Re-imagining HIV & AIDS Ministry from the perspective of the infected and

the affected

AIDS is a disease and should be treated as such... God, who loves all human
beings, cares for the well-being and health of every one of his children, and does not
inflict disease as a punishment.
Dr Emilio Castro
1

Introduction
The HIV/AIDS pandemic has grown in its size. The pandemic has become a
health, social-economic and development disaster, with far reaching implication for
individuals, communities and countries. No other disease has so dramatically
highlighted the current disparities and inequities in the health care access, economic
opportunity and the protection of basic human rights. With respect to the people who are
living with HIV/AIDS (PLWHA) we can see that they are marginalised in the care
receiving front because of the threat of infection and the stigma in society regarding
HIV/AIDS.
This affects the people who are related to those who are infected. Hence there is a
need to re-imagine a ministry from the perspective of the ones who are infected and
affected by the disease.
HIV/AIDS Global Situation
By the end of 2003, UNAIDS/ WHO estimated 40 million (34-46 million) people to
be living with HIV/AIDS. In the same year, the HIV/AIDS pandemic claimed more than 3
million (2.5-3.5 million) lives and 5 million (4.2-5.8 million) people became infected with
HIV. Each day there were 14,000 new HIV infections, and close to a half of these are
young people under 24 years of age with over 95% occurring in poor and middle-income
countries. Globally, the major mode of transmission is through unprotected sexual
intercourse. Injecting drug use, sexual intercourse between men, mother to child
transmission and contaminated blood in health-care settings are other modes of HIV
transmission.
2

Chronic conditions are dened by the World Health Organization (WHO) as
requiring on going management over a period of years or decades and cover a wide
range of health problems that go beyond the conventional denition of chronic illness,
such as heart disease, diabetes and asthma. They include some communicable diseases,
such as the human immunodeciency virus and the acquired immunodeciency
syndrome (HIV/AIDS), which has been transformed by advances in medical science from
rapidly progressive fatal conditions into controllable health problems, allowing those
affected to live with them for many years.
3

Stigma and Discrimination
HIV/AIDS- related stigma and discrimination rank among the biggest and most
pervasive barriers to effective response to the AIDS epidemic. Stigma is a social process

1
World Council of Churches, AIDS and the Church Hearing on AIDS from
http://www.oikoumene.org/en
2
Global HIV/AIDS report. A joint WHO/UNIADS report (Geneva: World Health organization,2003), 4
3
Ellen Nolte and Martin McKee (Eds.), Caring for people with Chronic Conditions (Berkshire, New
York : Open University Press, 2008), 1
Re-imagining HIV/AIDS ministry from the perspective of the infected & the affected Page 1

that marginalizes and labels those who are different and discrimination is the negative
practice that stems from stigma, or enacted stigma. Stigma and discrimination target
and harm those who are least able to enjoy their human rights. In fact stigma,
discrimination and human violation form a vicious circle, generating, reinforcing and
perpetuating each other and the outcome, in the World of AIDS is life-threatening.
Stigma increases peoples vulnerability by isolating and depriving them of treatment, care
and support and worsens the impact of infection.
The worldwide effort to remove the barrier of stigma and discrimination include:
Encourage leaders at all levels, and in all walks of life to visibly challenge
HIV/AIDS-related discrimination, spearhead public action against the many other
forms of discrimination that are faced in relation to HIV/AIDS,
Involving people living with HIV/AIDS in the response to the epidemic,
Creating positive legal environment for fighting discrimination,
Enabling the challenge against discrimination and receive redress through
national institutions
Ensuring that prevention, treatment care and support services are accessible to
the ill.
4

Biblical & Theological Basis for care
In Ephesians 4, Paul speaks of the body of Christ, the true Chruch, as growing
according to the effective operation of each member. Other portions of Scripture (eg.
Rom.12, I Cor.12) teach that every born-again believer is gifted by the Holy Spirit to
contribute to the growth of the Church. God has a definite purpose for each individual, a
foreordained program for accomplishing His sovereign purpose through every member of
His body (Eph. 2:10). In Christ, God has provided every person with significance, a
meaningful purpose for living.
5

The Lord God is the creator of heaven and earth; the creator of all life forms in
the earth community. He created all life and everything good. In this HIV/AIDS era, he
sees the misery of his people, who are infected and affected by this disease; He has
heard their cry on the account of this epidemic. He knows their sufferings and he has
come down to deliver them from HIV/AIDS. So he calls to send us to the infected and
affected, to bring his people, his creation, out of the HIV/AIDS epidemic.
6

Caregivers to PLWHA
Who are the caregivers for people with illnesses related to HIV and AIDS? The
question sought to discover who the main care-givers for PLWHA within the family and
society at large are and why. It is understood that family members or relatives are
providing care for the people who have illnesses related to HIV and AIDS. Two reasons
were given for this. The first one was that it is their responsibility, and the second reason
was that they are closer to the sick persons. AIDS is a chronic disease so that one person
or gender cannot continually carry out the responsibility of caring for PLWHA alone over
a period of years, without support from other members within the family. But patriarchal

