A woman living with HIV reads her Bible in a small village in southern India.
When international experts on HIV and AIDS get together every two years, there’s a lot of science speak, with seminars and workshops ranging from new vaccine trials to the testing of a vaginal ring that appears to dramatically lower the risk of HIV infection in women.
Yet at the 2016 International AIDS Conference, held in July in Durban, South Africa, it was clear from the very first day that science can only do so much. Combatting racism, sexism and poverty are just as important as developing new pharmaceutical weapons. South African actress Charlize Theron made that clear in the opening plenary when she declared, “AIDS does not discriminate on its own. It has no biological preference for black bodies, for women’s bodies, for gay bodies, for youth or for the poor. It doesn’t single out the vulnerable, the oppressed or the abused. We single out the vulnerable, the oppressed, and the abused. We ignore them. We let them suffer. And then we leave them to die.”
AIDS isn’t going away any time soon, despite advances in lifesaving antiretroviral treatment for those who can access the drugs. Indeed, the disease is rebounding in some populations, fueled by ignorance, lingering stigma and the false belief that the wily virus no longer represents a serious public health emergency.
Faith’s role in ending AIDS
In a presentation to religious leaders gathered for the conference, a top United Nations official warned against complacency.
“At the same time we are saving more lives than ever, the AIDS epidemic is coming back. It is rebounding and reemerging everywhere. The difference now to what we saw in the past is that the epidemic is much more selective. It is affecting the ones you faith leaders care most about, the ones left behind, the last and the least in your societies. This is the modern shape of the AIDS epidemic,” said Luiz Loures, the deputy executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and assistant secretary-general of the United Nations.
Mr. Loures said the medical and scientific communities need to go beyond traditional approaches as they respond to the new challenges, and faith communities must play a central role.
“It’s not just medicines and what happens in clinical wards and health centers that will solve this crisis. At the end it’s about how we approach people, about ethics, about what brings us together to work for better societies, societies that our children will be proud to live in,” he said.
In several parts of the world, religious groups provide a huge proportion of health care; in some countries of sub-Saharan Africa, it’s more than half. Mr. Loures said the churches’ focus on community-based health care usually works “faster and cheaper” than other responses to AIDS, and he praised the closeness of faith communities to affected populations. He said the recent Ebola outbreak in Africa proved the churches’ ability to respond quickly.
“Readiness is a new concept. Children who need treatment can’t wait. They’ll die first if we don’t take action. Readiness is related to proximity to people, and during the Ebola crisis the churches’ health workers were on the front lines and paid a high price for taking risks,” Mr. Loures said.
Much of the discussion among religious leaders at the conference centered around how faith-based organizations can contribute to a surge in testing and treatment among children in the next five years. Known as “Fast Track,” it recognizes that if the struggle against HIV only grows at the same rate as the past five years, the epidemic will outpace this resistance and grow markedly worse. Any hopes of ending AIDS as a significant public health issue by 2030—the international goal—will quickly fade.
“Science and treatment on their own are not enough. We cannot just treat our way out of this epidemic. We need to address the social determinants that are driving the stigma and discrimination to prevent people from getting tested and staying on treatment,” said Sally Smith, the senior advisor for faith-based organizations at UNAIDS.
“We know that the faith communities are central. In many of the countries where we have a high prevalence of HIV, they provide a large proportion of the health care. And religious leaders are determinants of what is provided in those health centers. They are also gatekeepers of public opinion about stigma, and they can also mobilize those communities to take up testing and treatment. Or not.”
Continuing the work
The phrase “AIDS fatigue” has crept into the lexicon of AIDS workers in recent years, despite giant leaps in fighting the disease.
“After 35 years of responding to an emergency, it’s hard to go that last mile,” Ms. Smith said. “People in the north and the west have witnessed how the treatment of HIV means the disease no longer rapidly kills people in their teens and 20s and 30s. It has gone off the radar. At the same time there are massive migration issues in Europe and other things grabbing the media’s attention. Responding to AIDS seems like an old issue to many people. Yet it is just at this critical point where we have the medicine and science to end the epidemic as a public health threat that the interest and the funding are disappearing.”
The Rev. Phumzile Mabizela, a Presbyterian pastor in South Africa who heads an international network of HIV positive religious leaders, says silence has become the next major challenge. “Although stigma has been reduced, it’s now silence that is rampant. This type of quiet withdrawal and disengagement is worse than the overt stigma, which we could deal with,” she said.
The dramatic reduction of mother-to-child transmission of HIV, something made possible by aggressive testing and treatment of pregnant women in recent years, means that many children are alive today who would have died in the early decades of the epidemic. Yet Deborah Birx, the U.S. government’s global AIDS coordinator, says we shouldn’t abandon those children now.
Of particular concern, she told religious leaders at the Durban conference, were girls “one-third to half of whom are no longer in school because their families can’t afford it or because they have to work in a household. And we know that for one-third of young girls in sub-Saharan Africa, their first sex is forced or coerced. So a third of our young women that we’ve saved from HIV are being raped in their communities. These are the issues that we have to talk about. We have to challenge the culturally accepted practice that girls are not in high school and that young girls are raped within their communities.”
According to the Rev. Dr. Nyambura Njoroge, an AIDS activist for the World Council of Churches, responding to such challenges means religious groups must strengthen their pastoral support for survivors of abuse. “We need intergenerational communication on sex and sexuality between parents and children and grandparents,” she said. “We address sexual and gender violence and yet we lack the skills to support the survivors of sexual and gender-based violence, especially the girls who are raped and end up with HIV. This is a major gap for us and demands long-term commitment and accompaniment.”
