with people living with HIV/AIDS organizations:
Chapter 1 Introduction
This document has been written to accompany
World Council of Churches, Partnerships between Churches and
People Living with HIV/AIDS Organizations: Guidelines, (2005).
Whereas the partnership document explores the question of why
churches should work with People Living with HIV/AIDS (PLWHA)
organizations and networks, this document has a focus on how
churches may work with PLWHA organizations and networks. For
example: What issues do you need to think about? What are the
needs of PLWHA? How should you interact PLWHA? It is hoped that
this document of practical suggestions will assist in helping
make partnerships functional and effective.
Chapters two and three look at some of the
issues which confront churches and PLWHA organizations in their
attempts to forge partnerships. Essentially this is an appraisal
of the point churches and PLWHA organizations are at now. Many
of the issues described are testing the compassion and HIV and
AIDS competency of churches and often there are no easy answers.
For examples, issues such as HIV prevention, including
prevention inside marriage and abstinence before marriage, and
human sexuality, including same-sex relations, have the
potential to divide churches and to create obstacles to
partnerships with PLWHA and between faiths. Even if some
positions are contentious or unpopular, churches need to be able
to articulate their positions logically and coherently.
Similarly, PLWHA organizations are also
faced with an array of issues some of which may be divisive such
as how to respond to PLWHA who knowingly put others at risk of
exposure to HIV; HIV-positive husbands and partners who force
themselves on their wives or partners; and in some regions,
inter-generational sex as a perceived method of curing HIV
Acknowledging these difficulties and
working towards a common understanding with partners, is one
step in defusing the divisive nature of some of these challenges
and perhaps finding solutions. Defining boundaries means that
both parties can see what is possible and what is not; thereby
creating clarity when making decisions.
While chapters two and three provide
background on churches and PLWHA organizations, chapter four is
the heart of the document. Chapter 4 provides concrete
information on an array of issues which may need to be addressed
in working with PLWHA organizations. Particularly note worthy
are the sections on confidentiality, tokenism, capacity
building, and monitoring and evaluation. A recurrent theme is
the role of churches in advocating for access to treatment,
including anti-retroviral therapy.
Boxes are used throughout the text to
highlight specific issues or to provide examples of projects or
programmes or partnerships that have been successful. The
illustrative material in this document comes from a number of
existing studies and reports. One of the benefits of increased
cooperation and the development of partnerships between churches
and PLWHA organizations will be a growing body of knowledge of
how to work together and work through periods of uncertainty,
discontent and perhaps even confrontation. This will strengthen
the partners involved as well as churches and PLWHA
The Annexes contain sections on a self
assessment framework for AIDS competence, the correct use of
HIV- and AIDS-related language, the Covenant Document on
HIV/AIDS and human capacity development.
Please note that the full texts of the
declarations by churches on HIV listed in Box one ?List of
Declarations and Policy Statements by Churches and Faith-based
Organizations from 2001 to 2004? are available on the World
Council of Churches website at
http://www.ecuspace.net/contact.nsf. If you do not have access
to internet; you can obtain copies from:
Dr. Manoj Kurian
Programme Executive, Health and Healing
World Council of Churches
1211 Geneva, Switzerland
Tel: +41 22 791 63 23
Fax: +41 22 791 61 22
Chapter 2: Looking inside …
This chapter looks at some of the issues
which confront churches and PLWHA organizations in their
attempts to forge partnerships.
The section on churches acknowledges the
transition that has occurred in many churches but questions
whether words have been translated into actions. The section
also highlights the practical difficulties that can occur in
involving PLWHA and different strategies or initiatives to
eradicate HIV-related stigma.
With regards to PLWHA organizations, the
section highlights the diversity of people captured under the
term “PLWHA” and charts the history of the PLWHA movement both
before and after the formulation of the Greater Involvement of
PLWHA (GIPA) Principle at the Paris Conference, 1 December 1994.
It also highlights some of the taboo subjects in relation to
PLWHA and suggests that partnerships with churches will enable a
dialogue to find solutions to these difficult subjects.
2.1 Looking inside your church
Covenant 8: Church, PLWHA and HIV/AIDS 1
We shall remember, proclaim and act on the
fact that we are one body of Christ and if one member suffers,
we all suffer together with it; that the Lord our God identifies
with the suffering and marginalized and heals the sick (1
Corinthians. 14:26; Matthew 25:31–46). We shall, therefore,
become a community of compassion and healing, a safe place for
all PLWHA to live openly and productively with their status.
As many good ideas can suffer face
insurmountable obstacles if people begin on the wrong foot, both
churches and PLWHA organizations need to be prepared to work
together before commencing the common journey of a partnership.
Many PLWHA have been stigmatized in their communities and
discriminated against institutionally sometimes by churches. The
perceptions that churches condemn sinners and promote very
narrow guidelines on HIV prevention have created negative
popular views in many people in some regions of the world of
churches and their response to HIV. There is a need for
reconciliation for the individual, but also between individuals,
and between individuals and their churches. For this to be
possible churches and PLWHA need to be able to listen and be
open, humble, forgiving and most of all capable of showing true
A climate of denial regarding HIV and AIDS
issues has affected, and in some cases continues to affect, some
churches and faith-based organizations. For example, the
Siyam’kela study, South Africa found that this was especially
the case in more middle-class Christian congregations, as well
as the Muslim-faith community, which did not believe that HIV
and AIDS was a problem in their communities. 2
As was outlined in the introduction of the
accompanying document World Council of Churches, Partnerships
between Churches and People Living with HIV/AIDS Organizations:
Guidelines (2005) churches are in many different places in
responding to HIV; some are still in denial. While many churches
and faith-based organizations have begun the proverbial trek
across the Red Sea or are struggling in the wilderness. AIDS
raises many issues for churches – some of which have previously
been taboo or extremely difficult to confront, for example, from
sexual abuse and violence, rape, incest and infidelity, drug use
as well as death and dying to accepting the innate sexuality of
every human being. As discussed in chapter three, churches are
faced with an array of issues around HIV prevention, sin and
sexuality. In some respects, it is not surprising that twenty
years into a global pandemic, churches are still struggling with
how to respond.
Many churches have implemented a wide range
of interventions, mainly focusing on interventions and
programmes to provide care and support to PLWHA – traditional
responses by churches. Faith-based organizations have responded
to the specific needs of PLWHA in terms of material support such
as nutritional programmes and the distribution of food parcels,
setting up support groups for faith community members who were
living with and affected by HIV and AIDS, as well as pastoral
care. Churches have also formed support groups and prayer
Where possible, faith-based organizations
have attempted to respond to the health care needs of PLWHA in
the form of home-based care or establishing hospices in the
community. The provision of antiretroviral therapy is also
becoming a reality. The Pontifical Council for Health Pastoral
Care estimates that 26.7% of the centres dedicated to treating
HIV/AIDS in the world are Catholic centres 3. However, such work
is dependant on the funding and having relevant trained
Religious leaders can be sensitive to the
needs of PLWHA and are beginning to play a major role in
promoting a culture of acceptance and respect for PLWHA,
including notions of responsibility and tolerance 5. Provision
of spiritual and moral care to those living with and affected by
HIV and AIDS is often needed because people may experience a
range of difficult emotions, including fear of death,
depression, suicidal ideation, guilt, anguish, anger, denial,
shock, rejection and isolation arising from stigmatization6.
Thus, for example, one faith leader in the Siyam’kela study,
South Africa, suggested that the church could facilitate the
emotional healing of a person who has learnt that they are
HIV-positive by providing a ‘humane and loving’ environment
through, for example, pastoral counselling and prayers 7.
Given the newness of HIV and AIDS as a
serious endeavour for churches and/or congregations, some
churches like many governments and other organizations, made
mistakes in their initial response, which contributed to
HIV-related stigma and discrimination. In 2001 Canon Gideon
Byamughisha pointed out that, It is now common knowledge that in
HIV/AIDS, it is not the condition itself that hurts most
(because many other diseases and conditions lead to serious
suffering and death) but the stigma and the possibility of
rejection and discrimination and loss of trust that HIV-positive
people have to deal with 8. Some churches and individuals still
stigmatize HIV and discriminate against PLWHA; however,
overwhelmingly churches have made, and are making, great efforts
towards breaking the stigma both within their church and in
society more generally. The extent of such change is extremely
variable across regions, and between and within churches. There
can also be different reactions between church leadership and
church members. Sometimes leaders are moving faster than their
flock and sometimes a stubborn bishop stops his members from
acting in a Christian way. As an example of the variability of
responses, see the reactions described in box two “Jamaica
Council of Churches drafting policy on HIV/AIDS” below.
