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  • Mapping of Ressources - Western Africa

    Benin

    1.  General and Epidemiological Data

    1.1 General Data

    Benin is a country located in West Africa, bounded to the East by Nigeria, to the North by Niger and Burkina Faso, to the West by Togo and to the South by the Atlantic Ocean. Benin covers an area of 112,622 km² with an estimated population of 4,915,555 inhabitants aCCording to the 1992 general population census. The administrative capital of the Republic of Benin is Porto-Novo and the economic capital is Cotonou. The country's main religions are Christianity, Islam and animism.

    The Beninese economy remains weak despite a significant improvement which started in 1990 with a GNP growth rate of 3.5% in 1990/1991 as against 2% in 1989.

    1.2.    Epidemiological Data

    The AIDS epidemics is today conspicuous in Benin. In fact, since the discovery of the first AIDS case in 1985, Benin has declared 4,188 cases in 1999. The main mode of transmission of the infection is sexual (90%).

    Just as in all the African countries, AIDS has been spreading each year. In 1990, average HIV prevalence among prenatal consultations was 0.36%. In 1997, this prevalence increased 10 fold to 3.69%. AIDS prevalence among STD consultations in 1999 averaged 9.6%.

    Currently, in Benin, at least 50 persons are infected daily and the cumulative number of People Living With AIDS (PLWAs) has been estimated at over 159,000 persons in 1999. The estimated number of cumulative AIDS cases is 36,531, and the estimated number of cumulative cases of death is 33,021. ACCording to observers, HIV infection among the general population is expected to increase by 2025 by roughly 10% in the event of a controlled epidemic and 20% in the event of an uncontrolled epidemic.

    2.  National HIV/AIDS Infection Control Policy

    2.1.    Background to the AIDS Control Programme

    In the Republic of Benin, the appearance of the first cases in 1985 aroused the interest of the government who, while starting information and awareness-raising activities, approached the World Health Organisation (WHO) for technical assistance.

    Under this technical assistance, it was decided that the National AIDS Control Programme (NACP) and the implementation of a short-term plan (STP) would be established. This covered the period extending from 1987 to 1988.

    By relying on the results and lessons drawn from the outcome of this STP for Benin and the experience gained in the other fields, the NACP, designed a medium term plan for Benin (MTP) with the support of a WHO mission.

    2.2.    Strategy Thrusts of the AIDS Control Programme

    Two main objectives were spelt out under the medium term plan namely:

    Ø Preventing the infection of the transmission by HIV, particularly by developing Information, Education and Communication activities (IEC)

    Ø Strengthening health facilities for an effective care of HIV positives and AIDS patients.

    Pursuant to this objective, the following five priority areas were defined:

    1.     Prevention of the sexual transmission of HIV

    2.     STD care (control and prevention)

    3.     Care of PLWAs and HIV positives

    4.     Effective multisectoral approach to AIDS control

    5.     Decentralisation and integration of activities

    2.3.    Stakeholders Involved

    The fight against AIDS in Benin is being waged by stakeholders from different fields. Four types of stakeholders are involved namely, public sector stakeholders, international organisations, international and national non governmental organisations (NGOs).

    2.3.1.   Public sector stakeholders

    AIDS control falls naturally within the competence of the Ministry of Health. However, in view of the multidimensional nature of the disease, other ministerial departments are also involved in combating the disease. Consequently, focal points have been created in all the ministries. These focal points are, to some extent, resource persons in charge of organising the fight against AIDS in their ministry.

    2.3.2.   International Organisations

    These are the bilateral and multilateral cooperation agencies which provide their financial and technical support to the government, the national and international NGOs and other stakeholders involved in the fight against AIDS in the countries. The organisations include WHO, UNDP, UNICEF, UNFPA, FAO, HCR, WFP, CIDA, European Union, German Cooperation, UNESCO, USAID, French Cooperation, World Bank etc.

    2.3.3. International Non-Governmental Organisations

    These organisations intervene directly in the field in collaboration with the local NGOs. Their fields of intervention are the prevention of STD/AIDS, the care of sick persons, institutional support and the mitigation of the socio-economic impact of HIV/AIDS on the population.

