the largest, most stable and most
extensively dispersed non-governmental organization in any
country. Churches are respected within communities and most
have existing resources, structures and systems upon which to
build.They possess the human, physical, technical and financial
resources needed to support and implement small and large-
scale initiatives. They can undertake these actions in a very
cost-effective manner, due to their ability to leverage volunteer
and other resources with minimal effort. Unfortunately, the
resources, capabilities and potential of the Church are consider-
ably neglected or untapped, and it has not been considered part
of the solution and/or a driving force in the fight against
HIV/AIDS. Religious leaders and institutions have a powerful
voice in society, encourage greater focus on belief and value
change efforts, promote policymaking that includes the whole
“family unit,” and foster and provide access to care for those
affected by HIV/AIDS. On the other hand, the Church is chal-
lenged by HIV/AIDS. In order to maximize the Church’s poten-
tial contribution, both the Church and those organizations part-
nering with it must overcome two main challenges — the need
for institutional and structural change within the Church and
the need for “limited domain collaboration” concerning preven-
tion and control strategies adopted by RBIs.
Models of RBIs in Latin America
Current religious-based interventions taking place in Latin
America are generally not well known. However, they are hav-
ing a profound impact on HIV/AIDS programming within the
region. A sample of the different types of models and efforts
presently underway in Latin America can be categorized as fol-
lows: a) local capacity building through NGO programs in
Chile,Venezuela and Ecuador; b) participatory approaches
through church congregation or parish programs in Argentina,
Colombia, Ecuador and Honduras; c) collaborative actions

Holographic Overview xiii
through network-based programs in Ecuador, Panama,
Guatemala and the Dominican Republic; d) care and manage-
ment through hospital-based programs in Ecuador, Honduras
and Brazil; and e) coalition building through international pro-
grams, such as the work of MAP International in Latin America
and Africa, and WHO/PAHO in Central America.
Achievements of RBIs in Latin America
Foremost among the achievements of RBIs has been the
Church’s ability to encourage voluntarism and to leverage
resources in the fight against HIV/AIDS. Many Christian NGOs,
churches and parishes, as well as Christian networks and/or
Christian hospitals, have stepped forward to combat the pan-
demic and to give hope to those who are affected by it. Church
pastors, priests and congregations are increasingly changing
their attitudes towards people living with HIV/AIDS. Local con-
gregations have participated in marches, all-night vigils, health
campaigns and World AIDS Day celebrations. The Church is fill-
ing a gap that exists for people living with HIV/AIDS —that of
responding to their spiritual needs and questions about suffer-
ing and death. In the absence of the most advanced treatments
in the developing world,AIDS remains a death sentence and,
thus, the greater need for emotional and spiritual support. Local
churches may be the only place where people receive under-
standing, compassion and answers to their complex questions
and situations. HIV/AIDS has led Catholic, Evangelical and
Episcopal churches to work together and commit to concrete
interdenominational actions. Collaboration between health pro-
fessionals and people from the religious sector advocates for a
holistic approach to address the variety of needs of people liv-
ing with HIV/AIDS, primarily the integration of spiritual and
emotional health needs with the bio-medical ones. Regional
efforts coordinated by international agencies or development
organizations allow for the exchange of experiences and lessons
learned.

xiv Religious-Based Initiatives
Lessons Learned
A certain degree of mutual distrust remains between the
Church and many multilateral, governmental and non-govern-
mental organizations in Latin America, despite their many shared
goals in the struggle against HIV/AIDS. However, RBIs can have
a powerful impact on public policy and need to be mobilized as
an important part of any HIV/AIDS effort. RBIs in the region
have shown the effectiveness of using different communication
strategies to reach different population segments. Training
materials that respect denominational and church context differ-
ences and that focus on topics of sexuality, counseling and pas-
toral support are proving effective in fighting HIV/AIDS.
Positive changes in attitudes and perspectives have occurred in
churches and other affiliated groups working on health issues in
the region, but conceptual barriers to collaboration in HIV/AIDS
work still exist. RBIs already working in HIV/AIDS can play a
key educational role in facilitating further growth and openness
within these Churches and institutions.
Difficult ethical issues raised by certain strategies, such as the
promotion of condom use, can be resolved sufficiently to allow
collaboration and compromise, if addressed openly and with
mutual respect. Agreeing to limit the range of cooperation to
the issue at hand and to set aside other areas of disagreement
can perhaps defuse some of the tensions inherent in collabora-
tion among diverse groups and foster cooperation. Genuine
debate and action concerning how the Church in Latin America
can best show solidarity with those living with HIV/AIDS and
their families is sorely needed. The strengths and achievements
of RBIs to date — interdenominational action, high rate of vol-
untarism, changes in church and health personnel towards a
more holistic attitude and so forth — can be the building blocks
for future coordination between the Church and multilateral,
governmental and other non-governmental efforts in Latin
America. In brief, the fundamental point regarding HIV/AIDS is
that the response of Christian communities to the pandemic
should above all be based on compassion and a commitment to
serve others.

Holographic Overview xv
Recommendations
The Church and multilateral, governmental and non-governmen-
tal organizations have a great deal to offer each other by part-
nering in the struggle against HIV/AIDS through religious-based
initiatives. The Church can gain new tools, perspectives and
partners with which to pursue its responsibility towards the
community, and multilateral and other non-religious efforts can
gain an effective ally in the Church — an institution with vast
reach, resources and potential for impacting prevention and
care in the region. Recommendations for future HIV/AIDS pre-
vention and care programming and partnering include: a) an
open dialogue and compromise to replace any lingering mis-
trust and separation between religious-based and non-religious
international, national and local efforts; b) the participation of
RBIs in the development of HIV/AIDS related legislation and
policies, particularly as they focus on justice and dignity; c)
greater resources allocated for the production and distribution
of educational and training materials specifically designed for
use by Churches; d) development of partnerships between reli-
gious and secular institutions based on mutual respect, flexibili-
ty, and the commitment to cooperate towards limited, mutually-
agreeable goals; e) pursuit of enhanced coordination and net-
working within the Church and across lines of denomination;
and f) increased allocation of resources and support to those
RBIs committed to the compassionate care of individuals living
with HIV/AIDS and their families.

Hologram 4: The Detailed Description
I N T R O D U C T I O N
This booklet, a collaborative production of AIDSCAP/LACRO and
MAP International, is written with two primary purposes. First, it
attempts to increase awareness within the international health
community of the strategic niche that
religious-based initiatives (RBIs) are fill-
ing in the struggle against HIV/AIDS
globally, with particular emphasis on
Latin America. Secondly, it urges the
Church and multilateral, governmental
and non-governmental organizations
working in HIV/AIDS prevention and
care to move to a new level of partner-
ship and collaboration for enhanced
effectiveness and wider impact.
The booklet draws from the experi-
ence of both AIDSCAP and the Latin
American Office of MAP International,
based in Quito, Ecuador. One focus of
MAP International’s work in Latin
America is to encourage and support
the Church to be more involved in
total health issues, including respond-
ing to the HIV/AIDS pandemic. MAP
International’s collaborative work
throughout Latin America in mobiliz-
ing churches and other religious insti-
tutions for total health development
has demonstrated that RBIs have a key
role to play in an integrated strategy to
combat HIV/AIDS in the region.
Introduction 1
INTRODUCTION
Religious-based initiatives,
when properly supported and
coordinated, can be some of
the most strategic vehicles
through which to slow the
spread of HIV/AIDS. Moreover,
failure to mobilize and utilize
this foundational institution of
Latin American society would
almost surely mean failure in
the struggle to promote truly
effective and penetrating pre-
vention efforts in the region.

