AIDS in Africa

By Edward Baralemwa

Africa has survived many catastrophes, but not without permanent scars.  It has survived slavery, war, wild beasts, colonization and chronic underdevelopment. The human toll exacted fromAfrica by all of these tragedies does not, however, amount to the sheer numbers devoured by AIDS.  Unlike any previous challenge that African have dealt with, AIDS has the ability to erase entire communities.

As Zan Wesley Holmes observed in his article, “Encountering Jesus,”  “By all accounts, HIV/AIDS will continue to present challenges to this society previously unmatched by any other crisis.” In a real sense, many millions of people inAfrica are already suffering the effects of the disease, and they will continue to suffer into the unforeseeable future due to the massive social changes brought on by this disease.

By virtue of her mandate, the Church must use her influence and resources to rid society of this devastating epidemic. Her ministry ought to mirror Jesus’s example of compassion when he ministered to those afflicted with disease and despair.  Prerequisite to responding to the crisis, as Rev. Zan Wesley Holmes assert, is “when we know who we are, we will know what to do” (Holmes 1992). The true realization of our identity as Christians should be synonymous with immersion in the struggle to reverse the tide of the AIDS epidemic. Christians must therefore accept full responsibility to help liberate God’s people from the bondage of disease and the horrors and anguish of the effects of AIDS.

The Evolving Christian Response in Perspective.

In battling HIV/AIDS, it is fair to say that the Church has been through a series of paradigm shifts.  At the beginning of the epidemic the Churches, in general, regarded the issue of HIV/AIDS as a problem relating to the homosexual community, prostitutes and any others involved in behaviours and practices deemed unacceptable to its teaching and convictions.  It was not, the Church, believed, a problem within its rank that needed to be addressed. This was unfortunate phase was one of rejection, stigmatisation, discrimination and condemnation by and from the Churches.

The next phase in the Church’s evolutionary understanding of HIV/AIDS was ushered in the late 1980’s by the realisation that a number of its own members, many with credentials and integrity, were dying of the disease.  Unfortunately, the Church often responded to these deaths with denial, insisting that the cause of death was “something else,” but not AIDS.

However, as the reality of AIDS deaths gripped the Church, she had no choice but to try to explain this mysterious epidemic to its members who, understandably, were seeking answers from God. The Church in this phase responded in two ways. First, it took a firmer and more defensive stance in the early 90s than it had in the 80’s, stating that AIDS was clearly sin related and people needed to be delivered from it. Two, the Churches responded to the secular responses, which in many countries were embedded in the first medium term plans (National Strategic Frameworks), by criticising prevention strategies, specifically the safer sex messages, rather than providing a credible alternatives. This further distanced the Churches from being a constructive actor at the time that they were most needed.

The next paradigm shift plunged the Churches into internal differences of opinion in the mid 1990s. As more affluent and better-positioned people within the Churches, including the clergy, continued to die, there emerged a group of theologians, Church leaders and denominations who called for the redefining of the Church’s mission and ministry in light of HIV/AIDS, with a view to include a more Christ-like compassion in its approach and response to the epidemic.  People who advanced these ministries were generally looked upon as extreme liberals, and became unpopular within the Churches.

The late 1990s ushered in a completely new and rather surprising dispensation, not so much for the Churches as for governments and the donor community, who had for long timed viewed the Churches as opposing their anti-HIV/AIDS efforts. There was a mushrooming across different parts of the continent of small Christian projects and programmes, mainly Church-based, which responded to the epidemic, albeit within the limits of their resources and local reach.

When these groups sprung up they were often fragmented and uncoordinated. Because of the prior perceptions and usually lack of quality in Church-based programmes, there was little if any funding support for what soon became a massive ground swell of anti-AIDS work.  In many instances, governments and development agencies were sceptical of the nature and content of what these projects or programmes could offer. Therefore, these poorly resourced interventions struggled through difficult times of service delivery. From 1999 through to the beginning of the new decade, we witnessed a change of interest from international donors and governments focussing on the comparative advantage of faith-based organisations in delivering services on both fronts of care and prevention to grassroots communities. Thankfully, some programmes had even pulled through this difficult period with such an amount of success that they would go on to secure more funding and build their own integrity and credibility.

Despite this, many remained sceptical of the ability of Churches to effectively engage in the fight against HIV/AIDS. Some Church-based responses and organisations, however, had started to attract the attention of donors and governments and had proved their ability to deliver quality work and practices.

