Hope and Dignity In the Developing World

Hope and Dignity
In the Developing World
w w w . c r s . o r g

©Copyright 2009 Catholic Relief Services—United States Conference of Catholic Bishops.
Published in 2009 by:
Catholic Relief Services
228 West Lexington Street
Baltimore, MD 21201-3413
Telephone: 410-625-2220
Internet: www.crs.org
Email: HIVunit@crs.org
Project Coordinator: Daphyne Williams
Graphic Design: Valerie Sheckler
Cover Photos: Rick D’Elia, Rita Villanueva, Rick D’Elia, Sean Sprague, Dave Snyder
Acknowledgements:
This publication would not be possible without the hard work of Catholic Relief Services country programs and local partners. The
staff members in country programs and partner offices are the ones who make CRS’ great work possible. A heart-felt thank you is
extended to all field staff, dedicated and committed to their work in HIV programming.
We would also like to thank all Regional Technical Advisors for HIV, Country Directors and program staff who worked diligently
to assist in the production of this document including: Michelle Lang-Ali, Gaye Burpee, Jack Byrnes, Ana Maria Ferraz de Campos,
Lorainne Currie, Eda Cabaluna-Detros, Dr. Daniel Dharmaraj, Laura Dills Alexandre Diouf, Alemayehu Gebremariam, Candida
Gil, Brian Gleeson, Brian Goonan, Alan Isaac, Tracy Kaye, Karen Kent, Natalie Kruse-Levy, Linda Lovick, Anna McCrerey, Pamella
Mittelholzer, Cheryl Morgan, Flor Idalia Munoz, Shuhbra Phillips, Leslie Santamaria, Dorothy Madison-Seck, John Service, Mayling
Simpson, and Kristin Weinhauer.
Additionally, we would like to thank HIV and AIDS Unit and headquarters staff who assisted in the completion of this document
including: Gabrielle Bielen, Caroline Bishop, Mychelle Farmer, Sharon Abrams-Gordon, Michelle Harrington, Carrie Miller, Mark Levy,
Karen Moul, Prakash Nellepalli, Mary Riddick, Wendy-Ann Rowe, Shannon Senefeld, Carl Stecker, Jim Stipe and Daphyne Williams.
We would like to thank Valerie Sheckler for her layout and design of this publication.
Finally, we would like to thank the donors who enable us to implement such a wide range of HIV programming. Without your
support, we would not be able to have such an impact.
If you have any questions about this document or would like this document sent to you, please contact the HIV and AIDS Unit
within the CRS Program Quality and Support Department at HIVunit@crs.org.
Important Note: The photographs in this publication are used for illustrative purposes only; they do not imply any particular health status (such as HIV
or AIDS) on the part of any person who appears in the photographs.

Hope and Dignity
In the Developing World

Table of Contents
Introduction............................................................................................................................ 1
State of the Epidemic............................................................................................................ 2
Community-Based Care and Support............................................................................. 4
Orphans and Vulnerable Children................................................................................... 7
HIV and AIDS Prevention...................................................................................................10
Treatment—Antiretroviral Therapy...............................................................................13
Food Security and Nutrition.............................................................................................15
Livelihoods.............................................................................................................................18
Injecting Drug Use...............................................................................................................21
Prevention of Mother-to-Child Transmission..............................................................23
HIV and AIDS Policy and Advocacy................................................................................25
A Brief History of CRS..........................................................................................................27
Hope & Dignity in the devel oping w orld i

INTRODUCTION
In 25 years, HIV has infected almost 70 million people; AIDS has killed more
than 25 million and affected millions more on every continent. The rising tide
of illness and death—and the millions of orphans left behind—endangers the
development of many regions of the world.
Prolonged sickness and eventual death of those with AIDS diminishes a family’s
ability to sustain its livelihood and a community’s ability to maintain social
cohesion. Pressures on family and society affect the poor disproportionately.
Young women, in particular, carry the greatest burdens and risks related to HIV.
Hope & Dignity in the devel oping w orld 1
As Catholics, we are compelled to act.
This catalog provides an overview of Catholic Relief Services’ HIV and AIDS
programming around the world—which helps millions of the poor and
vulnerable live longer, healthier lives.
CRS supports more than 280 HIV and AIDS projects in 62 countries. We will
continue to expand our programming as the disease continues to devastate lives
of families and communities overseas.

St ate of th e Epid emic
HIV, or Human Immunodeficiency Virus, is the precursor
to AIDS. An HIV-infected cell works to produce new HIV
retroviruses. HIV retroviruses replicate in and kill the cells
that our bodies use to fight against illness.
HIV is only spread through
• Direct contact with needles and other sharps
contaminated with HIV infected blood
• Contaminated blood products and transplanted organs
• Transfer from an infected mother to her child during
pregnancy, the birth process or breastfeeding
• Sexual contact with an HIV-infected individual
AIDS, or Acquired Immunodeficiency Syndrome, is the
advanced stage of HIV infection. This stage is generally
characterized by the appearance of opportunistic
infections. These are infections that take advantage of a
weakened immune system and can include pneumonia,
tuberculosis and other crippling illnesses.
2007 Updates1
• HIV continues to be the most serious of infectious
disease challenges to public health in the world.
• The global percentage of people infected with HIV
remained steady in 2007.
• There was a decrease in the number of AIDS deaths in
2007 due to increased access to treatment and longer
survival times.
• There were reductions in the percentage of people
infected with HIV in some countries, such as Botswana,
Rwanda, and Zimbabwe.
• Globally, in 2007, there was a decrease in annual new
HIV infections.
1 UNAIDS (2008). 2008 Report on the Global AIDS Epidemic. Retrieved November 5, 2008 from
www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp
2 Hope & Dignity in the devel oping w orld
HIV and AID S Quick Facts1
• In 2007, there were approximately 33 million adults
and children living with HIV and AIDS around the
world. Sub-Saharan Africa is the worst affected
region, with nearly 22 million cases.
• There were 2.5 million new cases of HIV in 2007,
420,000 of which were children under the age of 15.
• In 2007, there were 15 million children between the
ages of 0-17 orphaned as a result of AIDS.
• There were 14.1 million women aged 15 and older
living with HIV in 2007.
• AIDS-related illnesses killed 2.1 million people
worldwide in 2007 (1 in 6 were children).
• AIDS is the leading infectious cause of adult deaths
worldwide.
• Globally everyday, around 7,400 people become
infected with HIV (1 person is infected every 12
seconds) and over 5,700 people die from AIDS
(1 person dies every 16 seconds).
Haiti
has an HIV
prevalence of
around 2.2 percent
with more than
120,000 people living
with HIV.
Latin
America
and the
Caribbean
have more than 2
million people living
with HIV.
rick d ’elia

EPIDEM IC
Women, HIV and AID S
HIV and AIDS affect men and women of
every race, ethnic group and economic
level. But women in the developing world
face heavy economic, legal, cultural, and
social disadvantages that increase their
vulnerability to the epidemic’s impact.
For example, families often withdraw
young girls from school to care for family
members who are ill with the virus. This
lack of education has a major impact on
the girls’ lives—leaving them less able
to provide income for their families and
more vulnerable to HIV infection.
In addition, older women often
shoulder the burden of care when
their adult children fall ill. Later they
become surrogate parents to orphaned
grandchildren. Young women widowed
by AIDS may lose their land and
property after their husbands die—
whether or not inheritance and laws are
designed to protect them. Widows are
often responsible for producing their
families’ food and may be unable to
manage alone.
In order to adequately address the
HIV epidemic, programming must
recognize these additional burdens
that the disease places on women in the
developing world.
1
Eastern
Europe and
Central As ia
had 1.5 million
people living with
HIV in 2007.
2 UNAIDS (2008). 2008 Report on the G lobal AIDS Epidemic. Retrieved N ovember 5, 2008 from
HIV
Population
in Heavily
Aff ected
Regions2
North
Af rica and
the Middle East
have approximately
380,000 people living
with HIV—190,000 are
women aged 15
and over.
Sub-
Saharan
Af rica has just over
10 percent of the world’s
population, but is home
to nearly two-thirds of all
people living with HIV
—some 22 million
people.
India
had an
estimated 2.4
million people
living with HIV
in 2007.
South
and
Southeast
As ia had 4.2 million
adults and children
living with HIV
in 2007.