Religious-based initiatives, when properly supported and coordi-
nated, can be some of the most strategic vehicles through which
to slow the spread of HIV/AIDS. Particularly in Latin America, the
almost 88 percent Christian population, the presence of Churches
in most communities, and the strong
influence of Church leaders in politics
and society, make RBIs a uniquely effec-
tive partner to combat this pandemic.
Moreover, failure to mobilize and utilize
this foundational institution of Latin
American society would almost surely
mean failure in the struggle to promote
truly effective and penetrating preven-
tion efforts in the region.
The involvement of the Church in the
prevention and care of HIV/AIDS is crit-
ical not only for society, but for the
Latin American Church as well. The reli-
gious values they espouse lead many of
these initiatives to focus on prevention
— through promoting sustained value
and behavior change through modifying
beliefs — as well as care — through
compassionate outreach or in-house pastoral or physical health
care for those affected by HIV/AIDS. This dual focus provides a
unique opportunity for leveraging of resources and strengths that
can complement other ongoing efforts to develop strategies in
the region.
As this booklet demonstrates, the Church in Latin America already
has the infrastructure, means and mandate to tackle HIV/AIDS
ministry effectively. Increasingly, as more RBIs in the region
become active in various forms of ministry in this area, the
Church will only grow in its capacity to implement distinct initia-
tives and also to serve as an effective partner with others in this
struggle. Policy makers, program managers, donors, and commu-
nity and government leaders will continue to recognize the bene-
fits and resources to be gained from working with RBIs.
2 Religious-Based Initiatives
“Total health” is “the capacity
of individuals, families and
communities to work together
to transform the conditions that
promote, in a sustainable way,
their physical, emotional, eco-
nomic, social, environmental
and spiritual well-being.”

Introduction 3
This booklet begins with a general review of HIV/AIDS and the
social and religious context in Latin America. Next, the strengths
and strategic advantages of religious-based initiatives are summa-
rized, followed by an analysis of RBI models active in the region
as well as highlights of their achievements. Finally, major lessons
learned are presented along with practical recommendations
encouraging collaboration between the Church and other organi-
zations working in HIV/AIDS prevention and care.
For the purposes of this booklet, the term“Latin America”refers
to the following countries: Argentina, Belize, Brazil, Bolivia,
Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, El
Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama,
Paraguay, Peru, Puerto Rico, Uruguay and Venezuela. To date, the
most well-known religious-based initiatives working in HIV/AIDS
prevention and care in Latin America have been coordinated by
either Catholic or Protestant groups. Therefore, the use of the
term “religious-based initiatives”refers to the work of these
groups, and“the Church”refers specifically to the Catholic or
Protestant churches, unless otherwise stated. Finally, as MAP
International defines it,“total health”is“the capacity of individu-
als, families and communities to work together to transform the
conditions that promote, in a sustainable way, their physical, emo-
tional, economic, social, environmental and spiritual well-being.”

S O C I A L A N D R E L I G I O U S
C O N T E X T O F H I V / A I D S
I N L A T I N A M E R I C A
Overview of HIV/AIDS in Latin America
In a progression now well-documented, the world was surprised
by an emerging new health risk during the late 1970s and early
1980s — HIV/AIDS. At first, attempts to address the epidemic in
the larger community and mainstream societal levels were ham-
pered by the sense that HIV/AIDS in the Western World first
affected groups known for their“anti-social”or risky conduct —
sex-workers, homosexuals and drug users — persons whom the
general society preferred to ignore.
As predicted, however, HIV/AIDS has since passed into the gener-
al population. It does not discriminate by sex, age, religion, geog-
raphy or economics. As we approach the end of the twentieth
century, HIV/AIDS holds a place in public health efforts like no
other pandemic in recent decades. While the search for a cure
continues, the past two decades have witnessed a disproportion-
ate impact of this pandemic in the poorest regions of the world
— Africa,Asia and Latin America.
According to the World Health Organization’s Regional Program of
AIDS/STDs June 1997 report,there are an estimated 29.4 million
accumulated HIV infections worldwide. Of the 1.6 million report-
ed AIDS cases around the globe,half of these (almost 800,000) are
in the Americas.6
The differences between reported cases and esti-
mations of accumulated infections show that there is a great deal
of misdiagnosis,delayed reporting and underreporting.
Of the cases in the Americas, two thirds are in North America and
one third are in the South, but it is predicted that within a few
years this ratio will be reversed.7
Although the number of people
currently living with HIV/AIDS in Latin America may be a relative-
ly small portion of the total global cases (around 13 percent), the
fact that this number is growing by 25 percent each year is of
grave concern.6
SOCIALANDRELIGIOUSCONTEXT
OFHIV/AIDSINLATINAMERICA

There are marked differences in the incidence of HIV/AIDS
among countries and sub-regions in Latin America, but it is clear
that the pandemic is now spreading rapidly in all areas of the
region. In 1996, Honduras had the highest ratio of cases per
million inhabitants at 168.9, with Belize second at 129.6. Brazil
and Mexico reported the largest number of AIDS cases in Latin
America, but they represent a relatively lower rate of 95.2 and
46.0 cases per million population, respectively.8
The principal modes of transmission in the region are believed
to be various forms of risky sexual contact (including prostitu-
tion and unprotected heterosexual or
homosexual intercourse with multiple
partners), needle-sharing during drug
use, and blood transfusions. Research
indicates that throughout the region,
AIDS cases are rising most rapidly
through heterosexual contact. 9
Social Context: Gender, Policy,
Political and Economic Issues
Gender
Throughout the region, there is
increasing cognizance of the particular
vulnerability of women to the HIV
virus. The WHO reports that world-
wide, almost 50 percent of people
infected with HIV are now women and
that this population group is the
fastest growing segment of the
HIV/AIDS population.6
A report from a
recent international conference on
HIV/AIDS stated that in South America,
“immediate and targeted attention to
women in the general population and
adolescents is now required, as these
subsets become the groups most vulnerable in the current
phase of the pandemic.”10
Throughout the region, there is
increasing cognizance of the
particular vulnerability of
women to the HIV virus. The
WHO reports that worldwide,
almost 50 percent of people
infected with HIV are now
women and that this population
group is the fastest growing
segment of the HIV/AIDS
population.6

Cultural, biological, religious and economic factors strongly
impact the vulnerability of women to HIV/AIDS in Latin
America — and RBIs hold unique resources for addressing these
factors:
“Machismo” culture. Traditions that establish different norms
and patterns of conduct for the sexes, often tacitly or overtly
legitimated by various religious groups, may easily translate
into inequalities for women and subjection to men.
Inequality of educational opportunities, the persistence of
traditional gender roles, and the dependence and lack of
social power of women, all have serious consequences for
the vulnerability of women to HIV/AIDS. Church groups
committed to transforming the subtle religious support given
to “machismo” in the region can play an important role in
beginning lasting cultural change.
Biology. Typically, Latin American women marry at a young
age (many before the age of 17) and often to much older
men. At this age, women may be physiologically more vulner-
able to STIs due to the effects of hormonal changes on the
genital mucosa. Transmission of STIs, including HIV, is more
efficient from male to female than vice versa. A pregnant
woman infected with HIV has a 25-40 percent chance of
passing on the virus to her child — requiring her to confront
her own death as well as the risk she has transferred to her
child.11
The Church needs to recognize this innate vulnerabil-
ity as worthy of special efforts to enhance protection and
communal care for women.
Religion. The Church and some of the traditional religions of
the region have contributed in varying degrees to the cultur-
al construction of sexual taboo myths that in practice apply
more harshly to women.Within the Church, a woman is nor-
mally assumed to be a virgin when she marries, yet a man is
“expected” to have some sexual experience. A young
woman’s self esteem may be further damaged by church
teachings emphasizing Eve as the cause of Adam’s original
sin, thus “responsible” for the sin of all subsequent genera-
tions. Restrictions on the leadership role of women in Latin

