Nikki Gamer: Hi everyone, this is Nikki Gamer for Catholic Relief Services. And welcome back to Behind the Story, a podcast series that invites you to celebrate the people behind 75 years of our history—the people we serve, our partners, our staff … and especially the supporters like you who make our work possible. In our last episode we spoke to Nathalie and Dave Piraino—both former CRS staff—about the Rwandan genocide that shocked the world in April of 1994 and changed the way we approach our programs in the midst of conflict and cultural tensions. But today we’ll be talking about a time—less than 20 years ago—when people said it was just too expensive …  too risky … too hard …  to stem the deadly tide of HIV and AIDS in sub-Saharan Africa. They said it couldn’t be done. But, of course, they were wrong. We’ll be talking to Michele Broemmelsiek, CRS’ vice president of Overseas Operations, and Dr. Carl Stecker, CRS senior technical advisor for HIV and global health—both of whom were on the front lines of our HIV work … and the impact it had on millions of people. Michele, Dr. Stecker, thank you so much for being with us and for taking time to tell this important story.

Michele Broemmelsiek: Well, thank you, Nikki. I’m really excited to be here.

Dr. Carl Stecker: And we’ve got some great stories we want to tell you.

Nikki Gamer: All right, so we have a lot to cover here, but I want to start with you, Michele. Can you take us back in time to sub-Saharan Africa as we were entering into our HIV work, and can you paint us a picture of what it was like in one of the hardest-hit countries—like Zambia?

Michele Broemmelsiek: Thank you, Nikki. My own story, in my career with CRS, intersected the HIV crisis in the year of 2001. And that was when I moved my husband and my 2-year-old daughter from Indonesia, where I was working for CRS. And I had my first job as country representative in Zambia. And actually, CRS had just opened our office there, and I had to learn on the ground what was going on. And, really, that was an experience of HIV. So maybe to connect the dots between what I saw and what the statistics were at the time … if you can imagine in Zambia, which had a population of 12 million, about that time. It’s a very large country. It’s twice the size of the state of California.

Nikki Gamer: Oh, wow.

Michele Broemmelsiek: So they had every month, 10,000 people dying from HIV. So that was like a 747 crashing every day in that country, every day of the year, that entire year, which led to 120,000 people died that year.

Michele Broemmelsiek: We had about seven staff. Two of us were American and the other five were Zambian. And every week someone on that team had a significant family member—a parent, a spouse, a sibling—die. They were going to significant funerals every week. So in the first year, I ended up attending a funeral. There were a row of people digging graves, and the grave diggers finished a row of graves 12 wide. So the funerals would all start simultaneously at those 12 graves, and they were digging another 12. And this was happening in three or four parts of the same cemetery that entire day.

Michele Broemmelsiek: So one of the reasons so many people were dying is there was no drugs. That means basically you’re just doing care for the sick. And the Catholic Church was really at the forefront … was help people die with dignity. You’re trying to pray with them, but you couldn’t offer them anything other than death.

Nikki Gamer: What does that mean when someone is diagnosed back in 2001? What does that mean for him or her?

Dr. Carl Stecker: I lived and worked in Cameroon, in the Central African Republic, for almost 20 years. And starting in the late ’70s, early ’80s, my wife and I—both as registered nurses—worked as missionaries in health care. In the early 2000s … I come to CRS in 2002 and begin work providing technical assistance to country programs who are struggling, as Michele described, how do we deal with HIV?

Dr. Carl Stecker: And I specifically remember arriving in Entebbe in Uganda, and there’s about a 40-minute drive from Entebbe to Kampala, the capital, where the CRS office was. All along the way were furniture makers making coffins … big billboards, scary billboards about “HIV kills.”

Nikki Gamer: So you go into a clinic back then and you get your blood tested and you’re told, “Yes, you have HIV.” How long from that point to developing full blown AIDS to passing away from this disease?

