Msgr. Robert J. Vitillo, the Special Advisor on HIV/AIDS for Caritas Internationalis, spoke about the recent challenges in combating HIV and AIDS, on the occasion of the upcoming World AIDS Conference in Vienna (18-23 July 2010).
Is the world facing up to the challenge of responding to HIV AIDS?
I fear that the world is forgetting AIDS nowadays. For example, one new and very serious concerns is whether governments will continue to support the “fight” against AIDS or if they will give priority to other issues.
The United States, for example, has changed the name of its global AIDS programme to the “Global Health Initiative”.
Similarly, the United Kingdom announced that it now would give priority to fighting malaria and maternal mortality. These are indeed valid concerns, but must they be pursued to the neglect of the 33.4 million people living with HIV in the world today?
In the beginning of June, I visited Uganda and talked to people coordinating the distribution of life-saving and life-prolonging anti-retroviral medications to people living with AIDS. They expressed grave concern about the future of these programmes. They had been instructed not to accept new people into anti-retroviral medication programmes. They also expressed fear that medication supplies might be cut off even for those presently receiving them. That certainly seems to be a step backward from the commitment made by governments to achieve “Universal Access” for HIV treatment, care and support for all who need these services.
I’ve been working in this field for the last 24 years. I remember going to hospitals in the 1980s, and everyone was dying. In Uganda, patients were lying and dying in the grass outside the hospital, because there were no more beds. If we stop our efforts, we will go back to those times. We need to move forward, not backward.
How can the International AIDS Conference which starts on 18 July in Vienna contribute to this issue?
We have to remind people that HIV is still here, and still constitutes a major health and development crisis in our world, especially among the poorest and most marginalised people. Those living with this virus often are plunged into greater poverty. Millions of children have been orphaned by the AIDS-related deaths of one or both parents; there are 14 million such children in Africa alone. The disease has and will continue to devastate entire generations in the poorest countries.
The International AIDS Conference does attract the world’s attention to AIDS, and, of course, it always counts on the attention of the media. For the scientific world it is a very good opportunity to learn about new studies. As Caritas, we take advantage of the opportunity to exchange good practices among those participating from the faith-based community.
The 6th Millennium Development Goal is to combat HIV and AIDS, namely to stop or even reverse the spread of HIV/AIDS by 2015. Is it still possible to reach that goal?
We have made some progress but there is still a long way to go. One of our main goals is to get more people on lifesaving anti-retroviral medication. Only 4 million have such access out of 10 million people who need it. For every two people who start such treatment, there are five new HIV infections. For many living with HIV disease, access to medication is a question of life and death. But there also are wider public health implications of this situation. If people take anti-retroviral medication are not assured of a continuous supply, they may develop resistance to the medication and thus can pass on a resistant strain of the virus to others who come into contact with their blood or body fluids. In that case, people infected with such resistant virus will not receive any benefit from the medications.
In its worldwide “HAART for Children” campaign, Caritas is focusing on children infected with HIV/AIDS. Why?
The focus on children came from our practical experience. We found that many children died before we could help them. “HAART” stands for “Highly Active Anti-Retroviral Treatment” but also represents a play on words (in English) to encourage pharmaceutics companies, governments and the entire human family to have a “heart” for children living with HIV infection.
What are the main goals of the campaign?
The main goal of this campaign is to inform and develop “child friendly” medications as well as HIV tests appropriate for children. Statistically, one third of children living with HIV die before they are one year old, and half of them die before their second birthday. With HIV tests most commonly used in developing countries, we cannot be certain about whether a child is living with the virus until s/he 18 months old. By that time, the immune system of the such children already has undergone serious damage and thus cannot defend them against any number of life-threatening infections and cancers.
Another problem is that we don’t have enough “child friendly” dosages and formulations of anti-retroviral medications; so doctors and nurses advise the parents of such children to cut up adult dosages. But how do we know that an adult pill is correctly cut into three, four, or five pieces? And how do we know that such pieces are the correct dosage for a particular HIV-positive child? We really need liquid and pre-measured dosages (fixed dose combinations) that do not require refrigeration in view of the frequent power cuts in Africa and other developing regions. Another problem is that some of the paediatric anti-retroviral medications that presently are available taste so bad that children often experience nausea and vomiting after receiving such medicines.
What is the contribution of Caritas?
Caritas and other Catholic organisations try to eliminate stigma by setting a good example of offering compassionate, non-judgemental welcome and care for those living with HIV. We treat these persons with respect and dignity and help them to empower themselves through formation of self-help groups and income generating projects to empower themselves. The Vatican estimates that more than a quarter of HIV treatment, care and support offered worldwide is under the sponsorship of Catholic Church-related organisations.
With regard to advocacy, the great advantage of Caritas is that we can communicate with people at grassroots level, but also with people at the highest levels of government and of the United Nations and other inter-governmental structures. In my opinion, Caritas serves as an important bridge between the “haves” and “have-nots” in today’s world that increasingly separates and isolates rich and power, powerful and powerless.
You have met a lot of people living with HIV and AIDS. What do such people want and need?
They certainly want equal chances and access to a better life. They don’t want to be stuck in the vicious circle of HIV and poverty, and they want access to medication. But many of them have a great sense of hope. Many, especially those taking anti-retroviral medications, say that, although they face daily fears and challenges, they feel as though they have a whole new life. They start to appreciate life again. So they have a great sense of hope and are teaching me and others, too, about true meaning of hope. It has been – and still is – a real privilege for me to work in this field for all those years.
About Msgr. Robert J. Vitillo
Msgr. Vitillo serves as the Special Advisor on HIV/AIDS for Caritas Internationalis and as the Head of its delegation in Geneva, Switzerland. He is recognised by many as a distinguished “expert” in the field of HIV and AIDS. He also works closely with UNAIDS, the World Health Organisation, and other international health-related offices. He also chairs the Catholic HIV/AIDS Network, an informal group of Caritas and other Catholic development and mission organisations, as well as religious orders active in providing financial and technical support to Church-related HIV programmes in developing countries. When, in 1987, the General Assembly of Caritas Internationalis identified the HIV pandemic as a priority area of reflection and action, he was asked to guide and represent the Caritas Network in this field. The 63-year old priest has been professionally trained in the field of psychiatric social work.