4
Elizabeth Marton Semguruka, Living with HIV/AIDS; Womens Perspectives Regarding
Care/Support Provided in Dar Es Salaam, Tanzania - M.Phil. Dissertation (Norway: University of
Oslo, 2004), 23
5
Lawrence J Crabb Jr., Basic Principles of Biblical Counselling (Grand Rapids, Michigan:
Zondervan, 1975), 59
6
http://www.oikoumene.org/en
Re-imagining HIV/AIDS ministry from the perspective of the infected & the affected Page 2

ideology denies men an opportunity to practice their Christian faith with regard to
providing care for ones neighbour.
7

Siwila therefore argues that, there is need for fresh examination of such socially
and theologically imposed roles particularly as related to the ministry of care-giving and
calling from God. This suggests that care-giving ought to be shared by all members of
the family irrespective of their gender in order to lessen the exhaustion and over-
burdening experienced by women and girls.
8


Relevance of Pastoral Care for PLWHA
According to Gerkin: Pastoral care involves not only the care of the individuals
and families, but also the care of the community itself. Pastoral care also entails the
thoughtful reinterpretation of the tradition that shapes Christian identity as that
tradition is brought into dialogical relationship with contemporary culture and its impact
on the community of Christians as well as its individual members.
9

Counselling services are very important for people living with HIV/AIDS and
family members. Therefore, counselling needs to be seen as more than the pre- and post-
test giving of advice. Household members sometimes become hurt and angry as they
undertake care-giving responsibilities. In some homes this can result in violence and
abuse. It is important, therefore, that embittered family members be helped to articulate
and express their feelings. Counselling services should seek to address important issues
such as preparation of wills, marriage and adoption, as these have been found to be
influencing factors for care and support.
In general sense, pastoral care can be understood as the compassionate
attending or presence of the community of faith, in the brokenness and sufferings of
persons and their relationships. The need for care is grounded in the existential
condition of humanity. To put it in the words of Vankatwyk, care involves our shared
vulnerability and the attendant anxiety about the tenuous nature
10
of life in the world.
In fact, the ministry of pastoral care is guided by the compassionate sensitivity to the
existential concerns of persons and communities. As such, the ministry of pastoral care
is to be understood as a countercultural activity that seeks both restoration of wholeness
of persons and their relationships and transformation of the world of pain, suffering and
non-care into a more caring, friendlier and safe place to live in.
11

People living with HIV and AIDS (PLWHA) networks, organizations and self-help groups
such as African Network of Religious Leaders Living with or personally affected
by HIV/AIDS (ANERELA+) and the Global Network of People living with HIV/AIDS (GNP+)
play important roles.

7
Rose Materu, Martin Luthers teachings on care giving in crisis times: A challenge to mens
involvement in the context of HIV and AIDS in the Northern Diocese of the Evangelical Lutheran
Church in Tanzania.
8
L. Siwila, Care-giving in Times of HIV and AIDS, when Hospitality is a Threat to African
Womens Lives: A Gendered Theological Examination of the Theology of Hospitality in Journal of
Constructive Theology, 13/1, (2007), 72
9
Charles V. Gerkin, Introduction to Pastoral Care and Counselling, (Nashville: Abingdon, 1997),
118
10
Peter L. Vankatwyk, Spiritual Care and Therapy: Integrative Perspectives (Waterloo: Wilfrid
Laurier University Press, 2003), 11
11
Rev. Abraham Mathew, Paradigm Shifts in Contemporary Pastoral Care: Challenges and
Prospects for Christian Ministry in In the Masters Service: Reflections on Christian Ministry in
honour of Rev. Dr. M. V. Abraham (Kottayam : M.T.T.S., 2011), 313
Re-imagining HIV/AIDS ministry from the perspective of the infected & the affected Page 3


Support from the Circle
While family members may be willing to care for the sick, this changes in a
situation where the relative suffers from AIDS. Yet most of the people with AIDS
immediately turn to their families especially their blood relatives and the vast majority
of the care for people with HIV /AIDS is indeed provided by blood relatives.
12

Caring for people with HIV/AIDS is hard, physically and psychologically as well
as socially and emotionally. Problems linked up with caring for a family member with
HIV/AIDS can disrupt a family.
13

