Faith-Based Organizations and AIDS: The Good, the Bad, and the Ugly. 2010

People within organizations should expose the underlying forces driving their agendas, and organizations operating in coalition should be encouraged to offer up a statement of principles so that hidden biases can be revealed.

The Body

"Come unto me all ye that labor and are heavy laden and I will give thee rest." As a Christian and a proponent of social justice for all, I have some questions regarding churches' response to AIDS.

I've enjoyed ten years of working in faith-based organizations (FBOs) that fight AIDS, and have seen much to inspire, educate, and horrify me. I'll base my comments on human rights and love, both of which are biblical principles, even if "human rights" isn't stated in those terms in the Bible.

There is a lot that is compelling about the work of FBOs in AIDS and a lot that, while compatible in theory, is quite contradictory and damaging in practice. Because FBOs have received millions of dollars from the U.S. and other nations, and from other funding sources such as the Global Fund to Fight AIDS, it is critical to examine how they are working and what their impact is on nations, communities, families, and individuals.

Why Are Faith-Based Organizations Engaged in AIDS Work?

The Bible offers a clear mandate to care for people in need of help and to attempt to balance the scales of justice. Matthew 25:40 says, "Whatsoever you do unto the least of these, you do unto me"; Micah 6:8 states, "What do I require of you?to live justly"; and 1 John 3:17 asks, "If anyone has enough money to live on and sees a brother or sister in need and refuses to help -- how can God's love be in that person?"

So it is not surprising that in sub-Saharan Africa, Latin America, and the Caribbean, FBOs provide up to 40% of all health care, and churches are present in many communities. At times there is no other health institution of any sort. In the U.S. there are also many faith-based health centers and other HIV service providers. The sheer presence and capacity of FBOs puts them in a good position to offer a range of services. Also, in many communities in Africa, Latin America, the Caribbean, the U.S., and to some extent Asia, there are very high percentages of Christians -- so the influence that FBOs and faith leaders have in the community is significant, for better or worse.

What Has Worked?

My first entrée to global work in AIDS was through an FBO. I was focused on supporting home-based care and hospices through Interchurch Medical Assistance World Health and its member organizations (a variety of mainline Protestant churches). The reach of these churches and FBOs into communities was tremendously helpful -- outreach workers were there for families and individuals in need of support and comfort in their final months. I also witnessed how the spiritual component offered great comfort, resulting in a peaceful death for many.

I've also seen churches have a very positive influence in the policy arena. The United Methodist Church, Lutheran Church, Church World Service, and others invested significant resources in policy analysis and mobilizing their congregations to advocate for increased funding for AIDS, as well as related issues like debt cancellation, which afforded countries the flexibility to assign more resources to health programs.

Similarly I've seen the establishment of the African Network of Religious Leaders Living with AIDS, which has worked to destigmatize HIV by having religious leaders speak out, offering messages of love and compassion, without judgment. Cristo Greyling and Gideon Byamugisha have encouraged language such as "The Body of Christ has AIDS" to signify that when one of us is infected, we all are, and that we need to address AIDS as a community issue -- not singling people out for blame.

In the last two years of my work with IMA World Health, I managed the organization's PEPFAR (President's Emergency Plan for AIDS Relief) treatment program. In theory, this should have gone well. FBOs have the reach, health facilities, relationships, and understanding of communities -- all of which should lead to a successful endeavor.

Indeed, the infrastructure afforded by the extensive networks of faith-based hospitals, clinics, and mobile units was a fantastic resource. Several of our partners were already successfully running treatment programs using generic drugs. At first the glut of resources and the prospect of being able to serve the hundreds of thousands in need of treatment was all very exhilarating. But those of us who were concerned about nuance came into conflict with the restrictions on reproductive health services, the inability to use generic drugs, and the "Anti-Prostitution Loyalty Oath," which restricts how organizations can use their funds to engage in speech or programs related to sex work. I found that many FBOs were not ready to buck the system on behalf of those they were supposed to serve. This strongly interfered with my ability to work, and I found myself in constant conflict. So, hundreds of thousands are receiving treatment through FBOs, and that's a good thing. But I put this on the cusp of the "What Hasn't Worked" section because I still ask, "At what cost?" and "Could we have done it better?"

What Hasn't Worked?

 In their AIDS response, churches have clearly been constrained by judgment and dogma. Kay Warren of the Saddleback Church rightfully pointed out, "The Church is more known for what it is against than what it is for." A friend of mine, Dazon Dixon Diallo of SisterLove in Atlanta, once said she wants to make a bumper sticker that reads, "Jesus Please Come Back and Save Us from Your Followers!" The words of Martin Luther King Jr. are also very apt: "Yes, I see the Church as the body of Christ. But, oh! How we have blemished and scarred that body through social neglect and through fear of being nonconformists."

On one hand there has been judgment regarding people with HIV and rhetoric around "the wages of sin equal death" and "you reap what you sow." At the 2008 Ecumenical Advocacy Alliance in Mexico City, one religious leader spoke of the condemnation and judgment she has faced since declaring her HIV status. There has also been stigma around certain high-risk populations, leading to damaging programs or outright neglect.

There are many examples of the influence of conservative Christian ideology and personalities on policy development. When PEPFAR was being designed, there were multiple forces influencing its policies, such as the Institute for Youth Development and the Children's AIDS Fund, which had an ideology rooted in conservative Christianity. This challenge to the separation of church and state should have been revealed early on and dealt with head on. Instead, it led to policies that didn't follow the scientific literature or the actual experience of gender inequality and other dynamics. Ideological polices masqueraded as evidence, like the Anti-Prostitution Loyalty Oath and the emphasis on HIV prevention through abstinence and fidelity to the exclusion of the proven effectiveness of condoms.

The gender inequality in many churches also permeates the societies where they are influential. This has played out in messages stating that being faithful is protection against HIV, when for many married women this is a death sentence. Both partners have to be HIV negative and monogamous for this to be effective. Yet people are offered simple messages without caveats. Church-based instruction on submission to one's husband has led women to stay in relationships with unfaithful husbands and to suffer violence at their hands. Often, churches do not offer guidance on the protection of women, focusing instead on the "sanctity of marriage" and "'til death do us part," regardless of the risk to the often powerless woman.

At the 2008 Ecumenical Pre-Conference in Mexico City, I appreciated the dialogue around gender, and specifically patriarchy, in the church. But there was no space in the program for the LGBT community and its issues -- unfortunate, given the early and continued epidemiology of HIV as well as the continued discrimination against LGBT people. How can there be an entire HIV conference without space for LGBT matters when we have had activists like Sizekele Sigasa and Salome Moosa, champions for HIV justice, who were murdered in South Africa in a vicious hate crime? When we have Solomon Adderly Wellington, a noted gay HIV activist in the Bahamas, murdered? When we have the President of the Gambia vowing to lop off the heads of gay people and criminalize any who offer safe harbor? When we have Steve Harvey, a gay HIV activist from the Jamaica Support Services slain in a country where there are more churches per capita than anywhere in the world? (Jamaica is my country of origin, yet I'm embarrassed to say that I would warn my gay friends about even visiting there, knowing that they risk life and limb due to homophobia.) And when we now have Uganda attempting to pass a law similar to that in Gambia, with the instigation of this legislation allegedly resting at the feet of certain U.S. evangelical churches.

Where are the voices of churches on these issues? Where is the high-profile public statement condemning such heinous hate crimes? Instead, there is much condemnation of same-sex relationships, and the intensity of Christian leaders' words, deeds, and attitudes seem to indicate that they are more concerned about these acts of love than acts of hate. One colleague spoke about being invited to dinner and learning mid-meal that his host was gay. He said, "There I was eating the food?." And this is a person who is in charge of HIV programs for his denomination! A participant in a workshop I facilitated stated that many in the church are only ready to embrace people who are "like us" by whatever notion of self-proclaimed sanctity "we" in the church define ourselves. My purpose here is not to sway those in the church who find a biblical basis to oppose homosexuality but rather to question their application of biblical principles. I ask them, what would Jesus do?

At Rick Warren's 2006 Saddleback Church conference an awkwardly titled session, "Loving Homosexuals as Jesus Would?" led to hopes that this evangelical leader was questioning attitudes toward LGBT people. Instead, it was a panel of speakers from the "ex-gay" movement, not a workshop offering guidance on how churches could be safe spaces that welcome all and uphold justice within a range of beliefs. They went beyond many churches in even holding such a workshop, but they need to take it further.

Does being known more for condemnation of individuals (and cozying up to big pharma and other questionable allies) instead of fighting for justice and human rights match the scene of Jesus in the temple overturning the tables of the money changers? Does it fit with the image of Jesus embracing and blessing a sex worker? His directive to her was to "go and sin no more." Repentance wasn't a precursor for his embrace. His championship of justice was not selective.