Dr. Carl Stecker: Test kits didn’t become available until in the late ’90s, and available in Africa until much after that. So you went through everything: It’s not a cold, it’s not the flu, it’s not just diarrhea, it’s not amoebic dysentery. And then you figured out with the combination of many different illnesses—Oh, this is AIDS, acquired immune deficiency syndrome—that this person must be HIV-positive. So then you began to treat what illness you could treat, but then you cared for the person because eventually they were going to die. But there was no cure for HIV. There is no vaccine for HIV. And so this was just hospice care, helping people to die with dignity.

Nikki Gamer: So we think of HIV here in the U.S. nowadays as chronic, but it’s treatable. But back then, it was really a death sentence.

Michele Broemmelsiek: And people would try so hard to do the few things they could to help their family. And so one thing they would do—Carl mentioned that you’d see all these coffin makers. It really was the best income-generating activity you could support people to do … which is, which is horrific because everyone was dying. But people would go out, because they didn’t want to pauper their family, and they would buy their coffin ahead of time. And they would literally sleep on top of it because that was the only piece of furniture they would have left. They knew if they didn’t, the cost to the family would be devastation beyond just the loss of that person’s life.

Nikki Gamer: What did HIV do to families, and then communities? Because I read that once someone was diagnosed, they were literally ostracized or isolated.

Dr. Carl Stecker: Yeah, so we saw shame, discrimination, stigma. We were often within our programs trying to get across the message that the only way that you can get HIV is exchange of bodily fluids. At one point in time in the early 2000s, the 10 countries with the most orphans and vulnerable children in the world were in Africa—all 10 of them having more than a million children that were orphaned.

Nikki Gamer: So Michele, can you talk for a minute about what that does to an economy, or even an entire country?

Michele Broemmelsiek: So we think in our head that this was mostly poor people, and, of course, there were many poor people who had HIV. But really the drivers—the people who are moving around and had multiple partners or were going to school and contracted HIV while they were in school—were people who were getting education. This destructive disease, in and of itself, would have been enough, right? To just, you know, take apart families, take apart culture and society. But on top of that, if you layer the stigma that Carl was speaking of, you know, which grew out of the fact that in the U.S., HIV in the beginning was passed mostly through homosexual contact. So that wasn’t true in Africa.

Michele Broemmelsiek: One of the things that for me was the most heartbreaking, was, building on what Carl said, about the million orphans. You know, the aunts, the uncles, the parents—and sometimes even the grandparents—were dying. You ended up with child-headed households, usually a teenager caring for their siblings. And I visited many of these households where you would have a 13- or 14-year-old taking care of a 2-year-old, trying to get the 2-year-old to hospital because they kept getting sick. So that that sense of the burden and the breakdown of what we even considered to be a family, and the care of a family, wasn’t even happening at the height of the crisis.

Nikki Gamer: Wow. That’s a pretty dire picture. Give me the scope when this was at its worst. What are we talking in terms of number of countries affected and number of people?

Dr. Carl Stecker: The height of the epidemic in Africa arrived in the mid-2000s—2004, 2005—when there were over 2 million deaths a year from HIV on the African continent, estimated, for both of those years each. So 4 million deaths just in 2004 and 2005. A lot of it was in southern Africa, eastern Africa … less so in central Africa, and even less so in West Africa.

Nikki Gamer: Can you tell us: Why did HIV spread in this part of the world in particular … and why so rapidly?

Michele Broemmelsiek: If someone is HIV positive, and they’re driving a truck thousands of kilometers across Africa and they’re stopping multiple times and they have relationships in those communities, then it spreads, right? So those people in those communities may have relationships. So that’s one factor … is the trucking routes. The other is that in southern Africa you have a lot of mining companies, so you have gold mining, diamond mining. So usually men leave their family in Zimbabwe or Zambia or South Africa, Lesotho, Swaziland, Botswana. They go to the mine, and they return home. So while they’re away, they have relationships in that town where they’re living at the mine.

Nikki Gamer: </