William Fleming has worked on HIV/AIDS and health programs in the United States and the developing world for more than 10 years and joined Christian Children's Fund in 2005.
Fleming has vast on-the-ground experience in developing countries, a Masters of Science of Public Health and a Bachelor of Arts in International Studies from the University of North Carolina at Chapel Hill.
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| William Fleming, Christian Children's Fund HIV/AIDS Program Specialist |
Q: You have worked on various HIV/AIDS and health programs in the United States and the developing world during the past 10 years. In your opinion, what have been some of the most far-reaching developments made in this time?
A: The commitment, on a global level, to a true continuum of prevention, care and support services for people living with and affected by HIV/AIDS has been a critical development over the last five years. Once it was accepted that we should and could do more — that prevention alone will not solve the problem, that HIV positive people in developing communities could effectively take advanced treatments, that access to treatment would reinforce prevention services — the U.S. Congress and Administration committed serious resources.
We are now faced with making the dream a reality. That is, providing a full range of services to families affected by HIV. But there is now little debate about what to do. Rather, the debate is centered on what works best.
Access to treatment is a second key development, without which the continuum mentioned above would be incomplete. However, the verbal commitments do not match the reality on the ground in most countries. There is still a long way to go to ensure equitable, timely access to treatment as well as the counseling and support services needed to achieve treatment adherence and improved health outcomes.
Finally, the growing commitment and resources for orphans and vulnerable children is probably most directly relevant to CCF’s work. The recognition of the size, rapid growth and predicted longevity of the orphan epidemic has helped expand the resource base for programs in this area.
In the end, a true continuum of services and access to treatment has to be achieved to effectively serve the growing number of orphans and vulnerable children. So the developments I have noted are, in reality, building blocks of a comprehensive response to the HIV/AIDS pandemic.
Q: One of your primary areas of focus is HIV prevention for youth. How will you integrate your experience, this insight, into your efforts with CCF?
A: There remains a lot of work to do to prevent HIV infection among youth. I think we need to evolve our thinking and commitment to a long-term perspective. As youth evolve, grow and change, their behavior changes along with their physical needs and vulnerabilities. Messages and services must keep pace and respond to their real needs.
Unfortunately, programming and funding cycles are not always in sync with this reality. Also, the social and economic status of youth in many developing countries is quite low, despite their frequently comprising 50 percent or more of the total population. As a low priority, their needs for health services, jobs, education, etc., go unmet, which has a direct effect on their vulnerability to HIV infection. So our approach must include a full range of services, including prevention and treatment as well as broader development services like micro-enterprise, education, vocational training, etc. Work must also help communities to prioritize the health and well being of youth as we do for younger children.
Youth are not only defined as a vulnerable group, but as a key asset in our response. In my experience, youth are playing a key role in mitigating the impact of the epidemic in their communities, and we need to build on that.
Q: How will these efforts build upon CCF’s existing HIV prevention for youth programs?
A: CCF has a very inclusive and enlightened view of the role youth and children can and should play in programs designed to meet their needs. I think the challenge is to determine how we can interpret theory into practical activities that our staff and partners can use to promote and protect the health of youth and children. I want to help CCF achieve a complete range of services that are tailored toward youth, helping protect them from HIV infection and expand the role of services for the broader community.
Q: Describe some of the key comparisons and differences between HIV/AIDS programs in the United States and developing countries?
A: The ongoing struggle to develop comprehensive programming for affected communities here in the United States is similar to the multifaceted efforts that have resulted in President Clinton’s Life Initiative and, later, President Bush’s Emergency Plan. Much stigma, denial, and foot dragging was overcome with true concern and compassion for people affected by HIV/AIDS, particularly in Africa.
Despite the recent increases in global program resources, the level of resources here in the United States and in other industrialized nations continues to be considerably higher than in developing countries. This is evident in the higher levels of access to advanced treatment and care services. However, like many AIDS-affected families around the world, low-income families and communities here in the United States are often unable to access needed services.
Many of these communities share challenges typical in less developed communities around the world, including: limited health service availability in their community; lack of insurance or means to pay for services; limited human resources despite high demand: little access to affordable support services such as transportation and child care, that can facilitate access to health services; language barriers.
Poverty and under-development are common denominators in the global epidemic. Thus, we should not think the problems are solved in the United States or that this country and the global epidemic are not linked or related, because they are.