One of the conflicts I experienced in my work with the AIDS Relief Consortium was the need to include prevention programs with the treatment work we were doing, as it makes little sense to be doing treatment alone. That would be like trying to plug holes in a dam while more spring open. A group that was in charge of $330 million of AIDS funding was constrained in the prevention resources it could provide. The restrictions came from the ideologically driven PEPFAR guidelines, which mandate how much funding can be used for treatment and what emphasis must be placed on abstinence and fidelity. In addition, the organizational policies of Catholic Relief Services don't allow condom distribution or a full range of reproductive health services.

Many in the church refer to the AIDS pandemic as an "opportunity for evangelism." Ken Isaacs of Samaritan's Purse stated "AIDS has created an evangelism opportunity for the body of Christ unlike any in history." Community Health Evangelism offers a presentation entitled "HIV/AIDS in Asia: A Window of Opportunity for Community Health Evangelism." This is troubling on at least two levels. First, there's the notion that people could be celebrating such a dread disease -- as if it was sent so that they could save more souls. Second, the idea of "bread in one hand and the Bible in the other" could lead to the coercion of people who are in a vulnerable position.

Recommendations

There are critical roles for FBOs that contribute substantially to the well-being of communities, families, and individuals with HIV. Some FBOs have used their influence to advocate for needed policies, including debt cancellation and universal access to treatment. Religious groups have also used their reach in communities to ensure that there is a comprehensive web of support for people with HIV. I applaud these efforts and hope that these initiatives persist and multiply.

But FBOs should establish guiding principles so that everyone knows where each organization stands. I pushed for the establishment of such principles and values at the Pan African Christian AIDS Network. All were enthusiastically in favor. But when we completed the process, it included a clause saying, "Marriage should only be between a man and a woman." I decided then that it was time to bid adieu, as I am an uncompromisingly staunch ally of LGBT rights.

People within organizations should expose the underlying forces driving their agendas, and coalitions should be encouraged to offer up a statement of principles so that hidden biases can be revealed.

Advocacy conducted by FBOs should be based on principles of human rights. If this is the guideline, the automatic corresponding principle is "do no harm." The judgment-based advocacy that has resulted in such policies as the Anti-Prostitution Loyalty Oath and hateful anti-gay legislation such as that being discussed in Uganda that proposes the death penalty for loving persons of the same sex would not pass the "do no harm" test.

There is a role for abstinence in HIV prevention. It's possible to choose abstinence and it's good to have support in adhering to that choice. But doctrines and societal edicts are not enough if someone makes another choice or if people find themselves in situations where they have little or no choice. People who are in these circumstances need to know the options for keeping themselves as safe as possible.

Finally, let's reward FBOs that are doing good work, replicate those practices, and emphasize these positive models. There are churches that have articulated biblical bases for supporting women's rights and gay rights, and who promote a broad range of social justice issues. There are others who have devoted themselves to treatment, the care of orphans and vulnerable children, economic development, peace work, and hospice care through highly effective work. We need many more like them.

Searching for Solutions to AIDS. 27/6/10

The benefit obtained through the intervention of something designed to reduce risk can be offset by people becoming careless with their behavior.

Catholic.net

Bishop Beetge Calls for Action. 02/10/08

Part of speech delivered at the Diocesan Synod by Bishop David Beetge of the Diocese of the High Veldt in South Africa:

Members of Synod may well know that over the past few years I have been the Liaison Bishop for the Anglican Church in Southern Africa’s HIV and AIDS programmes and, of course I have been closely involved in this work in our Diocese since our inauguration as a Diocese. Recently, with two members of the Provincial Office, I attended the International AIDS Conference in Toronto. I do not want to reflect on the Conference here but I do want to make an appeal. From figures presented to the Conference and from figures available here, the AIDS pandemic in Southern Africa has reached alarming proportions. I want to express my gratitude to our Archbishop for his leadership in this area and for the support he has given the Provincial Office and Dioceses as we have built a capacity at Diocesan and Parish level to address this issue. I want tonight, in all earnestness, to make one appeal.

This pandemic has, as I have said, reached alarming proportions. No-one can tackle this one single handedly. We need a sustained and united effort to work towards a generation without AIDS. In a statement last week I called on the Government, and by Government I mean all levels of Government, National, Provincial and Local, to commit themselves to working with Faith Based Organizations and NGO’s in a creative partnership that will pool the capacity each one has, together with the resources available in this country and through the international community, in order to address this pandemic in the most holistic way possible. I am urging the Government and NGO’s, including the Treatment Action Campaign, for the sake of those who are suffering and for the sake of those whom we want to protect from this virus, to put behind them the conflict and differences between them and to seek a new multi – sector partnership that will address this pandemic urgently. I am convinced that the only way forward is by Government (at all levels), Academics, the Medical profession, Pharmaceutical industry, NGO’s, Faith Based Organizations and others coming together and working together to address this pandemic. I also called for a national consultation, which will include all sectors, to address this pandemic. In addition SANAC needs to include all sectors and to meet on a regular basis so that this pandemic can be addressed by a united response within the country. I renew this call tonight.

HIV and AIDS is not just a medical problem or an individual problem – it’s a social problem too. It’s a social problem because the whole community, including the church, is affected in high-prevalence areas. It’s a social problem, because social factors like stigma, denial, gender inequality, and poverty help HIV to spread in our communities and exacerbate the effects of the pandemic. HIV and AIDS stigma exists because many people see HIV infection as a mark of shame, associating it with immorality and death. Actually, HIV is just a virus, and AIDS can now be treated as a chronic disease. People sometimes justify putting distance between themselves and people they know with HIV because they are worried about infection. But as you know, it’s luckily extremely difficult to catch HIV except by unprotected sex, sharing dirty needles or blood transfusions.

Contracting a chronic illness is a very high price to pay for love, and no-one deserves it. But because HIV is mainly sexually transmitted, and has been associated with adultery and premarital sex, some people feel that it is shameful, that it must be some kind of punishment or consequence of immoral sex. In fact, people can contract HIV through any unprotected sex, including rape, or sex within in a faithful relationship, if their partner happens to be HIV-positive. We should promote responsible, loving relationships within the Christian ethos, but we need to recognize that HIV does not have morals, and it’s not only transmitted by certain kinds of sexual activity. Tackling HIV requires talking openly about the importance of having safer sex and knowing one’s status, even in faithful, Christian relationships.

Stigma is unfair, it feeds on ignorance, and it has bad consequences. It makes us think that if we are good and faithful Christians we are immune to HIV: ‘HIV happens to someone else, not me’. In fact, this is mainly why we stigmatise: to feel safer ourselves, we push others away. Stigma sometimes makes us feel ashamed and judged for having HIV/AIDS, and forced to hide our status from loved ones, at a time we most need their love and support for being sick. Fear of stigma and discrimination is almost as bad: it can make us avoid doing things because we are worried about other people’s reactions.

AIDS is a call to the church to really look at our humanity in a very deep and positive way. It is a call to love: to embrace and support each other, whether we ourselves have HIV or are affected by HIV and AIDS in our families and communities. It is a call to lament: to mourn and challenge the inequalities and prejudices that make it difficult for us to deal with this pandemic. And it is a call to act: to challenge all forms of stigma and prejudice, as we did in the Apartheid years.

We recently commissioned a study on the nature and extent of HIV and AIDS-related stigma in the Anglican Church of the Province of Southern Africa. Some of you may be aware of the study, and some of you may even have participated. The Human Sciences Research Council is busy preparing the report as we speak. Over 850 questionnaires were completed anonymously in five countries of the ACSA, 130 of them by people living with HIV and AIDS, nearly two thirds of whom were Anglicans and the rest were members of support groups in our church. Two questionnaires - a general one, and one specifically for people living with HIV and AIDS - were prepared by the research team, with the help of the Anglican AIDS Office, an Anglican reference group and stigma researchers internationally. This is the first time we know of that such a survey has been done in a faith-based organization like a church.

Preliminary data from the survey suggests that regular church members and clergy know about the efficacy of condom use in HIV prevention. The church has taken a strong anti-stigma position at the highest level, and survey respondents were not highly judgemental. Only ten percent of respondents to the general questionnaire agreed or partly agreed to the proposition that people living with HIV or AIDS were not good Christians. Around ten percent of respondents also agreed or partly agreed that people living with HIV or AIDS were being punished by God. This can be contrasted to much higher levels of agreement on this question in a study across different denominations in Tanzania, around 44%. In spite of low levels of blame directed at others, we found relatively high levels of self-shame (internalised stigma) expressed by the general sample when asked how they would feel if they or a family member were HIV-positive.

What is more worrying is that people report others in their congregation holding more judgemental views than themselves. For example, as much as twenty percent of respondents to the general questionnaire reported that others in their congregation were likely to agree or partly agree to the proposition that people living with HIV or AIDS were not good Christians. Around 25 percent of respondents said that others in their congregation were likely to agree or partly agree that people living with HIV or AIDS were being punished by God. The level of discriminatory and exclusionary practice was low, but nevertheless of some concern. Thirteen percent had observed others in the congregation insulting or humiliating people living with HIV or AIDS because of their status, and ten percent of people living with HIV or AIDS sampled reported experiencing this personally in the last year. The effects of stigmatisation are felt by family members too. Sixteen percent of respondents to the general questionnaire reported that they knew of children or family members of someone living with HIV and AIDS who had been humiliated and insulted because of it in the last year, although not necessarily within the church. Respondents reported observing or experiencing relatively low but nevertheless worrying rates of total exclusion from the church: 4% of people living with HIV or AIDS reported being told to stop attending church because of their status – remember, not all of the people responding to this questionnaire were Anglicans.