COMMUNITY-BASED
CARE AN D SUPPORT
There are approximately 33 million people32in the world
living with HIV and AIDS. Our HIV and AIDS policy calls
for us to affirm human dignity and to seek effective
means of addressing the AIDS crisis. CRS helps those
living with the virus to care for themselves and others
through a comprehensive continuum of care—from
initial testing to nutritional support and ART to home-based
and palliative care.
In partnership with other faith-based and non-governmental
organizaitons, CRS directly supports
more than 4.8 million people affected by HIV and AIDS
throughout the world. However, travel to and from care
facilities is often difficult for the patients who need it most
due to illness and geographic location. For this reason, CRS
delivers community-based care and support worldwide.
Th e Basics
Our approach to community-based care and support is
based on these practices:
• Care for people living with HIV and ADI S should
be holistic. It should include medical and nursing
care, counseling and psychosocial support, spiritual
support, socio-economic support, and referral.
• The needs of people, families, and communities
are integral in the planning and delivery of HIV
and AID S care and support programs. People
living with HIV and AIDS, their families, and their
communities must be the central focus of problem
analysis, project design, implementation, and
management of home-based care programs.
• Care and support activities should be
complemented by HIV prevention education.
• Home care is the preferable means of care in
many cultural settings. Home care programs are
often more sustainable over the long term and more
successful when they are based within communities.
When many members of a community are involved
3 UNAIDS (2008). 2008 Report on the Global AIDS Epidemic. Retrieved November 5, 2008 from
Community-based Care
and Support Quick Facts
• The Catholic church provides care for one out of
every four people living with HIV and AIDS in the
world today. As a Catholic organization, CRS is
uniquely positioned to make a difference in the
lives of these individuals.
• In fiscal year 2009, CRS supported more than 280
HIV and AIDS projects in 62 countries with a total
value of more than 170 million USD.
• More than 2.2 million children are now living with
HIV; 1.8 million of them live in sub-Saharan Africa.
lane hartill
in care and support, there is less likely to be stigma
associated with the disease.
• The roles of men, women, and children as
caregivers are an important consideration. Women
and girls are often the primary caregivers of people
living with HIV. To address this imbalance, both men and
women should be encouraged to explore questions of
who provides care and support to family members.
CR S in Action: SUCCE SS
Zambia is one of the sub-Saharan African countries
most affected by the HIV pandemic. An estimated 14%
of Zambians are infected, amounting to over 1 million
persons in need of care and treatment. The burden of
HIV continues to pose a major challenge to Zambia’s
health care system, as well as to overall national
development. The CRS Zambia Scaling Up Community
Care to Enhance Social Safety-nets (SUCCESS) project
began in August of 2003. Its purpose is to support the
provision of comprehensive home-based care (HBC) in
the country, including the provision of basic medical
care and training family members to care for HBC clients.

SUCCESS-Return to Life (RTL) started in July 2006, as
a follow-up project to SUCCESS. The name “Return to
Life” reflects the return of people living with HIV to
productive lives after diagnosis, care, and treatment
by programs such as SUCCESS. Trained volunteers,
recruited from local communities, are instrumental
in facilitating HBC services for clients. Volunteers visit
clients in their homes at least weekly, depending on
the level of illness. Clients receive basic psychosocial
and pastoral support, as well as health and prevention
education on a number of topics. SUCCESS-RTL is
making a difference in Zambia. By offering quality
care and other HIV services, clients are returning to
productive lives. People can once again work and
care for their families, lessening the burden on the
community. There has been a reduction in stigma
and discrimination due to this project and fears of the
disease have diminished, encouraging more people to
get tested for HIV, disclose their status, and seek care
and treatment.
The SUCCE SS Program
• Provided care to 38,307 clients since it begun in 2003.
• Incorporated a nutritional component to the project
providing soya porridge mix (HEPs = High Energy
Protein) to moderately malnourished clients and a
fortified peanut-butter product (RUTF = Ready to Use
Therapeutic food) to severely malnourished ones.
• Initiated Savings and Internal Lending Communities
(SILC) for the caregivers and clients. Participation in
SILC groups enhances retention of caregivers within
the project by providing them an opportunity to
obtain loans to start income generating activities.
• Partnered with the Palliative Care Association of
Zambia, which under the slogan “Pain Relief is Human
Right”, advocated for authorization from the Ministry
of Health for hospices to dispense morphine to manage
severe pain related with terminal illness.
• Works with implementing partners across 6 Dioceses,
7 provinces, and 11 hospices; in association with the
Palliative Care Association of Zambia.
CRS in Action:
Home-based Care
and Support in Eritrea
The prevalence of HIV in Eritrea is less than 3 percent. Given
poverty, the mobilization and demobilization of troops,
lack of awareness, and commercial sex activity in urban
areas it is likely the prevalence will increase. HIV-related
stigma decreases willingness to disclose HIV status or seek
counseling and testing. These factors make it difficult to
meet the needs of people living with HIV in Eritrea.
CRS has been providing home-based care and support
(HBCS) in Eritrea since 2003 in partnership with the
Eparchy of Asmara Catholic Church. This project helps to
meet the medical, nutritional, and psychosocial needs of
people living with HIV by improving access to health care
and HBC providers, providing food rations and livelihood
security, and using in-kind grants for income-generating
activities. Beneficiaries have enjoyed an increased
quality of life as a result of the project. A compassionate
environment has been created where beneficiaries
and HBC workers share ideas, learn from one another,
and provide support through discussions and support
groups. The program has also helped orphaned children
return to school and beneficiaries gain access to HIV
treatment. O f the clients who received grants for income-generating
activities, three-quarters have already paid
back the program.
SUPPORT
dave snyder

SUPPORT
Mrs. Hiwet is a 52-year-old widow,
mother of nine, living with HIV.
When her husband was sick,
Mrs. Hiwet heard rumors that he
was suffering from AIDS but she
disregarded the gossip. Upon his
death, she was formally informed
that he did in fact die from AIDS.
Mrs. Hiwet was tested for HIV at
that time and was HIV positive. She
immediately felt despair and a loss
of hope, thinking of her children
becoming orphans. The counselor
that was working with Mrs. Hiwet
connected her with the CRS home-based
care and support project,
which changed her life. Mrs. Hiwet
was assigned a HBC caretaker
who visited her at least twice a
month. The caretakers provide
emotional, physical, and spiritual
support. The church also organized
a monthly coffee ceremony where
people living with HIV and their
caretakers gather to share ideas
and experiences, care, and learn.
Mrs. Hiwet has disclosed her status
to her children and now has their
support. The church also helps Mrs.
Hiwet with school materials for
her children and linked her with
the clinical management service
providers for her HIV medical
care and treatment. She is also
the beneficiary of interest-free
microfinance assistance, which
helped her to open a small shop with
her elder children. She was able to
repay her loan in a short time.
Mrs. Hiwet proudly states, “With
the steady increase in prices on
all commodities, house rent, and
the shortage of supplies in the
city, it is difficult to stand alone
without external assistance until
the market stabilizes. I am covering
all the expenses of my rental house
bills, school fees, and earning
some amount for my living. All
my children are continuing their
education without any problem.”
Mrs. Hiwet’s Success