From 2001 onwards there have been a series
of declarations and policy statements from various churches’
governance bodies. The most significant ones are listed in the
Box 1: List of Declarations and Policy
Statements by churches and faith-based organizations from 2001
to 2004 9
All Africa Conference of Churches, Mukono -
Kampala Declaration. Mukono - Kampala, Uganda, 15–17 January
Church of Norway, Statement from the
Bishops’ Conference. April 2001
All Africa Conference of Churches, The
Dakar Declaration. Dakar, Senegal, 23–25 April 2001.
Southern African Bishops Conference. A
Message of Hope to the People of God from the Catholic Bishops
of South Africa, Botswana, and Swaziland. Pretoria, South
Africa, 30 July 2001.
Anglican Communion across Africa. All
Africa Anglican AIDS Planning Framework "Our Vision, Our Hope"
The First Step. Johannesburg, South Africa, 22 August 2001.
The Ecumenical Response to HIV/AIDS in
Africa (EHAIA). Plan of Action, Global Consultation on
Ecumenical Responses to the Challenges of HIV/AIDS in Africa.
Nairobi, Kenya, 25–28 November 2001
Christian Conference of Asia, Consultation
on HIV/AIDS: A challenge for religious response: Statement.
Chiang Mai, Thailand, 25–30 November 2001.
The Lutheran World Federation, Compassion,
Conversion, Care: Responding as churches to the HIV/AIDS
pandemic. An Action Plan of the Lutheran World Federation, 18
Anglican Primates, Report of the Meeting of
Primates of the Anglican Communion: Appendix III Statement of
Anglican Primates on HIV/AIDS, Canterbury, United Kingdom, 17
Pan-African Lutheran Church Leadership,
Breaking the Silence, Commitments of the Pan-African Lutheran
Church Leadership Consultation in response to the HIV/AIDS
pandemic. Nairobi, Kenya, 2–6 May 2002
World Council of Churches (WCC) and
Christian Conference of Asia (CCA). Report of the WCC-CCA
Consultation on ‘An Ecumenical Agenda to combat HIV/AIDS in
South Asia’. Colombo, Sri Lanka, 24–26 July 2002.
Council of Anglican Provinces in Africa
(CAPA). Statement from CAPA AIDS Board Meeting. Nairobi, Kenya,
19–22 August 2002.
World YWCA. Executive Committee. Geneva,
Switzerland, November 2002
World YWCA. Executive Committee: HIV/AIDS
Policy. Geneva, Switzerland, November 2002
Lutheran World Federation, Latin America
Regional Consultation on the Lutheran World Federation Plan of
Action, “Compassion, Conversion, Care” - Justice, conversion and
integration, Catia la Mar, Venezuela, March 2003.
Primates of the Anglican Communion.
Pastoral letter from the Primates of the Anglican Communion. 27
Council for World Mission. Assembly
Statement. Ayr, Scotland, 15–25 June 2003
Lutheran World Federation, Adopted version
of message from the Tenth Assembly, Winnipeg, Canada, 21–31 July
World YWCA. World Council Resolution:
Reproductive Health and Sexuality. Brisbane, Australia, July
Norwegian Church Aid. HIV/AIDS, A policy
statement from Norwegian Church Aid. Approved by NCA Board 29
Symposium of Episcopal Conferences of
Africa and Madagascar, The Church in Africa in face of HIV/AIDS
Pandemic, Message issued by Symposium of Episcopal Conferences
of Africa and Madagascar (SECAM), Dakar, Senegal, 7 October
East - Central Africa Division of
Seventh-day Adventist Church. East - Central Africa Division
(ECD) of Seventh-day Adventist (SDA) Church Regional Workshop on
HIV/AIDS. The Nairobi Declaration. Nairobi Kenya, 10–13 November
Church of Nigeria (Anglican Communion).
Communiqué, National HIV/AIDS Strategic planning and policy
development workshop. Abuja, Nigeria, 10–14 November 2003.
Interfaith: Christian Conference of Asia,
World Council of Churches, Christian Aid, Norwegian Church Aid,
United Evangelical Mission, Church of Christ in Thailand AIDS
Ministry and Ecumenical Coalition on Tourism, For we are
Neighbours: Statement from the Interfaith AIDS Conference,
Bangkok, Thailand, 20–25 November 2003.
Catholic Bishops of Myanmar. Pastoral
Letter on HIV/AIDS and the Response of the Church. December 2003
Indian Catholic Bishops. Pastoral Letter
from Indian Bishops for World AIDS Day 2003: The challenge to be
his Light today.1 December 2003.
Lutheran World Federation and the United
Evangelical Mission, "Covenant of life"- Statement of Commitment
of the Asian Church Leadership Consultation on HIV/AIDS, Batam
Island, Indonesia, 1–4 December 2003.
Memorandum of Intention, Strategy
consultation on Churches and HIV/AIDS in central and eastern
Europe. St. Petersburg, Russia, 15–18 December 2003.
Romanian Orthodox Church. His Beatitude
Teoctist, Patriarch of the Romanian Orthodox Church. A message,
urging to love and tolerance for those suffering from AIDS/HIV.
Romania, 27 January 2004.
Regional Meeting facilitated by the Latin
American Council of Churches (CLAI) and supported by the World
Council of Churches (WCC), The Church and HIV/AIDS in Latin
America and the Caribbean, Panama City, Panama, 27 January–1
World YWCA. YMCA Global Capacity Building
Forum on HIV/AIDS: Strategic Framework for a Global YMCA Action
Plan on HIV/AIDS. Durban, South Africa. March 2004.
World YMCA. YMCA Global Capacity Building
Forum on HIV/AIDS: YMCA Movement Statement on HIV/AIDS. Durban,
South Africa. March 2004.
World Council of Churches’ Pacific Member
Churches, The Nadi Declaration: A statement of the world council
of churches’ Pacific Member Churches on HIV/AIDS. Nadi, Fuji, 29
March–1 April 2004.
World YMCA. Recommendations on HIV/AIDS
adopted by the World Alliance Executive Committee. Hong Kong, 2
The United Methodist Church. Global AIDS
Fund Resolution – Adopted by 2004 General Conference.
Pennsylvania, United States, 27 April–7 May 2004
The United Methodist Church. Drugs and AIDS
Resolution – Adopted by 2004 General Conference. Pennsylvania,
United States, 27 April–7 May 2004
Asian Muslim Action Network, Asian Resource
Foundation and Thai Muslim Network. International Pre-conference
Muslim Workshop on HIV/AIDS. In the name of Allah, the
Beneficent, the Merciful. Bangkok, Thailand, 9 July 2004.
Provincial Anglican Bishop. Communique, The
Province of Central Africa Bishops Retreat, Malawi, 13–14 July,
United Evangelical Mission, Anti HIV/Aids
Programme Policy, Adopted by the UEM General Assembly in Manila,
Latin America, Message from Churches,
Organizations and Programmes on World AIDS Day 2004, Women,
Girls and HIV/AIDS. 1 December 2004.
Interfaith. International Interfaith
Conference on Prevention and Control of HIV/AIDS, Delhi
Declaration. Delhi, India, 1–2 December 2004
The Cairo Declaration of Religious Leaders
in the Arab States in Response to the HIV/AIDS Epidemic. Cairo,
Egypt, 11–13 December 2004.
In the history of HIV and AIDS there have
been literally hundreds of declarations made by PLWHA
organizations locally, nationally and internationally, by
nongovernmental organizations (NGOs), the UN and governments,
few of which have been put into effect. Declarations can be ways
of directing the attention of a church to an issue. The question
for churches, who want to be seen as credible and accountable,
is whether all the time, energy and money expended in gathering
leaders together and formulating declarations really leads to
concrete coherent actions in countries and parishes, which in
turn have measurable effects on the lives of people.
Most declarations highlight that churches
and church and ecumenical organizations are grappling with the
HIV- and AIDS-related stigma. An effective way of moving from
declarations to implementation of intentions is to find concrete
and sustainable ways of working with PLWHA and their
organizations. This can form an indicator for monitoring and
evaluating the partnership.