In our church, the shared communion cup represents both a spiritual engagement with God and a statement of inclusion in the church community. Some people living with HIV and AIDS are missing out on this ritual at a time when they most need it, and this is happening in our own Diocese. Over all, about 14% of people living with HIV or AIDS reported that they had attended church less often since their diagnosis because they felt judged and criticized and about the same number reported others refusing to share the communion cup with them. Incidents of refusal to share the communion cup with people living with HIV or AIDS in the last year were reported by about a third of the HIV and AIDS coordinators and Bishops sampled. Regional variations suggest that in some areas the problem is more serious than others.

There is some completely unnecessary but very real concern within congregations about casual transmission of HIV. Knowledge about HIV and AIDS transmission is not very strong in certain areas (e.g. casual transmission through kissing). Ignorance and doubt about modes of HIV transmission can be linked to fear of sharing the communion cup with HIV-positive people. Belief in transmission by sharing cups and plates also seems to be correlated with other beliefs, such as the belief that PLWHA are being punished by God and that PLWHA are not good Christians.

In a social environment that is not always welcoming, and faced with personal crisis, we turn to God and our church for support. A PACSA study found that even where people did not disclose their status to the priest or church members, they found great strength through their relationship with God. In our study, over half of the PLWHA sampled (about two thirds of whom were Anglican) had discussed their status with God, while just over a third had discussed it with a religious leader. Over half had attended church more often since their diagnosis.

About half of the respondents to both questionnaires said their congregation was very welcoming and caring towards people living with HIV and AIDS, and another quarter said their congregation was quite welcoming and caring. Over half of the respondents to both questionnaires reported that people in their congregation thought it was good to discuss HIV and AIDS. People living with HIV and AIDS tended to report very slightly lower agreement on these questions.

In general, our preliminary results suggest that the Anglican church is probably an environment in which people living with or affected by HIV and AIDS receive considerable support, but also experience some stigma and discrimination. The moral power of the church does give extra weight to stigmatising or anti-stigma statements from the pulpit. We are fortunate to have an Archbishop who has led the way in tackling the problem of stigma. But we still need to support priests and bishops in developing AIDS-friendly parishes on the ground.

Stigma has its roots in fear. We are afraid of contracting HIV, we are afraid of speaking about the problem in case we are identified with the illness, and we are afraid of disclosing our HIV status in case we are judged, criticized or discriminated against. In order to move towards a more inclusive relationship with our fellow Christians, we need to create safe environments in which we can all speak openly of our fears, and share information and experiences. We have the resources to deal with fear: an ethics of hospitality and compassionate care, a recognition that we have all sinned but strive to be better, and the capacity to provide each other with trustworthy and relevant information.

Even after Apartheid, the church continues to have a major role to play in terms of social cohesion and social justice, in southern Africa. Both social cohesion and social justice are built on love and trust, and love and trust in turn are built on a secure environment. In this time of need where statistics show that in South Africa the total number of children under the age of 18 who have lost one or both parents is expected to peak at 5.6 million in 2014 and where abuse of children continues to be rife, the church needs to be a place of safety and nurture. We need to make sure that our church offers the sanctuary of safety and the security of trust to those who practice their humanity within our community, as well as those with whose care we are charged. The church as with all public institutions provides space for encouraging certain cultural values. The culture and community that the church desires to build is one of love and compassion, tolerance and forgiveness, a community that lives the good news of Jesus Christ. The attainment of such a culture is severely hindered by stigmatizing practices and other destructive behaviour that break trust and social cohesion. I am calling on all of our congregations to ensure that the space they occupy is a “safe space” for all especially the most vulnerable in our society.

Love, compassion and trust are all products of a cohesive community rich in social justice and what some call social capital. ‘Social capital cannot be found in a treasury or a bank. Its currency is culture. Culture stores the life practices and assumptions of a people. Culture circulates between individuals, families, groups, institutions and throughout the society as a whole. Culture forms and regulates the ways people live together. Its most powerful form of regulation is informal, silent and taken for granted. Social capital is first minted in the family, where adult parents, generally without realising it, transmit their own history and the culture of their life world to their children. The child inherits a framework for making sense of life, building an identity and realising the boundaries of difference’ (HSRC Morphet et al 2004.)

We are likewise powerfully influenced, each one of us, by our participation in the family of the church. The ‘church’ is at one time a building, an institution and a community, a structure ideal for taking in those with needs and ministering to them with love. Our Church can take the lead by openly disavowing the practices of stigmatisation and rejection that make poor people desperate, and by using our resources to support the needy. By doing so we will redirect fear into compassionate and appropriate action.

The Highveld Anglican Board of Social Responsibility (HABSR) is presently being constituted as a Section 21 Company. This process, when it is completed, will enable us to embark upon a fund-raising campaign for this ministry and for our projects. I will ask the Board to consider the services of a professional fund raising organization but we also need to commit ourselves to this work. If we could have 1 000 people contributing an average of R100-00 per month (for some might only be able to manage a lesser amount but many can manage more) what a difference we could make to those in need in this area. This is a challenge I present to Synod tonight – to enlist 1 000 people (or parishes) to commit a monthly amount towards our Social Responsibility work. We live in an area where people are in great need. As the Anglican Church in these parts we must play our part. Carol and I will gladly be the first to subscribe and will pledge R100-00 per month as from October. Will you do the same? And will you make this known in your parish and see if we can raise 1 000 people by Easter 2007? In the words of Jesus: “Truly I tell you, just as you did it to one of the least of these who are members of any family, you did it to me”. (Matthew 25:40).

Bottlenecks and Drip-feeds 08/04/06

“Bottlenecks and Drip-feeds” is the title of the keynote address given by Geoff Foster.(Save the children UK) at the recent CINDI conference. The failure of funds reaching those children who are most in need was an overriding concern expressed at the conference. Financial resources for orphan programs have increased substantially but funds often get stuck in organizational bottlenecks and don’t reach those who are affected. Of one dollar spent from donor funds, less than 5 cents translate into direct help. 

An extensive study commissioned by ‘Save the Children’ has found very few examples of effective mechanisms for channeling resources to community-level organizations responding to the needs of vulnerable children. During the conference, appeals went out to all organizations, especially FBOs (faith based organizations) that are rooted in the communities, to engage in advocacy work to overcome the bottleneck.

Drip-feed and technical support

The ideal model for efficient funding is “drip feeding”. A constant, never ceasing trickle (i.e. moderate funds) into the ground-stream of community level interventions. It was recommended to increase technical support for CBOs (Community Based Organizations and FBOs). Eg assist with financial administration and writing of funding proposals/ drawing up of budgets / coaching in language proficiency to enable people in the community to write simple reports in English.

How do we hold public officials accountable?

A number of high ranking government representatives were present and the atmosphere was at times very tense when they tried to justify the inertia of government departments. In some areas in SA, it may take up to two years to obtain a birth certificate. Yvonne Spain, CINDI director, spoke publicly: “The lack of service delivery by the Department of Home affairs is criminal” .

Social workers are often non-existent. (No figures were given for vacancies of social workers posts - figures for vacant nursing posts are 37 000.)

KZN (Kwa Zulu/ Natal) seems one of the worst hit provinces regarding the scarcity of social workers. A Lutheran project shared the case of a youth headed household:

Case study

The eldest sister is 21 and has already given birth to 3 children. She uses the child support grants (R 190 per child/per month) for her 3 biological children to support her 4 younger siblings. The project care workers have been to Social Services in Pietermaritzburg regularly during the past year – without success. The young “sister-mother” has not been visited by a social worker and cannot access state support for her younger siblings.

Ironically, it seems easier in KZN, to receive a disability grant (R 780 a month) for HIV+ status. So far, the grant has not been taken away from people who are on ARVs. This is quite different from other provinces where parents on ARVs are suddenly without income as the disability grant has stopped.

Integrated care projects

Another focus was the integrated model of care projects. Repeated appeals came from key note speakers and small groups presenters: “Don’t separate treatment education,

counseling, orphan care and home based care. Send your orphan care workers to treatment literacy workshops and involve TAC (Treatment Action Campaign) activists in orphan care. Don’t forget those children who stay at home to nurse their sick parents. Encourage parents to seek medical help and explain, for example, that TB is not AIDS and can be cured. Prevent orphan-hood by means of treatment support and education for sick parents.”

The move towards integration was indeed heartening for me as LUCSA has promoted the integrated care model. I was employed by LUCSA to add the treatment component to LAAP ( LUCSA AIDS Action Plan.)