American churches vary widely among congregations and
denominations, and this too is often demeaning for women.
Churches committed to promoting changes in these areas
from within the institution need support and partnership.
Economy. Widespread rural migration and poverty have
exerted pressure on men to leave their families for long peri-
ods in search of work in the city or in other countries.This
often leads to extra-marital sexual relationships, placing the
man at risk of contracting STIs or HIV/AIDS. When this man
returns to his home, he may then transmit the infection
unknowingly to his wife. In Ecuador, for example, this is par-
ticularly true among the indigenous population living in the
Laura, like many women, did not know the sexual practices of her husband outside
of their marriage relationship. Laura was not aware that she was at risk. She could
not question her husband about his sexual conduct, because if she did, she exposed
herself to the possibility of physical or psycho-emotional violence. Laura could not
ask her husband to use a condom because this would be seen by him as an affront
to his masculinity. Due to cultural norms, she was also unable to use a “female con-
dom” as a means of protecting her life. Laura’s only “mistake” was being faithful to
her husband, and although he knew he was dying, he hid the reason from her until it
was too late. One year later, she was diagnosed as HIV positive. Clearly, cultural
issues regarding the self-esteem of men and women and a generalized lack of regard
for women in society, greatly increased Laura’s likelihood of acquiring HIV/AIDS
from her husband.13

region of Cañar, where the increase in AIDS cases in the past
four years is directly attributed by doctors there to the
increase of migration by men to coastal cities in Ecuador or
to the United States.12
Public Policy
Over the years since the appearance of HIV/AIDS in Latin
America, an array of government policies related to issues sur-
rounding HIV/AIDS have been proposed to balance the compet-
ing demands of varied interest groups — medical and health
care professionals, government institutions, non-governmental
organizations, the mass media, public opinion and the wide
diversity of church-related constituencies in the region.14
Given
the variety and intensity of the challenges presented by the
Latin American social context, open discussion towards just and
rational policy-making around HIV/AIDS has been difficult.
Attempts to create coherent public policy capable of aiding in
the prevention and control of HIV/AIDS transmission have met
with a number of obstacles that have often impeded the imple-
mentation of these policies, including:
Loss of continuity. Frequent changes in government, leading
to the replacement of “old” health programs and personnel
with “new” ones with different emphases and HIV/AIDS pre-
vention strategies, create a serious impediment. For example,
the first attempt at legislating a new law related to HIV/AIDS
in Honduras, debated in that country’s Congress in 1991,
failed precisely due to a change in government.15
Under-funded health budgets. A precarious health budget is
a problem found in many countries — only in the past few
years has HIV/AIDS become part of national health agendas
in most of Latin America.16
In Ecuador, for example, the
health program of the current government constitutes only
two percent of the overall budget, and the AIDS program is
one of the last stated priorities within this health budget.17
In the Dominican Republic, PROCETS (the principal govern-
ment agency of AIDS education) has a monthly budget of less

than $7,000 for its activities — sorely inadequate to its task.
A combination of complex factors, including tremendous
external debt commitments, the priority of attending to pri-
mary care health needs and the existence of corruption in
government ministries, is exacerbating this problem of under-
funded health budgets.
Lack of human rights policies. Specific policies concerning
human, labor and legal rights for individuals with HIV/AIDS do
not exist in most countries, and where they are in place, they
are often not enforced. In Ecuador, for example, the
Ecuadorian Commission on Human Rights and AIDS (CEDHSI-
DA) recently relied on the support of non-governmental orga-
nizations, including MAP International, to present new laws to
Congress which would ensure the implementation of existing
laws in a way beneficial to those with HIV/AIDS. In the past,
despite active lobbying work, others have not been successful
in convincing the Ecuadorian Congress to adopt these laws.18
Political Economy
An inquiry into the political economy of the pandemic in Latin
America seems to tell a familiar story: scarce resources for pre-
vention and care, with vested financial and political interests
controlling much of who gets how much and why. For exam-
ple, in the Dominican Republic, the government is worried
about how HIV/AIDS will affect tourism, the biggest industry in
the country. Dr. Martha Butler de Lister, Resident Advisor of the
AIDSCAP project in the Dominican Republic, states,“It is not
politically correct to mention AIDS in this country because the
economy might suffer.”19
Similar economic interests determine
the response of many countries to HIV/AIDS.
At the microlevel, medical attention is out of reach for many liv-
ing with HIV/AIDS in developing countries. In Latin America, the
cost of drug treatment for AIDS averages between US $1,000 and
$2,000 per month, while the average basic family salary is around
$250. Even if a family can cover the cost of medicine, very little
money is left to pay for food or rent.20
Moreover, the segment of
the population most affected by HIV/AIDS is that which is the

most economically productive — those
between 15-45 years of age.6
When
these individuals, who previously
brought in a large portion of the fami-
ly’s income, are forced to leave work
(due to discrimination in the early
stages and physical weakening in the
latter stages), the entire family suffers.
Religious Context of the Region
Religion has played a critical role in the
lives of Latin Americans since the begin-
ning of recorded history in the region.
Though a variety of religions flourished
before the arrival of the Spaniards in
the 16th Century, from that time for-
ward, it has been Christianity that has
occupied the central religious role for
the majority of Latin Americans.
Catholicism was the earliest form of
Christianity in the region, and with its
various forms and adaptations, it has
long been“The Church”to the majority
of Latin Americans. Over the past few
decades, other Christian denominations
have experienced significant growth, in
the process dramatically changing the
religious dynamics of the region.
Current statistics indicate that approximately 74 percent of
Latin Americans identify themselves as belonging to the Catholic
Church, while a growing 13.6 percent identify themselves as
Protestants or “Evangelicals.” This latter group also includes the
Episcopal/Anglican Church, but in practice, this denomination is
often treated as a third segment of the Christian population in
many Latin American countries since it is seen as combining ele-
ments of the other two groups.The remaining 13 percent identi-
fy themselves as “other,”“non-religious,”“animist,” or “spiritualist.”
In Cuba and Uruguay, those identified as “non-religious” consti-
The segment of the population
most affected by HIV/AIDS is
that which is the most econom-
ically productive — those
between 15-45 years of age.6
When these individuals, who
previously brought in a large
portion of the family’s income,
are forced to leave work (due
to discrimination in the early
stages and physical weakening
in the latter stages), the entire
family suffers.

tute approximately one-third of the population, but in most
other countries this percentage is quite small. Brazil, Bolivia and
the Dominican Republic (and to a lesser extent Guatemala, Peru
and Venezuela) have a large number of people involved in spiri-
tualist or other traditional religious practices, in many cases
blending ancient tribal customs with Catholic practices.
However, the majority of these individuals still officially identify
themselves as belonging to the Catholic Church.21
Given the predominance of religious affiliation in the region,
and the historic, cultural and communal significance of the
Catholic Church throughout Latin America, religion and reli-
gious institutions appear destined to continue to play an impor-
tant role in the life of most Latin Americans. This context has
allowed religious leaders to develop a key voice in all aspects of
the life of the community — including health issues, behavior
decisions and sexual practices. This moral and communal
authority has been powerfully utilized in the fight against the
spread of HIV/AIDS in communities all over the world.
For over a decade, the Christian Church globally has acknowl-
edged its role in the fight against HIV/AIDS. In 1987, the World
Council of Churches proclaimed:
The urgency of the problem of AIDS profoundly chal-
lenges us to be the Church in deed and in truth; to be
the Church as a healing community. AIDS is a heart-
breaking problem,challenging churches to open their
hearts and repent of their immobility and their rigid
morality.22

