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Confronting the stigma of HIV/AIDS

By Douglas John Hall

We are walking down a road in the business section of Caboa in Manila, the Philippines. The offices are closed. It is night, but the darkness cannot cover up the grime on the streets. And people are everywhere.

Old men and men made old before their time are curled up on dirty rags in doorways. Jeepneys and pedicabs hustle people here and there. Street vendors squat by trays of cigarettes and candies. Bare-bottomed babies cling to their mothers. Canteens offer boiled eggs and grilled meat. The air is heavy with the smell of diesel fumes and garbage. Teenaged girls clustered in stairwells laugh and chat. Skinny young men eye the white strangers.

Five young women lead us through this maze, stopping here and there to introduce us to friends. Teenagers, mostly, though some are older. The women greet each other with boisterous hugs. It's community. Shy smiles and raised eyebrows voice their unspoken questions: What do we want? Why are we here? They pause to meet us, then return to their work. This is the red-light district in Manila. Business is booming.

Picture this: a young woman, anxious and weeping, stands before her father, a very religious man. "Father," she says brokenly, "I am HIV-positive." He says nothing, but leaves the house with a resolute expression on his face. Some hours later he returns with a coffin, which he places in the living room. "You have sinned and the wages of sin are death," he says. "Now then, die!" The woman's death within two weeks is undoubtedly hastened by her dramatic rejection by the family patriarch, a staunch Christian.

As one of 36 Christian theologians invited by the United Nations to attend a consultation in Namibia last December, I heard many such stories. It was the first-ever UN-sponsored meeting of Christian theologians. Most historic churches were represented, as were all the continents, though Africans were more numerous. The majority of the world's more than 40 million people living with HIV and AIDS live in sub-Saharan Africa.

We were to address the stigmatization of people infected with this disease - a growing concern for everyone involved in the struggle against it. As the most recent report of UNAIDS and the World Health Organization states: "Stigma and discrimination undermine prevention by making people afraid to find out whether or not they are infected, and discourage people from adopting preventive measures, such as insisting on condom use during sex, that might be interpreted as an acknowledgement that they are HIV-infected."

The report continues: "Stigma and discrimination also create a false sense of security that undermines prevention efforts.... By associating HIV/AIDS with groups of persons perceived as 'outsiders,' people harbour the illusion that they themselves are not at risk of becoming infected."

The reality is that religion itself is a major cause of stigmatization and discrimination. That was the challenge facing us as theologians in our five-day deliberations among the ancient hills outside Windhoek, the Namibian capital. Have the churches contributed to the stigmatization that prevents agencies like UNAIDS from stemming the spread of this modern plague? And have Christians the means, perhaps hidden in neglected aspects of their own Gospel, of correcting the "bad theology" that has led to such stigmatization?

The document that emerged from our meetings, HIV and AIDS Related Stigma: A Framework for Theological Reflection, says yes to both questions.

* * *

A young South African Anglican priest, Johannes Petrus Heath, HIV-positive for the past decade, brought us a rare understanding of the religious sources of discrimination, gained through his own pain. Advised at first to keep quiet about his condition, Heath found his real vocation required he reveal it; his calling entailed making himself available as priest to others living with the same reality. Today he co-ordinates a network of religious leaders living with HIV/AIDS in South Africa.

Heath has evolved a formula to explain the warped logic of discrimination: "AIDS equals SEX equals SIN equals DEATH." Heath told us the poignant incident of the young woman and her father to illustrate that "logic." The young woman with the virus, being unmarried, had engaged in illicit sex. She was therefore a sinner, and deserved to die.

For such religion, the progression from sex to sin to death is exquisitely visible in the case of HIV/AIDS, since the "sinful" act contains within itself the actual means of its punishment.

Quite possibly the poor young woman's father didn't even ask if she had consented to sex. Quite possibly she had not, for a great many of those infected are victims of male domination and rape; or dirty needles, or infected blood transfusion.

What kind of theology of sex, sin, and divine judgment is assumed when such "logic" is applied by Christians? First of all it is a "debased theology," in the words of the Windhoek document, which assumes that sex is an inherently questionable aspect of human nature even perhaps in marriage, unless it is undertaken for procreation. It sees sex under the heading of original sin.

While biblical faith never assumes that human sexuality is problemless, the document insists that "God created us as sexual human beings in all our differences. This is to be celebrated, enjoyed and treated responsibly.... God created us for one another and for God, and wants us to celebrate the gift of sexuality through which God's Creation unfolds."

Negative attitudes towards human sexuality, fostered by sub-Christian denigration of the body, are enormous barriers. As Dr. N.M. Samuel puts it, "if only the bite of a mosquito caused HIV/AIDS, then the Christian community would be in the global forefront of the struggle for prevention and care."