    2.3.4.   National Non Governmental Organisations

    There are hundreds of such organisations operating in the country which play a significant role in combating AIDS. Their activities fall directly in line with the policy defined by the government (NACP). Their areas of specialisation are mainly the prevention of STD/AIDS and the psycho-social care of infected persons, awareness-raising campaigns, educational advice, training, sale of condoms etc.

    3.  Position and Involvement of Churches

    In connection with this study, we met with top leaders of the following churches: the Catholic Church, the Evangelical Church of the Assemblies of God, the Baptist Church and the Presbyterian Evangelical Church. It should be pointed out that their viewpoints are convergent and identical in several respects.

    3.1.    Perception of AIDS by the Churches

    AIDS remains today a major social problem and a source of concern for all Churches for several reasons. AIDS cases have been increasing at an alarming rate. AIDS still remains an incurable disease which has been causing havoc among parents, children, the youth and executives of the nation, thereby generating serious socio-economic problems.

    A pastor of the Methodist Church stated that “AIDS has emerged as a disorder in our societies thereby creating spiritual and socio-economic problems which our Churches must manage”.

    Religious leaders know the name of the virus responsible for the disease, its mode of action in the organism and the principal modes of transmission. They also identified a number of factors which contributed to the propagation of the disease. The first and foremost is poverty with all that it involves. In addition to this are other factors such as ignorance of the population on the reality of AIDS, the peculiar situation of Benin which currently plays host to many foreigners particularly refugees from neighbouring countries, the irresponsible behaviour of parents, the expensive taste of young women for luxury and fast cash and the moral degradation engendered by the media who are considered the merchants of immorality.

    The position of the Churches in the light of these situations is that Christians, unlike non-believers, must be able to resist in order not to fall into the clutches of AIDS. The reason being that AIDS is acquired through reprehensible and immoral behaviours inconsistent with God's commandments.

    “Dear friend, go for a walk around Jonquet [1] you will see girls practically naked awaiting customers. It is sad to watch. Today, in Benin it is fashionable to see old men strenuously pursuing young adolescent girls. Likewise unmarried women who swarm the city talking to pupils and students. We have received reports that homosexuality is gaining grounds. These nauseating behaviours run counter not only to the teachings of God but also to African culture” These were the lamentations of a pastor of the Assemblies of the Church of God.

    Are these behaviours so serious as to prompt God to unleash AIDS on men out of anger?

    Apparently yes, aCCording to the Baptists and Assemblies of God. This is because based on a number of passages in the Bible and more precisely Deuteronomy chapter 28 verses 21, 22, 23, AIDS bears close resemblance to one of the diseases which God planned to unleash on the impious on earth. However, in reality, God is not responsible for the mishaps which befall men. Men are responsible for it themselves. The following is a parable from a Baptist pastor: “You know in Benin there is a highway code which every driver is expected to respect in order to prevent fatal aCCidents. However, there are people who do not respect the code. They cause aCCidents in which innocent people perish. In this case, who is responsible for the aCCident? Is it the one who drafted the code or the one who refused to comply to it? The same thing applies to AIDS. The unfaithful man contracts AIDS outside, brings it home to destroy himself, his wife and innocent children”.

    The conclusion a Catholic priest gave is that "God does not condemn. In the Bible God has refrained from cursing. God is always good and merciful. See how Abraham had bargained with God before the fall of Sodom and Gomorrah. To speak of a curse implies rejecting the sick. The Church must not use a language of condemnation. It should be merciful and aCCommodating towards the sick in the same manner as the prodigal son. AIDS is an indictment on the Church which should undertake self-criticism in order to know whether the message is preached methodically so as to take into aCCount all aspects of life of the faithful”.

    Finally, as far as all Churches are concerned, AIDS is not a punishment meted out by God but the consequence of the debauchery of men.

    3.2.    Involvement of the Churches in AIDS Prevention

    All Churches opt for chastity, abstinence and fidelity. The reason is that these measures are safer and consistent with the will of God. The point of divergence is the use of condom.

    As far as the Catholics, the Assemblies of God and the Baptists are concerned, the condom is an abomination. Advice on the use of condom amounts to advocating fornication and infidelity.

    In a world beset with hatred, wars, and moral degradation, Churches must be an exception and make statements which protect moral values.

    With regard to the Methodists, the Evangelical Presbyterians and Moslems, Churches must not embark on the marketing of condoms but can speak about it from time to time. The faithful who cannot abstain nor remain faithful can use them.