ORPHANS AN D
VULNE RABLE CHILDREN
Orphans and Vulnerable
Ch ildren Quick Facts
• More than 15 million children under the age of 17
have lost one or both parents to AIDS.
• Orphans and vulnerable children are at greater
risk of malnutrition, illness, abuse, sexual
exploitation, and HIV infection.
• Each day, approximately 1,200 children become
infected with HIV.
Beyond providing care for people living with HIV and
AIDS, CRS is called to support entire communities affected
by the pandemic. The population of children orphaned
and made vulnerable by HIV has risen into the millions. In
sub-Saharan Africa alone, more than 11.5 million children
have been orphaned due to the ravaging effects of AIDS.
CRS programming for orphans and vulnerable children
(OVC) is intended to stop the cycle of vulnerability that
continues to put children at risk from and to HIV infection.
Some of the most pressing problems vulnerable children
face include the burdens of caring for an ailing parent
and younger siblings, the loss of family income as parents
become ill or die, and withdrawal from school to care and
provide for family. With shrinking availability of public funds
to cope with this issue, local organizations must enhance their
capacity to respond to the needs of children affected by HIV
and AIDS in an effective and sustainable manner.
CRS programming responds to the needs of O VC by
supporting efforts to strengthen the means and ability
of families to cope with problems brought on by HIV and
AIDS. Key program areas include:
• Enhancing the capacity of children and youth to meet
their own needs
• Raising awareness within communities to create
an environment that supports children affected by
HIV and AIDS
• Supporting those who care for orphans and
vulnerable children
• Providing psychosocial support for children and
their families
CR S in Action:
Lesotho MO VE Project
The Mountain O rphans and Vulnerable children
Empowerment (MOVE) project provides food security
and nutrition, education, health and HIV services, life
skills education and HIV prevention services and support
and child protection to children living with and affected
by HIV in Lesotho. The HIV epidemic in Lesotho has had
a profound effect on the nation’s children. CRS works
closely with UNICEF and the National AIDS Commission in
promoting the cause of O VC in Lesotho. The total number
of orphans due to HIV-related illnesses is around 180,000,
with an estimated 100,000 children having lost both of
their parents. By 2010, orphans are expected to account
for more than 25 percent of all Basotho children, and
four out of five of those are estimated to be orphaned
as a result of AIDS. Although approximately 141,000 of
Lesotho’s orphans currently are in school, the enrollment
figures are beginning to decrease as many children are
dropping out to care for ill family members or to head
households themselves. Female children are dropping out
at disproportionate rates.43
4 IRIN Report (2007, January 3). Lesotho: New policy to help orphans and vulnerable children.
Retrieved November 5, 2008, from http://ww.irinnews.org/report.aspx?reportid=63001
dave snyder
martin lueders

The MOVE pilot was designed to respond to these multiple
needs through interventions such as assistance with school
enrollment and long-term structural change by engaging
and reviving community spirit and cohesion. CRS is working
closely with the Lesotho Catholic Bishops Conference, the
Clinton Foundation, Partners in Health, and Mission Aviation
Fellowship with the goal of bringing a complete continuum
of HIV and AIDS care and support to the communities
served. The program has implemented a child protection
curriculum; has provided assistance to beneficiaries in
gardening and food preservation, which has led to the
availability of food throughout the year; has increased
school attendance since children are provided with school
uniforms and essential supplies through the project; and
has improved the community emphasis on education.
Children in the project report that they now eat between
two and three meals a day since their caregivers now have
increased food supplies.
2007 MO VE facts
• The project targets 6,000 O VC and 3,000 O VC household
members.
• Eighteen schools are being reached by the project.
• Farming materials have been distributed to O VC
households.
• A child protection curriculum has been developed
which is being shared with other programs. CR S in Action:
Ts ungirirai Station Days,
Zimbabwe
The Tsungirirai Private Voluntary Organization, located
in Norton, Mashonaland West Province in Zimbabwe,
provides support for children orphaned or made
vulnerable by HIV and AIDS. The organization also
supports a community preschool, home-based care for
people living with HIV, HIV counseling and testing, and
community education for HIV prevention. Tsungirirai
began providing support to OVC in 1998, when staff and
volunteers encountered the range of needs of children
whose parents had died as a result of AIDS. Support
has expanded to the rural areas outside of the town of
Norton since 2000.
Station Days began in 2003, through volunteer insight and
suggestion. This is an activity that allows for the regular
and accurate collection of data on children’s health and
psychosocial status, called “Monitoring and Evaluation.”
The Station Days program is set up to benefit children
directly and immediately, in addition to gaining the long-
ORPHANS AN D VULNE RABLE CHILDREN
CRS les oth o
rick d ’elia

ORPHANS AN D VULNE RABLE CHILDREN
term benefits of the data collected on Station Days, by
disseminating material goods and information as children
pass through “stations” in which psychological, physical,
and social functioning are assessed. These Station Days
are enjoyable for the children, as it is time for them to
express themselves and be heard. Strategies for collecting
information from the children are designed to meet the
developmental capacities of children in various age-specific
groups. In addition to the Station Days, each week 200 OVC
come to Tsungirirai’s drop-in center for meals, psychosocial
support, and library activities. The data collected from the
Station Days serve as a way of monitoring and evaluating
the drop-in center’s effectiveness in meeting the care and
support needs of OVC.
Station Day Stations
Th e Gate
Each child is given a vitamin tablet or sweet and a ticket to check off
each station as the child completes it.
Cl inic Station
A nurse records the child’s height, weight, and general health status;
children are checked for communicable diseases.
Counseling Station
Five standard questions are asked that focus on life at home, school
and the Tsungirirai center. Knowledge about HIV and other topics
covered by the program is assessed.
Meet Gogo or Sekuru
Meet with volunteers, who are their elders, to receive advice about
manners, health and hygiene.
Library Station
Assessment of children’s academic performance as well as school
attendance and development of an action plan if there are problems.
Children may receive pens and borrow textbooks.
Supplies/Token Station
Children receive tokens for attending that can be used for basic
necessities like soap, toothpaste, hats, petroleum jelly, blankets,
oranges, toys and even a meal.

HIV and adi s PREVEN TINO
Catholic Relief Services (CRS) is responding to the HIV
pandemic in 62 countries around the world—primarily
in Africa, but also the most impacted areas of Asia and
Latin America. A critical part of our overall response is
to reduce the transmission of the virus while caring for
those who are most in need.
CRS takes an integrated approach to prevention that
uses best practices and is grounded in the Catholic
church’s teachings on human sexuality. All prevention
program activities encourage abstinence and mutual
fidelity within marriage and contain health education
messages about risk-avoiding practices that are widely
recognized as essential components of successful HIV
and AIDS prevention interventions. CRS also supports
risk-reducing practices—including delaying sexual
activity, limiting the number of sexual partners,
programs for counseling and testing, treatment of
sexually transmitted infections, and precautions that
promote blood safety and limit blood-borne infections.
The majority of CRS prevention programs are offered
in concert with the local church. CRS works to advance
the capacity of the church to respond to HIV and AIDS
around the world, while expanding the numbers of
people exposed to healthy educational messages
through the church’s vast educational and pastoral
infrastructure. We also work with the church to engage
other faith-based groups and advocate for appropriate
government responses.
CR S in Action:
Lesotho Faith Based
HIV Prevention Project
In O ctober 2008, CRS, received funding from the United
States Agency for International Development through
PACT to develop a faith-based HIV prevention response in
Lesotho. With about 90 percent of the population affiliated
with a Christian denomination, a faith-based intervention
has the potential to be very effective in Lesotho. HIV
Prevention Quick Facts
• Prevention is the only hope for reversing the
HIV epidemic.
• Fewer than one in five people who are at risk for
HIV has access to HIV prevention services.
• Only one in ten people living with HIV has been
tested for HIV.
• For every two people receiving antiretroviral
therapy for HIV, five are newly infected.
• Information, and services to help prevent HIV
infection are out of reach for the most at risk.
“ Faith-based organizations play a crucial
role in the fight against HIV/AIDS. The
involvement of faith-based organizations
is multifaceted and includes organizations,
spiritual, emotional, psychological and
value-related issues. Faith leadership plays
an important role in motivating people
to become involved in HIV/AIDS-related
work…Faith underpins and propels the
response of the Church as an institution to
the HIV/AIDS epidemic. The morality of care
and compassion obliges individuals and
organizations to become involved in the
prevention of spread of HIV and to care for
the sick or those whose lives are affected by
the sickness or death of family members.” 5 1
— Dr. Maretha de Waal, University of Pretoria
5 Dr. Maretha de Waal, University of Pretoria, Turning of the Tide: A Qualitative Study of SACBC
Funded Antiretroviral Treatment Programmes, January 2005, p. 10.
dave snyder