As the AIDS/HIV epidemic continued unabated into the new millennium, it continued to confront the Churches with an unprecedented reality of sickness and death as part and parcel of their ministries. There were continued calls from governments and development agencies to the Churches to champion a quality and comprehensive response at the grassroots level through their networks. This call was due to the realization that a number of Christian organisations and projects working in HIV/AIDS could link together, better rising to the challenges brought on by the disease.   

Understanding the fundamental meaning and responding to the epidemic.

The fundamental understanding of the AIDS epidemic by Christians is best expressed by addressing the principles of human dignity, solidarity and grace among others.

Human Dignity

The principle of human dignity has been best articulated by Catholic Clerics.

Kenneth R. Overberg, of the Catholic AIDS Network chronicles excerpts from Bishops statements as follows: “Made in God’s image and likeness, every human person is of inestimable worth. All human life is sacred, and its dignity must be respected and protected” (The Many Faces of AIDS). “The Gospel demands reverence for life in all circumstances” (Bishop John Ricard, 1994). “Discrimination and violence against persons with AIDS and with HIV infection are unjust and immoral” (Called to Compassion and Responsibility). “The necessary prevention against the AIDS threat is not to be found in fear, but rather in the conscious choice of a healthy, free and responsible lifestyle” (Pope John Paul II to a Vatican AIDS conference, 1989).

In taking this stance, the Catholic Church has made it clear that every human being is created in God’s image, redeemed by Jesus, and called to everlasting life regardless of what diseases he has contracted and how he contracted it.  All persons therefore have a worth and dignity. It is this conviction about the preciousness of every life that grounds the Catholic Church’s teachings about HIV/AIDS. (Mackie –1995)

One of the greatest tragedies of AIDS over the years has been the unrelenting discrimination that infected people and their families have had to bear. Individuals have been dehumanized to incredible levels by friend, family and communities, stripped of the sense of worth and their dignity. The families in turn have not been spared of the feelings of shame, fear of infection, and isolation within communities. Communities and nations were blacklisted as dangerous communities, nationals of which would be screened before being granted visas to certain countries.

It begs the obvious that an individual’s worth ought to be cherished and protected, not only by friends and family, but by organisations too. The Church ought to provide a home and open arms to those who are outcast from society, and the Church should proclaim loudly that all manner of discrimination will be treated as wrong.

The sacredness and preciousness inherent in humans compels us all to live in ways that embody and express this dignity. We must acknowledge that each one of us is called to personal responsibility, which no doubt includes positive behaviour change. Because AIDS touches on matters of sexuality and sexual orientation, substance abuse and addictions, and often in the context of poverty, racism and gender, the Church has many times been tempted to muzzle its prophetic voice in calling people to a moral responsibility and behaviour change so as to sound politically correct, conforming to secular demands concerning a response to HIV and AIDS. The Church should never relegate her responsibility to minister the truth, and sometimes the uncomfortable message of behaviour change and behaviour modification. This will include affirming healthy relationships, which find their roots in trust, honesty and mutual respect. The Church is obliged by the Master Christ to unapologetically remind all HIV-infected persons of their grave moral responsibility to not pass the virus on to anyone else.

Solidarity
The Church’s prophetic mandate to call for moral responsibility in no way demeans her responsibility to the persons infected and affected by HIV/AIDS. In her teachings, the Church speaks extensively of the rights and responsibilities to society. It is expected to reach out to those infected and affected by the disease, to stand together in solidarity and extend a compassionate arm with understanding. There ought to be provision of spiritual and pastoral care, not forgetting medical and social services, for the affected individuals and their families. As early as 1990, at their Bishops Conference inMexico, the Catholic prelates made the following commitment:

A comprehensive AIDS education then has to: place AIDS within a moral context; impart  accurate medical information and challenge misinformation; motivate individuals to accept the responsibility for personal choices and actions; confront discrimination and foster the kind of compassion which Jesus showed to others; model justice and compassion through policies and procedures” (New Mexico Bishops, 1990).

Likewise, in 1989, the pope exhorted the world that “As far as HIV is concerned, moreover, social responsibility has an important international dimension” (Called to Compassion and Responsibility).”  AIDS has by far many more profound repercussions of a moral, social, economic, juridical and structural nature, not only on individual families and in neighbourhood communities, but also on nations and on the entire community of peoples” (Pope John Paul II to a Vatican AIDS conference, 1989).

These simple yet prophetic words calls us to a solidarity with the afflicted, leading us to care not as an obligation, but because we share and feel with the people in their plight.  When we respond in this manner, drawn by love and compassion, we will be compelled to educate and deal with the social structures that can reduce someone vulnerability to HIV/AIDS, as well as enhance the response in both scale and scope.

