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AIDS in
South Africa: Why the Churches Matter
by Sarah
Ruden
http://www.religion-online.org/showarticle.asp?title=2023
South Africa
has the world’s second largest AIDS epidemic (in gross numbers).
Its neighbor, Zimbabwe, ranks first. During the past ten years,
while AIDS has come under control in central African countries
with far fewer resources, the disease has gone out of control in
South Africa, in the richest, most cosmopolitan nation in the
whole sub-Saharan region. An estimated 10 million South
Africans, out of a population of approximately 40 million, will
die of AIDS during the next ten years.
In a recent article in the
New York Times, author Nadine Gordimer expresses views
about the disease that South Africa is eager to promote and that
have wide acceptance in America. Gordimer calls for more money
to develop a vaccine, for Third World debt relief, and for less
military and more public health spending within Africa. She
thinks that, given Africa’s poverty and social malaise, we
cannot condemn the promiscuous sex that is spreading AIDS. And
she concludes by warning of the epidemic’s economic impact,
saying that "the bell tolls for thee, globally."
A critical look at these
ideas might help explain why the epidemic continues to rage in
the part of Africa with the most resources for fighting it. With
a unanimity that invites trust, the scientists working to
develop a vaccine have said that the nature of retroviruses
itself is the main factor holding up an AIDS vaccine. Third
World debt relief would probably not have the intended
consequences. The states receiving this relief would be likely
to use the public money freed up from social welfare demands to
expand their militaries -- and military spending is one of the
things Gordimer deplores. That donor countries have been the
enablers of Africa’s arms addiction has certainly been the
pattern so far.
That the AIDS crisis
threatens Africa’s economic development seems unarguable. In
central Africa during the early ‘90s, AIDS threatened to become
a disease of the middle and upper-middle classes, decimating the
skilled trades and professions. The higher a man’s income, the
greater his access to sexual partners, and traditions of
polygamy encouraged him to take advantage of all his
opportunities. The danger this posed for the region’s economic
future -- a danger reported in the Western press and widely
publicized locally -- contributed significantly to a rethinking
of both public policy and private mores. Most important, this
threat motivated the public to move beyond apparently inadequate
"safe sex" campaigns to more difficult and effective changes. In
Uganda, for example, an HIV test now is required before
marriage, and the social pressure in favor of chastity has grown
markedly.
South Africa
is different. Its white and its thoroughly westernized black
middle class are not very vulnerable to the disease. The case of
Charlene Smith, one of the few white rape victims, became a
media sensation. She was able to obtain the drug AZT as a
precaution against the transmission of HIV, and to prosecute her
attacker and see him sentenced to 30 years in prison to prevent
his carrying out his further threats against her. But destitute
rape victims have no such protections. For this and other
reasons, in South Africa AIDS remains almost exclusively a
disease of the underclass. The prosperous here simply do not
share the fate of the poor to the extent common in other African
countries. The income gap is wider than in any other nation
except Brazil, and the institutional divides left over from
apartheid are immense. Consequently, most of the people on the
favored side of the prosperity gap do not see AIDS as an
eventual or indirect threat to their own well-being.
Almost 35 percent of South
Africans are unemployed. These are the AIDS-vulnerable,
uneducated black and "colored" (mixed-race) poor. Unemployment
is a major reason for the country’s very high rate of violent
crime. Up to 70 percent of the army is HIV-positive. But the
military is being drastically cut back anyway; soldiers of the
next generation will be both fewer and better skilled. Gordimer
cites a prediction that 270,000 out of 1.1 million public
servants will be infected by 2004. But nearly as many, mostly
from the lower ranks, may lose their jobs through the
privatization and rationalization already under way.
Losses of employees to AIDS
are an expense and trauma to American institutions, but not to
those in South Africa, where people who are HIV-positive hide
their condition as long as possible for fear of persecution and
die relatively quickly once they have AIDS, since few
interventions are available to them. Private charities and
extended families take care of the vast majority of AIDS
orphans.