The following year, Pope John Paul II, in an address to the
Catholic Health Association, made these remarks concerning
AIDS:
Today you are faced with new challenges, new needs.
One of these is the present crisis of immense portions
which is that ofAIDS ...Besides your professional con-
tribution and your human sensitivities towards all
affected by this epidemic, you are called to show the
love and compassion of Christ and His Church.23
While the world Christian movement has recognized the strate-
gic role of the Church in HIV/AIDS, the Church in Latin America
has perhaps been slow to respond. One reason for the delay
may have been that until the early 1990s, the number of
HIV/AIDS cases reported in the region was relatively small.
Later, as the numbers began to increase, the complexity of the
issues, challenges and opportunities facing the Church began to
surface more openly. For instance:
Lingering Protestant/Catholic tension. Protestants and
Catholics in the region remain divided over significant issues.
While tension between the two churches has decreased some-
what in recent years, at least two distinct“Churches”are seen
to exist in Latin America. Furthermore, other divides exist
within both of these broad groups. Protestants from what are
often called“mainline”denominations in the U.S. (Methodist,
Presbyterian,American Baptist, and so forth — largely identify-
ing with relatively liberal theological and social positions), and
Protestant“Evangelicals”(various independent denominations,
Assemblies of God, many Mission agencies, and so on — identi-
fying with more conservative positions, generally) have experi-
enced significant polarization over certain issues in recent
decades. As a result of these tensions, a unified“Church”
response to the pandemic has been difficult.
Rapid church growth in some sectors. The fastest growing
segments of the Church in Latin America are those associated
with charismatic or Pentecostal movements. These move-

ments tend to focus attention on the daily problems of the
congregation and God’s supernatural response to them as in,
for example, God’s provision for the poor. While it appears
that opportunities exist within at least some of these groups
to promote openness to HIV/AIDS ministry as part of this
focus on concrete struggles, the variation among these
groups makes generalization difficult.
Social action in tension with evangelism. Balancing the
promotion of social responsibility and evangelism in the
Church has proved challenging. Latin American Evangelicals
are sometimes stereotyped for not taking seriously the con-
crete needs of people and communities, while Catholics in
the region have been in turn accused of not focusing enough
on evangelization — perhaps being too focused on social
action. Protestants (and to a lesser extent, Catholics) them-
selves were sharply divided over related issues as articulated
by the Liberation Theology movement beginning in the late
1960s in the region. Opposition or support for this move-
ment became a litmus test for fidelity in some of the more
conservative and liberal branches of each church for a time.
Education of church leaders in the equal importance of both
spiritual and social responsibilities is needed.
Understanding of HIV/AIDS is broadening. A new and
more complete understanding of the nature and effects of
HIV/AIDS in the region has recently emerged. Beyond the
physical effects, it is now recognized that a wide range of
social, political, religious and economic factors are involved,
with impacts on the psychological, emotional and spiritual
lives of those affected. The Church has unique resources to
address these total health issues in a holistic manner.
Initial condemnation in the Church. Some in the Church
initially believed that God’s plan for the world included
HIV/AIDS as a scourge on those whose behavior was outside
of Church teaching — as “just another in a string of disasters
that must be withstood in preparation for the Second
Coming, when humanity will be freed from the travails of
this world.”7
This spiritualizing of the pandemic, still a factor

in many churches in the region, must be confronted and
overcome if the Church is to play an effective role in this
struggle.
Vulnerability of women. Women’s increased vulnerability to
HIV/AIDS presents a challenge to the Church. Nevertheless,
some Catholic and Protestants groups are forging new paths
for dialogue and progress between the sexes, where topics of
sexuality, sex, pleasure and equity
between the couple are discussed from
the perspective of mature spirituality.
The above issues illustrate not only the
difficulties facing the Church, but also
its potential strengths in working in
HIV/AIDS prevention and care. Some
sectors of the Church will no doubt
continue to be challenged to explain
and overcome their initial prejudice
against people with HIV/AIDS.
However, the reality of the pandemic is
pressuring the Church in Latin America
to modify its ways of responding.
Now that there are many members of
the Church living with HIV/AIDS, the
Church will be even more motivated
to develop strategies to care for and
include these individuals in the life of
the congregation.The increasing inci-
dence of transmission among the het-
erosexual population demands that
everyone become involved in respond-
ing to HIV/AIDS. Many in the Church
now see this reality. A Chilean pastor
addressed this point well with the
admonition to his fellow pastors that,
rather than condemning others, the
Church should be studying how
HIV/AIDS can be used as “a chance to
express the grace of God.”7
The increasing incidence of
transmission among the hetero-
sexual population demands that
everyone become involved in
responding to HIV/AIDS. Many
in the Church now see this real-
ity. A Chilean pastor addressed
this point well with the admoni-
tion to his fellow pastors that,
rather than condemning others,
the Church should be studying
how HIV/AIDS can be used as
“a chance to express the grace
of God.”7

It should be clear from the foregoing that the Church in Latin
America has already been at least partially mobilized to tackle
issues of HIV/AIDS. Yet much of the Church’s vast potential
remains untapped to date — it remains to be seen what will be
done to support and leverage this potential partner and
resource in the future.

M A I N S T R E A M I N G R B I s :
B E N E F I T S A T L O W C O S T
Religious-based initiatives are proving to be pivotal to the suc-
cess of prevention and care efforts in Latin America as well as
globally. Churches are found in nearly all communities in Latin
America, and they wield a significant level of influence — cul-
turally, politically, socially and educationally. Churches are usual-
ly respected in communities, and most have existing resources,
structures and systems upon which to build.
Recognizing these and other advantages provided by churches as
partners in addressing health issues in the broader community,
MAP International-Latin America has directed its efforts in recent
years towards educating the Church itself on health matters, and
challenging the Church to think more broadly about health devel-
opment issues. A UNAIDS representative has stated the case this
way,“Any government or organization fighting the Church institu-
tion is in a losing battle! The Church
must be involved as part of the solution
in development.”24
In this spirit, this
section argues that RBIs should increas-
ingly be a driving force in the fight
against HIV/AIDS in Latin America.
HIV/AIDS and
the Church’s Mandate
An Untapped Resource
In a practical sense,the Church can be
viewed as the largest,most stable and
most extensively dispersed non-govern-
mental organization (NGO) in any coun-
try. It possesses human,physical,techni-
cal and financial resources needed to support and implement
large-scale initiatives,and it can undertake these actions in a very
cost-effective manner,due to its ability to leverage volunteer and
other resources with minimal effort.
MAINSTREAMINGRBIs:BENEFITSATLOWCOST
“Any government or
organization fighting the
Church institution is in a losing
battle! The Church must be
involved as part of the solution
in development.”24

In recent years, many examples of the Church leveraging its
resources against HIV/AIDS have developed in the region. In the
Dominican Republic, for example, the nuns of the Religiosas
Adoratrices care for women living with AIDS at the mission and
visit others in their homes. Likewise, Christian health profession-
als in Santa Clara, Cuba, have formed a
group of volunteers to undertake pre-
vention and care activities for people in
their area living with HIV/AIDS. In
Santiago, Chile, a Christian professor
volunteers her time and teaching tal-
ents at a local AIDS care organization.
She tutors children, who are unable to
receive formal education because their
families are affected by HIV/AIDS, links
these families with local churches and
gives vitamins and food to the most
needy families.
Church members can provide a strong
and motivated volunteer force in a com-
munity. Many programs in Latin America
garner volunteers,of course,but these
volunteers often have some expectation
of receiving something for their efforts.
Their action may come with some
“strings attached.” In religious-based ini-
tiatives,volunteer activity has traditional-
ly been part of the culture of the
Church,and those who get involved
generally work out of conviction alone,
with no expectation of pay or advance-
ment. Worldwide,studies of RBIs and
social action show that on average ten
percent of a Church may become active-
ly involved as volunteers.25
When this is
compared with the usual two percent
involvement of general society in volunteer actions or direct mail
responses,the advantage of RBIs becomes clear.
In a practical sense, the Church
can be viewed as the largest,
most stable and most
extensively dispersed NGO in
any country. It possesses
human, physical, technical and
financial resources needed to
support and implement large-
scale initiatives, and it can
undertake these actions in a
very cost-effective manner, due
to its ability to leverage volun-
teer and other resources with
minimal effort.

