The work of Mildmay International

1. The work of Mildmay International

2. Worldwide prevalence • 33.4 million people are living with HIV worldwide • 2.1 million are children under 15 • There were 2.7 million new cases of HIV in 2008 • 2 million people died from HIV and AIDS in 2008 Since its initial recognition AIDS is believed to have killed 25 million people

3. The number of children living with HIV has been steadily increasing: • 1990: 250,000 children • 2000: 1,450,000 children • 2007: 2,100,000 children Every 15 seconds a child is infected with HIV

4. Treatment • About 34 million people are now living with HIV, of whom more than 30 million live in low- and middle-income countries. • WHO estimates that at least 9.7 million of these people are in need of ART. • As of the end of 2008, 4 million people had access to ART in low- and middle-income countries.

5. Role of FBOs • Faith Based Organisations provide 40% of care and treatment for people living with HIV+AIDS globally, and in sub Saharan Africa up to 70% of care is being given by Christians.FBOs only receive between 5-7% of global funding.

6. Major International Players

7. International shift in policy • Change in USA funding policies impact health care around the world • Shift to utilize HIV+AIDS funds in a way that builds the capacity of the entire health care system of countries "Even the best health services in the world cannot tackle AIDS alone. "AIDS funding can and does bolster health systems more widely-providing wins for both AIDS and health in general.“ World Health Organization (WHO)

8. HIV in the UK

9. Diagnosed HIV-infected individuals accessing care by place of residence, UK Annual survey of HIV-infected persons accessing care : HPA data

10. The work of Mildmay International

11. Who we are • Mildmay is a not-for-profit international NGO (registered in Kenya, Tanzania, Uganda, Rwanda and Zimbabwe) and a UK-based charity with a non-denominational Christian foundation.

12. Where we work Where we are currently working: UK, Uganda, Kenya, Tanzania, Rwanda, Zimbabwe, Ukraine, Russia, Moldova, Romania Where we have worked before: South Africa, Botswana, Gambia, Malawi, Nigeria, Sudan, Zambia, India, Hong Kong, Japan, Belarus, Poland. Argentina, Brazil, Ecuador.

13. Our vision A world in which everyone with HIV+AIDS can have life in all its fullness

14. Our mission • Our mission is to improve the quality of life of those who live with HIV+AIDS throughbuilding in-country capacity to fight HIV+AIDS. • We do this through the creation and delivery of: • Comprehensive model holistic care services for adults and children, their families and communities • specialist training and technical assistance to health workers and institutions, thus empowering others to improve standards of care in their communities

15. History • 1860’s –Christians responding to cholera outbreak, deaconesses going into slums, then starting the hospital • 1940’s amalgamated into the National Health Service • 1980s –NHS closed smaller district hospitals

16. History • 1988 Christian trustees lobbied to re-open, responded to the then untouchables, people with AIDS – first hospice in UK, pioneering work • Visited by Princess Diana in 1991 • Family AIDS care centre opened in 1993 – named Spencer House. • Mildmay Hospital based in Spencer House from Nov 2008

17. History – Our work expands to Africa • 1998 - The Minister of Health of Uganda visited Mildmay and requested us to open a hospital and care centre in Kampala. • From there our work expanded to Kenya, Tanzania, Rwanda and Zimbabwe as well as other parts of the world. • We provide training in many parts of Eastern Europe, including Ukraine, Russia, Romania and Moldova

18. Our holistic philosophy • We have developed a patient-centred interdisciplinary approach to care for adults and children living with HIV+AIDS • Physical, emotional, spiritual, dietary, cultural, community & social needs • Well Being - holistic approaches • Engagement to maximise independence • Connecting to networks & circle of support

19. Our areas of expertise • HIV+AIDS palliative care and rehabilitation(including HIV-related Neuro Cognitive Impairment • Mildmay pioneered HIV+AIDS palliative care back in 1988 opening Europe’s first AIDS hospice • Today, Mildmay provides one of the world’s only specialist rehabilitation unit for those with HNCI, HIV-related neuro cognitive impairment, providing adult residential and therapeutic day care models • Mildmay’s centre in Kampala was Africa’s first dedicated HIV+AIDS care and training facility which has expanded to include capacity building within rural clinics • Mildmay now provides rehabilitation and palliative care training throughout sub-Saharan Africa and Eastern Europe