    3.3.    Involvement of the Churches in AIDS Control

    In Benin, Churches have not remained inactive in combating the AIDS epidemic. Each of them, has tried as much as possible to be involved in the fight against this scourge.

    3.3.1.   Catholic Church

    Prevention activities

    The Catholic Church is probably the most active Church in the field of AIDS prevention. The objective of the activities is to contribute towards the reduction of HIV/AIDS in the country by sensitising Christians. The target groups are the parishioners and more precisely the youth. The strategy is the mobilisation of the Christian community through Information, Education and Communication (IEC).

    The main activities carried out are the organisation of educational discussions for the youth, women and catechumens in the prayer groups, choristers and during the various meetings in the parishes. In addition, lectures-discussions were organised on the oCCasion of the various meetings bringing together the faithful. The main stakeholder of these activities are young educators trained for the purpose, as well as a number of lay doctors who are Church members and a number of priests.

    The themes tackled cover AIDS and sexual education. In this regard in particular, the Church acknowledge that it has not done much, because youth sexuality was a relatively taboo matter

    whereas the AIDS scourge makes it incumbent on the Church to wake up and act promptly. The subjects and discussions cover extra and pre-marital sexual relations, abortion problems, family planning etc.

    Care of AIDS and HIV positive patients

    The care of patients is one of the main concerns of the Catholic Church. It is in this perspective that the Church instituted a pilot project called SEDECA [2] . The project aims at giving a human face to the disease and hope to those who are its victims. The main purpose is to organise the medical and psychosocial care of the patients and PLWAs in order to dispel the ignominious character of the disease. The project intervenes in five health facilities, the most important of which are the Porto-Novo hospital, Diake hospital (Porto-Novo) and the Bon Pasteur dispensary at Bohicon. In fact, the project's zones of intervention are Abomey, Bohicon and Porto-Novo.

    The project trained a total of 18 advisors, 3 regional directors and 3 deputy directors. These advisors established care units within the health facilities. Their role is to psychologically support the sick through advice with a view to making them aCCept their situation. They also intervene sometimes in families in order to facilitate the aCCeptance of the sick and assist those who are in the terminal phase. The project provides its assistance to the sick through food, care and essential drugs. In order to give hope to the HIV positives and shield them against basic needs, the project provides financial support in order to carry out small scale income-generating activities. The project is financed jointly by the Catholic Church and USAID.

    The big lesson learnt is that AIDS is certainly an illness which kills but for the mere fact that the PLWAs are supported, counselled and their pains shared, they regain hope in life and can resist and live for a longer time. Clearly, abandonment and despair destroy the victims more than the virus itself.

    The problem of voluntary testing and care of AIDS orphans

    The SEDECA project encourages people to undergo voluntary testing in order to know their serological status. Those who wish to undergo this test are provided with counselling and support by advisors prior to and after the tests. Furthermore, the test is not demanded by the Church before marriage. This initiative is left to the discretion of the couples and their families.

    With regard to support to AIDS orphans, the Church has opened a centre for the care of AIDS orphans in Abomey. This consists in surrounding orphans with all the parental affection which they lack and providing their food, health and educational needs. In all, 100 orphan children are currently being taken care of. This project is being financed by UNAIDS.

    3.3.2.   Assemblies of the Church of God

    AIDS control prevention activities

    As soon as the Church became aware of the seriousness of AIDS, it sent a pastor for training in Nairobi. On his return, he was in charge of planning and organising prevention activities for the faithful.

    Thus, a 3-day information seminar was organised for the youth from the various parishes of the country. From time to time, these youth organise educational discussion for their peers. Another information and awareness-raising seminar was organised for pastors of the Church in order to give them the opportunity to talk about AIDS and to attend to the sick. The other activities carried out are periodic sessions of film projections. From time to time, pastors touch on the AIDS problem in their preaching. The most active contribution from the Assemblies of the Church of God is made by the BUPDOS which is a structure of the Church. It should be emphasized that the Assemblies of God condemn the use of condoms and advocate only abstinence and fidelity.

