At the 6th Conference on Retroviruses and Opportunitistic Infections (Chicago, January 1999), it was presented that the origin of HIV can be traced to primates. It was suggested that HIV moved into the human population from a particular species of chimpanzee, probably through blood contact that occurred during hunting and field dressing of the animals. The findings presented at this conference was said to provide the strongest evidence to date that HIV originated in non-human primates.
The first cases of AIDS were identified in 1981, and since then more than 20 million people have died. Today, over 40 million people across the world are living with HIV. The spread and the destructive tendency of the epidemic have called for the attention of governments, and health and social services around the world.
A virus subsequently named HIV was identified as the cause of AIDS. The absence of a cure for the disease became the major cause of fear among both the affected and those not affected. However, the fear was somewhat alleviated by the fact that HIV, in Europe and North America at least, was first found primarily in the homosexual community. The long-term effects of this have been devastating. As heterosexuals breathed a collective sigh of relief and dismissed HIV as ‘a gay plague’, their ignorance about how HIV spreads left them continually exposed to infection.
Impact and Effect of HIV and AIDS
The affected person suffers the pain of the illness that could befall him or her. Pains could be physical or psychological. The fear of the unknown in itself comes with painful experience. The attitude of people around the affected person, which could be that of rejection, could be a serious source of pain.
Every health challenge is capable of affecting the financial standing of a person. The same happens in the case HIV/AIDS. The standard of living of the individual must change; and for that to happen, there will be extra spending on drugs and food. Even if the person enjoys free retroviral drugs, the point of collection may not be near the persons’ resident. Therefore, such person must spend on transportation get any such help.
Death becomes one definite fear of any HIV affected family. The very person carrying the infection continually leaves in fear because his health situation could go bad at any time. Also, members of the family of the affected person equally worry that they may lose their relative anytime.
Over the years, this has been one of the major challenges faced by HIV affected persons, and even their families. This refers to when the person is rejected. The persons’ friends stay away from them, and not accepting to even share things with them. The news is quick to go round that a person has got HIV, and such person is seen as the worst sinner around. Friends and sometimes family members gradually slip away.
The stigmatisation of individuals is a sin against God who made all human beings in His image. When an individual is stigmatised, it is equal to rejecting the image of God, and denying the stigmatised person the fullness of life. This is not just a sin against a neighbour but also a sin against God.
The full meaning of AIDS is Acquired Immune Deficiency Syndrome. An HIV- positive person receives an AIDS diagnosis after developing one of the AIDS indicator illnesses. Such person can also receive an AIDS diagnosis on the basis of certain blood tests and may not have experienced any serious illnesses. A positive HIV test does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician according to the CDC AIDS Case Definition.
The major problem about HIV (Human Immunodeficiency Virus) is the awakening of the person’s immune system. Over time, the problem gets to the point that the system has difficulty fighting off certain infections. These types of infections are known as opportunistic infections. Many of the infections that cause problems or that can be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS has weakened to the point that medical intervention may be necessary to prevent or treat serious illness.
Currently, it has been observed that the average time between HIV infection and the appearance of signs that could lead to an AIDS diagnosis is 8-11 years. It means that within this time, one may not notice the presence of the infection except if tested. This time varies greatly from person to person and can depend on many factors including a person’s health status and behaviours. Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative health care.
People do not want to bear the weight of stigmatisation so they change their behaviour. They decide to be silent about their status, and this has simply encouraged the virus to spread. In countries where admitting to a homosexual orientation remains socially unacceptable or even dangerous, the crisis can only get worse. In most developing countries, HIV became associated with sex workers, instead of with homosexuals. It was regarded as a product of promiscuity, which in turn led to silence and ever-increasing infection rates.
As with all sexually transmitted diseases, irresponsible sexual behaviour has been a factor in the increase in HIV prevalence. However, this is not a valid reason for rejecting HIV-positive people. How people contract the virus should not determine the attitude of the church – or of society – to their suffering. In secular circles, stigmatisation of HIV-positive people arose out of a sense of shame or guilt. It is an illness that is usually transmitted sexually and often leads to death. Since sexuality itself is often associated with shame and guilt the inclusion of death and fear made it worse. It is important to note that stigmatisation is not always imposed on people. There could be self-stigmatisation; a personal conviction that the infected person is an object of shame, or a sinner could be equally disturbing.
Apart from the non-Christian approach to HIV, Christians in the 1980s were faced with a new teaching that HIV was a punishment from God to the sexual immoral. The unexpectedness of the new disease and the speedy rate of its destructiveness could give reason for such assumption, comparing it with the plagues which God visited on his enemies in Exodus 7-12. However, the idea of HIV/AIDS epidemic being a form of divine punishment was not totally an acceptable claim. Yet many evangelical groups were eager to accept it in different parts of the world like in Europe and North America. It also gained ground in some traditional societies of developing countries; people who sought an explanation (such as bad spirits) for any kind of misfortune easily accepted that it is a misfortune or punishment from God.