Below I list some innovative “good practice” models in the hope that project leaders might be inspired. It is my deepest regret that I have not tried harder to get sponsorships for some coordinators of LUCSA supported projects to attend the conference.

Child counseling at schools.

Every orphan care worker knows the desperate plea by teachers: “can you please assist us with our traumatized children? We have children crying all day, others have become very aggressive and hit their class mates, others are totally withdrawn and don’t talk at all…..”

A group of teachers in Pietermaritzburg developed the “school counseling project”. 2 counselors are allocated to a school. They are members of the community who are being trained by professionals. The requirement is standard 10 and the positions are advertised. How do they choose the candidates? After a short interview the candidates are asked to play with the children for 30 minutes. Professional child-psychologists observe the play-time and make their choice. The school counselors receive a stipend and on-going training. (Funded by the Save the Children/UK)

“Adopt an orphaned household” - family sponsor model:

Thandanani, a Pietermaritzburg based organization, introduced this model in order to be less dependent on big donor funds. They approached churches in affluent parts of KZN and asked if any Christian families are prepared to sponsor orphaned households. They gave a profile of specific households and spelt out the needs.

Example of a household in need: The oldest sister is 17 years old and she has to look after 3 younger siblings. She does not receive any grant as she is under 21. There are no relatives. The needs were listed (school fees/uniforms/basic clothing/basic food) and amounted to about R 500 a month. Two affluent families have taken on sponsorship for 3 years. It will take about 3 years for the eldest sister to start the process of applying for a government foster grant (Legal age is 25 but social workers can motivate for a grant from 21 years onwards)

Thandanani care workers administer the sponsor funds and organize food parcels and clothing. 

The coordinator shared the story of the youth headed household profiled above: After one month of Thandanani assistance, relatives appeared from nowhere and offered to take the children.(!) The Thandanani staff was adamant that is was not in the best interest of the children to move away and they protected the household. The children were traumatized when their relatives showed sudden interest in material benefits. 

The other positive factor of the household-support was the reaction of the community. The children were no longer seen as potential thieves and the “orphan-stigma” was visibly reduced. Some orphans were even invited to visit their neighbours which has never happened before.

The children know the first names of the sponsor family but they don’t know the address and the entire correspondence and financial responsibility is carried by the Thandanani office.

Psycho-social support for abused “grant children”

A rough estimate is that more than 50% of orphaned children are well cared for by grand-parents and relatives (SA). We find, however, a disturbing level of abuse among the less well cared for which is often related to the South African welfare grant system. Relatives buy hire-purchase goods with the grant money and the distressed children feel totally unloved, often drop out from school and develop symptoms of emotional neglect. Care workers need to continue monitoring foster-care families. Youth-headed households also need counseling and guidance as many young “sibling parents” don’t have the maturity to be heads of households. We heard of a youth-headed household where the 23 year old sister received a full foster care grant for 4 younger siblings (over R 2 000 monthly) . Suddenly she had a good income but she ran away as she could not cope with the responsibilities. She received the monthly grant from the Department of Social Development after one single visit by a social worker who never returned. She never received advice or guidance not to mention counseling. Such cases are a sad illustration of collapsing government support structures.

Children’s villages

Community based care is the best. There is, however, a romantic perception among donors overseas that the African extended family will absorb children as long as they receive some material support. The extended African family is often a myth. Relatives do exist but they live in one-room shacks in the city. An increasing number of orphaned children are abandoned with no-one to care for them. For these children temporary shelters (sort of “sanctuaries”) need to be established. The ideal model is a children’s village within an existing community. This can mean a cluster of houses in the same street or simple buildings on church premises. Even better, to renovate empty buildings on mission stations. 

Abandoned children will be taken in until a suitable foster-care placement is found. The foster-care families will be monitored by care workers and the contact with the children’s village will remain allowing fostered children to return to play with their friends. 

In South Africa such villages can be registered as children’s homes (takes ca 2 years). Registration means that the state pays R 1 500 per child/per month. For a home with 50 placements this secures a monthly income of R 75 000. The village must have good credentials and financial records to get registered. The involvement of a church, assisting with monitoring is always a bonus. Government will not promote children’s homes, as too many such homes have become ruthless business enterprises. The churches, however, could play a big role in preventing such exploitation for personal gain. A faith based children’s village has a better chance to get registered.

Memory work and resilience in times of AIDS

This is the title of the book that introduces the memory box program. The director of the program is Prof Philippe Denis, a theologian and church historian who recognized the need of orphaned children to develop a sense of personal history, identity and resilience . They will have a better chance of reaching mature adulthood if they have been guided along the path of remembering their parents. Memory work is healing work for traumatized children. The book has a full training manual and is highly recommended for those who want to learn more about bereavement counseling for children. (Cluster publications 2005 cluster@futurenet.co.za ) Some organizations focus so much on treatment and preparing for the second chance in life that the memory box work has been forgotten. It was felt that this is a deep loss and the suggestion was mooted to promote the concept of a “life box” which should start when you become a parent.

The memory box is such an invaluable concept and tool to lead our children to stable adulthood that it should not be replaced by only focusing on treatment.

Creativity as a vehicle of hope

Religion/Media/Creativity were presented together in an afternoon program.

The film “a child is a child” was shown and few eyes remained dry. The film is accompanied by music and portrays orphaned children who develop coping mechanisms.

(To order as DVD/or video: info@vulekaproductions.co.za )

The discussion centered around methods of dealing with pain. How can the church be involved and bring back hope?

A group of traumatized women have started a creativity project, making quilts and appliqués with motives (often symbolically) depicting their traumas.

PACSA (Pietermaritzburg Agency for Christian Social Awareness) started self-help groups based on models developed by the healing and memory institute.

Churches can support Soul City staff who want to start active lobbying for introducing a children’s channel in TV. Many children spend hours in front of TV (often operated by a car battery). The South African TV programs have deteriorated to a very deplorable level and some programs can be categorised as “media child abuse.”

CINDI dolls

A touching (figuratively and literally) instrument of solace is the “CINDI doll”. The smiling doll is used in trauma counseling for abused children but the soft and cuddly knitted dolls are comforting for orphaned and lonely children as well. Many children living in deprived conditions have NOTHING that belongs to them. The doll (for boys and girls) is given to them by care workers and this companion will be with them during the night, cuddled in their arms. They can share sorrows and sadness with this friend. The CINDI doll is an idea that can be taken up by church partnerships overseas. Many people overseas would like to do something more than sending money. To knit hundreds (thousands and the millions we need to match the number of orphaned children) of dolls would be a meaningful contribution to raise awareness of the plight of children in distress in Southern Africa.

Volunteers or care workers?

All projects start with volunteers to visit homes and schools and take care of vulnerable children. Most of these volunteers are unemployed ( mainly women) who struggle to feed their own families. All volunteers hope to receive some income at some stage. Donors are reluctant to give funds for stipends (not to mention salaries). The conference heard many voices deploring the fact that those daily workers who are the back-bone of the projects don’t receive any remuneration. Some volunteers receive soap in their care-kit to be used to wash the patients but they have no cash to buy soap for themselves. Projects are encouraged to advocate for fair stipends for care workers.

Counseling and “off-loading” for care workers.

Ideally, care workers should have weekly meetings with trained professionals to unload and de-stress. Burn out and “compassion fatigue” are on the increase. Professional psychologists are, unfortunately, not always available. Project managers are thus encouraged to structure de-briefing sessions even without professional guidance. A good method is to sit around a circle and let everyone share her/his story. No interruptions, no questions asked during the sharing in the circle. Afterwards a limited amount of time can be given to respond to each other. This method only needs a minimally skilled facilitator who can “rotate” with every session. It is a self-help group for care workers and a weekly (or forth-nightly) session is highly recommended.

Support group for caregivers/guardians

AIDS workers are aware of the vital importance of support groups for PWAs. In the same way, support groups for caregivers can play a crucial role to strengthen coping skills. The method can be the same as above: sharing your burden by speaking in a “safe space” without interruptions or judgment. Some care projects make monthly support group meetings for caregivers compulsory for receiving food parcels. Traveling costs will be re-funded. Resource persons from the community can be invited.

Donor funding – “show us your latest financial statement?”

The bottle-neck “plug” plagues many community based organizations. There is the first hurdle of submitting a well formulated funding proposal but the catch 22 situation is the lack of financial statements at the beginning of a project. For example, a group of concerned women want to start a feeding scheme for children they found scavenging for food at the municipal dumping grounds. They apply to small businesses or companies for initial funds but they cannot show a financial statement as they have not had any monetary donations yet. Examples were given of CBO groups that had to close soup kitchens for hungry children because they did not receive any technical guidance (how to write a funding proposal in English) nor financial assistance. Mission instituted churches have a great advantage in this respect as most “main-line” churches have an HIV/AIDS desk and donor partners overseas. The best results have been achieved in projects where church and community work together and technical support is given.

Prevention

A surprising number of speakers stressed the fact that more programs must be geared towards boys if we want to make inroads in prevention. For example, boys learn that a well-brought up girl will “fight and say no” if she wants sex. It is not good enough to teach girls that they have a right to say “no” – we also need programs that reach boys.