• Is your parish or church
updated on declarations made by its leaders?
• What has been done in your
parish to implement the points in the declaration made by your
• Who in your parish or church is
responsible for following up on the implementation of the
commitments made in the declaration?
The example offered below in box two
“Jamaica Council of Churches drafting policy on HIV/AIDS”
illustrates how churches in Jamaica and in the wider Caribbean
are responding and highlights the difficulties in countering
Box 2: Jamaica Council of Churches drafting
policy on HIV/AIDS 10
Several church leaders admitted that their
biggest obstacle to getting an HIV/AIDS outreach going in their
community was the stigma and discrimination against persons
infected with the disease. They (churches) are not getting a
favourable response from the community, programmes officer for
the Jamaica Council of Churches (JCC) HIV/AIDS project, Ainsley
Reid, said. People (clergy) are excited and willing to do
something, but in rural Jamaica there is a big challenge because
of the stigma that exists at the level of the community.
He said that pastors and lay leaders
participating in a workshop in St James had their own
'misconceptions' about the disease and how it is contracted. The
December 2004 workshop was the second of four being hosted by
the Jamaica Council of Churches to sensitise more than 140
clergy and lay leaders island wide about HIV.
The JCC's work is part of a bigger project
which started in June 2003, involving a number of
inter-religious organizations in 13 other CARICOM territories.
The project, called "Building a Faith-Based Response to HIV/AIDS
in the Caribbean", is being spearheaded by the Caribbean Council
of Churches with a Canadian$ 2 million grant from the Canadian
Development Agency (CIDA). A major component is the formulation
of a set of guidelines that will guide churches in the region in
developing their own intervention strategies.
An inter-religious HIV/AIDS policy
committee, convened by the CCC in May this year, is now
preparing a document outlining "Guidelines for Caribbean
Faith-Based organizations in Developing Policies and Action
Plans to Deal with HIV/AIDS".
Many different strategies are required to
counter stigma. Box three “Strategies for Hope Trust: What can I
do?” describes a new video, designed to combat HIV-related
stigma, shame, discrimination and denial in churches. The video
features Rev. Canon Gideon Byamugisha from Uganda – one of the
first African priest to disclose his HIV-positive status. For
more information on Rev Gideon, see box 20 “Canon Gideon
Byamugisha – the Anglican Church stands behind its pastors” in
Reducing stigma involves a wide variety of
activities, many which churches and faith-based organizations
are already involved in. Box four on the “Church of the Province
of Southern Africa HIV programme” highlights this – the goal is
to be achieved through the sum of all the component activities.
Box 4: Church of the Province of Southern
Africa HIV programme, 2003–2006 11
The Christian Aid supported CPSA programme
is ambitions and complex – attempting to challenge stigma and
discrimination within the church and wider community and support
a wide variety of HIV care and prevention programmes. Although
churches in Africa often have relatively conservative views and
have sometimes been instrumental in promoting stigma and
negative attitudes to PHWLA this programme aims to counteract
these views. In the 6 countries (and 26 dioceses) in which it
works there are a wider range of approaches with some dioceses
having more active involvement of PHWLA and have more developed
programmes. The challenge is to support all dioceses to develop
and expand their work, and working with the African Network of
Religious Leaders Living with or personally affected by HIV/AIDS
(ANERELA+) is seen as key to this.
As of June 2004, the programme had
recruited and trained CPSA HIV staff and set up an HIV office to
manage the programme. Twenty-three dioceses in six countries had
been supported in their HIV work and helped to access other
sources of funding. In addition, they were assisted in
strengthening ecumenical and interfaith dialogue and
collaboration. Training was given to clergy and lay leadership,
and was assisted closely by ANERELA+. CPSA has now embarked on a
program to actively support and encourage members living with
HIV into fuller involvement in the program, starting with a
residential retreat planned for later in 2005, in which ANERELA
will be playing a leading role.
Workplace programmes and policies are being
developed to protect the rights of church workers, clergy and
lay leaders living with HIV and AIDS. Information on access to
social grants has been developed, and linkages have been
established with other churches and faith-based and community
See “From Boksburg to Canterbury - Steps to
Putting HIV/AIDS on the Anglican Map”
Even though many faith-based structures are
now beginning to realize the importance of encouraging openness
and realism in responding to HIV and AIDS; religious communities
still have a long way to go, especially when it comes to
actually understanding how to communicate about HIV and AIDS in
all aspects of their work. It is not sufficient to set up a
network or a self-help group of PLWHA; if the religious
community continues to stigmatize in other areas. Norwegian
Church Aid (NCA) experienced a striking example of such a
situation as described in box five below.
Box 5: Destigmatizing HIV within a church –
internal communications 12
Norwegian Church Aid (NCA) supported a
large faith-based organization, working in a very poor urban
area, to set up a self-help group for PLWHA. The group met
regularly once a week at the church campus. As stigma and
discrimination was a serious problem in this area, the group
soon became very popular and was appreciated by PLWHA as a
“refuge”, a place for receiving support and for joint
A striking feature of the group was that it
mainly consisting of men and women over 35–40 years of age, even
though the HIV prevalence in the area was very high among young
adults 18–24 years of age. How come they never showed up at the
group? After some informal chats with group members, the reason
was clear. Just up the street, the church was running some
vocational training programmes and income generating activities
for urban poor. It turned out that PLWHA were not admitted to
these programme. In other words, the younger PLWHA could not
afford to be associated with the PLWHA group and had to conceal
their status, as they were dependent on the training and income
from the activities in order to sustain themselves and their
families. When the church leaders were confronted with this,
they were aware of the practice. They had not realized either
the ethical dilemma or the mixed messages that the church was
Similarly, a UNAIDS sponsored Theological
Workshop Focusing on HIV/AIDS Related Stigma in Namibia,
December 2003, stated:
In relation to HIV and AIDS, experience has
shown that the best form of prevention is truthful education.
This applies to ‘truths of fact’ (what HIV is, how it is
transmitted, how it can be prevented, and what will happen if a
person becomes infected); but it also applies to ‘truth of
meaning’, which is a theme which churches are well fitted to
explore. ‘Truth of meaning’ relates to the meaning of suffering,
the nature of sin, the relationship between life and death, and
the search for the mind of God.
There is an urgent need to build
communities that are welcoming, supportive and capable of
breaking the silence about HIV and AIDS. Many churches are
committed, in principle, to doing this. But it is hard to see
how they can succeed without some painful soul-searching at the
level of the institutions themselves, as well as of their
hierarchies, clergy and members. For churches, truth-telling may
involve an acknowledgement that they have been party to
stigmatisation. They may have advocated ‘bad theology’ or failed
to challenge it. They may have condoned a climate of silence and
denial at institutional level, diluted or misrepresented the
facts in their educational programmes, failed to provide strong,
prophetic leadership, and been responsible for the poor moral
example which sometimes exists within the churches themselves.
It must be remembered that Jesus was particularly critical of
religious people when he caught them out in hypocrisy 13.
If churches are to engage effectively with
local, regional and international responses to the epidemic,
then issues of stigma and discrimination have to be confronted,
not just at the level of church organization and practice, but
also by Christian theology itself: at the level of what is
taught in seminaries, what academic theologians lecture, write
and think about, what the faithful believe and do, and what
values inform the pastoral formation of clergy and lay people
14, But this puts great pressure on those who teach in these
contexts, who may know little or nothing about HIV or AIDS, and
whose own background and training is unlikely to have provided
them with the tools for reflecting theologically upon it 15.
There are some practical materials available which are written
specifically on a theological response to HIV/AIDS 16; however,
more churches need to develop curricula with input from the
lived experience of PLWHA that focus on a theology of
compassion, support and healing related to HIV/AIDS and which
discusses judgement and condemnation.
Finally, the struggle for humanity is to
celebrate differentiation by enabling it to be equally enriching
in community. Unless Church leaders are willing to be with the
stigmatized publicly and consistently, then our actions will not
be credible or effective 17.
2.2 Looking inside the PLWHA movement
Around the world, when HIV has appeared,
PLWHA have often established networks or groups of self-help,
support and empowerment as well as organizations, generally
based on the notion of “positive living”, which involves the
• Looking after spiritual health,
for example asking the divine for strength, meditating, praying
or seeking pastoral counselling.