These examples show that the Church possesses tremendous,
yet underutilized, resources to respond to the HIV/AIDS pan-
demic. These resources should be more systematically mobi-
lized in order for the Church to more fully recognize its power-
ful potential for service.
Agents of Change: Religious Leaders
Have a Powerful Voice in Society
The important role of church leaders in society, evident in many
parts of the world, is also visible in Latin America. A 1995
UNICEF article presents a compelling case in support of the
influence that organized religion can make on “the priorities of
society and the policies of leadership,” including the important
area of health:
Religion plays a central, integrating role in social and
cultural life in most developing countries...There are
many more religious leaders than health workers.
They are in closer and regular contact with all age
groups in society, and their voice is highly respected.
In traditional communities, religious leaders are often
more influential than local government officials or
secular community leaders.26
The Church is an institution with longevity and stability, and it
has existed in communities for centuries despite changing polit-
ical and cultural situations.7
Overall, the Church has used the
authority it carries to positively influence prevention efforts in
the region. This is true despite the existence of more controver-
sial situations, such as the case in Nicaragua where Church lead-
ers opposed a particular public health prevention campaign due
to moral misgivings about its promotion of condoms. The
important contributions of the Catholic Church in designing
HIV/AIDS legislation in Peru and El Salvador recently are illustra-
tive of this point.14

The Church’s Mandate to Promote and Care for Life
The Church has an ancient biblical mandate to care for the health
of the community. The Gospel of St. Matthew and many other
Biblical passages call for the Church to be involved in the real,
earthly issues of its community and to encourage behavior
changes that safeguard health and defend life. Such a mandate is
especially important in developing countries where basic needs
are so visible and so extensive among populations with few eco-
nomic resources. The two greatest
commandments of the Church —“You
shall love the Lord with all your heart
and with all your soul and with all your
mind . . . and you shall love your neigh-
bor as yourself”— motivate the Church
to outreach in the communities in
which it is located as a means of
demonstrating this love of God and of
neighbor. This doctrinal basis can pro-
vide powerful motivation for HIV/AIDS
initiatives by Church groups.
Tangible actions of prevention and
care that could be undertaken by near-
ly any Latin American church in
HIV/AIDS ministry include:
promoting abstinence and the delay
of onset of sexual relationships, par-
ticularly among youth
encouraging mutual marital fidelity
caring for people infected with and
families affected by HIV/AIDS
providing psychological and pas-
toral counseling to family members
educating children and the family in
sexual issues
The two greatest command-
ments of the Church —
“You shall love the Lord with
all your heart and with all your
soul and with all your mind . . .
and you shall love your neigh-
bor as yourself”— motivate the
Church to outreach in the com-
munities as a means of demon-
strating this love of God and of
neighbor. This doctrinal basis
can provide powerful motiva-
tion for HIV/AIDS initiatives by
Church groups.

collecting donations to help cover medical treatment costs
becoming involved with local human rights, labor or policy
issues related to HIV/AIDS in a community27
The Role of the Church
in Values and Behavior Change
Experience has shown that changes in values and behavior are
critical to slowing the spread of HIV/AIDS, and indeed, value
modification and behavior change are closely related.28
Values
that become internalized, such as those resulting from religious
and spiritual conviction, can be powerful shapers of human
behavior — both in life-affirming or negative ways. Perhaps more
than any other societal group, religious institutions possess
tremendous resources for fostering changes in values, and ulti-
mately, changes in behavior. The moral resource of the Church
can play a key role in shaping positive and life-giving behaviors in
matters of sexuality, and even in drug abuse and prostitution —
key areas in the struggle against HIV/AIDS.
In the process of both challenging and building upon faith and
belief, the Church can play a key role in discouraging high-risk
behaviors and practices.Thus, the Church has an important func-
tion in molding values and behaviors that can affect the transmis-
sion of HIV/AIDS. It is essential, then, that groups like MAP
International and other Christian organizations continue produc-
ing effective HIV/AIDS educational materials and providing train-
ing compatible with Church ethics. Religious-based initiatives
should also continue to promote values that will bring about
long-term, sustainable changes in high-risk behavior.

The Church and Public Policy
The Church can have a powerful and positive influence on
health policy in countries of the region. As mentioned, the
influence of the Church has not always been used in ways seen
as constructive by policymakers. Yet on balance, the active pres-
ence of a strong moral voice in the region, through the Church,
carries with it the potential of tremendous benefits for the soci-
ety. The political strength of the Catholic and Protestant Church
in Latin America gives it both the opportunity and responsibility
to intervene with policymakers in helpful and constructive
ways, geared toward the promotion of life-affirming and dignify-
ing prevention and care efforts.
The religious perspective can contribute to government preven-
tion efforts in a variety of ways, including:
Encouraging greater focus on belief and value change efforts.
To date, for example, most government and internationally-
funded programs have focused on promoting the use of con-
doms, but few have tried to promote belief and value
changes that would alter sexual behaviors.29
The promotion
of condoms has been seen by some as the “foremost” strategy
in prevention efforts.30
However, condom promotion is only
one strategy, and there is room for the Church, with its focus
on changing values, to complement these efforts with other
methods.31
Promoting policy-making which includes the whole “family
unit.” In many health policies and programs focusing on
HIV/AIDS, the family seems to have been left out of the equa-
tion. This is quite short-sighted, since “families,” with all their
varieties and extensions, are where values are initially
formed. Indeed, the family is the basic unit of affection for
individuals and communities. In situations where this affec-
tion is lacking, people may seek to replace it by engaging in
brief sexual encounters that may put them at risk of contract-
ing a STI, including HIV.35
Since one of the main roles of the
Church is to strengthen the family, it can be an important
resource for HIV/AIDS prevention programs that focus on

providing affection and sexual education within the family
and on promoting safer sexual practices, such as marital
fidelity.
Promoting and providing access to care for those affected.
Ideally, the Church — as a community of compassion and sol-
idarity with those in need — can help provide care for indi-
viduals affected by HIV/AIDS, as well as help cover the costs
of medical treatment. Government programs can and should
leverage the resources of the Church, by virtue of its tradition
of voluntarism and service, as a cost-effective way to encour-
age wider involvement in caring for those in need. The
resources of the Church can be employed to develop sustain-
able strategies for enhancing support and participation in
HIV/AIDS care activities.
Working Hand-in-Hand Together to Stop HIV/AIDS
Religious-based initiatives can complement current strategies in
the fight against HIV/AIDS. The growth of the pandemic has led
international organizations working in the field to search for a
wide range of alternative prevention strategies to combat its
spread. A report from the XI International Conference on AIDS
presents information on the impact of prevention programs to
date and draws the following conclusions regarding initiatives
directed towards achieving behavior change in South America:
While attention has been given to partner reduction,
non-penetrative sex and the increase and correct use
of condoms, programs have not fully capitalized on
prevention messages addressing abstinence, mutual
fidelity and delayed sexual initiation — messages
which may be more aligned with the traditional/reli-
gious aspects of the region.22
Thus, RBIs are being recognized as key components in the fight
against HIV/AIDS. Current methodologies and strategies are
strengthened by their inclusion. In the early 1990s, for exam-
ple, the WHO’s Global Programme on AIDS designed strategies
for working with different sectors of the population. In Latin

America, the first sector chosen with which to work was the
religious sector. According to Dr. M. Roberto Calderón, formerly
the PAHO/WHO Inter-Country AIDS Advisor for Central America,
Panama and the Dominican Republic,“this decision was taken
considering some previous experiences that were encouraging
and which convinced us that it was possible to take advantage
of the important moral influence, spiritual influence and the
influence on encouraging healthy social conduct that churches
in all communities throughout the region exercise . . .”33
Based
on this rationale, PAHO/WHO supported a series of innovative
HIV/AIDS training workshops directed towards the religious
sector in Central America and the Caribbean from 1993 to 1995.
In May 1996, a similar workshop was sponsored by PAHO/WHO
and convened by CAFSIDA. CAFSIDA is a network of Christian
organizations working in HIV/AIDS in Ecuador that was found-
ed, and for some years coordinated, by MAP International-Latin
America. In the “First Encounter of the Religious Sector,” a con-
sensus was reached among the Catholic and Protestant sectors
of the Church in Ecuador to develop coordinated actions across
denominational lines — a still too uncommon occurrence in the
region. Activities that resulted from this joint PAHO/WHO and
religious sector effort include the signing in December 1996 of
an inter-ecclesiastical commitment to fight HIV/AIDS in the
country and a training workshop for Catholic leaders from 24
dioceses directed by the Evangelical AIDS Network of Ecuador
in September 1997.
It should be clear from the foregoing that the contributions RBIs
have brought to the HIV/AIDS struggle are unique and pivotal. As
the on-the-ground examples in this booklet illustrate, Catholic and
Protestant sectors of the Church in Latin America are responding
to the needs of the affected populations with concrete actions
that promote life in the face of the growing pandemic.