Fatherhood project

Our society is in desperate need of positive role models of fathers who show active interest in the lives of their children. The amount of child abuse has lead to a state of paranoia in our society. The speaker presenting the fatherhood project gave an example of a father who walked down the street holding the hand of his 5 year old daughter when some residents notified the police as they suspected him to be a child abuser. The media does not play the role it should: our society needs to see many more caring fathers in TV series and adverts.

Way forward for LUCSA?

Recommendations:

Die Zuma-Hofsaak. 07/05/06

Hoe word die vigsbekampingsveldtog deur Zuma se optrede en uitsprake beïnvloed? 

Artikel deur Nelis du Toit, Verskyn onder die titel "Zuma wen... Wie't verloor?" in die Kerkbode van 26 Mei 2006 

Die opspraakwekkende hofsaak waarin die voormalige Adjunk-president Jacob Zuma van verkragting aangekla en vrygespreek is, is verby. Waarskynlik sal die stof rondom hierdie hofsaak binnekort gaan lê, maar die impak of effek daarvan sal nog lank by ons bly spook. 

Dit is daarom nodig dat ons wel nog oor hierdie gebeure nadink. Wat gedurende en rondom die hofsaak gebeur het, het nie in isolasie plaasgevind nie. Dit weerspieël iets van ons samelewing waarin dit afgespeel het. En nog belangriker: dit het 'n groot invloed op ons samelewing. 

Ten spyte van die regter se verklarings en ten spyte van Jacob Zuma se verskonings is daar 'n paar indrukke wat tydens die hofsaak geskep is en wat ‘n mens steeds bybly. Die volgende paar vrae leef voort in my hart:

Hoe veilig is vroue in ons gemeenskap?

Terwyl die hofsaak onderweg was, was daar al 'n gees van teleurgesteldheid by persone wat vroue en kwesbare mense se regte ter harte neem, te bespeur. Hierdie teleurgesteldheid hou verband met die wyse waarop Khwezi se menswaardigheid deur lede van die publiek aangetas is. Die indruk het bestaan dat die regsproses en veral die media ook hiertoe bygedra het. Ten spyte van die versekering wat die regter in sy uitspraak gegee het dat sy uitspraak nie die posisie van vroue voor die reg benadeel nie, bly die indruk dat vroue dit nou eerder moeiliker as makliker sal vind om 'n klag van verkragting te lê – veral as die verkragter bekend is aan hulle. Sonder om te veralgemeen, wil ek beweer dat as vroue na hierdie hofsaak minder veilig voel, sal daar ook mans wees wat na hierdie hofsaak die indruk het dat hulle nie so maklik tot verantwoording geroep kan word as hulle vroue verkrag nie.

Wanneer is seks verkragting? En is net verkragting 'n oortreding?

Na die afgelope hofsaak is ek opnuut onder die indruk dat die reg oor verkragting praat slegs wanneer duidelike “bakens” verby gesteek is. En hierdie definisie of duidelike bakens maak veral nie genoegsame voorsiening vir verkragting binne ‘n verhouding of deur iemand wat aan jou bekend is nie.   Dit wil voorkom asof  die afloop van hierdie saak die “bakens” van wanneer seks verkragting is, verplaas het. Na hierdie saak sal verkragting waarskynlik nie makliker bewys kan word nie.

Dit is jammer dat die regsproses in hierdie geval alleen oor verkragting as sodanig gehandel het.    Dat die regter vir Jacb Zuma op 'n persoonlike vlak oor immorele optrede geroskam het, was nie genoeg om die ernstige aard van hierdie optrede aan te spreek nie.

Word mense met mag bevoordeel bo mense sonder mag?

My indruk is dat die wyse waarop die hofsaak in nuusmedia rapporteer is en al die gebeure daar rondom verwarring oor die waardigheid van die vrou veroorsaak het, wat onder andere insluit:

• haar gelyke status met die man voor die reg;
• haar gelyke status teenoor die man in verhoudings;
• haar reg om seks te weier;
• die betroubaarheid van haar getuienis;
• haar reg om teen enige vorm van ontmensliking beskerm te word.

Hoe mens ook al daarna kyk – daar was 'n mags-wanbalans die dag toe Jacob Zuma met Khwezi seks gehad het. Die indruk wat die hofsaak by my gelaat het, is dat Khwezi “uitgelewer word” aan “die beste regsspan wat geld kan koop” en dat sy hierdeur verder ontmagtig is. Ek verstaan dat 'n getuie se geloofwaardigheid getoets moet word, maar die wyse waarop Khwezi in die openbaar blootgestel is, het my ontstel. Die manier waarop mense buite die hof Khwezi se eer aangetas het, grens vir my aan verkragting van haar persoon en ek wonder steeds: waarom het dit so min openbare reaksie ontlok?

Die gevolg van al hierdie gebeure is dat mense – veral vroue wat in hulle verhoudinge 'n posisie van onmag beleef – ontmoedig word om geweld binne verhoudinge en spesifiek verkragting aan te meld. Dit dui na my mening op 'n onrusbarende bevestiging van onderdrukkende houdings en praktyke in ons gemeenskap. Vir 'n gemeenskap wat reeds worstel met persepsies dat manlikheid bewys word deur 'n vrou te onderwerp, is dit nie goeie nuus nie.

Die verhaal van MIV en vigs in Suider-Afrika bevestig dat baie vroue onderdruk word en dat seks dikwels binne hierdie konteks plaasvind. Té veel getroude vroue wat aan hulle mans getrou is, word met MIV geïnfekteer! Té veel jong meisies verklaar dat hulle eerste seksuele ondervinding teen hulle sin plaasgevind het! Té veel jong dames wat in 'n seksuele verhouding is, verklaar dat hulle bang is om “nee” te sê wanneer hulle maat seks wil hê!

Moes soveel verkeerde MIV inligting die wêreld ingestuur word?

Die vals inligting aangaande MIV en vigs en veilige seks wat gedurende die hofsaak uitgespreek is en by wyse van mediaberigte die wêreld ingestuur is, maak my baie onrustig. Enigeen wat erns maak met persepsies in gemeenskappe weet dat vals inligting rondom MIV en vigs soos 'n veldbrand versprei en dat korrekte en feitelike inligting met moeite aanvaar word. Dit sal veel meer as 'n paar regstellings en verskonings van Jacob Zuma vra om hierdie wanvoorstellings uit te wis. Pogings om korrekte inligting oor MIV en vigs aan mense deur te gee, is vir maande, indien nie jare nie, teruggesit.

Hoe het dit alles die stryd teen MIV en vigs beïnvloed?

My indruk is dat die belangrikheid van die vigspandemie deur die hofsaak en die gebeure daaromheen onderspeel is. Pogings om die samelewing te sensitiseer ten opsigte van moreel verantwoordelike en gesonde seksuele lewenswaardes, keuses en praktyke sowel as die uitdra van betroubare inligting, is ernstig benadeel.

Die koninkryk van God kry onder andere gestalte in gemeenskappe waar weerlose mense veilig is, waar seks uitdrukking van wedersydse liefdestrou is, waar reg en geregtigheid gesamentlik gesoek word en waar die belangrikheid van waarheid geag word.

Binne hierdie konteks het kerke en spesifiek kerkleiers die verantwoordelikheid vir die handhawing en uitbouing van 'n Bybelsverantwoorde morele en sedelike kultuur in Suid-Afrika. Dit sluit in dat alle mans en vroue (oud en jonk) en in die besonder alle lidmate opgeroep moet word om:

• verantwoordelike en veilige seksuele keuses te maak;
• alle medemense se menswaardigheid te respekteer;
• ingelig te wees en betroubare inligting te gebruik.

Healing the Church through a Pandemic: Ecclesial Reflections on the Scriptures. 03/03/08

Speech for Tearfund by the Revd David Peck, Archbishop of Canterbury's Secretary for International Development

3/3/2008 

I want to talk this morning—as we prepare to enter Holy Week—about repentance and redemption. Specifically, how the church can turn at least some of its stigmatising into repentance; and some of its laments in the time of HIV and AIDS into a redemption song. If it is truly the case that we are healed by God's wounds on the cross, then we must also see the potential for a divine intervention in which the church is healed by those who are afflicted by this pandemic. 

Musa Dube, the great Botswanan theologian, has for a decade told the church that we need our bible study to be more contextual.[1] In a world where tens of millions of our neighbours are infected and affected with HIV and AIDS, we are long overdue in reading our bibles in the light of the pandemic, and in the light of our own need for healing as the body of Christ.

I am so grateful to Tearfund for the invitation to speak to this gathering. But my wife was horrified that I accepted this invitation. What can you tell Tearfund or Kay Warren about either AIDS or the Bible? Absolutely nothing I replied. But I have a lot to learn that I will never know unless I agree to speak. So thank you to Rachel Carnegie and all her Tearfund colleagues for this overwhelming opportunity to learn by being forced to teach. 

