Individual members and the organizational structures of the Catholic church have done much to respond to the HIV/AIDS pandemic over the course of the last decade. Most notably, Conferences of Catholic Bishops have seized the opportunity to reinforce conservative moral teachings and values, especially with regard to sexual behavior and marital relationships. Church leaders have expanded the vision of church-related HIV/AIDS services far beyond that of providing health care to a whole range of social and pastoral activities. Caritas Internationalis has sponsored educational and awareness-raising seminars for church leaders and other professionals at the regional, national, and local levels while also supporting service programs around the world expanding medical and social service facilities; supplies of food, medicines, and HIV-antibody testing equipment; staffing and transportation for mobile home care programs; and support for residences for homeless persons with AIDS, for development-oriented orphan care programs, and for alternative income-generating projects for commercial sex workers. Caritas has been particularly successful in promoting North-South and South-South experience coordination and cooperation among AIDS service providers. Finally, the church is uniquely able to help dying people confront the final realities of HIV/AIDS.
The World Health Organization expects there to be 10 million children infected with HIV by the year 2000 as a result of mother to child transmission. Most of these children will in developing countries, but there is also a growing problem in Europe and the US. Rates of HIV-1 transmission from infected mothers to their babies in developing countries range 25-39%, but are as low as 12% in some more developed countries. Recent studies have shown a 26% transmission rate from mothers who were infected post-natally and a 16% rate for those infected pre-natally. Infection rates do not seem to be related to the duration of breast feeding. Pediatricians with experience of HIV infection, however, think that the rate of transmission is much higher than statistics would indicate. AIDS is firmly established among heterosexuals. It should therefore be clear that the number of infected infants and children will continue to increase. The author presents concerns with regard to the clinical management problem of diagnosing HIV infection in children, the main indicator diseases for AIDS in children, the Bangui criteria used for the clinical definition of AIDS, psychological and social factors, confidentiality, childhood immunizations for HIV-infected children, the sexual abuse of children, and children orphaned because of AIDS.
The Mobile Program was launched in 1987 and now responds to the needs of the AIDS-affected community through the Kitovu Hospital working in 15 Catholic parishes in Masaka Diocese in Rikai and Masaka districts. The program home care, orphan-oriented, and education components serve individuals who have been clinically diagnosed with AIDS, the worried well who wish to know their HIV status, orphans, AIDS-affected widows and guardians, and families affected by the AIDS epidemic. There is no family in the area which does not have orphans from relatives who have died from AIDS. Caring for these orphans often taxes already limited family resources. The Orphan's Program tries to help these families cope with the situation. The program for orphans has the following objectives: to provide school fees, uniforms, and scholastic materials to needy AIDS-affected orphans; to raise awareness among orphans regarding the spread of HIV and the need to adopt safer sex practices; to facilitate peer counseling among the orphans and to provide individual counseling to those in need; to stimulate the creativity of orphans through drama, song, and art, and to provide recreational facilities; to promote the spiritual growth of the orphans in their respective denominations; and to upgrade the teaching standard in schools with orphans. 2000 children of parents who used the home care service are on the immediate waiting list to receive services. Their dying parents were reassured in the program that their children would be cared for once orphaned. Nongovernmental organizations in the area care for orphans, but only less than one third of the children who need help. The paper discusses program drop-outs, the social and behavior change program, the problemmatic lack of personnel, the parish/community leader's AIDS course, guardians' seminars, and income-generating activities.
Almost 22,000 AIDS cases had been reported to the national AIDS control program in Uganda by December 1990, but there are many more cases which have not been reported. The number of people infected with HIV is many times greater than the number of AIDS cases, with the Ugandan AIDS Control Program estimating in late 1990 that 1.3 million people were HIV-positive. HIV is transmitted in the country primarily through heterosexual intercourse and perinatally from mothers to children. Men and women are infected in equal proportions, with 80% of infections among individuals aged 16-40 and 10% among those aged 0-5 years; almost no one aged 6-15 is infected with HIV. AIDS in Uganda affects all members of the family, either directly or indirectly. In this context and with only one doctor per every 23,000 people in Uganda, the AIDS Support Organization (TASO) was founded as the first organized community response to AIDS in Uganda. The organization provides counseling, AIDS information, nursing care, educational support, and material assistance to approximately 5500 people with HIV or AIDS and their families. Seventeen volunteers founded TASO in November 1987. None of the founding members had training in counseling or experience managing an AIDS support group and twelve of them had HIV or AIDS. Many TASO workers currently are infected with HIV or have AIDS. The author describes the AIDS clinic for children held by TASO every Friday morning at Mulago Hospital in Kampala.
As of January 1, 1993, approximately 19.5 million people worldwide had become infected with HIV, of whom 18.3 million were adults and 1.2 million were children. 62% of these individuals were in sub-Saharan Africa, 19% in Southeast Asia, 8% in Latin America and the Caribbean, and 7% in North America. The pandemic remains highly dynamic and volatile, spreading both in every community and country already affected, and in new communities and countries. Already a major problem for children in many areas of the world, HIV/AIDS will impose even more severe direct and indirect effects upon children in the years to come. The number of children infected with HIV worldwide is projected to grow to 2.3 million by the end of 1995, while children with AIDS will number more than 2 million. The global total of 2 million AIDS orphans will double to more than 4 million by 1996. This increase in the prevalence of HIV/AIDS among children has already and will continue to challenge basic concepts about children. People concerned with the health and welfare of children in all countries must be fully informed about HIV and AIDS. Following the overview of the epidemiological situation worldwide, the authors focus upon HIV prevention and AIDS care from the viewpoint of societal challenges arising from the pandemic. The paper also highlights the emerging opportunities for advancing the health, welfare, and rights of children.