HIV/AIDS Challenges the Church
In the course of formulating effective and appropriate respons-
es to the HIV/AIDS pandemic, the Latin American Church has
confronted numerous challenges. Even at this stage in the
development of RBIs in the region, several significant challenges
must yet be overcome by the Church and its partner organiza-
tions in order to maximize the
Church’s potential contribution in
HIV/AIDS programming. At least two
of these deserve special attention.
One is the need for institutional and
structural change within the Church,
and the other is the need for “limited
domain collaboration” concerning pre-
vention strategies adopted by RBIs.
Changes within the Church
As RBIs in Latin America have begun to
expand, it has become clear that even
greater internal changes are needed
within the Latin American Church for
it to more fully participate in the strug-
gle against HIV/AIDS. As a result of
dialogue and education, however,
changes are occurring.
Church leaders open to addressing
HIV/AIDS have at times been afraid of
censure by peers and, thus, reluctant to
raise sexual issues.34
To admit that
homosexuality or marital infidelity
exists within a congregation may
appear to some parishioners to mean
admitting that the Church has failed in
its mission — that of instilling Christian principles in its mem-
bers. And some Church leaders, due to complex situations in
their own lives, may fear being judged by the same standards of
purity in sexual conduct they preach to others.
Several significant challenges
must yet be overcome by the
Church and its partner organi-
zations in order to maximize
the Church’s potential contribu-
tion in HIV/AIDS programming.
One is the need for institutional
and structural change within
the Church, and the other is the
need for “limited domain col-
laboration” concerning preven-
tion strategies adopted by RBIs.

Furthermore, Latin American Church leaders may hesitate to
give comprehensive information on sexual issues to youth,
ignoring the fact that 40 to 70 percent of these young persons
may already be sexually active.35
Instead, leaders often “over-
spiritualize” the issues by presenting in isolation the argument
that “the body is the temple of God” and must not be defiled. In
doing this, Church leaders are missing a unique opportunity to
encourage young people to assume responsibility for struggling
with their own sexual decisions, and may, in fact, close the door
to a dialogue with them on issues that they, too, find troubling.
Christina Gutiérrez, a Christian woman involved in HIV/AIDS
education efforts in Chile, concluded that many churches “don’t
want to talk about AIDS because it means talking about sexuali-
ty, homosexuality, death — themes that make many in the
Church uncomfortable.”7
Yet fear of these issues within the
Church only harms the Church itself. The congregation knows
the reality outside may not conform exactly to what a “fear-
based” sermon may imply. Instead of strengthening the Church
and enabling it to be the powerful behavioral change agent that
it can be, this “fear” can make the Church less effective in
HIV/AIDS prevention efforts.
To combat this, programs and educational materials developed
from a Christian perspective are critically needed. Especially in
rural areas where materials are hard to find, Church leaders
need this type of support as they strive to overcome these fears
and develop their own activities in HIV/AIDS prevention and
care. While most are prepared to share the Gospel, many lack
the skills needed to design total health programs. In interviews
conducted with Church leaders in rural areas, it was found that
the desire to participate does exist, but without help from the
outside, they do not feel prepared to create sustainable pro-
grams.34
For this reason, MAP International-Latin America and
other Christian organizations around the region are producing
HIV/AIDS materials with educational tools designed to foster
long-term sustainable changes in high-risk behavior. The Church
can use these tools to effect changes in values and overcome
fears of sensitive topics.

Furthermore, education designed to encourage tolerance and
compassionate care is still critical for church leaders and mem-
bers of congregations who know little about HIV/AIDS.
Resistance still exists within some
Church congregations to show solidari-
ty with, or to provide care for, people
living with HIV/AIDS. These attitudes
also must be confronted and overcome
with education.
Toward Enhanced Diversity
in Strategies to be Adopted by
RBIs and Others
Given the diversity of opinion among
churches (as well as between churches
and governmental, non-governmental
and multilateral organizations) on issues
of HIV/AIDS prevention strategies, cre-
ative solutions will be needed to devel-
op space for collaboration across lines
of politics and world views. One
approach that has been used successful-
ly in the United States to overcome this
dilemma has been described by Rev.
Gary Gunderson, Executive Director of
the Carter Center of Emory University’s
Interfaith Health Program, as“limited
domain collaboration.” In this
approach, diverse partners who gather
to address a particular issue agree to
limit their range of cooperation to the
issues at hand and to temporarily set
aside other areas of disagreement. This
approach to collaborative partnership may hold great potential
for avoiding undue tensions within the variety of diverse groups
confronting HIV/AIDS in Latin America.
Given the diversity of opinions
on HIV/AIDS prevention
strategies, creative solutions
will be needed to develop space
for collaboration across lines of
politics and world views. In the
“limited domain collaboration”
approach, diverse partners
gather to address a particular
issue, agree to limit their range
of cooperation to the issues at
hand, and temporarily set aside
other areas of disagreement.

One of the more contentious strate-
gies for some segments of the Church
is, of course, the promotion of con-
dom use — a strategy not officially
sanctioned by the Catholic Church
and in some cases controversial with-
in Evangelical Churches. According to
Rosa Maria Dantas, an AIDS worker in
Brazil, at times “governments have
backed off from aggressive education-
al campaigns that might promote con-
dom use and even from scientific edu-
cation courses in public schools” in
order to avoid confrontation with
important Church leaders.7
For a number of years, disputes over
strategies, ethics and tolerance issues
have been a frustrating but expected
part of partnership between the
Church and governmental, non-govern-
mental and multilateral organizations.
While most organizations working in
HIV/AIDS prevention recognize that
the use of condoms cannot alone con-
trol the spread of the pandemic, many
in the Church perceive that it is often
the first or only strategy promoted by
secular groups and, thus, view collabo-
ration with these groups as a threat to
their integrity. In Mexico, for exam-
ple, Catholic bishops declined to join
the efforts of CONASIDA, a group
which has achieved great success in
combining government and NGO
resources in education and prevention
efforts, precisely because the program
promotes condom use as its “first strat-
egy.”36
From the Church’s perspective,
The “first strategy” approach to
the use of condoms has often
served as a deterrent to more
active involvement by the
Church. This is regrettable
since the Church is in a unique
position to provide a single
coherent message of abstinence
and fidelity in coordination —
rather than in competition —
with other prevention
messages. The Church might
be more open to promoting
condom use as “one strategy
among many” in specific
high-risk instances, if the issue
were defused of its volatility
and tension.

full participation in this program seemed to require compro-
mise on a key ethical position — the delay of sexual inter-
course until after marriage and the promotion of respect and
fidelity within marriage.
All branches of the Church do not speak with one voice on this
issue, however. On one hand, some mainline Protestant church-
es are open to prevention strategies that include the use of con-
doms; while on the other, charismatic Evangelical churches tend
to be less likely to discuss even relatively non-controversial
issues surrounding sexuality, much less condom use. Officially,
the Catholic Church does not sanction condom use under any
circumstances, but paradoxically, some observers have noted
that there seems to be more frank discussion about sexual
issues and greater freedom to promote the Church’s role in
addressing HIV/AIDS within local Catholic parishes. This may
be a reflection of the Catholic Church’s broad history and expe-
rience of engagement in social action.37
It seems clear this“first strategy”approach to the use of condoms
has often served as a deterrent to more active involvement by the
Church, both Catholic and Protestant. This is regrettable since the
Church is in a unique position to provide a single coherent mes-
sage of abstinence and fidelity in coordination — rather than in
competition — with the various prevention messages provided
by others. And, at least a large segment of the Church would be
more open to promoting condom use as“one strategy among
many”in specific high-risk instances, if the issue were defused of
its volatility and tension. If one spouse is HIV positive, or there is
uncertainty regarding the sexual practices of a spouse, or Church
members are otherwise putting themselves at risk through sexual
activity, the Church has a responsibility to promote“life.” In these
situations, this may mean discussing abstinence and at least
explaining consistent and correct use of condoms, if not actually
promoting them. Thus, while flexibility may be needed from the
Church in these cases, multilateral, governmental and non-govern-
mental organizations should capitalize on the positive health
impact the Church’s message of abstinence in singleness and
fidelity in marriage produces in the general society.

