The inception of HIV and AIDS programmes within the diocese dates back to 20 November, 1991 when the Public Health Education Programme (PHEP)456 director at the time, Dr. Janet Lefroy wrote to all parish leaders informing them about World AIDS Day457 to be commemorated on 1 December, 1991 and which aimed at educating and reminding people of the impact of HIV and AIDS within societies.458 She noted that the theme of that year‟s AIDS Day was “Sharing the Challenge” (Kwa pamoja tuukabili UKIMWI) and that since December 1st would fall on a Sunday; the parishes were urged to do the following to commemorate the day:
To pray for persons living with HIV and AIDS and their immediate families;
To read to the congregants the attached information.459 (This information is presented in chapter one - it sketches the situation of HIV and AIDS in Tanzania and in particular, the Kilimanjaro region).
To give an opportunity to parish public health committees or any other group within the parish to educate the congregants about the pandemic through a role playing exercise or through other possible means. 460
She concluded her letter saying: “I believe that by God‟s grace we will be able to help society to overcome HIV and AIDS.”461 Lefroy‟s letter shows an awareness of what was
456The Public Health Education Programme (PHEP) is one of the three units of the Department of Health and Social Service at diocese level. The others were diaconal and medical. Towards the end of 2005, the diaconal unit became a department due to the enormous challenges posed by HIV and AIDS within the diocese. The main task of the PHEP is to educate the communities on the importance of hygiene and nutrition, which started in 1972. Each parish has a PHEP committee whose responsibility is to select and supervise a group of grassroots parish health educators. The committee members are trained by a team of trainers from church health facilities, governmental and non-governmental organizations.
457 World AIDS Day was first commemorated in 1988 and is organised by UNAIDS which chooses themes for each year. The focus of this day is to create awareness, improve education and fight injustice. In 2005, UNAIDS handed over this responsibility to “The World AIDS Campaign” (WAC) which is an independent organisation.
458 Janet Lefroy, “Barua kwa viongozi wa sharika kuhusu Siku ya UKIMWI Duniani tarehe 1 Desemba 1991”- file DK/23/11/ 29, p. 1.
459 This information highlighted the reality of the pandemic within the country with special focus on the Kilimanjaro region by 1990.
460 Lefroy, “Barua kwa viongozi wa sharika kuhusu Siku ya UKIMWI Duniani,” p. 1.
461 Lefroy, “Barua kwa viongozi wa sharika kuhusu Siku ya UKIMWI Duniani,” p. 1.
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going on worldwide concerning the pandemic. It also served as a starting point for the congregants to be aware of and get involved in the struggle against HIV and AIDS.
In the following, the PHEP director, in a committee meeting held on 18/11/1992,462 suggested the establishment of an HIV and AIDS programme. This suggestion resulted from the fact that the diocese has thus far not created any specific HIV and AIDS committee, apart from the existing PHEP committee.463 The response from the assistant bishop who was then the chairperson of the committee was that: “the diocese is aware that the health committee is the HIV and AIDS committee.”464 This response assumed that HIV and AIDS was a health issue only, and this view point is why most of the programmes lack a gendered and a theological response. This assumption was also made by the Tanzanian government as we saw in the previous chapter who had formerly left the response of the pandemic to the Ministry of Health.465 However, the progression of the pandemic forced the government to adopt a multi-faceted approach from 1992, as discussed in chapter four. Similarly, the background of the candidates who were selected to draw up the diocese‟s HIV and AIDS control programme, confirmed the above argument. Of the five nominees, four were health professionals, and only one was a pastor. The team included Dr. Janet Lefroy, the PHEP director, Sr. Aisa Makundi, the PHEP coordinator at the diocese level, and Dr. Ngoda who was the secretary of the diocese‟s Health and Social Welfare Department together with Rev. Daniel Lyatuu, the director of Clinical Pastoral Education (CPE) at the KCMC466 Hospital and Sr. Margret Mshana, the former coordinator of the PHEP unit.467 I have been unable to access any document related to their meetings that discussed a strategy to combat the pandemic.