Christians do not have to overlook the complications and vulnerability of sex; but when we are unable to affirm it as integral to our very existence as creatures of God, we end up with an unbiblical split between body and soul - with the body as the problem. Instead of Gospel, our message takes on the colour of a petty moralism that puts sexual matters at the top of its catalogue of vices.

* * *

Secondly, if the formula "AIDS equals SEX equals SIN equals DEATH" is a bad theology of sex, it is an even worse theology of sin. I suppose one shouldn't be surprised by that. Sin is probably the most misunderstood word in the Hebraic-Christian vocabulary. The profound biblical term has been reduced to "sins," nasty little "thoughts, words and deeds" that can be categorized, confessed, and set straight ritually. Conveniently for the self-assured, people too can be categorized, and stigmatized, on the basis of their deviation from the norm.

But this is the most egregious misunderstanding of sin. In the Bible and the best theological traditions it is understood as broken relationship. In the words of the Windhoek document, "biblical faith understands sin relationally, namely as the breaking of our essential relatedness to God, to one another, and to the rest of creation. Sin, therefore, is alienation and estrangement, and infects us all."

Indeed, sin is a gracious concept, for it puts everyone into the same boat: "There is none righteous, no not one," says Paul (Rom. 3:10). In fact, if sin is broken relationship, then it is most visible in our vilification of others. "After all," says the Windhoek statement, "the sinful attitudes most frequently identified by Jesus as being incompatible with His Kingdom were pride, self-righteousness, exclusivity, hypocrisy and the misuse of power - all of them ingredients in the deadly cocktail that causes stigma."

* * *

Third, and perhaps most insidious, the false theology that moves from sex to sin to death betrays the very essence of our faith's conception of God, by presenting God's attitude towards humankind as one of uncompromising and dispassionate judgment. That there is judgment in the love of God as revealed in Jesus Christ none but sentimentalists would deny; but it is a restorative, not a retributive judgment. God does not desire the death of the estranged, but their reconciliation and fullness of life. The whole thrust of the Gospel is lost if the compassion and grace of the God of Bethel and Bethlehem is replaced by a deity who favours the death penalty.

"It is wrong to interpret HIV/AIDS (or other human catastrophes) as God's punishment for sin," states the Windhoek document, "and the judgmental attitudes that result from this interpretation undermine the church's efforts at care and prevention. It is also theologically unsustainable, a fact demonstrated powerfully in the Book of Job and the healing narratives of the Gospels. In reflecting on the connection between HIV transmission and sin, it is important to remember that many people who become infected bear no responsibility for their condition: babies born with the virus, abused women and children, and faithful partners of unfaithful spouses."

Refusing to follow the "logic" that leads from HIV/AIDS to inevitable death has another, highly practical side. It has been amply demonstrated that contracting the virus does not lead inexorably to death. If the appropriate drugs are available, and adequate nutrition provided, carriers can live well beyond the limits predicted earlier. A more authentic theology, backed by the just distribution of global resources, can alter dramatically the future course of this whole episode in human history.

The economics of the situation are obvious, for it is no statistical accident that the greatest growth of HIV/AIDS sufferers is found in the South, and among impoverished groups in the North. The quest for a better theology, however, is not incidental. Until something can be done about stigmatization, many persons with the virus - hopeless and fearful of ostracization by their communities - will fail to seek help until it is too late.

* * *

The Windhoek document should be studied, although it has one or two weaknesses, as might be expected of a consultation involving diverse ecclesiastical and geographic groupings. One is its failure to tackle religious attitudes towards prevention, with particular reference to the use of condoms. Here, I think, the commitment of the Roman Catholic hierarchy and others to theologies of sexuality that effectively exclude sexual activity as part of the sheer joys and necessities of creaturely existence, has resulted in a grave omission. It is wonderful that Christians are active in the care of the millions of children born with AIDS or orphaned by it. But an ounce of prevention is worth a pound of cure.

Another lack has to do with the report's failure to address the association of HIV/AIDS with homosexuality. While in the developing world (and increasingly in the more affluent nations of the North) sexual transmission of the virus is most often through heterosexual contact, no one group is more stigmatized than those oriented towards their own sex, especially gay men.

The great strengths of the Windhoek document are:

- Its readiness to confess the theological failures and misconceptions of the churches, its boldness in naming "debased theologies" of sexuality, sin, and divine justice, and its quest for alternative understandings of central themes of Christian faith;

- Its determination to base its finding, not on entrenched ecclesiastical dogma, but on Scripture. The central claim of the New Testament is that Jesus, in his teaching, his life, death and resurrection, is the lens through which Christians must try to comprehend the world and act responsibly.

In confronting the horrendous reality of discrimination against those who bear the brunt of this epidemic, Christians could do no better than to meditate long and hard on the following sentences from the Windhoek report: "In the Cross of Jesus, God enters the suffering creation to heal it from within. Jesus showed solidarity with us, and compassion. On the Cross Jesus died, stigmatized and outcast, beyond the city walls."

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