Condom use itself should not be seen
so much as an issue of “morality,” but
as a prevention strategy with limited
scope. If the Church truly believes
total health is more than the “physical
condition” of an individual and true
well-being includes emotional, spiritu-
al, socio-economic, physical and envi-
ronmental elements, promoting con-
dom use is clearly not a comprehen-
sive enough response to HIV/AIDS. It
may be a practical and easy solution to
a physical health risk, but it does not
take into account the spiritual, social
or emotional aspects that contribute to
total health. For this reason, it is not in
itself a sufficient response for the
Church or religious-based initiatives.
Therefore, strategies other than con-
dom promotion should be considered
by multilateral, governmental and non-
governmental organizations when
designing prevention programs and
messages for churches in Latin
America. In doing so, all benefit from
the single, coherent message the
Church communicates. Above all,
more discussion is needed to set
ground rules for collaboration that
allow all partners to maintain their eth-
ical and strategic integrity in the
search for effective means to prevent
the spread of HIV/AIDS in Latin
America.
If the Church truly believes total
health is more than the “physi-
cal condition” of an individual
and true well-being includes
emotional, spiritual, socio-eco-
nomic, physical and environ-
mental elements, promoting
condom use is clearly not a
comprehensive enough
response to HIV/AIDS. It may
be a practical and easy solution
to a physical health risk, but it
does not take into account the
spiritual, social or emotional
aspects that contribute to total
health. Therefore, it is not in
itself a sufficient response for
the Church or religious-based
initiatives.

M O D E L S O F R B I s
I N L A T I N A M E R I C A
In this section, we focus on actions churches are currently tak-
ing to combat HIV/AIDS throughout Latin America. Although
religious-based initiatives are generally not well known, they are,
in fact, having a profound effect on HIV/AIDS prevention and
care in the region.
A rapid assessment of the initiatives in place reveals the exis-
tence of numerous individual and coordinated activities in many
countries of the region. The following models provide only a
sample of the different types of RBIs presently underway in vari-
ous countries. For ease of analysis, the models have been cate-
gorized as NGO programs, Church congregation or parish pro-
grams, network-based programs, hospital-based programs or
international programs.
NGO Programs: Local Capacity Building
The Lutheran Church in Chile works through a local NGO, EPES
(Educación Popular En Salud), to provide HIV/AIDS education to
some of the poorest communities in Santiago and Concepción.
They have created local neighborhood networks, called the Red
Comunal El Bosque, that teach women how to develop
HIV/AIDS education and prevention activities in their communi-
ties. In addition, the local neighborhood networks proactively
assign women to various commissions (human rights, children,
treatment), helping these women to build self-esteem and gain
the courage to seek the support of their spouses in the fight
against HIV/AIDS.
A local NGO in Venezuela, Servicio Ecuménico Koinonia, offers
HIV/AIDS workshops from a total health perspective and pro-
vides clinical, pastoral and family counseling. In its grassroots
efforts with women, this organization focuses on two major
issues: 1) building self-esteem through discussion of sexual and
reproductive rights; and 2) improving awareness of the biologi-
cal, social, economic and spiritual issues related to HIV/AIDS.
MODELSOFRBIsINLATINAMERICA

They also promote the creation of self-help communities to
show solidarity with and minister to individuals living with
HIV/AIDS and their families.
For two years, Sociedad Internacional Misionera (SIM) in
Ecuador has been providing HIV/AIDS prevention training in
churches and schools, and through “community fiestas” in the
marginal urban slums of Guayaquil. Using informal education
techniques, over 50 of the participants in these workshops have
become volunteer facilitators for other groups in their commu-
nities. Besides counseling people living with HIV/AIDS, they
also provide short-term loans for HIV+
individuals to use as start-up capital in
small businesses. Surprisingly, after
one of these young men died from
AIDS, his family remained so grateful
for SIM’s assistance that they repaid his
loan post-mortem.
Church Congregation or
Parish Programs: Participatory
Approaches
For a number of years, La Lucila Baptist
Church in Buenos Aires,Argentina, has
sponsored a drug rehabilitation pro-
gram. Recently, they have realized
their work must also include services
for people living with HIV/AIDS. As
ex-drug users became integrated into
the Church community, Church leaders
discovered that a ministry to respond
to the special needs of these individu-
als was required. In addition, Church leaders were faced with
the task of helping others in the congregation overcome their
fear of dealing with people living with HIV/AIDS. The leaders
and members of the Lucila Church currently offer an integral
HIV/AIDS program at the Hogar El Retoño hospice. The pro-
gram includes self-help groups for people in residence who are
living with HIV/AIDS, and a farm project that provides econom-
Five types of RBIs active
in the region:
NGO Programs: Local
Capacity Building
Church Congregation or
Parish Programs:
Participatory Approaches
Network-Based Programs:
Collaborative Action
Hospital-Based Programs:
Care and Management
International Programs:
Coalition Building

ic resources to help sustain residents during the later stages of
AIDS when they are unable to bring in their own income.
In Colombia, priests of the Eudista Congregation have provided
hospice care for people living with HIV/AIDS for the past eight
years. Furthermore, as part of the community outreach, they
conduct education and prevention workshops in the communi-
ty for people living with HIV/AIDS and their relatives. In
Cuenca, Ecuador, Father Vega’s parish conducts similar HIV/AIDS
prevention activities among recent immigrants to the area.
El Pastoral del Buen Samaritano, a group associated with the
Catholic Church in the Choluteca province of Honduras, edu-
cates community members on how to include issues of love and
social justice when working with people living with HIV/AIDS.
Their activities also include informational campaigns about
HIV/AIDS, educational workshops, discussions on sexuality with
married couples, and participation in World AIDS Day activities.
Network-Based Programs: Collaborative Action
The Ecuadorian Christian network, Coordinadora de Acción
Frente al SIDA (CAFSIDA), exists to support and strengthen its
member organizations, and it also provides a place for informa-
tion exchange and collaboration. Furthermore, CAFSIDA works
with local churches to encourage interdenominational initiatives
and to increase awareness of HIV/AIDS. As of this writing, CAF-
SIDA is conducting a communication project entitled “Youth for
Life.” HIV/AIDS prevention messages will be promoted through
the airing of 50 radio spots on popular radio stations, the distri-
bution of t-shirts during radio contests, and the sponsoring of a
rock concert in Quito.
In 1994, a Panamanian network of Christian organizations,
Sector Religioso Contra el SIDA (SERECSIDA), arose from the
2nd HIV/AIDS Workshop for Christian Churches in Panama,
sponsored by the Ministry of Health and PAHO/WHO. This net-
work consists of members of the Baptist, Methodist,Assemblies
of God, Salvation Army, Episcopal and Catholic Churches.Their
objective has been to provide information on HIV/AIDS and to

train “multiplying” agents in prevention strategies through work-
shops, seminars and informal discussion groups. Furthermore,
they have trained religious and lay leaders in how to provide
pastoral counseling to people living with HIV/AIDS and their
relatives. SERECSIDA also coordinates an HIV/AIDS prevention
campaign among adolescents.
Organizaciones Cristianas de Atención Primeria en Salud
Integral (OCAPSI), a Dominican Republic NGO that unites
churches of different Evangelical denominations to develop total
health efforts, has focused much attention on HIV/AIDS through
a number of activities. These include: providing hospital atten-
tion (including medicines and laboratory exams); counseling
people living with HIV/AIDS and their relatives; facilitating edu-
cational workshops in several churches; directing seminars
about how to show solidarity with people living with
HIV/AIDS; and training pastors and Church leaders in how to
provide counseling.
A Guatemalan network, Programa Nacional Evangélico Contra
el SIDA (PRONECSIDA), includes the Indigenous Evangelization
Association,World Vision and the Evangelical Alliance from
Guatemala, among other organizations. PRONECSIDA offers
medical attention to those living with HIV/AIDS in Guatemala,
produces written informational material, directs training work-
shops on HIV/AIDS prevention strategies and provides phone
counseling.
Hospital-Based Programs: Care and Management
Hospital Voz Andes in Ecuador has an AIDS clinic that provides
health care for people affected by HIV/AIDS, including the phys-
ical, spiritual, social and psycho-emotional elements. The pro-
gram offers: on-going counseling; emotional/spiritual support
and continuing education to people living with HIV/AIDS and
their families; an interdisciplinary team of health professionals,
including social workers and nutritionists, that provide advice
and treatment; and frequent and appropriate outpatient medical
care to avoid the high cost of hospitalization.