• Looking after mental health,
for example, joining self-help groups, sharing feelings with
family and loved ones, including children, thinking positively
and renewing reasons to live.
• Making good health choices, for
example, getting medical help whenever ill, eating nutritious
food, drinking plenty of water, practising good hygiene, taking
extra rest when needed, avoiding smoking, alcohol and drug use,
protecting the health of others by not exposing them to HIV
infection, and taking antiretroviral therapy if medically
indicated (this assumes that it is available).
• Putting worldly affairs in
order, for example, making peace with others, arranging for the
care of children and making a will.
• Living as normally as possible,
for example working for as long as possible, spending time with
friends and family, and staying active in religious,
professional and community organizations.
Many people, both HIV-positive and others,
recognize the importance of such a response to both a HIV
diagnosis and an impaired immune system. It is striking a
balance between life and the reality of death. Yet this response
has sometimes been ignored or belittled by policy-makers and
medical professionals. PLWHA have fought for their involvement
in making decisions about their own health care, policy debates
on both national and international HIV-related issues, and
particularly on access to treatment
In June 1983 in Denver, United States, a
movement of PLWHA emerged 18. The ‘Denver Principles’ adopted at
the forum called for those living with HIV to be supported when
they opposed AIDS-related stigma and discrimination.
These principles gathered greater support
over time and were formally recognized in the principle of the
Greater Involvement of People Living with HIV/AIDS (GIPA) signed
by 42 countries at the 1994 Paris AIDS Summit. The countries
agreed to support an initiative to “strengthen the capacity and
coordination of networks of PLWHA and community-based
organizations”. They added that, “by ensuring their full
involvement in our common response to the pandemic at
all—national, regional and global—levels, this initiative will,
in particular, stimulate the creation of supportive political,
legal and social environments”. The governments also undertook
to “ensure equal protection under the law for PLWHA” 19.
In 2001, the United Nations General
Assembly Special Session on HIV/AIDS in the Declaration of
Commitment endorsed the GIPA principle 20, which was further
upheld in the Guiding Principles of the “3 by 5” Treatment
Initiative, which aims to provide three million people with
antiretroviral therapy by the end of 2005 21.
In section “4.4 Tokenism”, the texts of
declarations and strategic plans by churches and faith-based
organizations, which require or promote the involvement of PLWHA,
are set out.
Despite these pledges and commitments, the
active involvement of PLWHA in decision-making relevant to their
lives is still far from universal. Furthermore, the involvement
of HIV-positive women, youth and children has lagged far behind
that of men in most parts of the world. One constraint is that,
globally, only about 10% of PLWHA know their seropositive
status, and many other PLWHA are unwilling to be open about
their status because of fear of discrimination and stigma.
PLWHA organizations also have their
limitations and weakness. Firstly, the majority of PLWHA do not
belong to PLWHA organizations, which raises the issue for both
the church and PLWHA organizations of how to bring PLWHA into
some form of support group. Secondly, how do church and PLWHA
organizations respond to angry, isolated or desperate PLWHA who
knowingly put others at risk of HIV infection or, in some
regions, who may have sex with virgins in the belief that this
will cure HIV infection? How do church and PLWHA organizations
respond to authoritative, HIV-positive husbands or partners who
insist that their wives or partners provide unprotected sex?
Such acts are the effects of unjust social structures and
stigmatized, isolated, rejected and silenced PLWHA. Partnership
with PLWHA organizations will offer both PLWHA and churches a
way forward, through creating an environment where discussion of
taboo subjects can take place and cooperation on finding
solutions for HIV- and AIDS-related stigma that places many
PLWHA in distressing situations.
PLWHA organizations face challenges like
any other grouping of people. Unfair and discriminatory power
dynamics can occur within the PLWHA organizations. For example,
women in some support groups headed by men, often complain that
public roles are given to men and that women are allocated jobs
which do not pay much or are or given the unpaid jobs.
Similarly, orphaned girl-children face greater challenges due to
their gender and age. As a group, they are likely to be
subjected to sexual violence, exploitation, human trafficking
and face greater possibilities of dropping out of school due to
work commitments, forced marriages or teenage pregnancy. Women
and grandmothers who are HIV-positive due to their gender may be
hindered from HIV education, access to information, services and
resources Other challenges are associated with class, race, age,
ethnic and sexual orientation.
Power struggles can lead to open jealousy,
competition and conflict of interest may occur. In most
countries; there is a history of internal fighting within PLWHA
organizations, and conflict between organizations. While this is
wasteful of time and resources, normally, the PLWHA movement
that has evolved has been strengthened, though the cost is high.
Unfortunately, this appears to be a normal part of the evolution
of PLWHA movements.
PLWHA needs are not uniform – they reflect
the diversity of PLWHA. PLWHA include HIV-positive infants,
prisoners, orphans, widows, single women, migrants, poor or
unemployed men or women, people dying from AIDS-related causes;
older people, men who have sex with men, injecting drug workers,
commercial sex workers, care-giving grandmothers, recipients of
blood and blood products – in short PLWHA come from a broad
spectrum of society. All these groups of PLWHA have different
needs and they may form different organizations to reflect and
address their particular experiences and needs, and may require
particular forms of partnership.
The International Community of Women Living
with HIV and AIDS (ICW)22 was formed as a result of women’s
needs to have a support network which reflects their needs and
experiences. In 2003, the UN Secretary General, Kofi Annan,
established a task force to investigate the impact of HIV/AIDS
on women and girls. This was part of a movement, which included
the 2004 World AIDS Campaign focus on women and girls 23, and
the formation of the Global Coalition on Women and AIDS
initiative24. In 2004, the World AIDS Campaign slogan “Have you
heard me today,” highlighted the unique and complex burdens of
HIV and AIDS experienced by women and the girl-child due to
their gendered identities 25. To help churches grasp the plight
of many woman around the world; the Ecumenical Advocacy Alliance
developed liturgy that encouraged the use of a poetic prayer,
highlighting biblical women and their experiences, tying it
together with the stories of contemporary women as shown in the
Box 6: Have you heard me today? 26
Woman 1: I am Eve, the bone of your bone,
and the flesh of your flesh.
Woman 2: I am Sarah, the woman who calls
you Lord and master.
Woman 3: I am Hagar your maidservant; your
unofficial wife, expelled from your house.
Woman 4: I am Leah, the woman you married
against your will.
Woman 5: I am Dinah your only daughter who
is raped by Shechem.
Woman 6: I am Tamar, your desperate widow
who plays the sex worker.
Woman 7: I am Ruth, your young widow
sleeping at your feet, asking for your cover.
Woman 8: I am Bathsheba, raped by your king
and married by the same.
Woman 9: I am Vashti, your wife banished so
that all women can obey husbands.
Woman 10: I am the Levite’s concubine,
raped by the mob and cut up by my lover.
We are the broken women of the Hebrew Bible
We are broken women in a broken world.
We are women searching for our own healing.
Have you heard us today?
Woman 11: I am Mary, the pregnant woman
with no place to go.
Woman 12: I am the Samaritan woman, with
five husbands and none for her own.
Woman 13: I am Martha, the woman who is
cooking while you sit and talk.
Woman 14: I am Mary, the woman who silently
anoints your feet with oil.
Woman 15: I am the street woman, washing
your feet with my tears.
Woman 16: I am the bent over woman, waiting
for your healing touch.
Woman 17: I am the bleeding woman,
struggling to touch your garment of power.
Woman 18: I am Anna, the widow praying for
liberation in your temple
Woman 19: I am the persistent widow in your
courts, crying, “Grant me Justice.”
Woman 20: I am Jezebel, the demonized
woman, blamed for all evil.
We are women of the Christian Testament.
We are broken women in a broken world.
We are women searching for our own healing.
Have you heard us today?
Woman 21: I am the woman in your home, I am
Woman 22: I am the woman in your house, I
am your lover, your live-in girlfriend.
Woman 23: I am the woman in your life, I am
Woman 24: I am a woman in your workplace, I
am your secretary.
Woman 25: I am a woman in your streets, I
am your sex worker.
Woman 26: I am a working woman in your
house with no property of my own.
Woman 27: I am the woman in your life with
no control over my body.