The Church has been a champion in caring for the sick in many countries, learning from and following the example of Jesus. However, this ministry to the sick has since been challenged and indeed transformed in certain situations by the global spread of the AIDS epidemic because of the seriousness of the suffering and the horror of its effects. This is more so in resource limited settings. There have emerged special care units and programs for persons with AIDS and home care interventions, caring for children orphaned by AIDS, and providing specialized pastoral care. All this is anchored on the Biblical teachings. This has provided opportunity to everyone to contribute in one form or another. This has been done and can be further done through Local HIV and AIDS service organisations, through the congregations and support groups. 

Prevention should always remain part of any intervention in responding to AIDS. Education, too, must be pivotal in the response. Implementation of such an integrated intervention is possible in congregations, parishes and other church-based institutions such as schools. 

In expressing solidarity with those who are hurting and downcast, we express our connection to them around the world. It is this understanding that triggers the need for social justice. It is appalling that the vulnerability to HIV infection is heightened in the face of the economically disadvantaged populations. It is the attributes that constitute these populations disadvantages which serve as perfect breeding ground for HIV infection. These are poverty, oppression, marginalization and segregation. The association between HIV infection risk and being poor or/ and female is well proven.  Therefore, even as the Church pushes for personal changes in behaviour, there should also be an equally aggressive attempt to push for systemic change which will lead to diminished racism, sexism and classism.

Recently, we have seen significant scientific breakthroughs in the treatment of HIV/AIDS by means of a combination of therapies. Whereas this has tremendous results, it is deplorable that the majority of the infected persons in the world do not have access to the requisite health care to match the therapies. In some better to do countries these services may be provided by governments free of cost, but the devastation on women, men and children still remain in many parts of the world.

Grace
The coming of HIV/AIDS to the continent of Africa challenged and exposed the gaps and strengths in the Church’s teachings about the grace of God. There were stereotypes that could not be correlated with the realities of those who were infected with HIV, as well as those living with the anguish and pain of the disease.  The Old Testament images of God tended to come to the forefront, ones in which the belief that sin led to infection dominated.  It was not surprising, therefore, that it was difficult to explain suffering that was not correlated to sin.

Thank God for Jesus Christ as presented in the New Testament. Jesus, the God become man, sinless and blameless, suffered extreme pain unto death. He may have had power over death, as demonstrated in his healing of the sick, but he indeed submitted to suffering, pain and death. He ultimately conquered death through the Resurrection, but after only demonstrating that the journey of life is characterised by disease, pain and suffering, and must culminate in death. Whereas he could have removed death from the human calendar and life’s scene, Jesus only affirmed it by his submission to his tormentors.  All the same, Christ’s message is clearly a message of compassion, mercy and grace. The process of sickness, pain and suffering is not reserved for a class of people, or gender or race or nationality. It is seen as part of humanity. HIV and AIDS must be seen as a human disease, not God meting out judgement to His lesser children.  What God has promised is an invitation to enter into His kingdom by grace and not for anything anyone has done and warranted. Christ demonstrated this point while when he ate with sinners and the marginalised. He befriended the very people who were considered unworthy in his times. His example was that of unconditional grace and mercy to all people. This no doubt would be his message today in the face of the HIV and AIDS Epidemic. He would not agree with or condone behaviours that expose people to disease, but rather Jesus would rebuke all manner of immoral behaviour. But after the rebuke, he would call them to din with Him, reunited with His love and grace.   

The role, the very reason of the Church, is to emulate the example of Christ. The commercial sex worker, the homosexual, drug users, the poor and orphaned, the widow rejected should equally be on the agenda of the Church with relevant a messages to each group, that of God’s grace.

The Church urgently needs to proclaim a message that includes an articulation of the mystery of suffering, pain and death. A stark reality that must be withstood, helping to understand that God’s grace and mercies can be experienced even in such situations of disease, pain and suffering. Christians need to be exhorted to emulate Christ in word and dead as they encounter the grilling experiences in supporting people infected and affected by HIV and AIDS.

HIV and AIDS in the Context of the Church in Africa
Unfortunately, The Church’s response has not been proportional to the magnitude of the HIV/AIDS epidemic. Although over the last 5 years faith-based organisations have been acknowledged and accepted as principal stakeholders in the fight against this epidemic, at the community grassroots levels there still remains an enormous gap to be bridged. The Church’s current drive, capabilities and information base do not measure up to her potential or to the expectations placed upon her.  Furthermore, the Church’s current responses tend to be fragmented and isolated. Hence, we observe much duplication, with little if any shared experiences and learning. With the enormous potential embedded in the Church, there is a lot of opportunity to complement each other with various interventions rather than duplicating and competing.