Dr Michael Burke, of the Anglican Church of Tanzania Health Unit, has challenged churches to accept their role in combating stigma. He argued that ‘The churches have been the key maintainers of stigma while also having the capacity to address it.’ Christians who discovered that they were HIV-positive also preferred to remain silent. These accusations that are used to brand people in itself was injustice. Some infected men and women who knew themselves to have been faithful wives or husbands, being branded a sexual sinner, as well as being afflicted with a deadly condition, was hard to bear. Therefore it becomes a better choice to keep to themselves.
Christian churches have engaged in pastoral care in all aspects of human experience: education, healthcare and social justice among many others. Therefore, they are in a good position to participate in HIV prevention and care at all levels. In many countries, churches are already deeply involved in this work. There is, however, a need for churches and Christian agencies such as Christian Aid to formulate the theological principles that determine their response to the epidemic if this is to be seen to be well-founded.
The widespread theological debate in the 1980s that HIV was a punishment from God for immoral behaviours made people who found themselves infected to keep status hidden in order to avoid stigma and rejection by their church and family members. But with time, people began to understand the causes of the spread of HIV better. Its links to poverty and injustice became better understood. People began to understand that HIV could infect anyone, regardless of their faith, marital status, sexual orientation or social position. Churches began to accept that the role of the church was to proffer solution and support to the already distressed people, not to condemn them.
The need for a theological framework that facilitates discussion on the nature of God and his relationship with humankind (including people living with HIV/AIDS) became important. The model proposed here is based on Karl Barth’s work. It reflects the love of God and His involvement in the well-being of his people since the beginning of the creation. This is to say that the death of Christ on the cross for the redemption of the whole world is equally significant to those people living with HIV. If covenantal relationships between God and his people are to be restored and maintained, the various forms of injustice that underlie the spread of HIV have to be addressed. Foremost among them is stigma, which all too often leads to dangerous silence, as well as rejection.
Gender injustice also has to be tackled urgently. Women now make up nearly half the total number of people who are living with HIV/AIDS worldwide. Women are vulnerable because of poverty and their need to provide for their children at whatever cost. They are at risk of rape and abuse. They may lack the freedom to negotiate safe sex with their husbands. Cultural restrictions could also make them suffer discrimination.
Injustice must be tackled to control the HIV/AIDS epidemic. There is the need to restore hope to these people who may already have condemned themselves. To do this, the silence has to be broken. These people should enjoy both material and spiritual assistance to enable them live a normal life. This means issues such as suffering and sexuality should be openly and positively addressed. For the church, this involves enabling people to behave responsibly by providing teaching about HIV prevention. It also involves the church itself acting responsibly in terms of its theological response to the epidemic and the quality of spiritual care it offers to people infected and affected by HIV.
HIV/AIDS presents a challenge to the church in its commitment to upholding God’s covenantal relationship with his people in every aspect of their daily lives. This challenge relates to the way the church sees itself and understands its mission as a healing, worshipping and prophetic community. Within the church, it is vital that everyone can feel welcome and receive pastoral support. Breaking the silence about HIV means integrating into worship the concerns of people living with HIV. Externally, in order to identify the most effective ways of combating the HIV epidemic, churches need to examine their relationships with other churches and faiths.
Finally, the church must make its voice heard in order to change the structures that are assisting the spread of HIV. Most crucially, this means working to alleviate poverty by advocating for change in unjust trade practices and the removal of the burden of unpayable international debt.
A theology of hope and love must be accompanied by practical care, which not only aims to improve people’s quality of life within their community, but also demands action in the wider world.
With the increasing danger of HIV epidemic which has become apparent over the past 20 years, the Christian community has seen the need to answer a call to service in tackling HIV issues through what is popularly referred to as ‘a theology of AIDS’. Countries in the developing world and beyond have come to terms with the reality that HIV/AIDS is causing great havoc in their midst. Hence, the clamour for a theological response has become a feature of the churches’ conversations and conferences.
The way the human immunodeficiency virus (HIV) spreads, and the devastating effects of the illnesses that result from acquired immunodeficiency syndrome (AIDS) have been felt to demand a response from the church and its leaders across the world. But why is this so? After all, no one could see a need for a theology of cancer or of malaria, the biggest killers in many countries. What then is so different about HIV/AIDS?
The answer may not be far from the understanding that the problems associated with HIV are more than any we can talk about. HIV is not selective. It affects the rich and the poor, adults and children, Christians and non-Christians. Whether acknowledged or not, since its outset, HIV has been present even in the church itself. It has affected congregations, priests and pastors alike. And suffering individuals are beginning to ask: where is God in all this? But that is not the same as seeking a theology that is specific to HIV/AIDS. This search implies that a theology of suffering, with which Christians have wrestled over two millennia, is not enough to address this epidemic. Besides the rapid spread of the virus, HIV/AIDS is also perceived to be different because of how it is transmitted. This has frequently been linked to behaviour of which the church disapproves. A significant factor in the now increasingly urgent demand for a theological response to HIV/AIDS has to be the spectacular theological error of the church in the epidemic’s early days.
