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Using Millennia-old Religious Beliefs to Fight a Modern Disease

By: Michael Scharff

April 7, 2010

by Michael Scharff (2009-10 WFDD Fellow)

A decade ago, with Cambodia'™s HIV prevalence at nearly 1.2%, the United Nations Children'™s Fund (UNICEF) expanded to Cambodia a program to engage Buddhist monks in the battle against HIV.
Officially called the Regional Buddhist Leadership Initiative, its mission remains largely unchanged today. It uses the revered status of religious leaders as leverage to provide spiritual counsel and material support to individuals living with HIV. The monks also refer persons to health centers for medical care, and educate communities on the disease in order to prevent new infections. (Today, the Regional Initiative is active elsewhere in the Asian countries of Thailand, Myanmar, Laos PDR, Bhutan, Mongolia, China, and Vietnam.)

Monks in 12 of Cambodia's 24 provinces have signed on, although only certain communes within the 12 provinces are targeted. The Initiative is designed to be highly decentralized and to give the government a significant role in the process. UNICEF provides support to the Ministry of Cult and Religious Affairs at the national level, and the Ministry's provincial offices take the lead in identifying the monks and pagodas willing to participate. Supported by provincial and district working groups, the pagodas then assume full responsibility for the planning and implementation of activities. Participants are compensated for their transportation and receive a small allowance for food and incidentals if they are visiting a home or traveling to a different pagoda.

The Initiative is making a significant impact. According to UNICEF'™s figures, in just the first six months of 2009, monks and nuns counseled nearly 5,000 individuals and referred another 1,450 persons with HIV to health centers for medical treatment. Moreover, 2,700 children who lost one or both parents to AIDS were provided with basic material support in the form of school supplies and clothing.

And the situation in Cambodia has been improving. Prevalence in the country is at 0.7%, down from nearly 1.2% in 2003. Roughly 60,000 people in the country are believed to be living with HIV.

Ulrike Gilbert-Nandra, UNICEF's HIV Specialist in Cambodia, says the lower prevalence offers an opportunity for the Initiative to refocus its efforts. "Some of the HIV prevention messages used today are too limited and outdated," says Gilbert-Nandra. "œMonks need to be supported to disseminate messages which eliminate stigma and discrimination against people living with HIV. The monks should increasingly offer care and support to families and children affected by AIDS, and monks should educate communities about preventing transmission of HIV from mothers to children." Gilbert-Nandra suggests trainings of religious clergy stress the benefits of knowing one'™s HIV status, promote services which prevent mother to child transmission, and provide information about living with HIV. Complications that have arisen in attempting to implement some of the very changes Gilbert-Nandra proposes highlight the larger difficulties in engaging monks in community development initiatives.

One of the challenges of relying on local on-the-ground actors who are not health care specialists in a field that is constantly evolving is that they must be re-trained to address different needs that arise. Moreover, the technical knowledge is often difficult for the participants to absorb and some messages and words the monks, because of their faith-affiliation, simply cannot discuss. "œIf women are HIV positive and want to become pregnant, what do the monks say?" asks Gilbert-Nandra. "They need factual information in layperson'™s language in order to de-medicalize some of the HIV information." And for many of the younger monks, the monkhood is only a temporary position. It is nearly impossible for organizations to only train those who pledge to remain in the monkhood for an extended period of time. Compounding the difficulty of engaging monks is the highly decentralized network of monks and pagodas active in the Initiative. While the Initiative is operational in 12 provinces, not all of the pagodas and monks are participating. It is possible that a person with HIV may live near one pagoda, yet the closet pagoda choosing to participate in the Initiative may be miles away and take the monks many hours to reach, even in the dry season when road conditions are most favorable.

But despites the drawbacks, Gilbert-Nandra says the findings from an evaluation conducted in 2007 show that the Initiative is having a positive impact, one she says would not have been as meaningful without the participation of the monks. A background document on the Regional Initiative, published in 2003, cites a number of advantages to partnering with monks and pagodas. "Buddhist beliefs, Buddhist leaders, and Buddhist places of worship have proved to be a significant and enduring social force, particularly in rural communities," the authors wrote. "œIn some areas, community religious structures are in better shape than government structures. Villages that do not have health centers or social welfare centers often have temples." The authors continue, "œWhile HIV/AIDS is a relatively recent phenomenon, the principles and mechanisms that underpin the Regional Buddhist Leadership Initiative come from the heart of Buddhist tradition and belief. Buddhist ideals like moderation, self-discipline and compassion are also essential to effective HIV prevention and creating enabling environments for people with HIV/AIDS." One of the greatest future challenges may not be motivating monks to participate or even training them in technical knowledge, but rather getting the multitude of civil society groups and government agencies to work together, with a comprehensive strategy, towards an agreed-upon end-goal. "The question now," says Gilbert-Nandra, "œis how all of Cambodia's different religions and various faith based initiatives can share information, coordinate their efforts, and enhance their effectiveness so that the best interests of children and their families are protected and promoted."