Religious
Affiliation and HIV Transmission
by
Rev. Arden Strasser and Susan Strasser
List of Abbreviations
AIC
AIDS Acquired Immune Deficiency Syndrome
BC Behavior Change
CSM Condom Social Marketing
FBO Faith-based Organization
FC Faith Community
HIV Human Immunodeficiency Virus
IGA Income Generating Activities
NAC National Aids Council
NGO Non-Governmental Organization
OVC Orphans and Vulnerable Children
PLWA People Living with HIV/AIDS
SSA Sub-Saharan
STI Sexually Transmitted Infection
ZAN
ZCC
WCC World
Council of Churches
BACKGROUND AND MOTIVATION
Many segments of society, including the church, have
attempted to respond to the AIDS epidemic.
Other than government, business, health and education, the prime
organization many look to for leadership is the church. Although far from homogenous, faith
communities have veritable armies of members providing strength in faith and
hope for daily living. And while various
churches and faith based organizations (FBO’s) have
led the way in reducing stigma and caring materially, medically, and
spiritually for people living with AIDS (PLWA’s), the
church’s potential remains largely untapped.
The church in
According to the World Council Churches [WCC], (2004);
Churches are an integral part of life and society in
By an Act of Parliament in 1999, the National AIDS Council
(NAC) was created to coordinate national AIDS related activities. This council
was to be a semi-autonomous organization with broad level representation across
society. Its stated purpose was to
coordinate multi-sectoral responses to the epidemic,
including the churches, towards the National AIDS policy objectives (WCC,
2004) Churches participate in the Zimbabwe AIDS
Network (ZAN) with many mission hospitals, FBOs and
now even pastors in leadership roles.
The Zimbabwe Council of
Churches (ZCC) has a membership of twenty mainline Protestant churches as well
as friendly relations with the Roman Catholic Church. The Council employs a national HIV/AIDS
coordinator. According to the ZCC,
church programs in the country are widespread including:
· Home Based Care
164
· Counseling
55
· Testing
10
· Orphan
Care
340
·
Youth
55
(WCC, 2004)
The broad outreach of all worshipping communities has not been systematically analyzed. Yet among those churches who respond intentionally to the pandemic, there are a wide variety of responses, although fragmented and uncoordinated. For example, Byamugisha, Steinitz, Zondi, & Williams (2002) have collected numerous case studies.
Often these responses are unrefined.
Affiliation with a church involved in mitigation and orphan and vulnerable child care (OVC) care may influence members. Such intentional programs can include:
A relatively small number of church members are exposed to
innovative programs which are pro -active in advocacy, disclosure, and in preaching
new theologies around the pandemic. These church members can develop totally new
perceptions and personal Christian commitments around their place in the
pandemic, even seeing oneself as a change agent in society. Such programs include:
Additional responses to the pandemic use the reach of Church-wide
structures and juridical bodies which some individual denominations possess. Many AICs lack
formal structures, making it difficult to coordinate organized responses.
(Parry, 2003) Those churches with structures can exercise significant direction
and leadership in some of the following ways.
It was the case until recently that churches with conservative doctrine assumed and reinforced strong sexual boundaries as their response to AIDS. Conservative clergy rarely referred to AIDS in their preaching and did not participate in many ecumenical networks. They contributed little to stigma reduction and spiritual support of PLWAs.
Yet, some conservative churches in
The churches are increasingly engaging. In 2001, ten national Christian councils in
Southern Africa held up the goal that "the clergy is supposed to be
trained to talk and preach about sexuality and HIV/AIDS on the pulpit, with
married couples, the youth, the children and make the church act as a role
model" (World Council of Churches, 2001)
Participants also felt that the church must promote community
development, challenge cultural practices that oppress women and reach out to
truck drivers, border towns and bus and railway stations with teaching and
preaching.
PASTORAL LEADERSHIP
Although HIV/AIDS is increasingly part of seminary based
training, many mainline pastors state that they still feel inadequately
informed. Most AIC pastors have little
or no formal theological training. In
addition pastors complain of work stressors including lack of educational
materials and low salaries. For many Protestant
churches, inexperienced pastors are often placed in isolated rural settings
while the more experienced clergy benefit from urban resources and support. Many
clergy experience inadequate opportunities for collegial support, and suffer
from burnout, depression, and fatigue.