The Church is seen and viewed as one of the most strategic vehicles for HIV/AIDS interventions and strategies by virtue of its proximity to and location in society. The Church forms a widespread network at the grassroots acrossAfrica, voluntarily accessible to all people, providing a significant opportunity for comprehensive HIV/AIDS intervention.

The Christian community’s biblical mandate gives the Church a common vision for an HIV/AIDS free continent. In the gospel of Luke chapter 4, verse 18 there is the message of a holistic gospel which addresses the soul, body, mind and spirit. This mandate includes holistic development and total health for all towards which the Church should strive.  Therefore, the common mission of the Christian community should be effective prevention of HIV/AIDS transmission and a Christ-like compassionate care to the affected and the infected.

The Christian community can offer much in terms of volunteer services in the fight against HIV/AIDS. For improved sustainability and effectiveness, the work of the government community workers needs to be supplemented by the members of the Christian community, who ought to be equipped with professional skills to assist those infected and affected. The volunteer services provided by the Christian community should be seen as enrichment programmes of participatory and intensive care for individuals infected and those affected by HIV/AIDS. With the Church’s involvement, one anticipates a corresponding change in people’s sexual behaviours and a reduction of the spread of the virus.

The Church community has an important role as the primary advocate of the prevention strategies of abstinence and fidelity. The Church can offer a sustainable solution within its ongoing commitment to care for the local communities and reach out to them through educational and awareness raising programmes. The Church is appropriately placed to help people talk about and deal with issues of sexual health and relationships. This is an opportunity to promote the role of churches and to encourage cooperation with one another in order to expand upon discussions and together seek lasting solutions in the fight against HIV/AIDS. It is also an opportunity for the Church to further develop educational and public awareness materials so as to improve its capabilities and effectiveness on the ground. 

In order to achieve such a vision, there needs to be coordination and collaboration specifically by speaking messages that complement each other rather than contradict each other. This can be achieved through promotion of a joint voice on issues the Church agrees as of common concern, through common strategies, which can be adapted to country situations as deemed appropriate, and through resource mobilisation.

Often the Church is seen to be lacking in matters of professionalism, quality and standards. A common network is a strategic channel through which Christian organisations, institutions and community faith-based organisations can have their capacities built so as to measure up to the expected quality and standards in order to appropriately compete and receive the available resources on the common market.

A study by PACANet, which assessed the gaps, opportunities and strengths that exist in Church-based HV/IDS responses, revealed that programmes at the grassroots lack programme management, monitoring and evaluation, and accountability systems.

The study was conducted inZambia,Uganda,SwazilandandNamibiaand sought to:

  • identify existing HIV/AIDS interventions by the Church and Christian organizations;
  • identify and document existing resources available and accessible to the Church;
  • assess the capacity of churches based on their responses;
  • recommend mechanisms of how the Church can scale up its HIV/AIDS response.

At a consultative meeting held in January 2005 and organised by the World Council of Churches (Health and Healing Programme and Ecumenical HIV/AIDS Initiatives in Africa (EHAIA)), Caritas Internationalis, Ecumenical Advocacy Alliance, German Institute for Medical Mission (Difaem) and Norwegian Church Aid, it was observed that although churches in sub-Saharan Africa are the most strategically placed to reach into the remotest areas, they often lack the necessary skills, expertise and both human and financial resources to run their programmes, for example designing programmes, preparing proposals, handling reporting requirements, and monitoring and evaluation. At this forum, the donors lamented the lack of accountability and governance structures, which hampers the efforts of Church-based programmes to access much needed funding.

It is incumbent upon the people ofAfrica, to stand up, and act so that we reverse the tide of HIV/AIDS.  Let history reflect that our efforts were on the side of those who did whatever they could to avert the AIDS menace from continuing to prevail asAfrica’s damning catastrophe which hindered the continent’s integral development.

Literature

Earl E. Shelp &Ronald Sunderland
                        HIV and AIDS: The Evolving Church Response.

Global Mapping International
2005  The Contribution of Christian Congregations to the Battle with HIV/AIDS at the  Community Level.  

Overberg, Kenneth R.
1991 What does the church say about HIV/AIDS?” National Catholic AIDS Network
        

Norris, Mackie H.
1995 “The Black Church & the AIDS Crisis”. Focus Paper #29

Holmes, Zan Wesley
1992 Encountering Jesus,Nashville: Abingdon Press.