As I reflect on global and local responses to the AIDS crisis the last 20 or so years I will talk about three paradigms—or responses to the pandemic. The first in terms of a stigmatising response based on a misreading of our scriptures. The second to very briefly consider the compassion and care response and global solidarity which Tearfund and others have pioneered with partners in the UK and global south. But mostly I hope to focus on the third paradigm, where we are not just caring for and calling for better treatment of those who are positive and carrying the multiple burdens of poverty and illness in the absence of health care, but as churches North and South, East and West, actually being healed ourselves by the wounds which HIV and AIDS inflict upon us. 

I give thanks that in his providence God put me in Zimbabwe a week ago to read my bible and prepare for this day. To read the bible in Zimbabwe is a fearful thing. It is so frightening because one's own belief hangs over an abyss of suffering and undoing by death that unbelief is so obviously a rational response. Can the word of God really speak in this context where millions are infected with the virus? And when they are sick stand so little chance of getting paracetemol, let alone anti retro-viral treatments, from their government? And what on earth can the church do amidst a national crisis when it can not even cope with burying the dead?

We know that when Christians first read their bibles in the light of the pandemic the most vocal among us responded to some of the most vulnerable people by creating a global response of "I told you so" prejudice and hypocrisy that created a wall of stigma so high it will still take us years to tear it down. With notable exceptions (and Tearfund was one) It took most of us a decade to respond with something better than prejudice or stigma, and that was silence. After two decades and the deaths of 25 million people—most of whom were our fellow Christians—we are beginning to find repentance for our sins. My brothers and sisters, what in God's name were we thinking? And what in God's word were we reading? 

I want to remind us all where we made some wrong turns in our biblical approaches in the early years of the virus. Of course we remember good Evangelicals who denounced those with the virus and even reinforced the connection between AIDS and sin because of the ease of its sexual transmission. How smug we were that the transmission could only take place outside the safe enclave of Christian marriage and family life. And it all seemed as clear as it was untrue. Many of us bristled at the denunciations because they were unkind and uncharitable and thus unchristian, even while we believed there was real truth in it—and there is of course some truth in it which we must not lose. And from this point we made the best response we could with ABC campaigns: abstain, be faithful and use a condom. But there is more and better on offer now than that. I encourage you to make the journey I am still in the midst of from ABC to a new and more holistic acronym, known as SAVE. Perhaps we can talk more about these initials later. 

But we now know, through the exegesis of Hebrew scholars such as Johanna Stiebert[2] that the links with disease and guilt and sin are not so straightforward as we thought. First of all, where there is clearly retribution in the sending of disease as punishment for sin, we tend to forget that the same context often sees hunger and war as punishment for sin too. Somehow we do not often hear sermons where Iraq is said to be a punishment for sin; or the famine of Darfur is evidence of the sinfulness of the hungry Darfuri people. Nor do we complain that the UN's World Food Programme is undermining morality by feeding people. In such situations we are very astute at not beginning our thinking or our praying by "blaming the victims". But that is where out Christian response started. 

Stiebert makes the point that in passages from Jeremiah and Ezekiel (Jer 14.12; 16.4; Ezek 6.11) God's inflicting or curing of diseases is usually making a point about his mastery over creation rather than simply punishing vice. Moreover, there are all those people afflicted with illness whose sin is not at all clear. From Job to the man who was blind from birth in John, we naturally, but wrongfully, end up asking with the disciples, "Who sinned: this man or his parents?" 

JOHN'S GOSPEL CHAPTER 5 

Before getting to the meat of what I want to reflect upon, which is John chapter 9, let me briefly offer some thoughts about the paralysed man and the pool of Bethsaida in John 5.2-11. And let me do that in the light of a slogan that is both helpful and unhelpful. Some say AIDS is not a moral issue. They say this because Christians have over-moralised HIV. But in time I hope to unpack some of the deeply moral issues that I think HIV and AIDS does uncover. I find John 5 really helpful in stopping the false dichotomy which some create when the church properly want both to preach good news and make a professional medical response to the pandemic. 

In chapter 5 Jesus has two encounters with a sick man. In the first he simply heals him unconditionally. There is no talk of sin at all in the first encounter. The shock value of the story of course is that Jesus healed him on the Sabbath. Jesus treats the conventional morality and religious norms as entirely secondary to the needs of the individual. The paralysed man is denied access to his treatment because he is too weak and isolated to get to the pool. (If Jesus was working for Tearfund of course he would not have taken the easy short cut of just healing the guy, but gone on about creating better access to treatment from the pool of Bethsaida for all the others like him. But what can you expect from a Saviour who did not do any development studies at university?) 

But the healing encounter does not end with the paralysed man who can walk. Later Jesus finds the man at the temple and said to him, "See you have been made well! Do not sin anymore in case something worse happens to you." But we must not conflate what the TWO encounters. John is careful to make clear they are separated by both time and place. To take the second step of talking helpfully about the moral context in which all health and all health care is set in, we must be first unconditional and unwilling to have secondary rules and regulations interfere with our radical self offering. The two encounters when considered in their proper light gives us a more holistic opportunity to think about illness, health-care and morality in a way that is stigma-free. 

JOHN 9

Walking along the disciples saw one who was blind since birth and asked him, "Rabbi, who sinned, this man or his parents?" Jesus answered, "Neither this man nor his parents sinned. He was born blind so that God's works might be revealed in him." 

Here we see again how often the scriptures deal with disease or disability as an opportunity to show God's power and mastery over creation. And very helpfully for my purpose Jesus makes explicit that there is not necessarily any connection between sin and illness. He was born blind so that God's work might be revealed. I am sufficiently uneasy about the notion of God inflicting huge suffering for his own glory that I think what we are meant to understand is that this natural, indeed random phenomenon of the man's blindness, can be an occasion for God to manifest his glory through his Son. Our horizon completely changes in this encounter because this man was not just blind, but blind from birth. The affliction is as inexplicable as it is unchangeable. And yet, Jesus does heal. The means of his sight being restored was mud and spit (from things literally at hand—absolutely common: mud, touch and a bodily fluid). 

Now we are on dangerous ground here in a discussion about HIV. And I want to say something that take us right to the edge of this 4 way encounter between the disciples and the blind man; Jesus and the blind man; the Pharisees and the blind man; and the Pharisees and Jesus. Of course the 5th encounter is the most important--between us and the story. For we are meant to gain our sight along with the blind man and the disciples or else lose it with the Pharisees. And it is this role of sight being restored—or vision focussed—that I want us to be aware of. 

Verse 8 gives us plenty to think about in terms of stigma and its effects. There is an identity crisis: The neighbours and those who were used to seeing him as a blind beggar and treating him as such began to ask, "Is this the man who used to sit and beg?" Are we defined by our limitations—by our stigmatising? What happens when the limitations that the neighbours have put on the blind man are no longer there? Is he the same person? 

The next 10 verses are interrogations: How were his eyes opened? He and his parents are interrogated 4 times. Three times the formerly blind man gives the same account. But still, trapped in their dynamic of stigmatising, they insist he was born entirely of sin and in v 34 they finally expel him from the religious community. Thus Jesus then finds the man for whom something even worse than blindness has come to him: the stigma of exclusion, of excommunication. Even after being healed, something worse than the illness can be handed down from the neighbours and hierarchy to this man. I doubt his parents are going to the synagogue either. So the whole family system breaks down. 

And yet Jesus finds the formerly blind man—who at this point must be as bewildered as a man can be—and puts his new sight literally and metaphorically to the test. Jesus asks, do you believe in the Son of Man? And the man replies, "And who is he, Sir, that I may believe in him? And Jesus says, "You have seen him and he is the one who is speaking to you." And he replies, "Lord I believe." And he began worshipping him. (38) 

But the political implication of this and the political encounter comes next in verse 39: Jesus says, "I came into the world for judgement so that those who do not see may see, and those who do see may become blind." How scary is that!? There is nothing that limits your field of vision more than thinking that all that there is to see is what you can see in front of you.

So at this point let us change gears and consider another paradigm—one that does not give rise to stigma and exclusion. The paradigm shift required at this point is, if we were writing a slogan: STOP HEALING AIDS WITH THE CHURCH AND START HEALING THE CHURCH WITH AIDS![3] 

If we take John 9 seriously, as programmatic for the church, then we want to start out as blind and end up with sight and not like the Pharisees to start with sight and end up blind when Jesus comes. To do this we have to unlearn all those things we think we know about the AIDS pandemic, the bible and the Church. We must unlearn who we think is HIV+, and why, and what we think about them. For those who are infected by the virus and affected by its impact are not objects of pity or fear, as if we are somehow normal and they are the distant "other". We must learn from that great Roman Catholic healer Fr Jean Vanier, and from Kay Warren's own testimony, whose approach is to let the afflicted open us up to our own woundedness and incompleteness and our need for redemption rather than their need. When the afflicted open us up to our own wounds then we can become, as Henri Nouwen describes it, wounded healers.

