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World Vision operates HIV/AIDS prevention and care programs in more than 30 countries. World Vision's work is particularly focused on meeting the needs of millions of children who have been made vulnerable because of the disease, especially those who have lost parents to AIDS. HIV/AIDS awareness is also a significant part of World Vision area development programs, which provide long-term aid to communities in pursuit of self-sufficiency.

In December of 2000, World Vision launched The HIV/AIDS Hope Initiative, a global initiative focused on high prevalence and high-risk countries in Africa, Latin America and the Caribbean, Asia and the Pacific, and the Middle East and Eastern Europe. National offices, supported by regional HIV/AIDS Advisors and the Hope Initiative Models of Learning team, implement comprehensive responses to HIV/AIDS that focus on prevention, care and advocacy, as well as on integrating HIV/AIDS response with existing World Vision efforts in child health, microenterprise development, food security, education and peace building.


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How has AIDS affected World Vision programs?
Rising child mortality rates and falling life expectancies indicate that much of the development progress made in the last decade is being lost.

In hardest-hit areas, the disease reverses decades of development progress. In the emerging middle class, loss of income and medical bills push many below the poverty line. Many of the poorest families never see a medical bill; few have seen a doctor, and even fewer can afford AIDS medications. As a generation of parents is lost to AIDS, grandparents become the guardians often of 10 or more children. If grandparents are gone, many families are raised by older siblings, some of them not even in their teens. These children have to quit school to earn a living.

AIDS creates a need for new services, including prevention education, care for people living with HIV/AIDS and support for surviving children and families. Because these and other factors contribute to its spread, HIV/AIDS cannot be addressed without also dealing with issues such as poverty, unemployment, lack of education, prostitution, child sexual abuse and the low social status of women in most African cultures. Women are often powerless to insist that their partner wear a condom or even remain faithful.

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Where is the need greatest?
Sub-Saharan Africa. According to the United Nations, more than 25 million Africans are living with HIV/AIDS, and in some of the hardest-hit countries, more than a quarter of the population carries the virus. The adult rate of infection is 7.4 percent in Africa as compared with a world average of 1.1 percent. In fact, the vast majority of countries with the highest HIV/AIDS prevalence are in Africa. Within Africa, prevalence rates vary by country and region. While West Africa's average is 4.5 percent and East Africa is at 6 percent, Southern Africa has an alarming 13 percent infection rate.

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Who are the most affected?
Of the 40 million people living with AIDS worldwide, over 25 million are African. Of that group, more than 57 percent are women. In part because of cultural limitations on female rights and freedoms, Africa is the only region in the world where more women are infected than men. In addition, almost two million HIV-positive Africans are under 15. Children are infected in utero or during breastfeeding, and more than 90 percent of adult infection is through sexual transmission between a man and a woman.

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How are women affected?
For physiological and social reasons, women and girls are particularly susceptible to sexual transmission. Often bound by cultural traditions that afford them a much lower social standing than men, they cannot control the sexual behavior (including adultery) of their husbands, and have no voice in contraception. Due to poverty, many women seek income as sex workers, further spreading the disease. Ignorance about HIV/AIDS exacerbates the situation. For example, many men believe that having sex with a virgin will actually cure the disease. As a result, child molestation and rape are not uncommon.

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How are children affected?
Almost two million African children younger than 15 are infected with HIV/AIDS—90 percent of the worldwide total of children living with HIV/AIDS. In countries like Zambia and Zimbabwe, AIDS has increased the infant mortality rate by 25 percent. In addition to those infected by the disease, orphaned children have become one of the most significant populations in need of support. There are more than 12 million children orphaned by AIDS in Africa, and 15 million worldwide. That number is expected to reach 25 million by 2010, with more than 18 million orphaned children in Africa. In addition, there are roughly 30 million children around the world made vulnerable by HIV/AIDS, and this group is expected to grow to 50 million by 2010. These are children whose parents are sick, whose families have taken in extra children or who live in communities where there is not enough food, teachers or health workers due to AIDS.