In Western Europe and North America, HIV was first identified among homosexual men; while in other places, it was associated with female sex workers. Because of this, some churches were quick to say that AIDS was a punishment from God, similar to the punishment visited on disobedient communities in Old Testament times.
The church’s initial attitude rather fuelled the fires of the epidemic instead of tackle it. Christians who became infected by HIV preferred to remain quiet for fear of the wrath of their pastors and rejection by their congregations. Therefore, HIV continued to spread very fast.
To this day, the ‘punishment from God’ theory still exists among some believers. In the 1980s, pastors in more remote communities in developing countries have yet to hear word of the churches’ change of heart. Some western conservative church leaders continue to hold this view because the idea of divine punishment fits neatly with their own world-view.
Subsequently, churches and governments began to break the silence surrounding HIV/AIDS. Today, instead of a theology of punishment, the church resorted to preaching about a God of love and compassion who does not inflict sickness on his people, and for whom illness is not to be equated with wrongdoing. For over two decades now, the church has been at the forefront of home-care provision and health services for people affected by HIV. The church now gives emotional and spiritual support. People involved in such activities, as well as the individuals and families who are infected or affected by HIV, need some kind of theological framework within which to do their work and live their lives.
Many churches have begun to address HIV/AIDS in theological context, but most seem to be limiting their approach to a biblical studies perspective. This viewpoint is criticised as selective and Old Testament-based. It views the problem only as a ‘punishment from God’. Biblical studies are, of course, a crucial element in formulating a theological approach to HIV/AIDS. However, the Bible also has to be studied from a clearly articulated theological perspective. While it is good and right to comfort and encourage someone living with HIV by pointing them to Jesus’ love for outsiders, as shown in many of his healing miracles, theology also has to probe more deeply and widely. Clodovis Boff says “To address the question of where God is in HIV/AIDS, we need to ask. What is the nature of God as he is revealed through this epidemic? What does this tell us about the world as he sees it?” It will help to reveal that suffering should not be considered as all that God is willing give to his people.
In 1996, the World Council of Churches issued a statement about HIV/AIDS. It stated that ‘The church’s response to the challenge of HIV/AIDS comes from its deepest theological convictions about the nature of creation, the unshakable fidelity of God’s love, the nature of the body of Christ and the reality of Christian hope.’ It suggested that such convictions might be worked out in practice in a threefold model in which God who is Father, Son and Holy Spirit offers ‘a model of intimate interaction, of mutual respect and of sharing without domination’. This is an ideal that would be shared by those who are working with people living with HIV/AIDS.
The world with its sorrow and its happiness will always be a dark mirror to us, about which we may have optimistic or pessimistic thoughts; but it gives us no information about God the Creator. To people living with HIV/AIDS, to all the men and women affected by it, the church says that life is a gift from God, a free gift; something very precious. The God who loves each one of us could not take pleasure in humiliating us. If tackling injustice is central to reversing the tide of the HIV/AIDS epidemic, it is equally pressing to restore life to those who already see themselves as under a death sentence. This means, among other things, breaking the silence and offering hope, both in material, real-life terms, and theologically. ‘Difficult’ themes, such as suffering and sexuality, need to be addressed openly and positively. Suffering The HIV/AIDS epidemic has led some to reflect that the life-giving order of creation has given way to death-dealing chaos. This reaction is hard to justify theologically.
The HIV/AIDS epidemic is about more than sickness – it is the impetus for the scandalous rejection and stigmatisation of many thousands of people, and permeates every area of restoring life. Christians therefore need to have before them this vision of a loving God who knows from within not only physical suffering, but all-embracing torment. It is the face of this God that we are privileged to see in so many people who are living with HIV. So how are we to respond to the pain? Certainly, not with stoical resignation. That is not the example of Christ on the cross, nor is it a fruitful way of addressing the global challenges that HIV presents. If they are to be heard, the voices of those who are suffering need to be much louder.
Silence is the most dangerous effect of stigmatising people with HIV. Fear of stigma makes people afraid to reveal their positive status by changing their behaviour. This means that men and women continue to have unprotected sex, intravenous drug users continue to share needles, and HIV spreads faster than ever. Churches have often been accused of complicity in this silence. Archbishop Njongonkulu Ndungane of Cape Town has gone further by saying that ‘the church is to blame for the stigma and the spread of HIV/AIDS’, because a destructive theology linked sex with sin, guilt and punishment (emphasis added).
A second consequence of stigmatisation is that people who are not part of the stigmatised groups consider their way of life to be risk-free. In the UK, associating HIV with the homosexual community has led many people – especially young people who are particularly vulnerable because of their sexual behaviour – to wrongly imagine themselves to be protected. Stereotyping is dangerous, and not just for those who fit the stereotype.