Woman 28: I am the woman in your bed with a
blue eye and broken ribs.
Woman 29: I am the woman raped in your
house, streets, offices and church.
Woman 30: I am the woman in your church,
cooking, cleaning, clapping & dancing.
We are women of the world.
We are Women of Faith.
And we are secular women.
We are women seeking for our own healing
Have you hear us today?
Similarly, Young Positives came into being
to address the needs of young HIV-positive people 27.
Chapter 3: Challenges for churches
This chapter explores in depth issues
related to prevention such as the position of women and condom
use for serodiscordent couples. The ‘ABC’ approach to prevention
– Abstain, Be faithful, use Condoms – is discussed and
particularly what “B” – be faithful, could mean if the church
was more involved in the sex lives of its congregation. An
alternate model to the ABC preventive approach is also provided.
Further sections explore the relationship
between sex, HIV and sin, the need for churches to be open and
positive about sexuality and pre-marital HIV testing. The final
section focuses on drug use, and particularly injecting drug
use, as a mode of HIV transmission.
Many of these issues are testing the
compassion and AIDS competency of churches; often there are no
easy answers. These issues have the potential to create
obstacles to partnerships with PLWHA and between faiths. Even if
some positions are contentious or unpopular, churches need to be
able to articulate their positions with reason and coherently,
so that all partners know where they stand in a relationship.
While the material presented does specifically refer to
partnerships with PLWHA, it has been presented so that churches
and PLWHA organizations have clear statements of different
churches positions and the theological underpinnings on an array
of contentious issues.
3.1 HIV Prevention – sexual transmission
Churches and faith-based organizations
continue to debate what constitute appropriate HIV prevention
messages. While there is uncertainty regarding what the content
of prevention messages should be, the caring and support role of
faith-based communities in relation to HIV and AIDS is broadly
accepted. For example, the Catholic Church and the Seventh Day
Adventist Church 28 are heavily involved in providing medical
care for PLWHA.
Covenant 1: Life and HIV/AIDS prevention 29
We shall remember, proclaim and act on the
fact that, the Lord our God created all people and all life and
created life very good (Genesis 1–2) We shall, therefore,
seriously and effectively undertake HIV/AIDS prevention for all
people - Christians and non-Christian married and single, young
and old, women and men, poor and rich, black, white, yellow, all
people everywhere-, for this disease destroys life and its
goodness, thus violating God's creation and will.
The Siyam’kela study suggested that as many
churches are struggling with how to deal with prevention,
churches have found a safer response in providing for PLWHA’s
welfare, in line with the traditional role of the church as a
‘carer’. It’s a very difficult one. I don’t know for how long we
will be emphasising the problem of care and support and not on
prevention. Because I think churches tend to want to address
caring for the sick. I think that is important, but what do we
do to make sure we have methods that will help prevent the
spread of the virus? Faith leader 30
Indeed this perspective has long been
viewed as a theological misfit. Dube writes:
There is no doubt that as a church we pride
ourselves for our care- giving roles. We visit the sick, we pray
for them, we counsel them and their relatives; many times we
take care of the sick—we wash them, we pray for them, we feed
them and when they die we bury them. We are also there for the
orphans, doing all that is within our power to help. But the
problem with our excellent ‘care programmes is that they lack an
equally effective prevention programmes. This unbalanced
approach castes the church (and its leadership) as an
institution that focuses on symptoms. We only come in to manage
crisis, but we do not deal with the root problem. What is even
more problematic with this care-oriented picture is that it
seriously puts doubts in our theology of respect for life, if at
all it exists. If we really respect all life as sacred, if we
really regard every human being, Christian or non-Christian, as
made of God’s image—shouldn’t we demonstrate this theological
stance by designing programmes that make us effective
instruments in the prevention of HIV/AIDS as well? 31
The overarching prevention messages
conveyed by churches and faith-based organizations are in line
with religious teaching, that is, demanding abstinence before
marriage and faithfulness within marriage. Box seven
“Prevention: as addressed in Declarations” outlines the position
and commitments of various churches around the world on some HIV
prevention issues. Some of messages give life to the deeper
issues of developing greater respect for one’s own body and for
the bodies of other persons, especially persons with whom one
engages in intimate relationships.
THE pastoral challenge of the Church in
Africa, I suggest, is to develop a pastoral approach that forms
and informs our people so that, in the depths of their being,
they can decide about HIV – rather than being its victims in a
passive or fatalistic manner. Instead of saying things like
“AIDS happened to me” or “I didn’t know I was getting HIV or “I
had sex but it wasn’t really my decision,” to take their stand
as Christian youth and adults.
What I am expressing is an ideal, not a
judgement, and I recognize that there are people, especially
girls and women, who really have been victimized. But I am
convinced that people can say “no” to HIV and AIDS, and I pray
that from now on the Church will do everything necessary so that
our people can decide maturely and responsibly. If they learn
consistently to say “no,” HIV/AIDS will go away.
Let us help young people to learn about
their bodies, about the drive to develop strong and even
intimate relationships with others, along with the discipline
needed to prevent those relationships from becoming manipulative
or exploitive. Let us form consciences according to traditional
Church teaching and promote appropriate interventions that
strengthen the family, reinforce healthy norms, protect youth
and encourage abstinence and mutual fidelity in an effective and
sustainable manner. Let us try to reach the whole man and every
man, since HIV/AIDS is an affair of the integral person: body,
soul, mind and feelings, sexuality, family and community,
relationships. Whether single or married or widowed, priestly
celibate or vowed religious, the fundamental choice is whether
to remain faithful or not 32.
The Symposium of Episcopal Conferences of
Africa and Madagascar also placed such an emphasis, stating:
Besides teaching the morality of the Church
and sharing her moral convictions with civil society, and
besides informing and alerting people to the dangers of
HIV-infection, we want to educate appropriately and promote
those changes in attitude and behaviour which value abstinence
and self-control before marriage and fidelity within marriage
On World Aids 2004, Cardinal Javier Lozano
Barragán, President of the Pontifical Council for Health
On many occasions John Paul II has
addressed this question and has provided us with illuminating
approaches that throw light on the nature of this disease, its
prevention, the behaviour of patients and those who look after
them, as well as the role that civil authorities and scientists
should perform. I would like to emphasise his thinking as
regards the immunodeficiency of moral and spiritual values and
the accompanying of AIDS victims, to whom full care and services
should be provided because they are the most in need. In
particular, in his message for the World Day of the Sick 2005,
the Holy Father emphasises that the drama of AIDS is a
‘pathology of the spirit’ and that for it to be combated in a
responsible way it is necessary to increase prevention through
education in respect for the sacred value of life and formation
as regards the correct practice of sexuality 34
Box 7: Prevention: as addressed in the
declarations of churches
In 1987, The World YWCA resolved that The
World YWCA Council urge national YWCAs to establish programmes
providing preventive health education on the subject of AIDS 35.
The Seventh Day Adventist Church in 1990,
stated: “Adventists are committed to education for prevention of
AIDS. Adventist support sex education that includes the concept
that human sexuality is God's gift to humanity. Biblical
sexuality clearly limits sexual relationships to one's spouse
and excludes promiscuous and all other sexual relationships and
the consequent increased exposure to HIV” 36.
Tthe Plan of Action formulated by the
Ecumenical Response to HIV/AIDS in Africa (EHAIA) stated
concerning prevention 37:
1. We will promote effective means of
prevention, practices that save lives, and behavior that
minimizes the risk of infection. In doing so, we will support
the churches' historic commitment to faithfulness and
abstinence, while recognizing that life may present us with
contexts in which these ideals are unachievable.
2. We will always lift up, as the priority,
those who are most vulnerable to the risk of infection, people
living with HIV/AIDS, and those persons who are more broadly
affected by HIV/AIDS.
3. We will encourage networking (among
churches, faith-based organizations, international and
non-governmental organizations, institutions of higher
education, and governments) which aims to build relationships,
and which maximizes the benefit and efficiency of prevention
4. We will promote voluntary testing and
counseling. These play an important part in HIV education,
offering constructive advice on life-protecting behavior, and
clearing the way for resolutions regarding abstinence and
faithfulness. They also help to overcome stigma. As churches,
however, we will engage in dialogue and question the practice of
mandatory testing (pre-marital and other forms) and its
consequences for the person who is diagnosed as HIV-positive.
