AIDS Wars

I should have been prepared for the backlash! I stepped right into the middle of a heated controversy when I … Continued

I should have been prepared for the backlash! I stepped right into the middle of a heated controversy when I co-authored a report for Georgetown’s Berkley Center for Religion, Peace and World Affairs in November about the role of religious organizations in the battle against HIV/AIDS. Just last week, an angry letter from the Gerald Health Foundation in Boston to Georgetown University’s president actually called for the report’s withdrawal, with a litany of accusations.

The complaint? That our report gives insufficient “credit” to promoting abstinence and faithfulness as a central approach to the HIV/AIDS pandemic, and that it reveals an “anti-Catholic bias” in its treatment of Church teaching on condoms.

Perhaps nowhere is the role of religion in public policy and service delivery more significant than in the HIV/AIDS pandemic. The storm around the Berkley Center report is a depressing illustration of how hard dialogue can be. And how important.

Anyone who has seen the HIV/AIDS pandemic up close is scarred by it and wants radical solutions. Remarkable increases in funding for international HIV/AIDS work – including President Bush’s Emergency Program for AIDS (PEPFAR), have gone way beyond the expectations of only a few years ago. So have bold efforts to speed medical research like those supported by the Bill and Melinda Gates Foundation. Today drug treatment programs that were called pipe dreams only a few years ago are producing a Lazarus effect, with dying women returning to health and raising their children. All around, advocates push hard for bolder action.

The passions in the “AIDS wars” run strong. People fear that anything that goes in the wrong direction will undermine both efforts and support for programs.

But a healthy dose of humility is also essential – this is an eminently human effort, affecting millions. No one solution works everywhere. Research results come in all shapes and sizes. We do know pretty clearly some of what works and what does not, but there are plenty of question marks. The pandemic has surprised us again and again.

We did the report for two reasons. The first was to help “map” the vast and complex work of the myriad of religiously inspired AIDS organizations across the world, especially in Africa. Second, we wanted to encourage a forthright discussion of very different perspectives. Working in both secular and faith circles, I am acutely aware of raging controversies and the anger that surrounds them – I have often felt its brunt. But dismissing others because you disagree with them hardly seems the answer. That applies to both my secular colleagues, who may simply recoil when church roles are mentioned, and my faith colleagues, some of whom are too ready to disparage the enormous efforts of secular groups. Our goal is dialogue.

The trigger for our critics’ anger, I suspect, is an early statement in our report that religious involvement in the fight against HIV/AIDS is “part of the solution and part of the problem”.

The “solution” part is religion’s deep involvement in every dimension of the pandemic – from prevention to care and comfort to support of families left behind to the focus on ethics. People and organizations inspired by faith do stunning and often inspirational work. Catholics and Catholic organizations are among the most extraordinary. So the fact that often they are not at the table when policies are discussed is more than a pity – it is a tragedy.

But there are some real problems. Stigma is real still in many communities. I have heard several stories of pastors refusing to bury a person known to have died of AIDS. Some leaders actively oppose teaching about sex and HIV/AIDS in schools. Programs run by church groups are not always well managed and so far there is precious little evaluation of results.

This is where an alphabet war comes in. A catchy, easy-to-remember framing for the HIV/AIDS struggle has been the ABC approach: Abstinence, Be Faithful, use Condoms. The Berkley report reflected the view that for all its merits, “ABC” can be simplistic and stigmatizing. Some have suggested an alternative slogan: SAVE. That stands for Safe sex, Antiretrovirals, Voluntary testing, Education. Abstinence is not highlighted and this distresses many of the Catholic groups.

Since the report was finalized I heard Pastor Rick Warren, author of “The Purpose Driven Life,” present his own mnemonics which go in a similar direction – STOP and SLOW – representing both the ideal and an ideal with a dose of realism about human nature. STOP for him means “Save sex for marriage, Teach men to respect women, Offer treatment in churches, and Pledge yourself to one partner…” and SLOW means: “Supply condoms, Limit number of partners, Offer needle exchange, and, Wait for sex until older.”

We need a caring and respectful dialogue, not a war about alphabet soup. We need to listen to different presentations without resorting to angry monologues; they rarely convince or produce new ideas. And they don’t help in the effort to forge new kinds of alliances and partnerships. Surely we can listen to different perspectives and respect the motivations of others. That’s true for many things but nowhere more so than for HIV/AIDS.

The storm about our report will undoubtedly rage on. We can only hope it will lead eventually to a fuller, and more civil, airing of issues.

By Katherine Marshall | 
January 26, 2008; 11:07 AM ET


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  • Sister Katherine Lloyd

    I have worked hands on voluntarily with AIDS patients, and continue to support those with AIDS.The good woman who has been faithful throughout life until her husband passes and who marries again, with no knowledge of the past relationship history of her new husband.Those of cultural background such as some of the Pacific Islanders and West Africans where is is considered appropriate that the brother of a deceased man should have that man’s children by his widow in order to keep the deceased’s family line going.Those who it has recently been discovered to have contracted the virus from having organ transplants.”Judge not, for as ye judge, ye shall be judged also” needs to be remembered by many.Mother Theresa of Calcutta summed it up:The greatest sin is the absence of love or charity – the terrible indifference toward the neighbour who right on the street falls victim to exploitation, to corruption, to starving and to sickness.Katherine Lloydkatherine.lloyd@wideband.net.au

  • Edward Ordman

    Thank you, Katharine Marshall, and thank you, Katharine Lloyd, for the thoughtful reply. Ms. Marshall writes It is hard advice to follow when the debate has become so bitter and divided that even decisions with serious consequences seem to be taken to score debating points. A couple of years ago my wife and I were visiting Thailand with American Jewish World Service, and visited the Thai Aids Action Group, an NGO engaged in treating AIDS sufferers and in education to help prevent the spread of AIDS. Unfortunately, its (partial) funding from the United States foreign aid program had been cut off abruptly when a US inspector discovered in one of its offices a poster urging drug users not to share needles and to use needle exchange programs to get clean needles. While this organization itself did not run needle exchange programs, it did teach that AIDS could be spread through the sharing of needles. Its US funding was cut off since it was “aiding criminals”; its advice might prevent a drug user from getting AIDS, and of course we mustn’t do -that-. When we came back from that trip, it was awfully hard to avoid engaging in, as you say, “angry monologues.” We live in Memphis, Tennessee, where the “just say no” teaching approach and a complete refusal of the schools to talk about sex in any detail appears to have led to a significant increase in the number of abortions. I would very much like to see a dramatic decrease in the number of abortions, and a dramatic decrease in the spread of AIDS; but these will requite multifaceted approaches, not simplistic ones. Edward Ordman