The increase in HIV/AIDS cases
has tripled the work of pastors as more than 50% of their time is spent burying
people and dealing with issues of bereavement. This has led to burn out in many
pastors who have admitted that they are inadequately equipped to deal with the
psychosocial, socioeconomic, health and spiritual problems affecting people today.
(World Council of Churches, 2004)
While there are now groups for HIV+ clergy, there are no Zimbabwean religious leaders who have disclosed their HIV status, and no denomination encourages clergy to be tested as role models for their church membership. Such hesitation may impede self-disclosure in general. Role model self-disclosure is important insofar as it reduces society’s denial of AIDS and as it serves to reduce stigma.
CONDOMS AS OBSTACLE FOR CHURCHES
Although few pastors or priests deny the presence of HIV, there is little direct preaching on the subject. Many find it almost impossible to talk about condoms, but are privately eager to learn more. In addition, they are often open to educators speaking at church. While some people accuse the church’s reticence in promoting condoms as contributing to HIV transmission, this claim has also not been measured.
Pastors are somewhat anxious about the idea of partnering
too closely with western non-governmental organizations (NGO’s) or other churches
for fear that their particular values may be compromised or violated. As Ruden has
identified, "the "safe sex" controversy is perhaps the most
unfortunate distraction in the fight against AIDS, not least because it has
restricted cooperation among the churches." (Ruden,
2000) Yet, opportunities for discussion
exist. Clergy in neighboring
They,
share a
common feeling that they are a small moral voice in this fight against
HIV/AIDS, drowned out by a ‘big voice’ promoting condom use by donors and
government. Faith community (FC) leaders are expected to present themselves as
having an authoritative voice with respect to protecting the soul, but at the
same time are sincerely searching for ways to speak about HIV/AIDS in more
practical ways. Condoms become a metaphor for resistance. For example, FC
leaders wish to know how the message of condom promotion (a behavioral and
technical argument) might be grafted onto what they would posit as a moral
message of care, prevention and support.
(Williams, et
al., n.d.)
Social
marketing of condoms (CSM) by NGOs may actually have alienated potential allies
in the church. Pfeiffer notes that while
pastors of the growing Pentecostal and AIC movements in neighboring
As an
alternative method of introducing condoms, Pfeiffer notes that a different NGO tried
fostering relationships with churches,
“Through careful and patient engagement with the churches,
the organization had succeeded in generating a dialogue and had even gained
some pastors’ support for condom promotion. The organization avoids promoting a
prepackaged message, but rather attempts to establish a conversation about how
and when condom use might be considered acceptable within church doctrine.”
(Pfeiffer, 2004, p. 93)
Debate
continues on the type of public messages to promote condoms, yet Pfeiffer
contributes a paradigm shift for social scientists. "The
Zimbabwe’s
experience is similar, now sitting with a message "stalemate between
government, secular agencies and the churches, confused messages to…youth, and
an inability to move beyond the condom issue" (World Council of Churches,
2004) This was demonstrated in August
1999, when the Heads of Christian Denominations (HOCD) and ZCC released a
Statement on AIDS, upholding “education based on dignity and human value
leading to sexual abstinence before marriage, lifelong fidelity to one's
marriage partner and that the indiscriminate issue and use of condoms is not
the answer." (World Council of Churches, 2004)
Small changes occurred later in 2000, when the HOCD hosted a networking conference, out
of which came the finding that “Condom use is acceptable, within the family,
for discordant couples to protect the uninfected partner" (World Council
of Churches, 2004)
CHURCHES WHICH INSULATE
What is the influence of the churches that apparently do
nothing specific around AIDS? Ruden challenges common assumptions in stating that,
"a disproportionate amount of the credit goes to conservative black
churches with no AIDS programs and no specific AIDS message" (Ruden, 2000)“ In
South Africa, she notes that such churches are the only social institution that
can provide the female protection and gender role definition and enforcement
which youth need to survive today. She
holds that most youth programming is based on western
models of self-esteem and individual choice which is not culturally appropriate
nor can it realistically empower youth towards safe behavior, given the actual
reality youth find themselves in. (Ruden, 2000)
Such Apostolic and Zionist churches spiritualize illness,
which provides clear cut meaning behind AIDS for the many that are part of
these churches. The indigenous Apostolic churches resist western medicine. Drinking and smoking are officially
excluded. They do not discuss AIDS very
often, but it affects the preaching nonetheless. These churches could provide a “safe”
insulation from the outside “world” through strong behavioral and gender
boundaries. Certainly this approach
could theoretically serve to reduce HIV transmission.