Thirdly, stigmatisation leads to rejection. People who believe that HIV can be transmitted through touch, by eating food prepared by an HIV-positive person or by sharing their utensils, will reject anyone they know or believe is infected claiming that they are protecting themselves. This is a heavy psychological burden for the rejected individual.
Fourthly, the custom in many African countries makes families blame a widow for her husband’s death from an AIDS-related illness and throwing her and her children out of their homes. Rejection is not restricted to individuals, families or communities. In Haiti’s capital, Port-au-Prince, a recently established support group for HIV-positive people is campaigning against national and international discrimination. One of their members, Malia Malo, said that their aim is to end the refusal by some countries to accept residence applications from people who are HIV-positive. If a person discovers he is positive and is rejected by, say, the United States, it’s a double rejection. There is an effort to contact overseas networks to lobby international bodies such as the UN.
Jeanne Gapiya is one of the founders of Burundi’s Association of Seropositive People (ANSS). She first spoke out about her HIV-status at the 1995 World AIDS Day celebration in the Roman Catholic Cathedral in Bujumbura. ‘We must have compassion for people with AIDS’, said the priest in his sermon, ‘because they have sinned, and because they are suffering for it now.’ Jeanne can’t remember how she got from her seat to the front of the church. ‘I have HIV’, she said, ‘and I am a faithful wife. Who are you to say that I have sinned, or that you have not? We are all sinners, which is just as well, because it is for us that Jesus came.’
The effect of HIV on women
In Africa it was graphically described by Stephen Lewis, the United Nations (UN) Special Envoy on HIV/AIDS in Africa. Addressing a conference on microbicides, he said that the women of Africa run the household, they grow the food, they assume virtually the entire burden of care, they look after the orphans, they do it all with an almost unimaginable stoicism and as recompense for a life of almost supernatural hardship and devotion, and they die in pain. Because of poverty and gender inequality, women are not only particularly vulnerable to infection themselves; they also bear the consequences of the epidemic to a much greater degree than men.
Sheer economic need drives women into risky relationships in order to feed themselves and particularly their children.
If a family is in need, mothers may be forced to put their own daughters on the street. In Zambia, the Catholic Diocese of Ndola works with groups of young people to develop educational plays and presentations on HIV/AIDS. One of their plays focuses on exactly this situation. A mother sends her only daughter onto the streets because her father is too drunk to provide for them both. When the girl becomes ill, the mother blames her husband for the infection because he has previously put their daughter at risk by sending her out at night to buy beer for him.
There are the countless women and girls worldwide who have been infected with HIV as a result of rape. There are young girls who have been sexually abused by relatives and acquaintances, and so on. Stephen Lewis uses dramatic language to describe the plight of women: ‘It goes without saying that the virus has targeted women with a raging and twisted Darwinian ferocity. It goes equally without saying that gender inequality is what sustains and nurtures the virus, ultimately causing women to be infected in ever-greater disproportionate numbers.’ He is scathing about the international community’s failure to acknowledge women’s vulnerability over so many years: ‘The reason we have observed – and still observe without taking decisive action – this wanton attack on women is because it’s women.
Once again, injustice and unjust relationships are found at the heart of the spread of the HIV/AIDS epidemic. Gender discrimination is not the only human rights issue that affects women. Health ministers from 13 African countries recently appealed for Africans to get access to anti-retroviral drugs. This, they said, is ‘a new human right which the world has yet to accept.’ Since women now represent nearly half of all people living with HIV worldwide, being denied the right to the most effective treatment clearly affects them most. Women are not just disproportionately vulnerable to contracting HIV themselves. They also bear the brunt of caring for people infected or affected by HIV/AIDS, as well as becoming the main breadwinners. This burden affects women from childhood through to old age. Young girls risk being taken out of school to care for a sick relative or to contribute to the family income. Widows are left to bring up their children on their own. Grandmothers find themselves caring for any number of grandchildren once their own children succumb to HIV.
And in communities with health and education programmes aimed at combating HIV and caring for those affected, women usually make up the majority of volunteers. There are many inspiring stories about women who have undertaken such tasks with extraordinary dedication and success. However, this should not be allowed to obscure the underlying injustice of their situation. It is not simply that they live in societies where women are expected to bear this immense burden of caring and providing for others. What also needs to be challenged is the injustice at national and international levels that has landed them in the current crisis. For example, why will a young girl sleep with a teacher or an older man in order to pay her school fees? The underlying question should be: why does she have to pay fees at all? The answer lies in the international debt that prevents so many countries from providing free education.