462 The diocesan PHEP committee meets once or twice a year. In 1992 the committee met once in November.
463 KKKT-DK, “Miniti za kikao cha kamati ya Elimu ya Afya ya Msingi tarehe 18/11/1992,” file DK/23/11/ 29, p. 6.
464 KKKT-DK, “Miniti za kikao cha kamati ya Elimu ya Afya ya Msingi,” p. 6.
465 The United Republic of Tanzania, National Policy on HIV/AIDS, p. 3.
466 KCMC is defined as Kilimanjaro Christian Medical Centre, a health centre owned by the national church (Evangelical Lutheran Church in Tanzania) with the auspices of the government. It is located in Moshi, 3 km from Moshi town. KCMC is one of the four referral hospitals in Tanzania, and the largest of all. Other hospitals include Muhimbili in Dar-es-Salaam, Bugando in Mwanza and Mbeya in Mbeya region which serves southern highlands.
467 KKKT-DK, “Miniti ya kikao cha Elimu ya Afya ya Msingi,” p. 7. I have sourced only a letter to Rev.
Lyatuu to inform him on his appointment written on 13th January 1993. I assume that in case of Sr. Mshana, the PHEP staff communicated with her verbally since she was staying within the municipality.
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Nevertheless, a strategy and programme emerged from these HIV and AIDS committee meetings, as will be discussed below.
On 30/8/1993, the PHEP director wrote to all PHEP parish chairpersons to inform them that the theme for the week of concentrated public health education scheduled for 11/10- 17/10/1993 was “HIV and AIDS and the health of the community.”468 The PHEP chairpersons were asked to get the materials and posters for this theme from their circuit coordinators during their joint seminar where would be discussed how to facilitate and prepare those who would be involved in teaching in their parishes. The letter emphasised that congregants were to be divided into different groups according to their ages and genders, for example youth, women and men, to give them the opportunity to initiate free and open discussions. The Diocesan Health Week was organised for the first time in 1992; it usually takes place during the first week of September. Activities for the week are carried out by parish health education committees who undergo a prior seminar organised by their circuit coordinators.469 Themes for each year are based on current social issues within the communities, and the materials are prepared by PHEP teams in the various circuits on a rotational basis.470 For instance, the themes for 1992, 1994, 1995 and 1996 were: “Nutrition and health at all ages,” “Alcohol and the health of the community,” “Health and the environment,” and “Health and development” respectively.
Since HIV and AIDS became an issue of concern in 1993, the theme for that year was,
“HIV and AIDS and the health of the community,” as mentioned above, and it involved an appointed team and the circuit coordinators.
Various activities including public education are carried out on the week days from Monday to Saturday in the evenings, and on Sunday which is the climax of the week. In addition to presenting the summary and conclusion of the discussions on the theme, the parish health education committee presents a report on the activities of the PHEP committee for the year and the achievements or weaknesses thereof. The Sunday is also
468 Lefroy, “Barua kwa wenyeviti wa Elimu ya Afya ya Msingi kuhusu wiki la Afya tarehe 11-17/10/1993,”
file DK 23/11/29, p. 1.
469 Lefroy, “The History of the Public Health Education Programme 1997,” p. 2.
470 Lefroy, “The History of the Public Health Education Programme,” p. 2.
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marked by an offering to support the PHEP at the diocese level. The first time the diocese carried out the HIV and AIDS week it took place in October instead of September which is the agreed-upon period for health activities. I assume that there was a clash with another diocese programme. This particular HIV and AIDS week campaign was the starting point of HIV and AIDS education awareness within the diocese, and focused on prevention and behavioural change as will be discussed in detail in the next section. The second diocesan HIV and AIDS week was convened in 2003 around the theme “HIV and AIDS is a disaster.”471 It focussed on the continuing devastation of the pandemic within the communities. After this brief introduction to the background, I can now turn to the responses to questions with regard to diocesan HIV and AIDS programmes.
5.3 A gender analysis of the HIV and AIDS programmes/policy of the ELCT