Polygamy is allowed, obviously highly problematic vis-à-vis
HIV transmission. Fear (of AIDS, of
exclusion, or of shame within the group) works as a behavior control mechanism,
but is short-lived, only as long as the fear is maintained and fostered. When a person leaves such a church, the
controls on behavior are removed.
Although contrary to current development thinking, could
such grassroots religious communities work in influencing HIV
transmission? Unfortunately, rural
women in such churches are still not able to protect themselves from
transmission from their husband, who may work in town and not be a church
attendee. And in a highly mobile
society, members of these churches still lack the tools to negotiate the
complex urban environment. Insulation
from the reality may not be a long term solution, yet the questions beg more
study.
YOUTH AND SEXUAL BEHAVIOR
AIDS is reshaping
Traditional Shona culture had clear sexual boundaries in place, even with polygamy. As these boundaries erode with urbanization and modernization, youth find less social control on their sexual behavior choices. Additionally, rural Zimbabwean youth experience extraordinary pressures, and hardships.
Rural schools are generally much lower quality than urban schools and students’ battle lack of basic equipment and academic resources such as libraries and laboratories. And in rural areas, not all youth are attending school. Primary school attendance, as high as 98% six years ago, is declining. If the household loses an income provider to AIDS, there is greater likelihood that youth and children in that household do not complete schooling. Rural youth know hunger, poverty, academic pressure, and limited employment opportunities. Girls face sexual pressures from other boys as well as older men. Youth have financial pressure for their own personal items for hygiene, recreation, school books and food.
Youth today will also undergo major personal losses
affecting healthy psycho-social development, such as the loss of one or more
parents, caregivers, or siblings. Losing
an important adult takes away the opportunity for modeling and interpersonal
support needed for navigating the journey into adulthood. Youth opportunities for learning basic life
skills such as farming are dramatically reduced with the loss of parents. Families can dissolve as parents die from
AIDS. Trauma and distress arises from
these disconnections. Youth demonstrate
symptoms such as social disconnectedness, insecurity, lack of trust, inability
to deal with their emotions properly, anti social behavior, and sexual
experimentation (despite being HIV literate).
Sexual intercourse may certainly be part of these adolescents’ "need to establish acceptance, intimacy
and autonomy among peers…and finding love and adulthood." (Varga, 1997, p. 50)
Sexual
behavioral choices never happen in a vacuum.
Sexual practices of youth are influenced by their connection to
community, church, and household values, by the developed inner sense of one’s
ability to make choices for oneself, by alcohol use, and by cultural male
gender power over females. Financial and
food pressures to earn cash through sex can overwhelm even the youth with
strong moral centers. Some older
boyfriends show affection for girls through gifts, and the boys continue to
expect sex as part of the traditional “gift” exchange. (Langhaug, et al., 2005)
Reviewing these many dynamics within the lives of youth, "for many girls
unsafe sex is a rational choice which is perceived to result in, and safeguard,
benefits such as emotional intimacy, trust, legitimacy and even economic
stability." (Varga, 1997, p. 48) Ultimately, for girls, "the
psycho-social benefits of unsafe sex seem(ed) to outweigh the risks of HIV
infection." (Varga, 1997, p. 62)
The gap between the actual lived experience of Zimbabwean
youth described above and what their parents and elders (and clergy) pretend it
to be is more properly an abyss.
Youth, like all persons anywhere, need affection, mentoring,
and domestic stability. For youth to
develop resiliency and coping skills, significant investments of modeling,
education, and formation are ideally invested in them by society and
family. But with Zimbabwean society
under extraordinary stress, many youth are growing into adulthood without many
of the formative experiences for them to avoid becoming infected and to navigate
adulthood. This leads us into the theory
of social capital.