Outreach and in-reach
Churches play a key role in combatting the AIDS epidemic on the ground, says the Rev. Godson Lawson, a Methodist pastor who once served as the denomination’s leader in Togo. Today he’s an advocate for fighting the disease and the ignorance that fuels it.
“As African churches, we have to work more closely with youth and adolescents on this. We have to revisit our youth programs and introduce teachings about HIV in our Sunday school activities,” Mr. Lawson said. “We have deacons and deaconesses and women’s fellowships that we can use to sensitize people in the cities and the countryside and in the local congregations.”
The church can best respond to the AIDS crisis, Mr. Lawson says, by rethinking its mission.
“We need to update our theology, which in much of Africa comes from the 15th century. Sex workers, for example, are also women and men created by God, and they merit our love and compassion, not rejection and scorn. I’ve been working with sex workers in my country, visiting their workplaces, and I’m working as a chaplain with an organization of more than 4,000 gay people. Next week we’re going to deepen this discussion with a conference for gay people and church leaders from Benin, Cote d’Ivoire and Togo,” he said.
Such outreach to marginalized sectors of the population is a critical component of mission, Mr. Lawson says.
“We are taught as church leaders to stay in the pulpit and wait for people to come to us. Instead, we have to go to where they are and see how we can share their suffering that comes from stigma and discrimination. Gay men are in our churches and families, lesbians are in our churches and families. We need to listen to them and journey together with them so that they can have full access to their rights and so that those who are HIV-positive get the full treatment to which they are entitled,” he said.
Jennifer Ferariza Meneses went to the AIDS conference from the Philippines, where she serves as executive secretary and officer in charge of the Board of Women’s Work of The United Methodist Church. She says she listened in Durban to many stories of people who had struggled not only with the virus that causes AIDS but also the rejection of the community around them. It was often the religious community that finally offered them acceptance and safety. Ms. Ferariza said she came home to the Philippines equipped with new ideas and strategies for improving the response of church and ecumenical groups there.
And she’s ready for the struggle against AIDS to remake the church. “We give moral support and provide services for people living with HIV and AIDS. Yet people of faith continue to stigmatize and discriminate against them. Through the Durban conference, I came to a wider and deeper perspective that HIV is about justice. HIV is about gender inequality, gender-based and sexual violence, poverty and human rights. With 39 million HIV cases globally, a number that increases every single day, we must recognize that HIV is on our doorsteps, in our workplaces and our places of worship,” she said. Ms. Meneses is a United Methodist Women scholarship recipient and attended the 59th session of the United Nations Commission on the Status of Women as part of the United Methodist Women delegation.
Ms. Ferariza said faith community groups have long discussed the efficacy of their extensive outreach work among people living with or affected by the virus. “But the faith community must also do something about its ‘in-reach,’” she said. “Because HIV is not only about the people living with the virus. It’s about us, too. It’s about a new way of being church, deconstructing our theological framework and practices into more liberating and transforming theology and acts of faith. It’s about replacing our moral judgment with an all-embracing and affirming attitude. Addressing HIV is an imperative of our Christian faith, a serious work of creating safe spaces where we can nurture a community of Shalom.”
Another religious leader attending the Durban conference was Thabo Makgoba, the Anglican archbishop of Cape Town. He stopped by an interfaith networking area in the conference’s Global Village one day and chatted with people there.
The Global Village was a wild maze of displays, booths and discussion areas sponsored by special interest groups representing all sorts of people touched by AIDS. Right across from the interfaith area was the networking zone for sex workers. As he left the interfaith area, Mr. Makgoba stopped and introduced himself to the women.
Among those who shook hands and spoke with the archbishop was Babalwa Matikinca, an educator who runs support groups in the Eastern Cape for the Sex Workers Education and Advocacy Task Force (SWEAT). She says the church needs to cross into their world more often.
“Sex workers are often operating in hideaway zones, their work unknown to their family because there is a lot of stigma. They feel alone. The church should be a place where they can find comfort and support to help them cope. Just like Jesus, who, when people wanted to stone a sex worker, said that only those who hadn’t sinned could do it,” she said. “Jesus loves these women. His church should be a place where they feel welcome. They are responsible women, working hard to support their families.”
Mr. Makgoba’s visit provoked some new conversations. Lyn van Rooyen, director and project manager of the Christian AIDS Bureau of Southern Africa, which provides training about HIV and AIDS to groups around the world, sat down to talk with some of the women the archbishop had met, and they agreed to a series of future encounters between sex workers and pastoral agents.
Along with injecting drug users and men who have sex with men, sex workers are a key demographic in the struggle against AIDS. Stigmatizing or criminalizing them are widely seen as counterproductive, yet for some religious leaders with narrow limits on acceptable behavior, reaching out to these and others at the margins has stretched their understandings of sin and grace. Crossing from their well-defined religious space to the world where real people struggle isn’t easy.
God, however, would appear to have already made the journey. Ms. Matikinca says the SWEAT office in Cape Town already has a weekly support group for Christian sex workers, where participants share their struggles and pray for one another. The women run the group themselves.
Paul Jeffrey is a United Methodist missionary and senior correspondent for response. He blogs at kairosphotos.com.