Just the beginning

Former President Bill Clinton announced this month that his foundation had reached an agreement with generic drug manufacturers Cipla and Matrix to significantly lower the price of AIDS treatment in more than 60 countries. Undoubtedly, Clinton's accomplishment provides significant momentum in the ongoing fight against the AIDS pandemic.

However, the grim reality in many of the countries targeted by the agreement is that many of the people who could most benefit from the medications will still be unable to access them. People living with HIV/AIDS are often uninformed about the programs available to them, they don't always trust the international or governmental institutions that deliver them, and they rarely have the support services or even basic nutrition needed to make the antiretrovirals work. Grassroots organizations, with their long-standing presence in their communities and the invaluable trust of local people, provide vital links to such services.

HIV-positive 69-year-old Ishmael Kipikanama lives with his daughter (who is also HIV positive) and her three children in the Gikondo District outside of Kigali City in Rwanda. His wife died three years ago from HIV/AIDS. As his own body succumbed to the virus, it showed all the tell-tale signs-fever, cough, and diarrhea-and finally a free-fall to half his former weight. Although antiretrovirals were available to him through another generous foundation, he was unable to take his medicine. "The doctor told me to take plenty of milk [with them], but I couldn't afford it," he says. "Sometimes even getting cheap food to eat was difficult, and milk is a luxury."

Then, his local church stepped in. For little more than a dollar a day, the local church supported the entire family with a government wrap-around program. It covered the $65 per annum co-pay for government health insurance (and through it access to antiretrovirals), nutritious food, and a loan to start a food stall or other small business. The repayment on this loan was recycled to help other families in the same situation.

Through the support of the church, Ishmael's daughter, Alexandrine Vumiliya, 30, started a small business selling avocados and sweet bananas. She hikes the hills and valleys of Kigali on foot looking for buyers for her merchandise. Though her profits amount to little more than a dollar a day, they are enough to feed her family and pay school fees for her 9-year-old child. While Alexandrine is away working, her father cares for her two babies.

An Anglican church near Ishmael's home holds meetings for people living with HIV/AIDS every week where they share coping mechanisms and responsibilities. When surplus grain was distributed to the association, volunteers from the church ensured it was distributed to those who needed it most. The church also trains caregivers to visit people living with HIV/AIDS in their homes and provide simple services that make a big difference: cleaning sheets or cooking.

Already, more than 15 million children have been orphaned by AIDS, and this number is predicted to double or triple in the next 25 years. Africa is hardest hit-eight out of 10 children orphaned by AIDS live there. In some countries, 17 percent of all the children are already orphaned. Even if new infections were halted today, the broken economies and nonexistent working-age populations would reverberate throughout every rung of society. AIDS has dealt a colossal blow to African culture whose effects we will feel throughout our lifetime.

The single best way to invest in Africa's future is to protect its children. Our first priority must be keeping parents alive and present for them. The next priority must be the others in the community who already love and care for these children-their church and community leaders, other family members, and caregivers from within their own communities.

Against the backdrop of such acts of largesse as Clinton's negotiation, everyone has a part to play in the war on AIDS. Because of their intimate thumbprints in local communities, African churches and other faith- and community-based organizations will have the most vital role. Our job is to support them in doing it.

-Deborah Dortzbach is the international director of HIV/AIDS programs at World Relief and co-author of The AIDS Crisis: What We Can Do (IVP, 2006)