PREVEN TION
dave snyder
prevention activities target church leaders, both at the
national and local levels, and church congregations to help
them understand and appropriately respond to the key
drivers of the epidemic in Lesotho, including the problem
of early sexual debut, trans-generational sex, and multiple
concurrent sexual partnerships. Intervention activities
include the promotion of prevention messages through
established church structures and committees, within
families, and between community members.
It is believed that the incidence of HIV infection in Lesotho
can be reduced by discussing positive youth and adult
behaviours that are influenced by faith-based values and
supported by their peers. These values are communicated
through specific abstinence and faithfulness messages
and discussions that protect those at risk of HIV. The
project strategy uses church leaders at various levels
and existing church structures, including congregational
groups, to provide common and key HIV prevention
messages on abstinence and faithfulness that are tailored
to specific age and gender groups. A large number of
HIV care, treatment, and support activities are already
underway by branches of Christian denominations
in Lesotho. These established structures and activities
provide an obvious entry-point for further interventions
and discussion.
CR S in Action:
In Ch arge! Action Learning
on HIV and AID S for Youth
In Charge! is a participatory methodology that helps youth
aged 15-24 learn about HIV and AIDS, HIV prevention, and
reducing stigma and discrimination. The main objective
is to help youth take charge of their lives so they will not
become infected with HIV. It empowers youth to make
better decisions in their lives to avoid situations where
unwanted and unwise sexual activity could occur.
To assist two CRS partner organizations, the Ethiopian
Catholic Church—Social and Development Coordinating
Office of Adigrat and Alem Tena Catholic Church.
Through the use of CRS private funds, the In Charge!
Facilitator’s Guide was developed using a participatory
approach with valuable input and field testing by many
CRS, partner staff, and community members in their HIV
and AIDS education programs for youth.
In Charge! is based on the SARAR (Self-Esteem,
Associative Strength, Resourcefulness, Action Planning
and Responsibility) methodology which aims to raise
self-esteem using pooled knowledge to gain associative
strength, encouraging resourcefulness in finding
solutions and action planning to bring about change.
The curriculum can be used both in and out of school
by trained facilitators.
This methodology helps break the silence surrounding
HIV and AIDS to help youth:
• Learn correct information about how HIV is spread
“ Before In Charge! we talked a lot about HIV and AIDS, but when the students left the room, the
discussion was over. Now our students tell their parents about what they have learned and
the students come back to school the next day with questions from their parents. This never
happened before. It means that the discussion continues and the students begin understanding
on a deeper level that this disease is real and could affect their lives. In Charge! is the best
learning method for HIV and AIDS that we have had so far.”
— A teacher who uses the In Charge! methodology

PREVEN TION
Learn what they can do to avoid infection, • including
the importance of abstinence and being faithful to
one’s partner
• Become sympathetic to those affected by HIV and
AIDS and seek to end stigma and discrimination
• Become empowered to avoid situations where
unwanted or unwise sexual activity could occur
The guide is easy to follow and contains illustrations,
sample activities, guidelines on how and where to conduct
the group, and structured facilitation techniques.
CR S in Action:
Proyecto VIDA
HIV Prevention, Guatemala
In Guatemala, access to HIV care and treatment is limited.
Until recently, there was little response from the faith-based
organizations to the HIV epidemic. To respond to
the epidemic, CRS has supported the work of local partner,
Proyecto VIDA (Project Life) to help improve the response
in the faith-based community and increase access for
people living with HIV in Guatemala.
Since O ctober 2004, Proyecto VIDA has been
implementing HIV prevention actions and care
for people living with HIV in the southwest area of
Guatemala, one of the national HIV response target
areas. The goal of the project is to contribute to the
reduction of the spread of HIV by educating and
raising awareness among Guatemalan Catholic health
organizations. The project targets priests, sisters, and lay
people from health pastorates to help reduce stigma and
discrimination against people living with HIV and their
families. Proyecto VIDA is also targeting beneficiaries
and their families in addition to the outreach to religious
leaders by providing home-based care and support.
Now, an increased number of priests, sisters, lay people,
and members of health pastorates are being trained in HIV-related
topics, so that diocese are able to provide spiritual
guidance that promotes HIV prevention activities in their
parishes. Additionally, as a result of the work of Proyecto
VIDA community activities that promote reduction of
discrimination, stigma towards people living with HIV has
decreased. Due to the HBC interventions, people living with
HIV have better access to HIV care and treatment.
The Catholic church Guatemala is currently building its
technical capacity in order to implement HIV prevention
activities and provide pastoral accompaniment to people
with HIV and their families. CRS estimates that worldwide
one out of every four persons living with HIV receives care
through a Catholic institution. Our affiliation with the Catholic
church allows CRS to be highly effective as local treatment
managers for people living with HIV. Although CRS has a
spiritually based mission, we help people in need without
regard to race, belief or nationality. In fact, most beneficiaries
of our programs are not Catholic.
CRS Guatemala

TREA TMEN T—
AN TIRETROVIRAL THERAPY
Patients on ART still have HIV, but their immune system
is stronger. With proper nutrition they are able to regain
weight lost due to the disease and are better able to
work to support themselves and their families. When
antiretrovirals (ARVs) successfully contain the virus,
people can expect to lead a full, productive life.
Until recently, ART was unavailable in much of the
developing world because of its high cost. Without
this treatment many people with the disease would
often die within five years of infection and often face
debilitating infections while alive. This is particularly
significant in Africa, where almost three quarters of
people infected with HIV live.
We are on the threshold of change. A promising
combination of increasing awareness and decreasing
costs are giving many people living with HIV in the
developing world an opportunity to receive ART—
and hope.
CR S in Action:
AID SRelief Consortium
The goal of the AIDSRelief Consortium is to ensure
that people living with HIV and AIDS in the developing
world have access to high quality ART and medical
care. Launched in March 2004 and funded by the
President’s Emergency Plan for AIDS Relief (PEPFAR)
through the U.S. Department of Health and Human
Services, the project brings together the unique skills
of a consortium of organizations to expand delivery
of antiretrovirals to people infected with HIV in Africa,
Latin America and the Caribbean. CRS is the lead
agency for the AIDSRelief Consortium and is responsible
for its management in nine countries.
Working in partnership with mostly faith-based
institutions (both Catholic and non-Catholic), local
non-governmental organizations, and community
volunteers, the AIDSRelief Consortium provides the
Treatment Quick Facts
In 2006, 127,300 children • living with HIV
received ART, a 70% increase from 2005.
• In 2007, 3 million people worldwide had access to
ART, a 46.5% increase from the previous year.
• Although there has been great progress in the
past few years, more than 6.7 million people are
in need of treatment and have no access.
• The CRS led consortium AIDSRelief currently
provides ART to over 140,000 people and HIV
care to over 380,000 people in 9 countries in sub-
Saharan Africa, Latin America and the Caribbean
through almost 190 local partner treatment
facilities, mostly faith-based.
• In 2004, AIDSRelief was awarded 335 million U.S.
dollars over five years by the United States’
President’s Emergency Plan for AIDS Relief
(PEPFAR), to reach those in need of HIV care and
treatment in the hardest hit areas. PEPFAR has
extended this project for up to four more years.
• AIDSRelief is working to strengthen institutions
and build up a reserve of trained staff to
deliver ART. Doctors, nurses, community-based
volunteers and other health care workers have
been trained to administer various aspects of the
therapy across the 9 countries.
RICK D’ELIA
RICK D’ELIA