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Where in Africa is World Vision working?
In Africa, World Vision operates in 25 mostly sub-Saharan countries including Angola, Burundi, Chad, Congo, Ethiopia, Ghana, Kenya, Lesotho, Liberia, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. World Vision is committed to establishing an HIV/AIDS component in each of its Africa programs.

World Vision is also running HIV/AIDS prevention, care and advocacy programs in Haiti and the Dominican Republic, Mexico, Brazil, Chile, Honduras, Guatemala, Romania, Albania, Georgia, Armenia, Uzbekistan, the Russian Federation, India, China, Myanmar (Burma), Vietnam, Thailand, Bangladesh, Cambodia, Papua New Guinea, and many other countries around the world.


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How many children orphaned and made vulnerable by AIDS does World Vision care for?
World Vision cares for hundreds of thousands of children orphaned by HIV/AIDS in Africa and other regions, though the exact number is not known. A significant number of World Vision’s 2.4 million sponsored children, especially more than 800,000 sponsored children in Africa, may have been orphaned or made vulnerable. Also, World Vision mobilizes and trains volunteer caregivers for orphans and vulnerable children who provide assistance to thousands more children who are not covered by sponsorship. However, the exact number is not known. Because of the social stigma associated with the disease, it is impossible to know exactly how many orphans have lost their parents to AIDS. In fact, the prohibitive cost of HIV testing keeps many Africans from being aware of their HIV status or that of their deceased loved ones.

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What services do they get?
For sponsored children who have lost one or both parents to AIDS, World Vision provides education, health care, shelter and other basic needs. Older orphans, many of whom have become their families' breadwinners, are given vocational or agricultural training. In addition, World Vision is training volunteer caregivers to provide continuous monitoring of child well-being, protection against abuse and neglect, spiritual and psychosocial support, help in overcoming barriers to education, assistance with basic household tasks and in caring for chronically ill family members, as well as school fee assistance, food aid, and other material support when possible.

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What prevention programming has proven most effective?
World Vision’s Christian health professionals believe that a holistic approach to HIV prevention is most effective. World Vision encourages abstinence before, and faithfulness after, marriage to prevent sexual transmission. World Vision also provides correct information for how to reduce the risk of HIV transmission if unhealthy behaviors are chosen. And World Vision addresses HIV/AIDS as part of a comprehensive program that also deals with poverty, gender disparities, warfare, lack of education and other problems. This strategy, also known as the ABC model – for Abstinence, Being Faithful, and using Condoms if one spouse is HIV-positive, or if abstinence and faithfulness are not chosen – has been behind the remarkable success experienced by Uganda, which has seen its HIV-prevalence rate decrease from 21 percent in 1991 to 4.1 percent in 2003.

To implement its strategy, World Vision works through schools, churches and other community groups to provide values-based life-skills training, helping children and youth, aged 5 to 17 years, to avoid behaviors that put them at risk of contracting HIV. World Vision has also found that when youth educate each other, the information tends to affect more change in behavior. World Vision augments its Life-Skills training program by training youth peer HIV/AIDS educators, as well as forming peer HIV/AIDS support groups in many communities. In the first half of Fiscal Year 2005, more than 24,000 children and youth in Africa were active as peer HIV/AIDS educators, and almost 2,400 peer HIV/AIDS support groups were in operation.

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Does World Vision provide AIDS medication?
Outside of a few specific grant-funded programs, World Vision generally does not directly provide anti-retroviral drugs to people living with HIV/AIDS. However, World Vision provides referrals to programs that do provide ARVs, when available, and is active in many contexts in providing voluntary counseling and testing and basic healthcare, reducing the stigma that surrounds HIV/AIDS, and working in many other areas that promote and facilitate the success of ARV programs. Indeed, many clinical organizations (those who do administer drugs) do not have effective outreach programs and are often unable to make contact with the people in need of medication. World Vision refers its many clients to these clinical organizations to receive medication. In the Kagera Zone of Tanzania, World Vision refers clients to Medicines du Monde, which administers AIDS medications like AZT, as well as the cheaper, more-effective Nevirapine, both of which decrease the chance of transmission from mother to child in utero and through breastfeeding.