20. Our areas of expertise • Home-based care development • Home-based care bridges the gap between mainstream health and community settings, providing primary nursing and multidisciplinary care • Mildmay has worked with the Ministries of Health in such countries as Kenya and Tanzania to create a model that is Ministry of Health lead but community driven • Linked to ART, it operates a unique two-way referral and follow up of patients • Mildmay also provides home-based care kits, a new patient-held record system and a ‘quality of life assessment, supported by robust monitoring and evaluation systems • The model’s success relies upon a sustained programme of certificated training, enabling health personnel to not only be competent in HIV care and management but also able to train others

21. Our areas of expertise • Strengthening Health Care Systems • The relevance of our strategies and their cultural appropriateness is ensured through a range of in-country and external partnerships. These include Ministries of Health and academic institutions • We aim to integrate our initiatives into national/regional/local policy, thereby strengthening systems

22. Our areas of expertise • ART scale-up • Mildmay has extensive expertise in ART care and training for both adults and children – including dosage, adherence management and changing regimes • We deliver ART as part of our centre-based holistic care in the UK and in Uganda • Mildmay also provides specialist courses on ART as part of it’s relationship with the Kenya Medical Training college • In Uganda work continues to enable community clinics to offer ART as a part of their treatment processes

23. Our areas of expertise • Training and Education • Mildmay has over 15 years’ experience of HIV+AIDS training on the international stage • After four years’ success running an 18-month Diploma, Mildmay expanded it’s reach to include a three-year BSc Hons Degree in ‘A Health Systems Approach to HIV+AIDS care and management’. This is available in Uganda, Tanzania, and Kenya and is accredited by the University of Manchester • Mildmay also offers an impressive portfolio of programmes that espouse evidence-based practice and can cover all aspects of prevention, care and management • Courses can be centre-based at Mildmay facilities or delivered through our mobile training team • We offer proven expertise in programme design and implementation, along with national curriculum development

24. Our areas of expertise • Specialised paediatric work • Mildmay has built an unrivalled reputation for the quality and breadth of our paediatric HIV+AIDS services • From specialist outpatient clinics and in-patient care to innovative programmes providing urban and rural day care and emergency medical clinics. • Our model includes health monitoring, medical assessment and care, counselling and spiritual support, peer support, nutritional support, schooling and recreational play, skills and vocational training and apprenticeships as well as practical support such as emergency food supplies, clothing, bedding, school materials etc.

25. Our areas of expertise • Capacity-building partnerships • Mildmay’s approach to capacity building extends from the national to the community level • Mildmay works with UK and international government agencies to develop policy for the provision of care for people living with HIV • Mildmay has established partnerships with other charities across the world to minimise the duplication of effort, to share our expertise and develop the scope of our respective works • Forming in-country partnerships with local health care providers and involving ourselves at a community level allows Mildmay to empower and enable communities to care for themselves, to facilitate independence and long term sustainability

26. Our role as a FBO • Christians have the mandate but not the monopoly to care • Mildmay is enabling a Christian response to the HIV+AIDS pandemic

27. We partner with other FBOs

28. The church and HIV Donors are increasingly interested in HIV+AIDS work carried out by local churches and Christian grassroots organisations. There are a number of reasons for this: • Local churches are close to the community. • In many places local churches have a prominent position within the community. The church is often well-respected. • Serving marginalised people fits in well with the Christian faith. • Some churches have experience of social action within their communities. • Some churches are already effectively addressing HIV+AIDS in their communities.

29. The church and HIV • We don’t do sex • We don’t do gay • We don’t do contraception

30. Challenges for us all • Prevention. We cannot treat our way out of this pandemic • Infrastructure required to engage with global donors • Political required from all countries

31. Ways to get involved • Be informed (UK AIDS consortium) • Lobby • STOP AIDS campaign (http://www.stopaidscampaign.org.uk) • Volunteer here (www.mildmay.org) • Pray