The challenge to break the silence about human sexuality needs to be faced if we are to succeed in talking about HIV/AIDS. Since HIV is transmitted mainly through sexual intercourse, preventing its spread naturally demands a focus on sex and sexuality. But the silence that engulfs sexual issues seems all-pervasive. Parents find themselves unable to talk to their children about sex, indeed they may not talk about it to each other, and the church stays silent. Typically, if ‘I want to be able to help people to stand up in spite of the pain. People who feel that the world wouldn’t be any different if they died, need more than education. People are important and have a huge amount of worth. People don’t necessarily change, but God isn’t asking us to change them. You don’t see the image of God in what they do; you find it in understanding their story. If you give them time and listen, it’s not long before you see the pain behind the abuse and the beauty within the person’.
Where the church is concerned, a shift in theological thinking may be needed. This would involve moving from a judgmental approach to a recognition that sexuality is God-given, something not to be deplored but to be the subject of rejoicing and thanksgiving. This does not mean rejecting a Christian moral code of sexual behaviour, but rather rooting it in a rediscovery of the goodness of sexuality, instead of in wickedness. It is worth emphasising the need to redress the balance, theologically speaking, to move away from what Khathide calls ‘the demonising of sex’. This is necessary in order for people living with HIV to become free of stigma and for young people to be taught realistically how to avoid infection. Commitment to a sexual relationship that offers mutual support, and a partnership founded in the recognition of equality is a special form of covenantal relationship. The compilers of a book published for the All Africa Council of Churches make the link with the created order: ‘It is only when two people appreciate each other that they can appreciate the creation of God and their purpose for the world’.
It should be stressed here that HIV is not in itself a barrier to marriage or a long-term sexual relationship. What is crucial is responsible behaviour, so that an uninfected partner does not contract the virus, and truthfulness between partners. The possibility of one partner being infected, but not disclosing it to the other, has led to the highly debatable practice by some churches of demanding tests before marriage. In this case it would be the responsibility of the church to offer, say, appropriate counselling, and not to reject the couple if the result is positive. It is not for the church to deny couples the possibility of a relationship that is good and God-given, simply because one of them is sick.
Responsibility in a time of AIDS is vital. Many in our society refuse to take responsibility for the tragedy unfolding in our society. This extract is taken from a statement by Catholic theologians from southern Africa, that makes a number of significant points. The main thrust of their argument is that taking responsibility means not looking for someone to blame for AIDS, ‘whether that is the devil, ancestors, a witch, Americans or God’. Instead, they ask the church to accept that HIV/AIDS should be dealt with, not within a framework of individual moral values, but within the framework of social justice, and to recognise that it has failed to educate its members on the value of sexuality. The message is an important one. The Catholic Church, it is suggested, needs to take responsibility in confronting HIV/AIDS, acknowledging its own shortcomings and its hitherto limited approach. For all the churches, this can be broken down into two main areas: enabling people to behave responsibly, and acting responsibly themselves in terms of the spiritual and theological approaches they adopt. Behaving responsibly The Bible which says ‘thou shalt not commit adultery’ is the same Bible which commands us ‘thou shalt not kill’ (Exodus 20:13).
Knowingly infecting someone with HIV has been judged by English courts to be a criminal offence. In theological terms, such behaviour equally needs to be deemed sinful. And along with that sin of commission goes a sin of omission: failing to ascertain one’s HIV status and therefore unknowingly (although not necessarily unsuspectingly) infecting another person. In talking of sin, it is important to recognise that it is being applied here in the sense of deliberately behaving in a way that risks depriving another person of their life – not in terms of being the victim of such behaviour.
Likewise, stigmatisation and discrimination have to be seen as sinful, in that they deprive HIV-positive people of the freedom to live openly, seek treatment and enjoy a normal life. But that sinfulness should not be projected onto the person who suffers stigmatisation or discrimination. That would be equally irresponsible, in that it deprives people of at least some part of their lives in terms of loss of dignity and selfrespect. It is worth emphasising that responsible behaviour is a global prerequisite in the face of the worldwide HIV/AIDS epidemic. Sex tourism, typically undertaken by wealthy westerners, is a significant factor in the spread of HIV in Latin America and the Caribbean, and increasingly in South East Asia.
Many faith-based and secular groups believe that responsible behaviour is set out in the ABC approach to HIV prevention: Abstain, Be faithful, or – if you can’t do either or if one partner is HIV-positive – use a Condom. Unsurprisingly, it is the third element, so-called condomisation, which has aroused the most passion in churches. They either associate condom use with promiscuity or see it as contrary to the teaching that ‘every marital act must… retain its intrinsic relationship to the procreation of human life’.
Catholic moral theologians have been arguing for some time that using condoms to prevent the transmission of AIDS is a lesser evil, there has been no official Vatican pronouncement on the subject. However, church leaders are beginning to speak out. Notably, the Archbishop of Brussels stated in January 2004 that if a person infected with HIV ‘has decided not to respect abstinence, then he has to protect his partner and he can do that… by using a condom.’