    The activities of BUPDOS - Bureau of Development Projects and Youth Social Work (Bureau de Projets de Développement et des jeunes Oeuvres Sociales)

    BUPDOS is the organ which is responsible for social work and all the social development activities of the Assemblies of the Church of God in Benin. It is concerned with health problems in general and particularly AIDS within the Church. The strategies adopted are the integration of health programmes (AIDS/MST, Malaria and target groups).

    The target groups are the church communities and the pupils of some educational institutions. The project covers nearly the entire country and is especially concentrated in rural areas. The main activities are educational discussions, counselling, group discussions and film projections. The project trained 58 community health workers (CHW) and produced teaching and publicity aids such as training modules, communication guides, audio and video cassettes, posters, leaflets etc. What appears to be more interesting are the house-to-house visits which enable the CHWs to discuss thoroughly with families (father, mother and children). In addition to these were discussions in a number of primary schools (of Assemblies of the Church of God) in Porto-Novo, Cotonou and Comé.

    ACCording to the project officers, the main lesson learnt was during the house-to-house visits which are an enriching strategy making it possible to win the trust of the parties concerned and to interact better with them.

    With regard to the impact on the beneficiaries, it seems that there are moving public testimonies which testify that there are behavioural changes.

    Care of patients

    There are no special counselling services within the Church. The pastor responsible for AIDS matters confided in us that AIDS cases are rare; a reflection of the high moral within Churches. However, aCCording to a number of observers, all those who are ill do not always have the courage to come and confide in pastors. AIDS still remains a confidential affair. The rare cases recorded are managed by pastors through prayers, counselling and financial assistance for drugs.

    BUPDOS has just established a small care unit which is not yet functional.

    The problem of voluntary testing and the support to AIDS orphans

    The Church has not yet adopted an official position with regards to voluntary tests. A number of pastors encourage prospective couples to undergo screening tests. The decision to undergo the test lies with the future couples and their families. It can however happen at times that one of the prospective couples is HIV positive. In such situations, the pastors refuse to celebrate the wedding.

    With regard to orphans, the Church does not yet have a special programme for AIDS orphans. However within the Church there are arrangements aimed at providing assistance to regular orphans. In fact, the Church does not have an orphanage. However all the orphans are provided with medical care, education and food.

    3.3.3.   Methodist Protestant Church

    The Methodist Protestant Church in Benin has been dogged with turmoil to the extent that it is faced today with a break-up. This situation has enormously slowed down the momentum of the Church in combating the disease.

    AIDS control activities

    The main activities carried out by the Church to inform and educate members were the organisation of awareness-raising seminars, conference-debates during youth camps, and periodic educational discussions in prayer groups and during meetings of Church women. Doctors and other lay church members are closely associated with the realisation of these activities. Pastors of the church often touch on AIDS issues in their preaching. It should be emphasized that the Methodist Church advocates fidelity and abstinence as a preventive measure but also remains open to the use of condoms.

    The care of AIDS patients and HIV positives is carried out at the Bon Samaritain de Porto-Novo Hospital. However, apart from this, there are no other PLWAs management committees within the church.

    The Methodist Church has not adopted any position on the need to subject prospective couples to the screening test or encourage faithful to undergo the test voluntarily. Besides, the Church does not have any structure for the care of AIDS orphans. However, like all other Churches, it provides assistance to regular orphans.

    4.  Position of the Churches on Human Rights and Poverty

    All Beninese churches are involved in the fight against poverty. They have established schools, hospitals and vocational training centres. They are creating development projects for farmers, youth and women. They grant credit to women to promote their commercial activities, they also train the youth by forming groupings to undertake small-scale income-generating activities. They also handle refugee and child trafficking problems. With regard to human rights, the position of Churches is that they demand the release of a number of people jailed unjustly. They also strive to train their members on their rights and duties. Furthermore, some Churches work closely with the anti-torture associations.

    5.  Involvement of the Ecumenical Organisations and Denominational Health Facilities

    5.1. Cotonou Bethesda Health Center

    The Bethesda Health Centre was established by the Protestant Church of Benin which, in addition to its curative services, is actively involved in combating AIDS through its programme “Formation of Trainers and Church Health Motivators”(FASE - Formation des Formateurs et des Animateurs de Santé dans les Eglises). The project began in June 1998. Its goal is to improve the health of Christians and non Christians.

    The target groups are the faithful of the Protestant and evangelical Church of Cotonou and the entire Cotonou community.