Finally, AIDS has been most
common in the predominantly Zulu province of ZwaZulu-Natal. The
Zulus supported the apartheid regime and are a thorn in the side
of the new government, which is dominated by the Xhosas.
Commercial interests covet the fertile ZwaZulu-Natal farmland
now kept in small subsistence parcels through tribal allotment.
Why would policymakers fear that AIDS would have an economic
impact on the country? It can make economically superfluous and
burdensome human beings disappear.
The above sketch is the only
way I can explain the unusual feebleness of South Africa’s
attempts to deal with the epidemic. "Sarafina II," the
centerpiece of the Nelson Mandela regime’s anti-AIDS campaign,
was a glitzy traveling musical that, because it charged
admission, did not reach most of its target audience --
low-income black youth. The Health Department then tried to
promote Virodene, an industrial solvent with no medicinal
properties, as an AIDS cure, and this led to a vicious fight
with and estrangement from medical authorities.
The new president, Thabo
Mbeki, has become interested in the widely discredited Duesberg
hypothesis that the HIV virus is a fabrication and that AIDS is
really a set of symptoms of poverty or drug use. Mbeki has also
disputed the safety of the widely esteemed drug AZT. He insists
on exploring these issues thoroughly before providing rape
victims and HIV-positive pregnant women with AZT treatment to
reduce transmission of the virus.
Even those who at first
appear more forthcoming tend to have an "all or nothing"
strategy that suggests a basically dismissive attitude toward
the disease. In a recent article in the Cape Argus, Dr.
S. P. Reddy (a "health promotion practitioner and HIV/AIDS
researcher") argued that AZT could save 50,000 to 100,000 babies
a year from HIV. The virus means death before the age of five
for nearly all infected infants. The new drug nevirapine’s
effectiveness is similar to that of AZT, yet the cost is only a
tenth as high, less than $5 per child.
The use of this drug might
seem both humane and affordable. However, some children who
survived HIV would die later anyway from poverty-induced
ailments, Reddy wrote. Why bother with the drug unless South
Africa can provide "housing, education, clean water, health
clinics, health-worker training, and nutritional supplements" as
well? Thus, the "full ramifications [of the drug treatment] must
be carefully researched and costed."
Reddy’s rationalization is
fairly representative of views popular with the government and
the development elite, who strive to keep the international and
local media’s attention on South Africa’s AIDS crisis in order
to foster foreign aid and grass-roots projects. When I asked a
community worker in Cape Town’s squatter camps what ordinary
people were saying about AIDS, she replied, "They think it’s a
way for people to get jobs." There is a breath of truth in this
version of an AIDS conspiracy theory.
A subcategory of the "all or
nothing" approach is purveyed by organizations like Planned
Parenthood, which teach "life skills" in the hope that young
people will become sexually prudent as part of an integrated
improvement in their lives. Participants in programs get
information, encouragement in self-esteem and training in social
interaction, but no actual prescriptions for behavior. Also,
community health workers distribute contraceptives and treat
sexually transmitted diseases on the spot. The workers are
carefully chosen as ethnically and culturally similar to the
people they work with, and trained to communicate within their
milieu instead of imposing alien ideas.
The planners seem to have
imbibed from the study of population control (especially the
notorious coercion used in China) a dogmatic opposition to
"targeted" approaches. Their scruples are commendable, but
whereas failure to promote contraception means unwanted children
and overpopulation, failure to combat AIDS means mass death. Can
organizations say with equal conviction in both cases that
clients should simply be free to choose, with no pressure of any
kind?
AIDS is not causing, nor is
it likely to cause, an economic crisis in southern Africa. That
is the real reason why the epidemic is not being dealt with
effectively there. Perhaps half-consciously, certainly
imperceptibly to Western media, a narrowly economic
understanding of public welfare is allowing millions of people
to die. What’s neeeded is a call to action based on what the
epidemic actually is: a humanitarian catastrophe resulting
mainly from irresponsible sexual behavior. Against South
Africa’s cultural and economic background, the only hopeful
efforts to mitigate and control AIDS that I see are coming from
the churches.