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Where does World Vision get its funding for AIDS programming?
As with most World Vision programs, funds are provided by individuals, churches, corporations and foundations. The U.S. government provides cash and food commodity grants that benefit needy people including those living with HIV/AIDS, their families and AIDS orphans. In Fiscal Year 2004, World Vision US raised over $15 million in private contributions for HIV/AIDS, and over $70 million in grants from the US government, the Global Fund for AIDS, TB and Malaria, and other organizations.

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How much of World Vision contributions go to actual people in need versus administrative costs?
For the past seven years, World Vision has continued to lower administrative costs and overhead rates. In fiscal year 2004, 87 percent of revenue went to programs that benefit children, families, and communities in need.

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What is World Vision’s policy on use of condoms as a preventive measure?
In its health programs addressing HIV/AIDS and other sexually transmitted infections, World Vision supports a comprehensive approach to prevention that is supported by public health evidence and the Bible. World Vision promotes sexual abstinence outside of marriage and fidelity within marriage. Abstinence and faithfulness represent God’s intended means of sexual and marital fulfillment. Public health evidence supports the idea that abstinence and faithfulness are most effective in preventing the spread of sexually transmitted infections, including HIV/AIDS.

God highly values each individual and instructs us to do all we can to preserve and enhance life. In the prevention of HIV/AIDS and other sexually transmitted infections in high-risk situations, it has been demonstrated that condoms, used correctly and consistently, can significantly reduce the likelihood of transmission and slow the spread of the epidemic. Recognizing that not all people can choose or will choose to be abstinent, and that even within marriages one or both spouses may be HIV positive and/or may have sexually transmitted infections, and/or unaware of their exposure risk, World Vision programs may include appropriate information on condom use as a means to reduce risks and save lives.

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What is World Vision’s policy regarding encouraging breastfeeding or use of formula among mothers with HIV?
World Vision affirms the policies of the United Nations Children's Fund (UNICEF), the World Health Organization (WHO) and UNAIDS that, when a safe water source and sufficient supply of infant formula are not available to the full formula feeding of infants, breastfeeding should be encouraged among mothers who are HIV-positive. While the danger of mothers transmitting the disease to their children by breastfeeding is substantial – 10 to 20 percent – the risk to children of serious illness from unsafe water is even greater.

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How much difference can World Vision hope to make in light of the magnitude of this crisis in Africa?

While AIDS has devastated millions of African families, there are signs of hope. Uganda was the first country to report a decline in instances of infection. Uganda's infection rate decreased from 21 percent in 1991 to 4.1 percent in 2003. World Vision has seen some of its greatest successes in the Rakai District in southern Uganda, where the virus is believed to have first entered the country in the early 1980’s. In this area, AIDS is the leading cause of death, and one out of three children has lost one or both parents to the disease. While these people have been devastated by the virus in many ways, World Vision has helped them develop the resources they need to deal with its social, emotional, spiritual and economic ramifications.

World Vision began its Orphans Project in Rakai in 1990, providing primary-school aged children with tuition, clothing, and school materials. The program also provided agricultural support, vocational training, construction of primary schools and health centers, AIDS education, and counseling for guardians and orphans. Revealing a remarkable strength of character, though AIDS has impacted most of them in one way or another, the people in Rakai have also pulled together to support others within their own communities. World Vision has organized community support groups run by people who have been infected from within Rakai. In addition, courageous men and women who are already struggling beneath the burden of caring for orphans are working with World Vision to help others in their communities who are struggling more.

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