following critical components of antiretroviral therapy:
• Testing to determine if a person is HIV-positive and how
far the virus has progressed
• Antiretroviral medicines and related counseling
directly to patients in need and their support
systems/families
• Training of staff to use equipment, administer
treatment dosages and provide quality clinical care
• Education of patients regarding the importance of
taking all of their medications so that the virus does not
mutate and become resistant to the medications
• Equipment to hospitals and health care facilities,
including instruments, machinery and materials critical
to providing treatment
Ssenyonga A., at 5 years of age,
lost his parents in 1997 as a result
of AIDS. Following his parents’
deaths, he went to stay with an
aunt who lives near Villa Maria,
a hospital supported by the
AIDSRelief project as well as CRS
private funds. He irregularly
attended a nearby government
school, due to frequent illness. In
2003, he sought medical care at
Villa Maria hospital and was found
to be HIV positive.
Encouraged by the staff of the
Villa Maria program, he accessed
free medical care for opportunistic
infections from the Butenga Health
unit, a satellite health center of Villa
Maria. As his condition continued
to deteriorate, he was referred
to Uganda Cares, a government
unit 25 km away for Antiretroviral
Therapy (ART). Villa Maria provided
support for transport costs until
support from the AIDSRelief project
brought ART to Villa Maria in 2005,
eliminating the need for travel.
As his condition improved on
ART, Ssenyonga was enrolled in
apprenticeship training at a local
tailor near his home with other O VC
trainees. Within a year and a half he
graduated and was given a sewing
machine by the hospital. Now, at
16 years of age, he earns a good
income, which has improved his
livelihood. He actively participates
in activities to encourage HIV
counseling and testing and
adherence to ART. After realizing
there are more orphans in a similar
situation, Ssenyonga volunteered
to train another young person in
tailoring, who like him is living with
HIV and on ART.
Treatment
Ssenyonga: A Success Story from Uganda
RICK E’LIA

FOOD SECURITY
AN D NUTRITION
Food Security and
Nutrition Quick Facts
• By 2020, AIDS will kill 20 percent of Africa’s
farm workers.
• Seven million agricultural workers in sub-Saharan
Africa have died from AIDS since 1985. Another
16 million will die in the next 20 years. In several
countries, 60 to 70 percent of farms have suffered
labor losses as a result of the epidemic.
• A study in Zambia showed that households
headed by a person who was chronically ill
planted up to 53 percent less than households
headed by a healthy adult.
• The death of an adult from AIDS has a greater
negative impact than if the death were from
another cause. This is because of high costs
associated with care and treatment.
Food is a Fundamental
Human Right
According to USAID, food security occurs “when people
at all times have both physical and economic access to
sufficient food to meet their dietary needs in order to lead
a healthy and productive life.”
CRS believes that access to food is a fundamental human
right. It is estimated that over 850 million people in the
world do not have access to sufficient food, the majority
of whom live in South Asia and Africa. All aspects of food
security—availability of, access to, and use of food—are
threatened by high rates of HIV and AIDS. This global
epidemic has decimated families and left millions of
people in danger of not having enough to eat.
Part of the rising problem is the shift of the epidemic
from cities to rural areas. People living with HIV and
AIDS in developing countries are often the rural poor, a
population that is often the least equipped to respond
to the epidemic. HIV and AIDS are causing rural areas to
disintegrate quickly as farmers and their families become
too sick to work or too busy caring for their sick to
cultivate food.
CRS distributes food rations to families affected by HIV
and AIDS. To guard against food shortages in the future,
we work with communities to promote sustainable
agricultural practices and develop food markets.
Together, we are making a difference in ensuring that
every man, woman and child has basic access to food
through agricultural programs and initiatives that help
build stable and vital economies.
RICK D’ELIA
rick d ’elia

“Food aid plays a pivotal role in responding to HIV and AIDS. The first thing poor families affected
by AIDS ask for is not cash or drugs, it is food. And food has to be one of the weapons in the arsenal
against this disease.”
Th e Cycle of Poor Nutrition
People living with HIV have special nutritional needs. As
the infection progresses, they need more energy, to fend
off infection and therefore more food. People living with
HIV are also more likely to suffer a loss of appetite, thus
reducing dietary intake at the very time when nutritional
requirements are higher. Improving the nutritional status
of those with HIV and AIDS improves their quality and
length of life. Unfortunately in many parts of the world—
especially in Africa—families and communities are already
suffering from poor nutrition.
People living with HIV are not the only ones affected.
Children and adults whose family members are living with
— James T.
HIV are also less well nourished and more likely to be sick.
Evidence from East and Southern Africa demonstrated that
households affected by HIV and AIDS eat fewer meals and
consume less nutritious foods than households not affected
by HIV and AIDS. In addition, these families have less money
to spend on healthcare for non-infected family members.
CRS programs work to promote “positive living.” This
holistic approach encourages communities, including
those infected with the virus to care for themselves
through proper nutrition and other aspects of a well-rounded
care regimen.
CR S in Action:
THE PRODUCTI VE SAFTEY NET
PROGRAM , ET HIOPIA
Ethiopia is one of the poorest and most food insecure
countries in the world. Eighty–four percent of the
population relies on agriculture for its livelihood. After
years of a system dominated by emergency relief food
aid the government decided to move towards one that
addresses the basic root problem of chronically food
insecure households in a manner that protects their
productive assets. In collaboration with donors, the
Government of Ethiopia designed the Productive Safety
Net Program (PSNP) with the objective of protecting and
improving food security situation of targeted chronically
food insecure households in 282 food insecure woredas.
Specifically, the program is designed to address
immediate human needs while simultaneously supporting
the rural transformation process; preventing long term
consequences of short-term consumption shortages;
encouraging households to engage in production and
investment and increasing household purchasing power
thereby promoting market development. Food for work
is provided to those who can work, while households who
have no labor are entitled to receive safety net ration and
are considered as direct transfer beneficiaries.
CRS, through its Catholic Church implementing partners
at field level—Ethiopian Catholic Church—Social and
Development Coordinating Office of Harar (ECC-SDCOH)
FOO D
RICK D’ELIA

FOO D
and Wonji Catholic Church (WCC)—has provided support
including food, financial and technical assistance through
the PSNP to targeted chronically food insecure households
and local government offices since 2005. Funded by
USAID Food for Peace (FFP), the PSNP is now entering its
second phase and will continue though 2011. Partners are
implementing PSNP in five Woredas in O romiya Regional
State and one Woreda in Dire Dawa Administrative Council.
In addition to food insecurity, Ethiopia faces the HIV
pandemic with 3.5 percent of the population between
15- 49 years infected with HIV. There is an HIV knowledge
gap and stigma towards people living with HIV, which
deters people from seeking testing, care, and treatment.
There has been little attention paid to rural areas in
Ethiopia related to HIV programs.
PSNP project interventions include soil and water
conservation, water and irrigation system construction,
hygiene and sanitation interventions, agro-enterprise, and
seed voucher and livelihood fairs. HIV programming has
been integrated into these activities. The districts targeted
by the program are located in a mountainous, rural area.
As a result of the PSNP, there has been an increase in HIV
awareness, a reduction in stigma in targeted areas, and an
improvement in all livelihoods—including those of people
living with HIV. The program has also increased access
to clean water and nutrition. Community members have
increased financial assets as a result of integrated agro-enterprise
interventions. Nutrition education and food
preservation techniques have been taught concurrently
to improve long-term health and food security situation.
PSNP Facts
• The project is targeting 168,696 beneficiaries across six
districts (woredas) in Ethiopia—Kersa, Meta, Gorogutu,
Dodota, Sire and Dire Dawa.. Some of the targeted
communities live along a key trade and transportation
route that runs to the port of Djibouti, which is identified
as a “high risk corridor” for HIV.
• The first phase of project began in 2005 and completed
in 2008. However, USAID/FFP and CRS have agreed to
continue with a new Multi -Year Assistance Program
(MYAP) through 2011.
• This MYAP is designed to sustain and build upon food
security improvements achieved under complementary
interventions funded by multiple donors undertaken by
CRS in PSNP areas which continue to face high levels of
food insecurity related to lack of availability, access to
and utilization of food resources.
RICK D’ELIA