The Archbishop of Westminster declared more tentatively in July 2004 that the use of condoms in this situation ‘may be licit’. The heated debates that continue to rage round this issue have obscured the fact that condom use is an integral part of responsible behaviour by Christians and non-Christians, married and unmarried couples. Canon Gideon Byamugisha, the first Ugandan priest to state publicly that he was living with HIV, puts the position with characteristic forcefulness: ‘Safer sex support should be given in a way that makes it clear that the Church is not condoning unlawful sexual practices but rather enforcing a double commandment, “Don’t commit adultery, do not commit murder through HIV transmissions”.’
In this context it might be better to talk of manslaughter rather than murder, since there are relatively few instances of people deliberately infecting others. More commonly, people do not know they are HIV-positive, and pass the virus on through ignorance. Once again injustice comes into the picture. Poverty may be preventing people from having access to life-saving information, or they may simply be too terrified to be tested, because of the rejection and stigmatisation they fear will follow. Canon Byamugisha suggests that the HIV crisis demands that the church speaks out beyond its own walls to those who do not follow its teaching on sex outside marriage, by condemning the deadly consequences of unsafe sex. It is a message that also needs to be heard by those within the church. He concludes:
I have written on behalf of all those who have within their blood the virus that spells death for the host and thus have to make daily decisions in their sexual lives first to obey God and second to make sure that they don’t infect those they love (to die in agonising and excruciating pain like theirs). I am also writing on behalf of all those millions of faithful women and men who enter marriage unions as virgins but die later from HIV infection due to lawful but unprotected sexual contacts with their lawful but unprotected partners.
Responsibility, however, is not limited to choices made by individuals. If HIV prevention is to be effective, the message of responsible behaviour has to be conveyed to young people before they become sexually active.
In some countries, children as young as five or six are being taught about HIV; how it is transmitted and how to prevent infection. Bound up with this is the whole question of sex education for young people. Many church groups have argued that this also leads to promiscuity. However, research indicates that this is far from being the case. The evidence shows that sexual health and HIV education does not lower the age of sexual debut, nor does it increase sexual activity or the number of sexual partners. Sometimes the opposite has been found to be the case, with the age of sexual debut delayed and activity reduced. In any case, the failure of parents, schools and churches to talk about sexual matters to the children in their care, is dangerously irresponsible in the face of the HIV epidemic. Embarrassment, shame or a tradition of not talking about sex until a young person is on the verge of marriage, all ensure that children and young people remain vulnerable to HIV.
The Archbishop of Cape Town has put it: At the very point in their lives when God has given them all the physical means to love, our young people are, at times, abandoned by parents, society and the church and left to learn by themselves the life skills which sexual relationships require. In a world beset by the devastating HIV pandemic, we are leaving our young people, the flower of our church and our society, to wither and die through ignorance, the absence of open, honest and compassionate sharing of vital information, our embarrassed silence and resistance to reality.
The ‘resistance to reality’ that the Archbishop refers to is the refusal to accept that in most countries, the majority of young people are sexually active from an early age. Within the church, it is not uncommon to find that pastors are also reluctant to admit that the behaviour of adult congregations from Monday to Saturday is not the same as that which they are advocating, or taking for granted, on Sundays. A blinkered world-view on the part of people deemed to have some kind of authority is irresponsible. This irresponsibility is symptomatic of a breakdown in the In Kitwe, Zambia, children as young as six learn about HIV and are actively involved in prevention and awareness-raising, often by taking part in powerful dramatic sketches.
The Christian church is supremely well placed to offer the kind of holistic care that secular and faith-based organisations alike have stressed is vital to such positive living. In the words of the World Council of Churches: ‘The experience of love, acceptance and support within a community where God’s love is made manifest can be a powerful healing force.’ They go on to make the point that to offer people such healing is more than a responsibility, it is an obligation: ‘In the gospels we are required to love: this is a demand, a requirement, not an option.’
While individual pastoral care is undeniably of great value, ‘love, acceptance and support’ surely have even greater healing power when they are offered by a whole community – large or small. This is because people living with HIV are likely to have experienced rejection not just by individuals but by whole social groups. Again, the church has unique healing power by virtue of its life as a community, alongside the practical or spiritual support offered by individual members. The call to act responsibly should not, therefore, be addressed solely to people living with HIV/AIDS in order to prevent them from transmitting HIV, nor to those not yet infected to protect themselves against it. It is also a call to Christian counsellors, educators and carers, and to the church as a whole. If the life-giving Creator God is to be seen in the face of a human being living with HIV, then the Christian community has a responsibility to respond accordingly by providing trustworthy information in place of silence or myth; showing love rather than awakening fear; offering hope that will not be disappointed; and helping people overcome their feelings of guilt (before God) and shame (before other people), rather than allowing such feelings to intensify.
The HIV/AIDS epidemic poses immense challenges to society as a whole. For the Christian church that is committed to upholding God’s eternal covenantal relationship with his people – not as a remote ideal, but as something that is revealed day by day in every aspect of life – some very specific challenges lie ahead. These relate to how the church sees itself and understands its mission.