Churches feel obligated to
make spending money on medical care a priority, even if the only
outcome is likely to be the temporary relief of suffering. The
South African Council of Churches has helped to establish a
number of home-based AIDS care groups. These relieve
overcrowding in hospitals, allow for the dignified treatment of
patients and help destigmatize the disease. The churches
undertake unglamorous charity work such as collecting food for
AIDS victims and their families and caring for children with
AIDS and AIDS orphans, as in Cape Town’s Nazareth House, a
Catholic outreach.
Education efforts are mostly
in the early stages, but are growing rapidly. Many churches have
fitted their traditional teachings about chastity and monogamy
into programs to fight the disease. One example is the ZAP AIDS
Project, under the auspices of Catholic Welfare and Development.
ZAP AIDS does its work in public schools, prisons, churches of
many denominations, and shelters for street children.
Denominations are not
unanimous in their definitions of sexual morality, but their
disagreements are limited to questions that, in Africa, have
little to do with AIDS. Homosexuality is a contentious issue
within the Council of Churches, but in South Africa homosexuals
are a relatively low-risk group for AIDS. (Arguing this, an
actively homosexual man recently went to the Human Rights
Commission and won the right to donate blood.) Another question
is whether condoms should be available to those who do not
accept monogamy. Even the liberal churches strongly urge
monogamy, though not insisting on legally binding or
heterosexual unions.
The "safe sex" controversy
is perhaps the most unfortunate distraction in the fight against
AIDS, not least because it has restricted cooperation among the
churches. The more permissive of the mainline churches staunchly
defend condoms, a resource that has been important in combating
AIDS in the industrialized world. But the use of condoms is at
odds with some aspects of African culture. In many regions of
southern Africa, men prefer dry sex, and some women even take
pains to dehydrate their vaginal canals. Without natural or
artificial lubrication, condoms tear and come off.
Though the Western myth is
that the Catholic Church in the Third World is retarding public
health measures for the sake of a theological nicety, that is
certainly not the case on this continent. African men’s
resistance to condoms is already considerable. Condoms are
imported by the ton and given away by the double handful -- and
hardly used. In TB eradication campaigns, the overreporting of
people’s cooperation with medical advice is measurable (chemical
tests show whether patients have taken their pills or not) and
quite high. If appropriate adjustments were made to the
statistics for reported condom use (in the few programs that
actually follow up distribution with surveys), the already
modest numbers would shrink to practically nothing.
Reasons for not using
condoms vary in Africa, as they do everywhere, but one is
particularly strong. African men, the decision-makers with most
of the power, tend to believe even more than do African women
that sex is for procreation. Activists paddle upriver in working
against this belief, and they must work against it in promoting
condoms, the most confrontational of modern birth control
methods.
The churches would do better
to forget about condoms and put their energies into what they do
have to offer, which they themselves fail to appreciate fully.
Their stance for chastity and monogamy, often labeled as
"unrealistic," is actually much better suited to African
culture, especially in its present troubled condition, than are
modern Western teachings about sexuality emphasizing personal
freedom and individual development.
For many women in southern
Africa today, heterosexual intercourse is either coercive or
deceitful in some way. Either a woman is actually raped (South
Africa has the highest rate of rape in the world; the rumor of
the "virgin cure" has sent male AIDS patients on the hunt for
younger and younger girls to rape), or she is pressured socially
and economically. Women do not believe they have the right to
disobey men, and wives and girlfriends are desperately dependent
on their men. Extreme poverty may force women to become
prostitutes in order to survive. And many women do not know and
are afraid to ask whether a man has other partners.
A nurse and midwife who
routinely deals with AIDS in families lamented the effect of
anarchic sexual practices on the spread of the epidemic. She was
especially concerned about the attitude of young men. Xolisa,
15, said that she and her friends were regularly harassed,
chased and grabbed, sometimes in public. "They try to drag you
inside -- you have to get away," she said. As a veteran of
Planned Parenthood education, she was fully aware of and
articulate about the danger of AIDS, but she was facing that
danger alone. The police were "useless," she said, as the media
also assert.