LIVEL IHOO DS
Loss of productive labor to HIV and AIDS forces
households to sell livestock and other assets to cope with
the mounting expenses associated with caring for the
terminally ill and, when the time comes, burying the dead.
One recent survey found that 40 percent of households in
Zambia affected by chronic illness had sold assets to cover
food, medicine, and funeral costs. Households already
in severe poverty possess virtually no capacity to survive
such additional burdens.
HIV and AIDS are also diminishing the human capital of
future generations. Children, particularly girls, are often
taken out of school to care for sick family members.
Girls may be sent to work in order to subsidize family
income—preventing them from getting a formal
education or learning important life skills.
Building Ass ets
In order to live healthy, productive lives, people need a
wide range of food, water, shelter, and security, among
others. These assets allow individuals to start businesses,
feed their families, obtain medical care, and educate
their children. O ne of the most effective ways to improve
the lives of those affected by HIV and AIDS is to ensure
that these assets are available. In this way, vulnerable
communities can care for the chronically ill; while
through education and skills building avoid behaviors
that put them at risk for HIV infection.
CRS and our partners help people to build the assets
they need to achieve sustainable livelihoods. For
example, some programs help vulnerable communities
produce more food through agricultural improvement
programs, while others work with clients to build or
improve water and sanitation systems for drinking,
irrigation, and livestock.
Reducing Vulnerabilities
An important goal of these programs is to increase the
ability of communities and households to respond to the
Livelihoods Quick Facts
• Each of the five capital assets—human, financial,
natural, social and physical—are impacted by the
HIV epidemic.
• People are driven to adopt risky strategies to
survive in the face of HIV and AIDS. The break-up
of households due to labor migration in times
of food insecurity as well as the exchange of
sex for money or food during crises increases
vulnerability, with women and children being
particularly exposed.
unanticipated shocks of natural disasters, disease, and
conflict. Without this protection, vulnerable families are
unable to climb out of poverty. CRS programs promote
HIV and AIDS education and awareness to prevent future
infections, offer micro-enterprise development activities
including savings and internal lending communities
(SILC) to help families create financial safety nets, and
distribute food to prevent malnutrition.
RICK D’ELIA
By helping to build and protect these assets, CRS and
partners ensure that income-generating activities will
endure. CRS complements its asset-building activities
with emergency response plans so families and
communities can protect the assets they have obtained.
CRS in Action:
HIV and AID S Livelihoods
Project Svay Rieng and
Prey Veng in Cambodia
The current HIV prevalence in Cambodia is 1.6 percent.
In Svay Rieng and Prey Veng provinces, there is an
increasing need for treatment, care, and support services
for people living with HIV and orphans and vulnerable
children focused on livelihoods and sustainable systems.
Approximately 40-45 percent of the Cambodian

LIVEL IHOO DS
population lives below the poverty line. In the project
areas, health-related expenses are a primary cause of
poverty as families use their scant savings, sell their
land and other possessions, and borrow money to pay
for poor quality health care.
The goal of the HIV and AIDS Livelihoods Project is to
help improve the livelihoods of HIV affected families
in Svay Rieng and Prey Veng provinces. CRS provided
technical, financial, and administrative support to
four partners in 88 villages. The project began in 2005
through funding from USAID and CRS private funds.
The project used an integrated farmer group model.
Through the HIV and AIDS Livelihoods Project,
awareness of HIV and anti-stigma messages were
spread among farmer groups and group leaders
with support of our partners. The project reinforced
the groups practice of to welcoming HIV-affected
households into their groups for support. HIV-affected
members were provided revolving funds
and loans from the group to help get them started
with composting, vegetable production, and chicken
and pig raising. HIV-affected households experienced
increased support and improved livelihoods. Orphans
and vulnerable children have improved school
attendance as a result of the livelihood projects.
CRS in Action:
Junior Farm Field
Schools (JFFS) in Zimbabwe
Zimbabwe is in a state of political, economic, and
humanitarian crisis, a situation compounded by an
HIV prevalence of 15.6 percent. The country has the
world’s highest number of orphans per capita and the
fastest shrinking economy outside of a war zone. The
cost of food and other basic necessities is increasingly
out of reach for the average Zimbabwean. There are
shortages of food staples, fertilizer, and spare parts,
among other items, due to a lack of foreign currency to
pay for imports and the impact of government-imposed
price controls. More than two out of three Zimbabweans
are not formally employed. Food insecurity across the
country is increasing because of a severe shortage of
supplies in most markets, very high market prices, and
the continued erosion of people’s purchasing power.
CRS has been working to implement the Protecting
Vulnerable Livelihoods Program (PVLP) since 2004 to
reduce the proportion of Zimbabweans who suffer
from hunger and extreme poverty. PVLP supplies basic
agricultural input, promotes innovative and appropriate
agricultural strategies, strengthens community and
household safety nets, improves access to community-managed
water and sanitation, and mitigates the
negative impact of HIV. Farmer Field Schools were
developed as local centers of agricultural learning and
seed production, and provide drip irrigation kits and
seeds for community nutrition gardens. Junior Farm
SEAN SPRAGUE

Field Schools (JFFS) target OVC who may not be able
to receive agricultural knowledge from a parent, as
would traditionally occur. In addition to learning about
cropping, soil conservation, and small livestock, JFFS
participants also receive information on HIV prevention.
JFFS also act as centers for training in the Participatory
Health and Hygiene approach, to help reduce water-borne
diseases inthe community.
JFFS have not only benefited OVC by improving their
food security and livelihood but also by providing
excellent social interaction to encourage collective
discussion about social problems such as HIV.
Pheanh Rong, 29, lives in Svay Rieng
Province and is married with one
young son. Both Rong and his wife
found out they were living with HIV
two years ago. Both receive care
and treatment and have stayed
strong over the past few years.
They are working hard to support
their family with the assistance of
RADE, CRS’ partner in Prey Veng.
Once Rong discovered he was
living with HIV, only his very
close relatives visited his family.
Neighbors and other farmers no
longer contacted him; he was not
involved in any social support
groups or committees in the
community. He had to spend a lot
of money to travel to the referral
hospital to receive care. In 2006,
RADE began implementing HIV
prevention and anti-stigma and
discrimination awareness with
community farmer groups, as
well as mobilizing communities
to understand, help, and care
for vulnerable households facing
challenges like HIV, TB, and extreme
poverty. Rong and his family were
invited to join the farmer group
in his village to help him regain
his livelihood and receive social
and economic support from his
community. Now, Rong explains
that since joining the farmer
group, “I have many people come
to visit my family and help care
for us and now we all understand
clearly about preventing HIV and
how HIV is transmitted. I have also
learned about animal raising and
seed production, as well as other
support; we are now growing
vegetables from seeds supported
by the group revolving fund for
eating.” Rong and his wife received
support and technical assistance
from the farmer group leader and
other members, including vital
encouragement and support.
Additionally, RADE has helped
the family continue to send their
son to school by providing a
uniform, school bag, and soap.
Rong and his wife hope to “find
a good future for [their] child”
and continue to live a healthy
life with HIV.
LIVEL IHOO DS
Cambodian Family Receives Community Support
and Acceptance in Rural Livelihoods
richard l ord