In the face of the epidemic, three particularly relevant aspects of that understanding are
- the church as a healing community,
- a worshipping community and
- a prophetic community.
In order to meet the challenge of offering healing and renewal to those it serves, the church must first acknowledge its need to heal itself. This is seen as presenting a theology of love and hope, instead of a theology of vengeance. It also involves repentance for having increased the stigmatisation of, and discrimination against people living with HIV/AIDS.
But then, if the church is to be effective in halting the spread of the epidemic, further healing needs to be done. The church must transcend and heal internal divisions, and cooperate with secular organisations and representatives of other religions, including those to whose beliefs it may previously have declared itself to be implacably opposed. In other words, to be effective in the face of a worldwide epidemic that has yet to reach its full proportions, the church needs to be inclusive in nature. It must also look urgently at its willingness to engage both in ecumenical cooperation and interfaith working. Inclusiveness ‘Our church has AIDS’ was the slogan on a badge distributed at a conference for church leaders in Mukono, Uganda in January 2001. At the time, it seemed like quite a brave move, but the statement is well rooted in theological belief and social fact.
In the worst affected countries, HIV/AIDS leaves no Christian family or church congregation untouched. Paul’s teaching that if one part of the body of Christ suffers, all suffer together (1 Corinthians 12:26) is a call to the church worldwide to acknowledge the epidemic as its own. The response to this call for a particular and vital form of inclusiveness, where the church not only admits that HIV is in its midst, but offers full and open acceptance and loving care to those affected, has barely begun.
In South Africa, it is not uncommon to find individual churches that have designated themselves ‘AIDS-friendly’. These are places where HIV-positive people know they will be welcome and free from stigma and discrimination, and find that their concerns are reflected in the worship. But worldwide, such churches are the exception rather than the rule. For example, in west Africa, there is still much silence surrounding HIV, and in Europe or North America, HIV positive people may be drug users who inspire fear or gay men who face discrimination. For ‘AIDS-friendly’ churches to be established in such areas, all churches must first recognise their own lack of inclusiveness and before God seek healing and the will to change. Inclusiveness is more than a proclamation in the church porch. It is a commitment by the whole church community to accept, love and care for those who might otherwise be rejected. It is a commitment by church leaders; both ordained and lay, to promote this acceptance through their teaching and leading of worship
This refers to a movement promoting unity between different Christian churches and groups. If there is anything the HIV/AIDS pandemic in Africa has revealed, it is unwillingness to work together with other Christian groups. An ecumenical or holistic approach in an analysis of the parable of the two sons (Luke 15:11-32), the Argentinian liberation theologian Lisandro Orlov looks at the way in which the father welcomes his returning son. He sets aside his pride to run to meet him. He embraces his son in a gesture of peace and reconciliation before the young man has had a chance to recite his prepared speech, and he gives him a ring and sandals, the latter a sign of a free person since only slaves went barefoot.
In many countries, the HIV epidemic has given ecumenical working a focus that it might not otherwise have found. Faced with such a huge problem, churches tend to find that their differences are forgotten and that they can work together fruitfully. On a practical level, cooperation gives them additional strength in negotiating with governments and overseas donors. The challenge is for them also to gain spiritual strength from one another. Nonetheless, tensions persist.
It is hard to find examples of different faiths genuinely working together on HIV. This is not necessarily due to a lack of willingness. Tanzania’s Interfaith Forum, set up in 1999 as a result of the World Faith Development Dialogue, brings together Roman Catholic and Anglican groups, Muslims, Buddhists and Ba’hai. However, it is structured primarily as a forum for discussion rather than as a body with the authority to take action.
There is little point in churches committing themselves to breaking the silence about HIV if it is not mentioned in the church itself. Much has changed in recent years, but the question remains inescapable. If nearly three million people are dying of AIDS-related illnesses every year, should this not be reflected in Christian worship, Sunday by Sunday, throughout the world? Yet in many churches, from those in the worst-affected countries to those in the least affected, HIV/AIDS is rarely mentioned.
Silence in society has its counterpart in Christian silence before God. In August 2001, a group of 60 or so clergy and pastors from five different denominations gathered in Kuruman, South Africa, for a one-day workshop on HIV and worship. For many it was the first time they had even been able to talk to each other about HIV and their ministry, let alone work together on ideas for integrating it into worship. Three of the church groups worked on specific prayers for people living with HIV/AIDS – not a straightforward task for people with different languages and who were not used to such formal composition. Another group devised a litany that included resolutions for future action, and the last group, made up of members of the Church of the Province of Southern Africa, created a special statement of belief (An AIDS Credo).