5. We will encourage and support creative
prevention programs. These might include, clubs in parishes,
schools and hospitals, especially for girls, and the utilization
of schools as information and counseling centers.
The Pan-African Lutheran Church Leadership
We commit ourselves to prevention.
We commit ourselves to examine attitudes
and behavior that can cause
harm to our neighbor in the light of our
We commit ourselves to taking a strong role
to ensure prevention of HIV by assisting in efforts to reduce
the spread of the pandemic.
We will speak the truth about the spread of
HIV/AIDS and its prevention including the behavior change that
We will not stand in the way of the use of
any effective methods of prevention.
Listening to the Spirit of Truth, we make
this commitment with the help of God.
The Council of Anglican Provinces in Africa
(CAPA) stated 39:
Prevention saves lives.
We are committed to teaching our children
and their parents life-preserving skills to inhibit the virus
that causes AIDS. The time for preparation for sexual maturity
is well before adolescence and the onset of sexual activity. Our
energies must focus on our daughters and sons at an early age.
While we know that information alone cannot save lives,
information and action can.
Lutheran World Federation in the message
from the Tenth Assembly stated 40:
Therefore, we commit ourselves and call on
member churches to further awareness regarding prevention of the
HIV/AIDS pandemic through education and information, including
speaking-out against harmful, abusive and exploitative sexual
practices, treating sexually transmitted diseases, promoting
faithfulness in marriage and advocating effective means of
prevention (e.g. abstinence, use of condoms, sterilized needles,
clean blood supply).
The Interfaith: Christian Conference of
Asia stated, “It is our common understanding that we should
speak openly about the basic facts of the HIV/AIDS crisis and
about all effective means of prevention” 41.
The Message issued by Symposium of
Episcopal Conferences of Africa and Madagascar stated 42:
Let’s change behaviour.
Besides teaching the morality of the Church
and sharing her moral convictions with civil society, and
besides informing and alerting people to the dangers of
HIV-infection, we want to educate appropriately and promote
those changes in attitude and behaviour which value abstinence
and self-control before marriage and fidelity within marriage.
We want to become involved in affective and sexual education for
the life to help young people and couples discover the wonder of
their sexuality and their reproductive capacities. Out of such
wonder and respect flow a responsible sexuality and method of
managing fertility in mutual respect between the man and the
This type of education can only be
undertaken effectively with the active collaboration of lay men
and women who not only speak about principles of morality but
also, as youth and as couples, give living testimony that
fidelity to these moral principles yields a humanising and
fulfilling affective and sexual life. Such education also
contributes to promoting healthy and stable families, and these
are the best prevention against AIDS. Organizations 43 which
specialise in such education for young people and for couples
exist throughout Africa and are having a small but gratifying
degree of success. We give them the support and encouragement
The Lutheran World Federation and the
United Evangelical Mission in the Statement of Commitment of the
Asian Church Leadership Consultation on HIV/AIDS agreed:“Knowing
that only through education and prevention we can curb the
spread and effects of this pandemic, we commit ourselves to:
• Integrate a good quality HIV
and reproductive health education in the Christian Education
curriculum to “ensure that young people have information and
life skills they need before they become sexually active and
sexual behavior starts to form.” This should also include
adequate information about the protective use of condoms in the
context of HIV/AIDS prevention, the danger of needle-sharing in
intravenous drug use and other preventive measures;
• Continue to promote fidelity in
marriage in a context of gender equality and informed choices”
In the Memorandum of Intention by Churches
in central and eastern Europe stated, “The political, social and
economic changes in Central and Eastern Europe throughout the
last two decades have made certain population groups vulnerable
to HIV/AIDS. We resolve to focus our church-related HIV/AIDS
work on the following groups:
1. Children and Youth, including those who
are orphans and/or homeless/street children
3. Children born of HIV-infected Mothers
5. HIV-infected and affected Persons
6. Drug users
We will continue to assess the needs of
other groups that may also be vulnerable to HIV infection.
The battle against the HIV/AIDS crisis is a
battle for the dignity of life. It calls us to use all effective
means of prevention within a context of Christian ethics” 45.
World Council of Churches’ Pacific Member
Churches stated 46 “Whilst we are mindful of the ethical issues
that HIV presents to the church, we are faced with a more urgent
reality that drives us to consider the highest ethic, which is
the preservation of life. The church lives in the context of the
wider community and has a clear responsibility to adhere to the
ethical principles that guide society.
We are therefore committed to address:
Prevention and Condoms – Condoms, when
appropriately targeted and promoted, are scientifically proven
to be an effective part of the prevention strategy against
sexually transmitted infections. We are committed not to focus
our efforts working against the use of condoms – but rather
recognize the freedom for individuals to make informed choices
and to have access to condom use.”
The International Interfaith Conference on
Prevention and Control of HIV/AIDS in 2004 stated:
We reaffirm that the primary goal and task
before all religions and faiths is to assist people to stay away
from risk behaviour affecting their physical, moral and
spiritual growth and development. This mandate before us when
effectively fulfilled will equip every one to protect himself or
herself and society against HIV/AIDS that has no cure or
We recognize that Religions and Faiths have
a mandate to light up the path of the youth since they have to
carry the torch of life on its eternal journey. In facing the
challenge of HIV/AIDS they are our best, first line of defence,
while being the most vulnerable as well. We pledge to work with
the youth in this fight.
We affirm that Religions and Faiths have a
critical role in placing the scientific facts of HIV/AIDS in
their due perspective. We recognize the importance of scientific
efforts for developing effective vaccine against the epidemic
and the need for requisite support for achieving a breakthrough
in such efforts 47.
The Cairo Declaration from an interfaith
meeting stated 48:
The family is the foundation for building
and defending society. It is therefore necessary to encourage
starting families in accordance with heavenly decrees, and we
should remove all obstacles in the way.
We emphasize the need to break the silence,
doing so from the pulpits of our mosques, churches, educational
institutions, and all the venues in which we may be called to
speak. We need to address the ways to deal with the HIV/AIDS
epidemic based upon our genuine spiritual principles and our
creativity, and armed with scientific knowledge, aiming at the
innovation of new approaches to deal with this dangerous
We reiterate that abstinence and
faithfulness are the two cornerstones of our preventive
strategies but we understand the medical call for the use of
different means to reduce the harm to oneself and others.
We view as sinful anything that may cause
infection through intention or negligence – as a result of not
using all possible preventive means available.
We emphasize the importance of reaching out
to vulnerable groups which are more at risk of being infected by
HIV/AIDS and/or spreading it, including commercial sex workers
and their clients, injecting drug users, men having sex with
men, and those who practice harmful behaviors. We emphasize the
importance of diverse approaches and means to reach out to those
groups, and although we do not approve of such behaviors, we
call on them to repent and ask that treatment and rehabilitation
programs be developed. These programs should be based on our
culture and spiritual values.
We call upon the media to abide by ethical
codes regarding the material they present.
We advocate the rights of women to reduce
their vulnerability to HIV/AIDS.
Nevertheless, churches are faced with
challenges in following the ‘abstinence and be faithful’
prevention strategy. Research on HIV transmission indicates that
messages of abstinence and faithfulness do not adequately
account for the issues facing communities 49; when they are
promoted as the only forms of HIV prevention. Such prevention
messages also focus exclusively on sexual transmission, ignoring
other methods of HIV transmission such as injecting drug use.
And an exclusive abstinence and faithfulness prevention message
may reinforce views that PLWHA are sinners.
For years, secular prevention programmes
for the general population have focused on the ‘ABC’ strategy –
Abstain and delay sexual initiation; Be faithful (and be safer)
or reduce the number of sexual partners; and use Condoms
correctly and consistently. For many people, particularly women
and girls, this approach is of limited value. They lack social
and economic power, and live in fear of male violence. They
cannot negotiate abstinence from sex, nor can they insist their
partners remain faithful or use condoms.
Ironically, trust and affection within
marriage and other long-term relationships are sometimes part of
the problem. Studies from various parts of the world suggest
married couples have sex more frequently than unmarried
individuals, but use condoms less often. Global studies of
relationships between sex workers and their clients show a
similar pattern: condom use was less consistent if sex workers
felt a level of intimacy with their regular clients. For
example, in Kenya’s Nyanza Province, surveyed clients of sex
workers reported using condoms less consistently if they were
with their usual sex worker 50.