INJECTING DRUG USE
IDU Facts
• Globally, 2.5 million IDUs are infected with HIV.
• In many countries of East Asia and the Pacific,
IDUs constitute a large proportion of people
living with HIV, ranging between 38 percent
and 77 percent.
• WH Oestimates that 15 percent of the people
with TB/HIV are living outside sub-Saharan
Africa, many of these associated with injection
drug use. Among the estimated 33.2 million
people living with HIV, TB is one of the most
common AIDS-defining conditions and the
leading cause of death.
Injecting Drug Us e
Injecting drug use is a risk factor for HIV. It poses a threat
to the injecting drug user (IDU) population, where HIV
is spread quickly due to sharing injecting equipment
in a close IDU community. However, HIV is also a threat
to the partners and children of IDUs. Drug users tend to
be a marginalized group with complex needs and have
poorer access to life-saving interventions. They are also
more likely to be infected or co-infected with tuberculosis,
which presents other life-threatening challenges.
Th e HIV Epidemic in IDU s
Global trends illustrate that there are two broad
patterns of HIV epidemics: generalized, sustained in
the general populations of many sub-Saharan African
countries, and concentrated, found among populations
most at risk, such as men who have sex with men, IDUs,
and sex workers and their sexual partners. The HIV
epidemic in some parts of Southeast Asia and Eastern
Europe is largely attributed to IDU. Interventions that
target the IDU population include drug rehabilitation
programs, education for IDUs and their families,
increased access to care, and treatment and support
for IDUs and their families.
CRS has responded to the HIV crisis in the IDU population
by providing holistic programming, including nutrition,
education, and psychosocial support to IDUs and their
partners and families. CRS programs help reduce the
stigma around HIV in this population so more people
are encouraged to get tested and gain access to care
and treatment. CRS has involved local and faith partners
to acknowledge the epidemic and helped build their
capacity to respond.
CR S in Action:
PANI , Northeast India
It is estimated that national HIV prevalence in India is
approximately 0.36 percent, which corresponds to an
estimated 2 to 3.1 million people living with HIV, due
to the large population in India. In recent years, the
epidemic has stabilized, but there is still great variation
between states within the country and certain population
groups. Surveillance data from 2006 show an increase in
HIV infection among several groups at higher risk of HIV
infection, such as IDUs, men who have sex with men, and
sex workers. In northeast India, more than 50 percent of
the HIV infections are attributed to needle and syringe
sharing among IDUs. Northeast India is also home to a
mobile population and displacement due to civil unrest. HIV
spreads rapidly in IDUs since this group is often connected
through tight networks that share injecting equipment.
IDUs continue to represent the group with the greatest risk;
however the virus is also spreading rapidly in the general
population. Unemployment and few income generating
or career opportunities feed into the elevated rate of drug
use. All of these factors highlight the need for a holistic
approach to HIV prevention, care, and treatment among
this population.
CRS’ Preventing AIDS in Northeast India (PANI) project
operates in four northeastern Indian states: Manipur,
Nagaland, Mizoram, and Assam. The goal of the project
is to contribute to the stabilization of HIV prevalence
martin lueders

among women and youth and improved health
condition of IDUs and HIV and AIDS-affected and infected
groups in NE India. The project has worked to increase
access to HIV prevention, care, and support, while also
increasing the capacity of local and faith-based partners.
After three years of implementation, the PANI project
contributed to improved quality and access to HIV
care, improved quality of life, decreased stigma and
discrimination, the formation of several support groups
for people living with HIV, and improved awareness and
capacity among partners.
PANI Facts
• 4,845 PLHIV registered for care and support services.
• 640 Children living with HIV on antiretroviral therapy.
• 1,181 Adults living with HIV on antiretroviral therapy
• Education on HIV and stigma reduction provided to
35,141.
HIV in Northeast India
• In Manipur, estimates from 2002 demonstrate an HIV
prevalence of 55 percent among IDUs.
• In Manipur, it is estimated that 10.5 percent of women
who visited sexually transmitted infections clinics and
1.8 percent of women who visited antenatal clinics were
living with HIV.
• HIV prevalence among the non-injecting wives of male
IDUs increased from 6 percent in 1991 to 45 percent in 1997.
• More than 50 percent of IDUs in Manipur were between
the ages of 26 and 35 in 2002.
INJECTING DRUG USE

PREVENTION OF
MOTHER-TO-CHILD
TRANSM ISS ION
Mother-to-child transmission of HIV may occur during
pregnancy, labor, delivery or breastfeeding. United
Nations Children’s Fund (UNICEF) and the World Health
Organization (WHO) are working with agencies to build
capacity and expand prevention of mother-to-child
transmission (PMTCT) service delivery points, strengthen
referral linkages, and model integration of PMTCT
services within existing services, maternal and child
health and community level structures and activities
around the world.
CRS is working in concert with global PMTCT goals to
effectively promote primary prevention of HIV in women
of childbearing age, prevent HIV transmission from a
woman living with HIV to her child, and provide ART,
care, and support to women living with HIV and their
families. CRS is working with national governments
to build effective PMTCT strategies and programs,
strengthening health systems to provide HIV care and
treatment for pregnant women and their children, and
helping to promote HIV testing for all pregnant women.
PMTCT Facts
An estimated 370,000 children under • 15 years were
newly infected with HIV in 2007, nearly 90 percent
of them in sub-Saharan Africa. Without treatment,
an estimated half of these infected children will die
before their second birthday.
• Effective interventions are able to bring the risk
of children infected through mother-to-child
transmission to less than 2 percent. Without
intervention, between 20-45 percent of infants
may become infected.
• In 2007, only 33 percent of pregnant women in
low- and middle-income countries accessed HIV testing.
• Of HIV infected pregnant women in 2005, only 34
percent received PMTCT antiretrovirals.
• Of pregnant women who receive counseling for
PMTCT, there is near universal acceptance for
HIV testing.
CR S in Action:
Th e Maryknoll Program,
Cambodia
The Royal Government of Cambodia has had a successful
response to HIV, including extraordinary prevention
efforts, the rollout of a national treatment program, and
increased availability of voluntary testing and counseling.
All have led to a decline in new infections among
Cambodian adults (from 1.2 percent among adults aged
15-49 in 2003 to 0.9 percent in 2006) and the provision
of ART to almost 30,000 adults and children. However,
women were almost four times more likely than men to
be among the newly infected, with 40 percent of new
infections occurring among monogamous women. This
shift in the gender distribution of HIV, where the epidemic
existed previously among males who engaged in high
risk injecting drug use and sex, has caused an increased
emphasis to be placed on access to HIV services for women
and children. PMTCT programs that focus on increasing
mothers’ access to comprehensive care and treatment are
needed to minimize vertical transmission of the virus from
mother to child and to reduce orphanhood.
DAVE SNYDER
HILDA M. PEREZ

PMTCT
The Maryknoll PMTCT program began in 2002 in response
to the expressed needs of mothers in other Maryknoll
HIV programs. The program, originally an offshoot of
the Little Sprouts pediatric program, has grown into a
highly respected program that offers comprehensive
services. The Maryknoll PMTCT program complements the
Cambodian National PMTCT program by providing much-needed
social support. The national program provides
ART for mothers living with HIV according to national
protocol. Maryknoll provides extensive services to more
than 120 women per year in four main areas:
• Counseling and training for pregnant women and
their partners about HIV testing, nutrition, safe infant
feeding, and hygiene
• Home visits before and after delivery to ensure
adherence to treatment, support infant feeding and
prepare women for birth
• Direct assistance for antenatal care and delivery fees,
transportation, food and lodging
• Training and resourcing PMTCT and other facility-based
staff to enable them to carry out their functions
effectively and safely.
Maryknoll PMTCT Facts
• In 2007, the Maryknoll program assisted the National
Maternal Child Health Program in bringing PMTCT
services to 24 percent of all mothers living with HIV who
were successfully delivered at PMTCT facilities that year.
• In 2007, the Maryknoll program reduced infant deaths
to 0 from 3% the previous year.
• In 2007, infected infants fell from nearly 7% in 2006 to 4%.
KARL GROBL