    The strategy is formation of trainers for the design and carrying out of IEC activities in the various Churches. In all, 20 staff members were trained including 12 trainers and 8 motivators representing 2 trainers per church.

    The role of the trainers is to train other educators in their respective churches so that together they can focus on awareness-raising, educational and spiritual counselling activities for their peers. The main themes tackled, in addition to AIDS, are family planning, common ailments such as malaria, physical and spiritual health of Christians and the sexuality of young Christians. With regard to this last point, the trainers and motivators teach the youth to know their body, the consequences of abortion, pre-marital sexual relations etc.

    With regard to prevention, even though FASE does not condemn condoms, it however does not give too much advice on its use. The focus is rather on fidelity and abstinence. For reason of financial constraints, the project could not produce educational and publicity materials.

    With regard to the lessons learnt, it was observed that AIDS is such an agonising subject that when it is mentioned tactlessly people are sometimes upset. However when the issue is raised in the framework of the Gospel and in relation to sexuality, family planning, physical and spiritual health and common diseases, the messages are better aCCepted.

    The FASE project is not interested in the care of the sick. The cases of illness are reported to the NGO Arc-en-Ciel (rainbow) which is responsible for care of the sick.

    5.2.    Le Bon Samaritain Polyclinic

    The Bon Samaritain polyclinic is a health centre of the Methodist Protestant Church located in Porto-Novo.

    Each week it organises public educational discussions for the sick and those aCCompanying them. In addition, doctors are often called upon from the hospital to organise lectures-discussions in the educational institutions and during meetings of the Church youth.

    The area in which the centre excels most is the care of the sick and HIV positives. In the hospital there is a unit responsible for the psycho-social and medical care of the sick and the HIV positives.

    Currently, the unit has 60 HIV positive patients under its supervision. In the year 2000 nearly 50 AIDS cases were recorded most of whom are already dead. The medical treatment provided to the sick as well as the HIV positives are not free. The hospital does not practice tri-therapy; it does however provides treatment by BACTRIM. The hospital does not provide house-to-house treatment. However, oCCasionally, doctors make discreet visits to the homes of the HIV positives, who so desire, because society is not yet very well prepared to aCCept PLWAs and HIV positives; it is on aCCount of this that most of them were abandoned by their families. The hospital is constrained to look after them up to their death.

    5.3. The Young Men' Christian Association (YMCA/ UCJG) - Bénin

    The YMCA of Benin is a young institution which is at its beginnings. The permanent structures and staff necessary for its functioning at full capacity are not yet in place. The YMCA of Benin has not yet implemented an AIDS project. However, thanks to its dynamism and dedication, the team in place has periodically organised lectures-discussions, drama and game competitions in a number of educational institutions in Cotonou.

    The activities generate enthusiasm and interest among the youth groups and this is an attribute for the future suCCess of the AIDS project which is becoming increasingly necessary.

    6.  Organisation of the Churches into a Network

    The Beninese churches do not yet have a functional network where all Churches would have undertaken actions together against AIDS. However, there are ecumenical structures bringing together several Churches. This is the case of CEPEB (Council of Protestant and evangelical Churches of Benin) which brings together the Protestant and evangelical Churches. CEPEB has also not yet undertaken common actions on AIDS. However one can see the emergence of a number of initiatives geared towards the creation of a collaboration framework among Churches in a network. This is the case of the UCMP (Christian Medical and Para Medical Union) a nascent ecumenical body which brings together the evangelical, Protestant and Catholic Churches to combat AIDS. Furthermore, UCMP prepared a draft which it submitted to the WCC for financing. At any rate, this body will play an important role in the future network. However, apparently it is not yet very functional and not yet well known by all the churches.

    In consequence, Church leaders who met were all in favour for the creation of a network which includes Muslims for joint action against AIDS. This attitude is a prerequisite for the establishment of a network which will serve as a framework for collaboration and exchange for all Churches against AIDS.

    [1]     A neighbourhood of Cotonou (Capital of Benin) where sex workers ply their trade

    [2]    SEDECA which means in the fon language that AIDS is not death

    Introduction | Benin | Burkina Faso | Ghana | Guinea | the Ivory Coast | Liberia | Mali | Nigeria | Senegal | Togo