Xolisa and other young
people I spoke to confirmed that parents typically retain the
traditional notion of choosing spouses for their children, but
put it into practice only to the extent of refusing to meet
boyfriends and girlfriends or even acknowledge that there could
be any. (An alarming custom is for the parents of a teenage boy
to build him a small, private hut behind the family home;
girlfriends can meet him there, unseen by his family.)
Young people are thus left
to negotiate their relationships without guidance from the
people most interested in their welfare. Peer pressure,
heavy-handed seduction and rape are the outcome, with
predictable victimization of young girls by older boys and grown
men. AIDS spreads more easily from men to women than in the
opposite direction, and traumatic sex, with the tearing of
tissues, is the easiest route to sexual transmission.
The most reassuring message
to a typical African girl is that her community will protect her
from early, chaotic sex and that she will be able to marry a man
indoctrinated against adultery and raise her children in safety.
Trying to get someone so powerless to "take responsibility for
her sexuality" is a cruel joke. With family and tribal
structures pathetically weakened by colonialism and apartheid,
and the government inept and indifferent, the only institution
even seeking to make these all-important promises is the church.
Though these promises cannot always be kept, they are far more
practical than projects to "foster every individual’s right to
his or her own unique development" -- projects that make no
sense in the African context.
A return to chastity would
be a return to a workable African society. Gordimer states that
"promiscuity is difficult to condemn when sex is the cheapest or
only available satisfaction." That is an obstacle only insofar
as human activity is a laissez-faire marketplace. That
marketplace begins to turn into a community when people insist
that all its members have a future to protect, so that it is
unacceptable for any to behave irresponsibly.
Muslims as well as
Christians have strict views on sexual conduct, and even
animists are expressing their desire to restore older mores.
(Credo Mutwa, a leader of traditional healers, appeared in the
Cape Argus recently speaking of ancient practices
involving voluntary quarantine, which he claimed defeated
earlier waves of venereal disease introduced by colonial
forces.) But the Christian churches are strongest and best
positioned, and therefore bear the greatest responsibility for
demonstrating what can be done.
What the churches are doing
is not enough to contain the epidemic, but they are ensuring
that many of their members survive it. Keith Benjamin of the
South African Council of Churches reports that in a group of 25
clergymen interviewed, not a single one had had to deal with a
congregant who was an AIDS patient. He sees the clergy’s
distance from the disease as unfortunate, but I think that he
has missed the good news. Among those who feel bound by it, what
the churches say about sex is life-saving.
Ironically, a
disproportionate amount of the credit goes to conservative black
churches with no AIDS programs and no specific AIDS message --
the churches regularly accused of having their heads in the
sand. Most black churchgoers belong to these denominations. (The
Zionist Church alone has 3.9 million members; this single
institution keeps nearly one out of ten South Africans
relatively safe from the new plague.) Lucy is a 26-year-old who
attends the Gospel Church of Power in Guguletu, a squatter
settlement near Cape Town. She said her church had nothing to
say about AIDS. No one in the church had AIDS. All its members
were very strict about marriage.
Some churches do go too far,
and ostracize the few AIDS sufferers they have to deal with. In
the mainline churches, certain parishes have refused pastoral
care to victims and their families. Some of the conservative
black churches have an actual policy of exclusion, which extends
to a ban on church burial. This is, of course, inexcusable for
any people professing to follow the teachings of Jesus -- but it
is somewhat understandable, given the churches’ own weakness and
exclusion in South Africa. The apartheid government shut down
mission institutions and defamed religious proponents of racial
equality. Churches’ commitment to nonviolence (and in some cases
refusal even to take sides) diminished their influence with the
liberation movement, and consequently with the new government,
if not the whole new polity.
But the absence of economic
incentives to fight AIDS might make an observer feel, apart from
any moral, sectarian or theological considerations, that a
religious revival alone can save South Africa from eventually
consigning perhaps a third of its population to death. This is
my own conclusion, although I am a Quaker, a member of a sect
that is liberal and tolerant almost to the point of being
secular and that frowns on proselytizing. I simply see in this
part of the world the greatest practical need for churches to do
what they ordinarily do, and to do more of it.
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