Vulnerability to HIV exposure – an
individual or community’s inability to control their risk of
infection – is multifaceted, so no single prevention
intervention will be effective on its own. Key elements in
comprehensive HIV prevention include:
• AIDS education and awareness;
• behaviour-change programmes,
especially for young people and populations at higher risk of
HIV exposure, as well as for people living with HIV;
• promoting male and female
condoms as a protective option, along with abstinence, fidelity
and reducing the number of sexual partners;
• confidential voluntary
counselling and testing;
• preventing and treating
sexually transmitted infections;
• primary prevention among
pregnant women and prevention of mother-to-child transmission;
• harm reduction programmes for
injecting drug users;
• measures to protect blood
• infection control in
health-care settings (universal precautions, safe medical
injections, post-exposure prophylaxis);
• community education and changes
in laws and policies to counter stigma and discrimination; and
• vulnerability reduction through
social, legal and economic change 51.
Comprehensive prevention addresses all
modes of HIV transmission. Since HIV epidemics are extremely
diverse across regions, within countries and over time,
programme planners need to place different emphases on the mix
• in low-prevalence settings,
prevention among key population groups (e.g., sex workers and
their clients, injecting drug users, men who have sex with men)
can be effective in keeping HIV at low levels across society;
• in high-prevalence settings,
prevention among key populations continues to be important, but
broad strategies reaching all segments of society are needed to
reverse the trend of the epidemic; and
• in all countries, prevention is
impeded if universal access to treatment, as well as impact and
vulnerability-reduction measures, are not clearly parts of the
Churches and faith-based organizations are
struggling with prevention messages when faced with the
realities of sexuality and drug use in their congregations,
particularly among the youth. As one faith leader questioned: Is
it really possible for them (people) to totally abstain? I think
there are a lot of things that we need to discuss as the church
and see what actually works 53.
Another challenge facing faith-based
organizations is the best strategy to adopt to promote
HIV-transmission prevention within marriage. The feasibility of
merely advocating faithfulness and rejecting the use of condoms
in marriage has been questioned. See box eight “Women and HIV”.
While some churches rejected the use of condoms, others feel
that the occurrence of unfaithfulness in marriage is a reality
that should be reflected in churches’ responses to HIV and AIDS.
Certain churches and faith-based organizations, in light of the
high rate of infection among married couples, serodiscordant
couples, and the belief that some women are disempowered in
intimate relationships, encourage married women to insist on the
use of condoms to protect themselves from infection. For
example, the Pan-African Lutheran Church Leadership, the
Lutheran World Federation and the World Council of Churches’
Pacific Member Churches. See relevant texts in box seven
“Prevention: as addressed in Declarations”.
Box nine “The Use of Condoms – Theological
Perspectives” outlines different theological grounds
underpinning different views on the use of condom in HIV
prevention with in marriage.
Covenant 6: Gender Inequalities and
We shall remember, proclaim and act on the
fact that the Lord our God, created humankind in his image. In
his image, he created them male and female, he blessed them both
and gave both of them leadership and resources in the earth; he
made them one in Christ (Gen. 1:27 -29; Galatians 3:28–29). We
shall, therefore, denounce gender inequalities that lead boys
and men to risky behaviour, domination and violence; that deny
girls and women leadership, decision making powers and property
ownership thus exposing them to violence, witchcraft accusation,
widow dispossession, survival sex – fuelling HIV infection and
lack of quality care and treatment.
Box 8: Women and HIV
Women are twice as likely as men to
contract HIV from a single act of unprotected sex, but they
remain dependent on male cooperation to protect themselves from
Women are particularly vulnerable to HIV,
with about half of all HIV infections worldwide occurring among
women. This vulnerability is primarily due to inadequate
knowledge about HIV and AIDS, insufficient access to
HIV-prevention services, inability to negotiate safer sex, and a
lack of female-controlled HIV-prevention methods, such as
microbicides. The female condom allows women some control but is
not widely used and is relatively more expensive. In some of the
regions worst-affected by AIDS, more than half of girls aged 15
to 19 have either never heard about AIDS or have at least one
major misconception about how HIV is transmitted.
Across the world, between one fifth and a
half of all girls and young women report that their first sexual
encounter was forced. From a very early age, many young women
experience rape and forced sex. Violent or forced sex can
increase the risk of transmitting HIV because forced vaginal
penetration commonly causes abrasions and cuts that allow the
virus to cross the vaginal wall more easily.
Marriage is no protection against HIV.
Across the developing world, the majority of women will be
married by age 20 and have a higher rate of HIV infection than
their unmarried, sexually active peers.
The “ABC” slogan – Abstain, Be faithful,
consistently use a Condom – is the mainstay of many HIV
prevention programmes. But for too many women and girls, this
message holds no weight. Where sexual violence is widespread,
abstinence or insisting on condom use is not a realistic option.
Because of their lack of social and economic power, many women
and girls are unable to negotiate relationships based on
abstinence, faithfulness and use of condoms.
UNAIDS, World AIDS Campaign. Women, Girls
and HIV/AIDS: Strategic Overview and Background Note, 2004.
Box 9: The use of condoms – theological
There is clear consensus among (Catholic)
Church leaders on the norm and value of abstinence outside
marriage. For example, Pope John Paul II told young people
during his visit to Uganda in February 1993:
Do not let yourselves be led astray by
those who ridicule your chastity or your power to control
yourselves. The strength of your future married love depends on
the strength of your present effort to learn about true love.
Chastity is the only safe and virtuous means to put an end to
the tragic plague of AIDS 56.
On the other hand, there appears to be a
diversity of opinions among the hierarchy with regard to
information and education about HIV prevention for those who do
not share the Catholic tradition or who will not or cannot
remain faithful to its teaching. The bishops of New Zealand, for
example, refused to participate in a government-sponsored
preventive education campaign:
Values cannot be separated from health,
whatever people’s religious beliefs may be. The public is
seriously misled if the impression is given that technical means
alone can solve problems that require profound changes in human
attitudes and behaviour … 57.
Other Church leaders, however, have
advanced more flexible positions with regard to information
about the use of condoms in preventing HIV transmission. In so
doing, they explained that their intent was not in any way to
compromise the fundamental values of the Church on marriage, but
rather to respond to the current health crisis from a framework
of traditional moral principles.
Thus the Administrative Board of the United
States Conference of Catholic Bishops turned to the principle of
toleration of a lesser evil in order to avoid a greater one when
they foresaw the provision of information about condoms for
those who might be prone to sexual acts which could put them or
others at risk of HIV infection:
We recognize that public educational
programs addressed to a wide audience will reflect the fact that
some people will not act as they can and should; that they will
not refrain from the type of sexual or drug abuse behaviour
which can transmit AIDS. In such situations educational efforts,
if grounded in the broader moral vision outlined above, could
include accurate information about prophylactic devices or other
practices proposed by some medical experts as potential means of
preventing AIDS. We are not promoting the use of prophylactics,
but merely providing information that is part of the factual
The bishops of Papua New Guinea signalled
an openness to cooperate with their national government in order
to facilitate a comprehensive approach to HIV prevention
Both the government and the Churches must
play an active role in the prevention of disease since this is
the only means to fight against the spread of the disease and so
far there is no cure for it. They must give honest, complete
information to everybody, because everybody has the right to
know what HIV and AIDS is, what are the ways of transmission of
the virus, and what are all the possible means of protection 59.
In a statement by its Social Commission,
SIDA: La Société en Question (AIDS: Society in Question), the
French Bishops’ Conference seemed to make use of another
traditional moral argument, i.e., that of gradualism. This
approach recognizes that individuals find themselves in
differing stages of moral development and thus will require
diverse solutions for moral challenges. Cardinal Lustiger of
Paris seems to have paved the way for such reasoning when he
stated in a public television interview on World AIDS Day,
December 1, 1988:
You who suffer from this illness, you who
cannot be chaste, use the means that are proposed to you, out of
self-respect and out of respect for others. You must not cause
Many bishops and theologians have pointed
out that, in all this discussion, the fundamental imperative to
preserve life is primary. Thus Cardinal Schonborn of Vienna
said, in commenting on the French Bishops’ Statement: Love can
never bring death … In given situations, the condom can be seen
as the lesser evil 61. Belgian Cardinal Godfried Danneels has
spoken in favour of using condoms in certain circumstances to
protect against AIDS, saying not using prophylactics could
transgress the Biblical commandment which states, "Thou shalt
not kill" 62.