We believe in the unity of the body of Christ, that all are part of the body of Christ. We believe in the equality and dignity of all men and women, and accept each other as equal partners in the body of Christ. We believe that, when one member of the body suffers, we all suffer; and that when one member of the body rejoices, we all rejoice. We believe in acceptance of ourselves and of each other as we are, in the knowledge of the healing and forgiving nature of Christ in his love for the body, ever remembering Christ’s acceptance of the leper and the outcast. We believe in our personal Christian responsibility, as members of the body, to reduce the suffering of all members of the body by taking responsibility for our own lives and by accepting responsibility for the care of others.
Theology and the HIV/AIDS epidemic then moved to get it accepted. By the end of the day the diocesan bishop had been given a copy and had agreed to take it through the formal administrative processes that would enable it to be used in Sunday worship. Some did not wait that long. The next day, a Sunday, it was already in use by some local congregations. Theological thinking was translated into immediate action.
Many worship leaders, regardless of the country they work in, do not find it easy to incorporate issues to do with HIV. Often this is down to a simple lack of confidence, either assuming that they need specialist knowledge in order to pray, or just not knowing what to pray for. Sometimes it is down to fear, with the local pastor not wanting to upset people by mentioning a taboo topic. All of this could be addressed through some very basic training or even just workshop discussions such as the one held in Kuruman. But ideally, HIV/AIDS (in all its aspects, not just as it features in worship) should be a regular element in ordination training for clergy as well as in local lay training.
In many countries, the HIV/AIDS epidemic has forced the church to come out of its shell, to admit that the snail itself has HIV and to open its eyes to the situation that surrounds it. But to be truly prophetic the church needs to engage in prophetic action. The HIV/AIDS crisis must not prevent the church from engaging with the wider issues. The relationship between the HIV epidemic and factors that cause whole nations to sink into poverty, such as unfair trade rules and international debt, must be exposed, and it is part of the role of a prophetic church to do this. National and local churches are well placed to demonstrate to the world their commitment to offer unconditional care to those living with HIV and to be involved in initiatives to prevent the further spread of the virus. In so doing they will show themselves to be faithful partners in their covenant relationship with God.
If the church takes seriously its call to be prophetic, then now is the time for it to demonstrate its openness to ‘the fresh air of the Spirit’.
- Do everything possible to preserve the dignity of the infected person as well as to respect the individuality of each client. A supportive environment is achieved by genuinely accepting people with HIV/AIDS with no reservations and emphasizing positive living at all times. No one knows when they will die and what will be the direct cause of death. This makes it important to live every day in the best possible way.
- The counsellor must be without prejudice and fear, and must be well informed but not ashamed to acknowledge limitations or seek more information when unsure.
- He or she must personally have come to terms with the disease and should not be judgemental, should not make assumptions and should be capable of respecting the clients’ ways of coping with the infection.
- The counsellor must be willing to share responsibilities with other people in the team caring for the clients. It may be useful from experiences in the field to illustrate how responses could become supportive.
Mr O., about 38 years of age, was an old patient of one of my senior colleagues who had managed him since he was diagnosed HIV-positive about six years ago. He has accepted and adjusted to living with HIV as a result of the accessibility of health care and because of the level of acceptance that he received from the group. He was referred for counselling on a particular occasion following his expression of feelings of depression, dejection and hopelessness. He was ill but this was complicated by his wife leaving their home. He claimed that his wife had fought with him because he did not agree to spending some money they had in savings to settle her dowry. Mr O. appeared withdrawn and sad and he did not welcome the counsellor with his usual smile and comment about doing well.
The strategies that were used in the counselling session that followed were as follows:
- Sitting next to the patient after shaking his hand and exchanging pleasantries as the counsellor always does.
- Acknowledging that the client’s feelings and reactions may not be unusual.
- Identifying specific areas of concern to the client and exploring what the client had done.
- Commending the client for all that he had done to continue to take care of himself and to make appropriate contacts with his and his wife’s relatives who were to resolve the crisis related to the dowry.
- Inquiring whether he wanted the counsellor to talk to other members of the family as she is well known to all of them.
- Conveying to the client that attention had been paid to his feelings and concerns. At the end of the session the client was again encouraged to get in touch with the counsellor whenever necessary.
- There are fundamental problems in ensuring privacy and confidentiality. Nigerian culture accepts that everyone in the neighbourhood takes an interest in what is happening in the lives of their neighbours. As positive as this may be at other times, it has been a hindrance in counselling patients with HIV/AIDS. Therefore, the person should be able to trust you, which means that you must live a life that is trustworthy as a pastor or infected persons will not open up.
- The problem is that the counsellor may be inhibited in visiting clients at home to avoid bringing upon them suspicion and the associated stigma, possible ridicule and even possible homicide by non-supportive family members who may see the client as a disgrace.
- Some pastors are as ignorant and as afraid as members of the general public, if not more so. The may apply a wrong approach and eventually make things worse for the infected person and those around him or her.
- There is an acute problem of non-availability of trained counsellors to handle most of the sensitive issues that often arise, to help the untrained persons who are forced to take responsibility and to give the time required to meet the needs of the people affected.