Harare Zimbabwe


AIDS and the Pastoral Care of the Sick

Since its first appearance in June 1981, the disease now known as AIDS (Acquired Immune Deficiency Syndrome) has opened up a particularly sensitive and demanding area of the Church's pastoral concern for the sick. Jeffrey Weeks points out that:

AIDS is not a disease of a particular type of person. It has affected, and killed, heterosexuals and homosexuals, women and men, white and black, young and old, rich and poor, the promiscuous and the inexperienced. It is the result not of a way of life but of a virus.

By 1984, the virus responsible for AIDS had been identified and given the name Human Immuno-deficiency Virus (HIV). This virus can now be identified by a blood test known as the HIV anti-body test and, in the USA, 2 to 3 million people were infected with it by 1988. The incubation period (time from infection to manifestation of signs of being infected) for HIV is up to and not greater than 3 months after which there is a period of being an asymptomatic carrier (infected and infectious but otherwise apparently healthy). Some remain asymptomatic carriers but others develop one of two further conditions. The first is AIDS Related Complex (ARC), in other words, moderate to severe ill health with remissions and a possible return to being an asymptomatic carrier. The second is AIDS, sometimes called “full-blown AIDS”, in other words, such severe damage to the immune system that the body can no longer protect itself against common infections. Of those who develop AIDS, only 20% will survive two years and only 5% will survive five years. Such a high and rapid mortality rate, together with the often censorious attitude of society at large towards sexually transmitted diseases, means that particular demands are placed on those involved with the pastoral care of those suffering from AIDS related illnesses.

By 1999, when the eleventh United Nations organised UNAIDS conference on AIDS and sexually transmitted diseases was held in Lusaka, Zambia, it had become clear that the number of people infected with HIV in many parts of the world was growing faster than had been predicted and, in some countries, HIV and AIDS had become a major threat to development. That year, the numbers dying from AIDS reached 2.6 million, 800,000 of them in Africa. Twenty-two million people in sub-Saharan Africa were affected and there were 7 500 new infections every day. More than 20% of Zambians were infected and it had reduced life expectancy by 25%, creating social havoc and undermining health services. There was a growing number of orphans and abandoned children, more teachers were dying that were graduating each year, absenteeism in the business sector was increasing, and more time was spent tending to the sick than tilling the soil. A Zambian 15-year old had a 60% chance of dying from AIDS. Between 1981 and 2006, 25 million people died from AIDS. By 2006, an estimated 39.5 million adults and children were affected worldwide, 62.5% (24.7 million) in sub-Saharan Africa. Africa has an estimated 12 million AIDS orphans. About that time, the worse-affected country in the world was Zimbabwe where between 18 and 25% of the adult population were HIV positive and where one in every four in the age group 15-45 actually had the AIDS virus. Zimbabwe had been one of 42 states whose heads of Government or Representatives signed the Declaration of the Paris AIDS Summit in 1994. That declaration solemnly declared the obligation and responsibility of those states “to ensure that all persons living with HIV/AIDS are able to realise the full and equal enjoyment of their fundamental rights and freedoms” and their “determination to fight against poverty, stigmatization, and discrimination.” As the AIDS epidemic spread around the world, many Protestant, Catholic and Jewish clergy, along with Religious and laypeople, became involved in the pastoral care for, and counseling of, those stigmatized by AIDS. While the active practice of homosexuality is regarded as sinful by the majority of their denominations, many of those cared for by these clergy were gay or bisexual men. The small but dedicated group of people who pioneered this ministry has since been recognised in many circles for the prophetic way in which they reached out to one of the most marginalized groups in contemporary society. Their work has also given rise to a number of excellent publications dealing with the pastoral care of AIDS patients. One of the earliest, and best, is Love in a Cold Climate. AIDS: Some Pastoral and Theological Perspectives, edited by John Hervé in 1988. The spiritual and mental needs of those suffering from HIV and AIDS needs to be recognised and Brian Parry, a vicar in Birmingham with personal experience of caring for an AIDS patient in his own home, writes:

Care is not all for a sufferers physical needs, in fact the pastoral care from both the spiritual and mental aspect is equally important. Obviously I can only speak from my own experience. The pattern of needs will obviously differ but I can't help feeling that the basic needs will be similar for the non-Christian or Christian. I will consider the personality needs as I call them ... The first was Fear in the form of panic which became heightened as soon as the diagnosis was confirmed. ... The second experience was Shame. For a long time to come there will be a stigma attached to the disease. ... The third experience is closely associated with the shame. There will obviously be rejection from some people... So there will be a need to rebuild confidence from time to time. Fourthly, I want to return to Fear, not so much the panic kind of fear experienced when the illness is confirmed, but the fear of the inevitable unknown (death).

In the early years, there was great fear of AIDS, not only among the public at large, but also among those responsible for the spiritual needs of AIDS patiencs. Barrie Newton, who was the Anglican Chaplain to St Mary's Hospital Paddington, points out that There is very great emotional stress and strain on people caring for AIDS patients and one of the roles of the Priest (as Hospital Chaplain or Parish Priest) is supporting church members who are Doctors and nurses.

He notes that many AIDS patients are surprised "to find someone wearing a dog-collar who could bear to be in the same room" with them. In St. Mary's everyone, patients and staff, have always received under both species and the myth that AIDS can be contacted in this way would seem to be only a myth. While Doctors agree on this point, the Anglican Archbishop of York has recommended intinction if there is any doubt on this point. Generally speaking, Roman Catholic ministers of the Eucharist do not usually offer the Eucharistic cup to those infected with HIV or AIDS in situations where it might lead to embarrassment for the patients or for others. Recognising that the pastoral care of AIDS patients is not very different from that of other patients, he argues that a person suffering from AIDS should always be given the option not to receive a visit from the pastor and that, if there is such a visit, it should always begin by the pastor establishing himself as a fellow human being because patients

will want the same sort of pastoral support in hospital anyone of this background would want; they want the sacraments, to go to chapel, to be prayed with and blessed.

As with many sick people, those suffering from AIDS often suffer from feelings of isolation and he suggests that the best way to break down these feelings “is to put your arms around them! (Or at least hold their hand.)”

Pat Mullins, O.Carm