Cardinal Simonis of Utrecht used the
principle of self-defence when considering the situation of
discordant couples: In this precise condition, and only in the
realm of marriage and not in other situations, the condom may be
seen as a form of self-defence. Cardinal Agré, Archbishop of
Abidjan, advanced a similar argument in 1997: In our struggle,
we prefer abstinence, of course... The use of condoms is
specific in ethical cases when one of the partners knows that he
is HIV-positive or ill. The bishops of Chad placed this issue
even more squarely in the realm of individual conscience as well
as of the intimate space between husband and wife:
It is up to each and everyone of us to
train one’s conscience and to assume one’s responsibility
according to the situation in which one finds oneself. Because
‘no one is bound to do the impossible’, spouses cannot be asked
to abstain from sexual intercourse; we therefore understand that
a person, through love, may be led to use the condom to protect
himself/herself or to protect his/her partner. But everybody
must understand that the condom does not provide 100% protection
and that it does not ultimately solve the real problems raised
Within the context of preserving life and
of self-defence, the use of the condom to avoid HIV
transmission, especially in circumstances involving discordant
couples and involuntary sexual activity, also has been seen from
the perspective of the principle of double effect whereby the
condom would not be seen as a contraceptive device but rather as
the means to safeguard life which is threatened by a deadly
disease agent. Two prominent theologians in Rome seemed to
recognize such an approach when they considered the situation of
a prostitute who insists on condom use with clients as long as
she feels compelled to continue her commercial sexual activity.
Father George Cottier, Secretary General of the International
Theological Commission and theologian to the Papal Household,
A woman [prostitute] who understands that
she cannot put her life or the life of another in danger is a
woman who has grown morally, in comparison to a woman who has no
consideration for her health or the health of others … I
personally think that one must take into account the fact that
these circumstances lead to death. The principle fully holds: Do
not kill 63.
Speaking about a similar situation,
Maurizio Faggioni, MD, moral theologian and member of the
Congregation for the Doctrine of the Faith, said: Only in this
path of pastoral graduality is it possible to tolerate – here,
Catholic ethics does not approve, but tolerates – the use of a
Finally, the Southern African Bishops
Conference in a “message of Hope” in July 2001 stated:
There are couples where one of the parties
is living with HIV/AIDS. In these cases there is the real danger
that the healthy partner may contract this killer disease. The
Church accepts that everyone has the right to defend one’s life
against mortal danger. This would include using the appropriate
means and course of action.
Similarly where one spouse is infected with
HIV/AIDS they must listen to their consciences. They are the
only ones who can choose the appropriate means, in order to
defend themselves against the infection. Decisions of such an
intimate nature should be made by both husband and wife as equal
and loving partners 65.
Religious leaders can play a vital role in
educating people about HIV prevention, over and above the
current discourse of abstinence and being faithful to one
partner. The ideal for religious leaders is usually the
promotion of ‘sound family values’ and no sex outside of
marriage; however, the reality for many people is very different
66. Religious leaders need to look more closely at making their
teaching relevant to the everyday existence of their members.
HIV is fast changing the world in which we
live, and churches need to change as well. AIDS is demanding
that churches respond. How is a church in a country with 20% HIV
prevalence dealing with 20% of its members being HIV-positive?
Have church teachings on abstinence worked? The answer to the
latter question is no, given the prevalence of HIV infection
among believers. Simply, the fact that of the approximately 40
million people living with HIV and AIDS, 30 million are
Christians, means that we have to get churches to take action.
The church is just as affected by AIDS as society around it. If
we can get the churches to fight the illness rather than those
who are ill, then we will have achieved a lot. If people who are
HIV-positive are integrated into church life, or if pastors can
speak openly in their parishes about being HIV-positive
themselves, then we will have achieved a great breakthrough 67.
Responding to AIDS does not mean that
traditional teachings are irrelevant; but rather that teachings
need to be given without judgement and adapted to fit today’s
lived realities. For example, box 10 below describes the African
Network of Religious Leaders Living with or personally affected
by HIV and AIDS model of HIV prevention and care, which offers a
comprehensive HIV prevention and care approach.
Box 10: HIV prevention and care: an
Some of the messages given to mitigate the
spread of HIV have sadly added to the stigma. “ABC” is one such
message 68. Within the African Network of Religious Leaders
Living with or personally affected by HIV and AIDS (ANERELA+), a
new model has been developed, called SAVE (Safer practices,
Available medications, Voluntary counselling and testing, and
Empowerment through education).
HIV prevention will never be effective
without a care component and the SAVE model combines both
prevention and care components as well as providing messages to
counter stigmatization. HIV is a virus not a moral issue. As
such the response should be based on public health measures
tempered by human rights principles.
S refers to safer practices covering all
the different modes of HIV transmission. For examples, safe
blood for blood transfusion, barrier methods for penetrative
sexual intercourse, sterile needles and syringes for injecting,
safer methods for scarification and adoption of universal
A refers to available medications.
Antiretroviral (ARV) therapy is by no means the only medical
intervention needed by people living with HIV or AIDS (PLWHA).
Long before it may be necessary, or desirable, for a person to
commence antiretroviral therapy, medical needs concerning
opportunistic infections and pathology tests arise. Treating
opportunistic infections results in better quality of life,
better health and longer term survival. Of vital importance to
every person are good nutrition and an adequate supply of clean
water, and this is doubly so for PLWHA.
V refers to voluntary counselling and
testing, one intervention which may mitigate HIV-related stigma
and increase the effectiveness of HIV prevention efforts. A
person who knows his or her HIV status is in a better position
to protect him or herself from infection or from infecting
another, depending on the person’s status. In addition, someone
who is HIV-positive can be provided with information and support
to live positively. People who are ignorant of their HIV status
or who are not cared for can be sources of new HIV infections.
E refers to empowerment through education.
It is not possible to make an informed decision without all the
facts. Misinformation and mis-action are two of the greatest
factors driving HIV- and AIDS-related stigma and discrimination.
Correct information needs to be disseminated to all within
churches so as to ensure that people respond to others through
knowledge and from a perspective of Christ centred love. This
will assist people to live positively – whatever their HIV
status – and break down barriers which HIV has caused between
people and within communities. Education also includes
information on good nutrition, stress management and the need
for physical exercise.
Clearly, ABC has come under much scrutiny,
including the need for additional prevention methods to be
included, for example, D for drugs; E for education, F for
fighting contaminated needles and G for good practice of
medicine . However, some of the more potential positive benefits
of the ABC strategy have perhaps not been fully explored. Box 11
“Better sex as a solution to prevention of HIV infection in
relationships: the B in ABC” opens up the question of satisfying
sexual relations within a relationship and explicitly raises the
question for churches and faith-based organizations – what is
their role in ensuring that their congregation live full and
satisfying sex lives, both for their physical and spiritual
wellbeing as well as an effective mode of HIV prevention.
Box 11: Better sex as a solution to
prevention of HIV infection in relationships: The ‘B’ in ABC 70
Reflections by David Patient, a PLWHA, and
Neil Orr, who worked with a specific church in Mozambique - from
the very highest levels to the lay preacher as well as about 200
people from Vida Positiva Training. Once the feed back was
assessed then started the education of the lay preachers around
'Tantric sex' [name later changed due to objections] and the
subsequent feedback from the ministers was quite profound.
The objective of this article is to
introduce an HIV prevention strategy that may actually work in
married and other committed relationships: Teaching committed
couples how to have better sex, this reducing the need and
incidence of infidelity. And yes, this implies the absence of
We need to distinguish between
relationships with procreation versus recreational sexual
objectives in HIV education and prevention strategies. The
reason is simple: Couples want babies, which means condoms are
simply not used.
The statistics regarding condom use in this
category of at-risk population speak for themselves: Condom use
is high and effective – in youth and sex worker sectors, but not
elsewhere, at least in the developing world. As stated, the
reason is simple: People want children when they get married or
commit to each other in the long term. This aspect of committed
relationship is deeply entrenched and reinforced culturally and
via religious institutions.