A health care center in Honduras, Hospital Evangélico, has
designed a Community Service Program (PROSEC) which
includes elements of HIV/AIDS education and care. This pro-
gram offers HIV/AIDS information in a variety of settings, includ-
ing sex education courses in local elementary schools, training
workshops with local church congregations and continuing
education courses for rural pastors. Plans are under discussion
to begin self-help groups for people living with HIV/AIDS in the
area. For the past 5 years, PROSEC has sponsored a national
health educational workshop (attended by 120 Church leaders,
students and health professionals in 1996) to discuss issues
related to the family, sexuality and HIV/AIDS.
The Capellanía Evangélica program instructs chaplains and ther-
apy assistants in seven cities across Brazil in HIV/AIDS counsel-
ing techniques.The program trains close to 250 health coun-
selors each year who work in public and private hospitals
around the country. While the training is given to Christians
and non-Christians alike, it provides a unique opportunity to
encourage these counselors to adhere to ethical principles and
offer loving care to people affected by HIV/AIDS.
International Programs: Coalition Building
The work of MAP International in HIV/AIDS prevention is illus-
trative of international-based programs that promote coalition
building. Recognizing the Church’s need to confront HIV/AIDS
and the potential impact of RBIs, MAP International-Latin
America (MAP-LA) designed a multi-year HIV/AIDS initiative in
1992 that includes phases of bibliographic research and needs-
investigations, educational material production and training in
prevention. These activities are coordinated with national
Christian AIDS networks, such as those mentioned above.
Elements of the program that have been implemented to date
include: a research project to determine the needs of the
Church leadership regarding HIV/AIDS; a review of the AIDS lit-
erature and educational materials in the region; an extensive
knowledge, attitudes and practices investigation focusing on
churches in Ecuador; a specific research project on the mobiliza-

tion of the Christian Church in Honduras in preventing
HIV/AIDS; and interviews with Christian leaders throughout
Latin America. MAP International’s AIDS Bulletin now has a
readership of over 10,000 in the region, and the phases of edu-
cational material production for high risk groups and support-
ing national AIDS networks are underway. Another recent initia-
tive involved the partnering with local businesses and other
NGOs to stage a rock concert in Quito to promote HIV/AIDS
awareness and prevention messages among youth.
These efforts have illustrated to MAP International and others
that the majority of the Churches in Latin America are ready to
confront the issue of HIV/AIDS and to initiate RBIs to address
its effects. However, the RBIs need appropriate tools and sup-
port to take on this important task.Therefore, several interna-
tional NGOs are partnering with government, other non-govern-
mental, Christian and global health organizations in providing
preventive training to Church, health and community leaders in
many countries of the region. MAP International, for example, is
presently partnering at various levels with other international
organizations, such as the Salvation Army, Compassion
International, UNICEF, PAHO, and FHI/AIDSCAP, among others.
Several international para-church organizations, such as the
Bible Society and Youth for Christ, have begun developing RBI
efforts to confront the pandemic in the region as well.
A key strength of international RBIs is that programs initiated in
different parts of the world can benefit from the lessons learned
in other regions. For example, MAP International-East &
Southern Africa (MAP-ESA) in Kenya has been in the forefront of
mobilizing and enabling churches from all major denominations
to respond to the HIV/AIDS pandemic through networking and
partnering, research on home care and behavior change, facilita-
tion of policy formulation, material development and dissemina-
tion, and training of church leaders. Experiences and lessons
learned from the MAP-ESA program continue to be shared and
adapted extensively, especially by other MAP offices. MAP
International has facilitated south-south exchanges through sev-
eral initiatives, including: sponsoring a Peruvian pastor to attend

an African HIV/AIDS conference in Uganda; inviting MAP-ESA
staff to visit the MAP-LA offices and participate in workshops in
Ecuador; adapting and utilizing educational materials produced
on different continents; and drawing African and Latin America
leaders together to discuss global religious-based initiatives on
HIV/AIDS during the past two International Conferences on
Christian Health Ministry in the United States.
Achievements of RBIs in Latin America
These models point to the many achievements of religious-
based initiatives in the region. Foremost among these has been
the Church’s ability to encourage voluntarism and leverage its
vast resources in the fight against HIV/AIDS throughout Latin
America. While this booklet does not give examples from every
country of the region, each country contains Christian NGOs,
churches or parishes, Christian networks, or Christian hospitals
that have stepped forward to combat HIV/AIDS and to give
hope to those who are affected by it.
In general, efforts to sensitize society that good health includes
more than just physical well-being have been quite successful.
As these RBI models illustrate, health needs can be met effec-
tively through the Church — those relating not only to spiritual
health but also to family and emotional health. Through their
holistic example, these RBIs are enriching other HIV/AIDS pre-
vention and care efforts in the region.
Each of the five types of models mentioned in the previous section
has a unique subset of population with which to work,and each
calls upon specific skills and resources to reach the“audiences”
with messages. Each RBI must be based on the context of the com-
munity in which it works in order to direct its efforts and respond
to the specific local needs. InArgentina,for example,HIV/AIDS
prevention messages must include cautioning against needle-shar-
ing due to the high rate of transmission through injection drug use
in the country. RBIs,such as the work of La Lucila Church in
BuenosAires,have been very effective in the struggle against
HIV/AIDS due to firsthand knowledge and understanding of the
social,cultural and epidemiologic context in which they work.

NGO Programs
At the grassroots NGO level, many Church pastors and priests
now have changed attitudes towards people living with
HIV/AIDS. They no longer view HIV/AIDS as only a “sinner’s
pandemic.” These changed attitudes are directly related to the
hard work of community, health and Church leaders in encour-
aging compassionate attitudes and loving action towards those
affected by HIV/AIDS.
Several of the models reflect critical actions being undertaken to
focus on improving the self-esteem of women and men.These
actions have helped improve relations between spouses and in
couples. Furthermore, contrary to the cultural norm, they have
challenged men to respect and value women more, particularly
given a woman’s vulnerability to acquiring HIV/AIDS/STI.
Local Congregations
Some local congregations and parishes
have initiated concrete religious-based
initiatives, recognizing that, as a
Church, they are called to witness —
in word and action — the healing,
love and hope Christ has to offer the
people of Latin America and the whole
world. These activities have included
collaboration with civil society (non-
religious) efforts, including marches,
all-night vigils, health campaigns and
World AIDS Day celebrations. RBIs
have also shown themselves to be
cost-effective — in part because of the
Church’s strengths in garnering volun-
teer participation.
Thus, churches and parishes are filling
an existing gap for people living with
HIV/AIDS — that of responding to
their spiritual needs and questions
about suffering and death. A local
Churches and parishes are
filling an existing gap for
people living with HIV/AIDS —
that of responding to their
spiritual needs and questions
about suffering and death.
A local church may be the only
place where they receive
understanding, compassion and
profound answers to their
complex questions.

8.Synopsis.Religious.Based.Initiatives

8.Synopsis.Religious.Based.Initiatives

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