For most who are HIV+ any illness is as much a social, economic and political construct as it is an immunological one. The virus is transmitted from person to person, but with drugs to treat the viral agents, progression of the disease too often comes from a lack political will in the nations of the world to make drugs available to poor people. To people who lack nutrition; who lack nurses; who lack governments who give a damn about them; and who lack churches who give a damn about governments not giving a damn. 

And what complicates the response even further is an international community who is so anxious about the church preaching in the midst of a crisis that it balks at doing business with us. And the nightmare effect of all this is local Christian groups like the Mothers' Union in Zimbabwe, and all across Africa, who want to visit the sick and offer better care even where there is little hope of treatment, but can't get the equipment or training needed to make the small but crucial differences they can. So the despair spirals and the division deepens. The UK government and UN AIDS organisations speak about the unique local and global reach of the church to stand in solidarity with people living with HIV and AIDS, but it is they now who are doing too little and too late to both support the church and call it to account. 

But that must not stop the church from getting its own global and local house in order and to keen knocking on their doors. So what are our sins as a church from which we could be healed by HIV and AIDS? The gravest sin is of course the apathy of the indolent rich. Lazarus and Dives have something to tell us here. Forgetting to remember the vulnerable in our midst, those outside our national gates. Failing to live as the body of Christ in which we are all members one of another. 

The second sin that we as a church have to pray for repentance around is patriarchy. How on earth have we allowed women, who bear the brunt of poverty and family breakdown, to yet again to bear the brunt of this disease? And what are we not seeing or saying as a church about a masculinity that holds women in contempt? And what are we not saying about a femininity that thinks misogyny is fine with God. It is not. 

Too often it is a male hierarchy (lay and ordained) whose cumulative effect of insensitivity, ignorance, cowardice and detachment (take your pick!) that reinforces and perpetuates what has to be seen as hatred of women. How else could so much death and suffering be visited upon them and predatory and bullying male sexual behaviour go unchecked in countries with millions and millions of confessing Christians? Yet what do we hear on Sundays about this latent hatred? The sound of silence. Worse than the sound of silence, we hear the sound of the gospel preached with vehement irrelevance! 

And I am sad to say that I have been party to it. I have seen sentences in speeches I and others have tried to include written out of scripts before my very eyes for fear of the muck-rakers who, with the Pharisees, constantly look to the Archbishop of Canterbury to see how they might destroy people like him. Thank God we have leadership that is as deep as it is devout and steadfast from Rowan Williams in our world. If you want to read some of the most beautiful theological reflections on eroticism and sexuality, you must read his essay, The Body's Grace.[4] 

CONCLUSION: TOUCH AND THE BODY'S GRACE

I want to wind down with a quote from Timothy Radcliffe, OP, a celibate Dominican priest, who also writes beautifully on theology, sex and the politics of our bodies. In a recently published essay, after some long quotes from Archbishop Rowan, Radcliffe writes this:

"If a good sexual relationship overcomes the distortions of power, reaching for equality and mutuality, then [that sexual relationship] is a preaching of the gospel to the society in which we live. [A good sexual relationship] challenges the unjust structures of every society. All too often relationships merely echo the patterns of dominance of the society. If society is ruled by men, then men will probably rule in the home and in the bed. So a good sexual ethic offers a challenge that is implicitly political. If we are formed in our homes for reciprocity, then we will not be at home in political structures that oppress.[5] 

Instead of asking who sinned—this man or his parents—let us look turn the church and the world upside down and see it as a means of our healing. Dare we say that the most serious challenges to the evangelisation of the world are contained in the drivers of the disease: poverty, patriarchy; and our inability to talk honestly about sex and sexuality? If we can galvanise our families, our congregations and nations; indeed communities of nations to follow where we lead; to resource where we serve; and to think as we pray then poverty and patriarchy and drug-pushers and prostitution can begin to be rolled back from our own cities and those of the developing world. 

In those who are HIV+ we see only ourselves. Instead of projecting our own fears and fantasies on them we have the chance of having our own theological health restored by them. We should see the ministry of the church in a world that is HIV+ as the best chance we have of being healed of our sinful patriarchy, our crushing wealth, our hatred of women, our fear of the sick, our denial of death, and our fear of sex and our own inadequacy, impotence and vulnerability. 

As Japhet Ndlovu observes from Zambia, "Jesus brought an image of holiness defined not by its distance from what is considered to be unclean, but by its proximity to it. Into a world so divided and separated within itself came Jesus, who, with the touch of a hand, restored human community."[6] 

How we perceive the body of Christ which is HIV + is how we perceive ourselves. If we are to love our neighbour as our self, and our neighbour, both literally and metaphorically, is affected by HIV and AIDS, this can only bring us back to our selves: to our sexual selves; to our moral selves; and to our gendered selves. It can only bring us back to our own bodily vulnerability and grace. You too will be ill; you too will grow old and dependent; you too will need medication that you may or may not be able to afford. You too will have your body taken from you. If we do not see ourselves as affected by HIV and our churches as responding to it, then it is not those who HIV positive who are liable to Christ's judgement as some first thought 20 years ago. Alas for us who live complacently with AIDS and patriarchy today: for we think we see, and yet are blind. 

[1] Bible study given at POSITIVE: the UK Church Conference on HIV, sponsored by Tearfund and Bracknell Family Church, England 15 March 2008

[2]Musa Dube, Towards an HIV/AIDS-Sensitive Curriculum, WCC Geneva 2003 p.10

[3] "Does the Hebrew Bible Have Anything to Tell Us about HIV/AIDS", in M W Dube, HIV/AIDS and the Curriculum, WCC Publications, Geneva 2003p 24

[4]I first heard this call to action from ANRELA+ in March 2006 at a consultation "Lifting the Veil: Islam, Christianity and the Challenge of AIDS", St George's House, Windsor Castle, England.

[5]Rowan Williams, The Body's Grace, written in 1989 for the Lesbian and Gay Christian Movement and available at http://www.igreens.org.uk/bodys_grace.htm

[6]Timothy Radcliffe, OP, 'This is my body given for you' in Christians and Sexuality in the Time of AIDS, Continuum, Cerf 2007 p63

[7]Ndlovu as quoted in as quoted in Patterson, AIDS related Stigma,WCC 2007 p 2

Learning To Be Church In The Time Of AIDS. 02/07/08

Kenya: From AJANews 69, July 2008

At a Theology Symposium on Ecclesial Witness in the Global World, held in March 2008 at Tangaza College, Kenya, Michael Czerny SJ, AJAN Coordinator, reviewed the experience of the faith community vis-à-vis AIDS.

Man no longer perceives properly, understands properly, desires properly, or acts properly. This lament from Bantu oral tradition, more than just a critique, can be seen as a call to action, to become, as Bernard Lonergan writes in Method in Theology, our true selves by observing the transcendental precepts: Be attentive, be intelligent, be reasonable and be responsible. Each precept takes us further, promoting us from mere experiencing towards understanding, from mere understanding towards truth and reality, from factual knowledge to responsible action. As we learn to be Church in the context of HIV and AIDS, our journey is an ever more exacting application of this mandate for authenticity.

1. Be attentive and show compassion
A leper came up to Jesus and pleaded on his knees: 'If you want to' he said, 'you can cure me.' Feeling sorry for him, Jesus said, 'Of course I want to!' and stretched out his hand and touched him and said, 'Be cured!' And the leprosy left him at once and he was cured (Mark 1:40-41). To touch is to draw near enough to pay attention and listen, not to keep at arm's length or even further. Drawing near, to see the human face of AIDS, without being too afraid of suffering and death, is to show compassion which heals. This We Teach and Do, the Kenya Catholic AIDS Policy, says: Let everything be done, not only with efficiency and professional competence, but also with the hands and mind and heart of Jesus - not just excellent, but clearly Christian.

2. Be intelligent and competent, and really learn to understand AIDS
AIDS is complex; it is not just medical, not just traditional culture, not just women's empowerment, and not just individual behaviour change. AIDS is not the only challenge in Africa, but it is a most serious one and, like a window, opens up on nearly all the others. This We Teach and Do gives a long list of powerful contributing factors, which make infection as well as the onset of AIDS more likely: First of all, grinding poverty throughout Africa, situations of injustice and, in many places, conflict and involuntary displacement. In order to understand HIV and AIDS, we add intelligence, competence and serious research to our opening attention and compassion.

3. Be reasonable, including the good!
Church teaching urges men and women to treat each other as sons and daughters of God. It is not the risk of HIV, which makes sexual licence immoral; the Church does not teach a different sexual morality when or where AIDS poses no danger. But this teaching is not easy for the world to accept. The Church encourages everyone to live an integral sexuality, which means behaving responsibly. All those involved in the Church's ministry - pastorally, in education and in healthcare - should help people to develop a well-formed conscience. This includes the Church's moral teaching as well as solid information about HIV and AIDS.