CHURCH AND
A wider view from the social sciences highlights churches’
ability to build social or human capital, sometimes called social capacity. Social capital refers to the diverse networks
of children, youth, and adults (households) and local institutions, through
which a child grows into healthy adulthood, learning the community norms, and
their own identity, from modeling and being cared for across the years. The remaining social and cultural milieu of
rural
Social capital theory underlies a promising, community AIDS intervention
undertaken in
CHURCH AND DIRECT YOUTH OUTREACH
In general, youth who grew up in church are not unduly critical
of church, but they often find that it loses relevance with their actual experience. They may continue attending church, and even
find some value through attendance, although they are less likely to attend
because of family or parental influence.
They find much of the Sunday preaching as talking down to them. Reaching out to unchurched youth has great potential, as youth are
likely to join with friends at the few churches with very attractive youth
programming. Most church workers remain
frustrated with their inability to change youth behavior.
Since their moral formation is still underway, efforts in
faith development and education are important, but verbal interchange should also
be primary. "Information by itself
does not change behavior." (SAfAIDS/Panos/BYNC,
2003, p. 29) For that reason, one
promising youth ministry approach is peer-to peer education programs, which
some schools already include. Teens
receive training in topics such as goals, relationships & sex, gender &
power, making choices, values, HIV/AIDS/STIs,
puberty, reproduction, condoms, contraception, sexual negotiation,
communication skills, marriage, etc.
They are also encouraged to discuss these issues as they apply to their
lives. They then serve as informed youth
leaders, who carry forward a culture of positive and safe living in their
schools through their club profile, entertaining presentations and service
activities. (Condoms are not distributed
at Zimbabwean schools, yet they are part of the curriculum. However, just like the
The
The next stage was workshops for youth and youth leaders at both parish and school level. The workshops concentrated on behavior change through three stages of participatory techniques to help them develop personal informed choices. The youth consolidate their decision in a written commitment with prayer to help them keep AIDS free. These youth clubs now exist at the local parish levels and have been extended into schools by the youth themselves giving both peer support and outreach. (World Council of Churches, 2004)
A different program of interchange in churches for BC was recently undertaken by the NGO Deseret International, which incorporated both youth and their parents. (Happy, 2005)
Clearly, there is then room for a wide array of outreach approaches
in addressing youth behavior. And given the very large portion of the
population youth occupy, reducing new HIV infection in youth could be the most
effective investment for the future of all of
Obstacles remain for the church in influencing youth. Even when the condom debate is removed, challenges include limited resources, uninformed church leadership, adults holding the decision-making power in congregational life, cultural avoidance of discussing sex, and generational dissonance and inability to communicate (church elders vs. church youth). Ironically, the church has sometimes served to directly contribute to HIV transmission. It is the popular church 24 hour overnight prayer meetings which youth identify as high risk venues. (Langhaug, et al., 2005)
THE FAITH DIMENSION OF THE CHURCH AS AN ASSET
The church is not an NGO or FBO, but an organic grassroots
expression of human-divine exchange. Its
central qualities of faith, hope, healing, mercy, and continued seeking
inspiration on the biblical text separate it from any other social grouping. Worshipping communities can foster and shape
self-identity, vision and honesty.
Such strengths are great contributions to social life. Churches can lose their identity in trying to
imitate FBOs and NGOs, although churches do give
birth to FBOs.
Despite some serious obstacles like polygamy in the Apostolic church and
some highly dualistic theologies, our thesis is that the church’s role in
forming, norming, advocating and creating safe social
space is essential in reducing HIV transmission in all persons, including youth.
Therefore, the church should not weaken, but strengthen its
assets in the inner life, in prayer, and in more mature preaching around
HIV/AIDS, including Biblical theologies of the body, of stigma, of Christian
community life, of choice and responsibility, of gender equality, of non-violence,
of prophetic witness, of sexuality as part of co-creation, etc. (Weinreich & Benn, 2004) Additionally, Zimbabwe needs
role models from the church for inspiration and guidance, models of Zimbabweans
committed to a spiritual life.
While NGOs and government provide cognitive analysis of
AIDS, people still seek the meaning of AIDS and misfortune in general. This is one imperative task of religion.