HIV and AIDS
POL ICY AN D ADVOCACY
CRS works to raise awareness about key issues that
affect the poor overseas. Our policy positions are based
on Catholic teachings and informed by extensive
consultation with our partners overseas and in the
United Sates.
In the United States, our advocacy is undertaken
directly in dialogue with decision makers in the
United States government, including Congress, and
international organizations. We engage Catholics in
the United States to use the power of their citizenship
to alleviate human suffering, remove its causes,
and promote social justice. We also support local
communities overseas as they engage in advocacy to
address policies and practices that undermine justice.
HIV and AID S
Policy and Advocacy
Our HIV and AIDS policy and advocacy work in the
United States has focused on ensuring a comprehensive
and morally appropriate response to global HIV and
AIDS. CRS advocacy positions are fully in keeping
with Catholic moral teaching, focusing on providing
adequate treatment for those infected, preventing
the spread of disease through education and behavior
change, and assisting communities devastated by
the disease.
Advocacy in the countries where we have programs
is a key element of CRS strategy to promote solidarity
and stop the spread of HIV. CRS works to increase the
capacity of local community organizations—including
the regional and local church—to address both the root
causes and the human, economic and political impact
of the HIV pandemic.
The HIV pandemic is not just a health issue, it is also a
development and security crisis that impacts every facet
of human survival, especially in the poorest countries.
The sizes, spread, and impact of the HIV pandemic on the
economic, social, and political structures of developing
nations make it a priority policy issue for CRS. Therefore,
we work with our overseas staff and partners to identify
priorities and assess how to shape our HIV and AIDS
policy in connection with other sectors, including food
security, health, and education initiatives.
CR S in Action: PEP FAR
The Catholic church is the largest provider of care for
people living with HIV in the world. CRS alone is helping
millions of people living with and affected by HIV across
Africa, Asia, and Latin America. CRS is helping to save
lives by providing ART to more than 140,000 people
living with HIV worldwide as part of a large grant
funded by President’s Plan for Emergency AIDS Relief
(PEPFAR). CRS staff members have witnessed firsthand
how women and men near death have returned to
normal lives, and are now caring for their children and
contributing to their communities.
CRS was active in advocacy to influence the PEPFAR
reauthorization in 2008. The United States Conference
of Catholic Bishops (USCCB) and CRS welcome the
passage of a new five-year version of the PEPFAR,
a 48 billion U.S. dollars five-year commitment that
will help alleviate the suffering of some of the world’s
most vulnerable people. PEPFAR reauthorization
contains the following principles, which were
advocated by the CRS community:
• Strengthens food and nutrition programs that are
vital for treatment and care of HIV and AIDS patients,
orphans and vulnerable children
• Invests in building up the healthcare workforce in
countries with PEPFAR programs
• Retains a strong “conscience clause” that allows
religious organizations such as CRS to refrain from
participation in activities that conflict with their
moral teachings
• Ensures that abstinence and be faithful programs to
prevent HIV infections receive balanced funding.
RICK D’ELIA

“I would also like to urge all people of good will to multiply their efforts to prevent the spread of
the HIV virus, to oppose the contempt that often affects those who have the disease and to care
for the sick, especially when they are still children.”
CR S in Action:
Af rica Rising, Hope and Healing
For years, advocacy groups, church leaders and
humanitarian organizations like CRS have been calling for
increased attention and funding to fight the pandemic
ravaging sub-Saharan Africa. Until 2003, the United States
government was only spending 1 billion USD annually
against the AIDS pandemic.
In 2001, CRS launched African Rising, Hope and Healing
(www.crs.org/africa/campaign/), a campaign to bring
attention to HIV, AIDS, peacebuilding, and poverty in
Africa. Through the campaign, CRS promotes advocacy
with the United States government, international financial
institutions, and corporations to pursue policies that
support the continent’s development.
Africa Rising, Hope and Healing demonstrates our
commitment to the African people and reinforces the call
— Pope Benedict XVI, November 28, 2007
from United States Catholic Bishops in “A Call to Solidarity
with Africa” to join “our voices…with others to encourage
a sustained, just and comprehensive engagement of the
world’s vast resources to generate lasting solutions that
respect the full, human dignity of our brothers and sisters
in the poorest countries of Africa.”
Many dioceses, parishes, national Catholic organizations,
and Catholic colleges and universities have held prayer
services and discussion roundtables, published news
articles and organized fundraising drives, and planned
Africa-themed celebrations.
Most importantly, through the establishment of CRS’
legislative network (http://actioncenter.crs.org/site/
PageServer?pagename=ac_homepage), Catholics in
the United States are communicating directly with their
elected officials in Congress and the legislative branch to
ask for greater United States involvement in addressing
the issues facing Africa—particularly the HIV pandemic.
ADVOCACY
Photo by Doug Kapustin /Baltim ore Sun

A Bri ef History of CRS
ANDREW MCCONNELL
Catholic Relief Services began its work in 1943, resettling
the refugees of war-torn Europe. More than 60 years
later, our mission continues to focus on the poor
overseas, using the teachings of Jesus Christ as the
foundation of our mission.
As the official international humanitarian agency of the
United States Catholic community, CRS provides relief and
development assistance to over 100 countries around the
world. O ur original mission of disaster relief has expanded
to focus on helping individuals and communities build a
stronger future. We reach more than 70 million people
with initiatives that address:
• Agriculture
• Community Health
• Education
• Emergency Response
• HIV and AIDS
• Microfinance (savings and credit programs)
• Peacebuilding
• Water and Sanitation
CRS programs teach communities how to become self-sufficient
and plan for future emergencies. We continually
seek to help poor and marginalized populations
throughout the world, providing assistance on the basis of
need, without regard to race, creed, or nationality.
Expanding Reach and Focus
As Europe regained its balance in the 1950s, CRS began
to look to other parts of the world, seeking out those

who could benefit from the assistance of Catholics in the
United States. For the next five decades, CRS expanded
its operations, opening offices in Africa, Asia, and Latin
America. In the 1990s, Catholic Relief Services worked in
the aftermath of natural disasters like Hurricane Mitch in
Central American and man-made tragedies like the war in
Kosovo. And in just its first few years, the new century has
brought hurricanes, flooding, more conflict, and the great
Indian O cean tsunami that CRS has responded to with
temporary shelters, medicines, food aid, and hope.
During our expansion, CRS build on a tradition of
providing relief in emergencies and began seeking ways
to help people in the developing world break the cycle
of poverty. By building community-based programs that
are sustainable over the long term, CRS can ensure that
local residents are the central participants in their own
development and that projects can be accomplished
through the efforts and resources of local communities.
Today these programs include agricultural initiatives,
community banks, health education, and clean water
projects. In addition, our justice and peacebuilding
initiatives support our strategy of solidarity by addressing
issues of mutual understanding and by supporting
individual and community healing.
Looking to the Future
With more than a half-century of experience overseas, we
understand that rebuilding societies requires more than
mortar and bricks. Through our work, CRS seeks to foster
within the United States Catholic community a sense of
global solidarity—providing inspiration to live out our
spiritual tradition of compassionate service to the world.
As we step into the next millennium, we renew our
commitment to the most vulnerable members of our
human family, mindful of the principles of Catholic
teachings and the foundation upon which our work is built.

Hope and Dignity In the Developing World

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