4. Be responsible and serve
The Church has been responding practically since the beginning. Usually those who first take up the challenge are prophetic, heroic, but gradually the ministry is mainstreamed. Note the process: HIV-and-AIDS-work begins way beyond the pastoral edge; then the Church slowly expands her frontiers, bringing outside issues in and making them her own, in the heart of parish ministries and the commitment of her Bishops. What was out is now in, but slowly.

The Church needs to do more in two senses: first, what she is already doing well needs to be multiplied; secondly, more creative, focused and sustainable responses need to be developed. As we face and fight AIDS, we are becoming the Church which Christ calls us to be. In the words of Cardinal Murphy-O'Connor, Archbishop of Westminster visiting Zimbabwe: It is when caring for the poor, sick and most vulnerable to bring them hope that the Church is at her finest.

Reflection from Cameroon from AJANews. 03/09

AJANews 77 - March 2009

CAMEROON: AN ESSAY
Joseph Désiré Havyarimana SJ is a member of Rwanda-Burundi Jesuit Region and a Masters student in social anthropology at the Catholic University of Central Africa in Yaoundé. An experience shared in AJANews and the writings of a Cameroonian anthropologist prompted him to think about the need for an all-embracing approach to the struggle against HIV and AIDS. Dedicating this entire issue of AJANews to his reflections, we welcome your reactions. 

I often wonder about approaches to the struggle against HIV and AIDS and about how sexual violence figures in. Can one fight effectively against transmission of the virus in situations of sexual violence? What becomes of victims who resign themselves to their fate, bearing consequences of something they never chose in the first place? 

Learning the right questions

The more I read testimonies and outcomes of research, the more I realise that I am not the only one asking such questions. It made me very happy to read the testimony of Winston Mina SJ, a Filipino doctor and then a novice of the Jesuit Missouri Province, in AJANews 70 - August 2008. He believed he had already learned all there was to know about HIV and AIDS but, after working with AJAN, he realised that he had much to learn as yet. His conclusion prompted me to reflect on the challenges of the struggle against the pandemic: 

All my new-found knowledge points to a truth that I did not appreciate before: AIDS is not just a medical problem; it is a complex development and justice issue. Addressing it effectively requires going beyond ARVs and CD4 counts. Employment, income distribution, food availability, education, gender inequality, sexuality, availability and accessibility of health care, peace and order and political stability must be addressed. Given the complexity of the problem, it is imperative that all the different sectors of society and countries of the world come together to control the pandemic. 

Mina pinpoints certain structural causes of the pandemic, which all activities related to the struggle against HIV and AIDS should tackle, rather than merely limiting themselves to routes of transmission of the virus. Too often, we may be led to believe that the abstinence-fidelity-condom trilogy is a miraculous solution and that it is enough to administer this recipe for people to put it into practice. Far from it. The testimony of Mina seeks to disabuse us of such an illusion. 

Somewhat like Mina, I used to believe that I knew quite a bit about HIV and AIDS, until I read and reread a book by Prof. Sévérin Cécile Abega (+2008), an anthropologist, writer and university professor. Abega sought to account for the persistently high HIV prevalence rates in Africa, especially in Cameroon where he undertook his research. The pertinence of his analysis renewed my interest in the problem, especially as regards the advantages to be gained by taking a long-term view, namely to attack the true causes of the expansion of this scourge in Africa. 

The mastery premise

In his book, Les violences sexuelles et l'État au Cameroun (Sexual violence and the State in Cameroon), Éditions Karthala, 2007, Abega identifies the social determinants and factors explaining the pandemic: sexual activity and some of its modalities like multiple partners and not using condoms, male domination of women, and so on. All this gave rise to the creation of awareness-raising tools aimed at encouraging the adoption of minimum risk sexual behaviours as per the abstinence-fidelity-condom trilogy. However, there are grounds to fear that in reality, the success of awareness campaigns based on such tools is limited - this explains the progression of prevalence rates - because the behaviours presume strong self-discipline and a real mastery over one's own body. In other words, abstinence, fidelity and the use of condoms are based on the premise that an individual has mastery over his or her body. But is this always the case? Can one always abstain, be faithful to a faithful partner, even when one desires to do so with all one's might? Has it not been shown, for example, that people who have been sexually abused are more at risk of exposure to unprotected sex, to having multiple partners and to exchanging sex for money or drugs? Has it not been proved that physical violence, the threat of violence or the fear of being abandoned curb the capacity of women to ensure that condoms are used or to break off relationships that they perceive as risky? Certain situations such as inequality, continues Abega, do not allow for the adoption of minimum risk behaviours because they weaken the control a person has over his or her own body. 

Moreover, the oft-cited HIV vulnerability factors, like poverty and gender inequality, are not immediate causes. The primary hypothesis of Abega is that vulnerability to HIV cannot be understood as anything other than the manifestation of historic processes that have been going on since before colonisation up to our time.  

Sexual violence and the State

Abega argues that this diachronic reasoning cannot be complete without a synchronic approach, which understands the causes identified to be manifestations of a larger system, namely the State. He says that research in the human and social sciences adequately proves that violence is endemic in the relations that take shape between the citizen and the State in Africa. Specifically, he contends, it is insertion in administrative structures, the recognition that one is a member of the State personnel, which makes for violence: One is no longer just anybody and may believe oneself untouchable and protected by the State machine being served. This prompts the use of violence in near-total impunity. This violence could thus characterise caring and teaching staff as well as those in other settings like police, prefects and so on. It is also the prerogative of political powers or rather of governments who, lacking real legitimacy, seek to affirm their dominance by resorting to the use of force. This was the case in the first years of independence in Africa, especially in Cameroon. 

Abega believes that such violence is a factor contributing to sexual vulnerability. He affirms loudly and clearly that sexual vulnerability of women and of young people is manifest in Cameroon due to: administrative practices; agents of the State; laws that do not evolve fast enough to take social changes into account; and a system that concentrates political power and money in the hands of an urban elite, while leaving the majority, especially the rural masses, in poverty. Inequality also plays a role, for the hand that receives is always lower than the one which gives, limiting the possibility of negotiating a relationship as equals, including the exercise and control of one's sexuality. Finally, this violence is also that of a failed system which embeds in the language of witchcraft or sorcery the evolutions that seem to cast the established order into doubt, even when this is the outcome of an economic crisis and/or a crisis of values. Needless to say, what is true for Cameroon may well be true for most of sub-Saharan Africa. 

Creating the 'Other'

The point of all this violence, says Abega, is to create the Other. The Other belongs first and foremost to another ethnic group. And if the Other used to be set apart by his race in times of colonisation and apartheid, one may say that the mechanism recurs nowadays with the emergence of new forms of social stratification. Within the State, the Other is not a member of another ethnic group or a neighbouring tribe; he must be determined by mechanisms of hierarchy and stigmatisation. Thus, we witness the creation of a social class which surrounds itself with privileges and creates the Other, in this case a deprived social category. And this enterprise is proven to be successful when it is interiorised by those whom it is suppressing, to the point that the situation appears normal to them. This interiorisation, continues Abega, also occurs on the sexual level. 

The above is convincing. It proposes avenues likely to rein in the expansion of the pandemic in Africa, while showing us that the struggle is much wider than often imagined. The challenge appears to be that of searching for those factors and causes, according to each country, which lead to a loss of control over one's own body; and the aim would be to restore this control to Africans. While Prof. Abega goes back to the pre-colonial period to discover how this control declined down through the ages, Winston Mina points to important factors that are likely to perpetuate this decline today. He suggests that unemployment, mal-distribution of income, unavailability of food and education, gender inequality, unavailable and inaccessible medical care, war, disorder and political instability need to be tackled. These factors create inequality and aggravate vulnerability by putting those who are disadvantaged at the mercy of those who are well off and who at the end of the day decide when, where and how sexual relationships take place. 

Not just a medical problem

It is high time that those involved in the struggle against HIV and AIDS take the analysis and suggestions of men like Winston Mina and Sévérin Cécile Abega seriously, when they say that AIDS is not just a medical problem. The challenge we now face is how to restore to men, women and children control over their own bodies in a world where inequalities are and will remain a reality for a long time. How to restore the value of self-respect in a context where mastering one's sexuality is difficult and no longer a priority for communities preoccupied with daily survival? I believe that Mina's conclusion cited at the beginning provides us with avenues along which to direct our activities. After all, HIV is a matter of development and justice; you cannot have one without the other. Morality would come in only to perfect what would already be perfect. 

And Dr Winston Mina SJ concludes his reflection: AIDS is a problem that robs those afflicted and affected of their dignity and of their humanity, diminishing ours as well. All of humanity, with God's grace, is called to solve this problem. And this, perhaps, is the most important lesson of all.  

AJANews is published by the African Jesuit AIDS Network (AJAN) in English, French and Portuguese and is available free of charge. To subscribe, or to change your e-mail address, please click on Update Profile/Email Address below or write to ajanews@jesuitaids.net. 

Danielle Vella, Editor
Eric Simiyu Wanyonyi SJ and Marcel Uwineza SJ, Associate Editors
Michael Czerny SJ, Publisher

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Towards a Theology of AIDS