Meaning, purpose and crisis resolution used to be worked through by traditional
diviners in
PRELIMINARY LITERATURE STUDY ON FAITH, CHURCH AND BEHAVIOR
There are hundreds of case studies of church programs responding to HIV/AIDS which have been collected and published. (World Council of Churches, 2004) (Parry, 2003) (Byamugisha, et al., 2002) There have been a few qualitative research studies in Africa which intentionally incorporated the clergy, such as one led by MAP International, in which awareness packets were sent to Kenyan pastors with HIV facts, sermon outlines, prevention information, and care and compassion encouragement. (Black, 1997)
Although not carried out in
CEDPA’s new training manual for
faith communities includes behavior change theory, models, and activities. The users become competent in the steps of
knowledge, approval, intention, practice, and advocacy. (CEDPA, 2004)
Studies in the
There is no quantitative research yet on the influence of church affiliation on HIV transmission. Even the African church leadership realized this gap, and called for "specialized research on those aspects of the pandemic where they can make a unique contribution." (World Council of Churches, 2001, p. 8)
|
References |
|
|
|
|
|
Black, B. (1997, June). HIV/AIDS and the church: Kenyan
religious leaders become partners in prevention. Aidscaptions, 4(1), 23-26. |
|
Byamugisha, G., Steinitz, L., Zondi, P., &
Williams, G. (2002). Journeys of Faith:
Church-based responses to HIV and AIDS in three southern African countries.
|
|
CEDPA. (2004). Faith
community responses to HIV/AIDS. |
|
Fullilove, R. E., Green, L.,
& Fullilove, M. T. (2000, June). The Family to
Family program: a structural intervention with implications for the
prevention of HIV/AIDS and other community epidemics. AIDS, 14(supplement 1), S63-S67. |
|
Happy, C. (2005, June 3-4). HIV & AIDS prevention for
youth in faith-based organizations. Coming
together to overcome HIV/AIDS in Zimbabwe:
HHS programs conference, p. 11. |
|
Langhaug, L. F., Mutisi, M. C., Mutanga, O.,
Gore, O., Manyonga, B., Masiyiwa,
M., et al. (2005, June 3-4). Using participatory methods to asses the riskiness of rural communities for adolescents: an anlysis of risk maps in the Regal Dzive
Shiri Project. Coming
together to overcome HIV/AIDS in Zimbabwe:
HHS programs conference, p. 15. |
|
Langhaug, L. F., Mutisi, M. C., Mutanga, O., Manyonga, B., Masiyiwa, M.,
Gore, O., et al. (2005, June 3-4). Exploring the context of the evolution of
sexual behavior among rural Zimbabwean adolescents. Coming together to overcome HIV/AIDS in Zimbabwe: HHS programs conference, p. 16. |
|
Larson, D. B. (2000, July-Sept). The power of prayer. Contact, 170, 6-7. |
|
Latkin, C. A., Tobin, K. E.,
& Gilbert, S. H. (2002, December). Shun or Support: The Role of Religious
Behaviors and HIV-related health care among drug users in |
|
Parry, S. (2003). Responses
of the faith-based organisations to HIV/AIDS in sub
saharan |
|
Pfeiffer, J. (2004). Condom social marketing,
Pentecostalism, and structural adjustment in |
|
Ruden, S. (2000, May 17). AIDS in
|
|
SAfAIDS/Panos/BYNC. (2003) Men and HIV in |
|
Varga, C. A. (1997). Sexual
decision-making and negotiation in the midst of AIDS: youth in |
|
Weinreich, S., & Benn, C.
(2004). AIDS - Meeting the Challenge:
Data, Facts, Background. |
|
WHOQOL HIV Group. (2004, October). WHOQOL-HIV for quality
of life assessment among people living with HIV and AIDS: results from the
field test. AIDS CARE, 16(7),
882-889. |
|
Williams, D. G., Arratial, M. I.,
& Makondesa, P. (n.d.).
|
|
World Council of Churches (2001) Global Consultation on the ecumenical response to HIV/AIDS in |
|
World Council of Churches. (2001). WCC Southern |
|
World Council of Churches. (2004). Responses of the churches to HIV/AIDS in |