Apart from being a complicated sickness needing complex care (medical,
psychosocial, practical and material and spiritual), AIDS is stigmatized. The sickness has
several characteristics that make it suspicious. First, it is associated with sexuality,
particularly with illegal forms like prostitution. This association is not very simple, but
deserves attention when thinking about how family members deal with HIV/AIDS.
Ideally when the people in the whole circle come around the patient, which
includes the physicians, surgeons, nurses and the paramedical personnel in the
hospital, the patients relatives, visitors and even those who without actual face to face
contact with the patient and often even without the patients knowledge, they function as
a community faithfully praying for the healing of the patient.
The attitudes of those in direct contact with the patient, even over phone or
through other message, are very important, for these can generate healing energy. But
the faith of a community and its fervent and sustained prayer can definitely exercise high
therapeutic efficacy. The prayer of a single person, in direct contact with the patient or
without such contact, can also be immensely effective. There are secular substitutes for
prayer available to agnostics: like positive imagining, or intensely desiring and willing the
healing of the patient.
Even in these, a fundamental faith in the positive or beneficent aspect of reality
is a precondition. The joint effort in prayer of more than two people has always a special
effectiveness. This is the mystery of community.
14

The mission of the Church in the context of HIV/AIDS
Mission refers to: Gods saving work and the churchs participation in that
work. The mission of the church has its origin in the mission of God, and that the
church is called to participate in Gods mission by words and deeds. Regardless of the
sinful nature of human beings, God uses them to manifest the divine purposes of
creation, justice and salvation, and display Gods unmerited grace and love among all
people. The church is involved in missio Dei to bring salvation and justice which reveal
Gods love and grace to his creation. This implies that Gods mission does not encompass
only spiritual affairs but also the social and economic wellbeing of humanity. In other
words, the missio Dei has to deal with the wholeness of the person.
Nurnberger argues that the mission of the church is not confined to spiritual
matters but rather has to address the contemporary issues that are evident amidst Gods

12
Caldwell JK, et al: African Families and AIDS: Context reaction and potential Interventions;
Health Transition 1993; 3, 1-16
13
Osei Hwedie K., AIDS on Individual, Family and Community: Psychosocial issues. Social
Development in Africa 1994: 9/2, 31-43
14
Paulos Mar Gregorios, Healing- A Holistic Approach (Kottayam: Orthodox Seminary, 1995), 43
Re-imagining HIV/AIDS ministry from the perspective of the infected & the affected Page 4

people such as disease, poverty, violence and illiteracy.
15
Provision of care to PLWHA is
ultimately part of Gods mission to his people since pain and suffering are the realities of
their daily experience. All Christians are called through baptism to participate in Gods
mission.
Answering the Call
Churches in many countries with high HIV prevalence, particularly those in
Africa, are already suffering from the onslaught of the HIV pandemic. Members of
churches have similar rates of HIV infection as the community in which they live.
Churches, as living organizations, have much to learn and to give to their members who
are living with HIV and AIDS. Churches must go through a transformation process,
become AIDS competent and be a better home for those directly affected by the
pandemic. Churches, as living organizations, are inseparable from their members.
16

HIV-related stigma is seen to be at the heart of many failed efforts over the years
- both church and secular - to respond to HIV, particularly to break the silence and
denial surrounding the existence of HIV in communities.
17
Many interventions, whether
for HIV prevention, care, support or treatment, have also been less than effective due
to HIV-related stigma.
Churches must go through a transformation process, become AIDS competent
and be a better home for those directly affected by the pandemic. Churches, as living
organizations, are inseparable from their members. The worldwide church is one body of
Christ. Therefore, for churches, whose theology holds that, "For in one Spirit we were all
baptized into one bodyIf one member suffers, all suffer together with it; if one member
is honoured, all rejoice together with it," (1 Corinthians 12:13 and 26), the church is
inseparable from the PLWHA. This holds true for churches many members who are living
with HIV and AIDS and for their sister churches, which may have few members living
with HIV as they are all part of the one body of Christ.
There is no "us" (the uninfected) and "them" (PLHWA) within the worshipping
community of the church. In being followers of Christ, who identify themselves with the
suffering (Matthew 25:31-46), and recognizing that some members of the church
are HIV-positive, the whole body of Christ, the church, is HIV-positive.
Partnership with PLWHA organizations is therefore central to the
mission, ministry and identity of the church as the body of Christ. As an expression of
its ministry and commitment to identifying with PLWHA and to breaking stigma and
discrimination
18
, the church needs to make part of its confessional liturgy, wherever
Christians are gathered for fellowship, that "the church is HIV-positive"
Conclusion
True spiritual ministry is the healing of people-body and soul. In our tradition,
salvation means healing, giving life where death rules. To save means to make alive. That
includes deliverance from not only Hell, but also from the power of death and of evil as
well. But not just from a future Hell where the flame is never quenched and the worm
dies not. Salvation means also delivering people, and that not just Christians, from

15
Nurnberger, K., Martin Luthers message for us today: A perspective from the South,
(Pietermaritzburg: Cluster Publications, 2005), 149
16
http://www.oikoumene.org/en
17
http://www.unaids.org
18
http://www.unaids.org
Re-imagining HIV/AIDS ministry from the perspective of the infected & the affected Page 5

present Hell, the hell of stress and anxiety, of guilt and fear of condemnation, of pain and
torment in all forms, from disease and sickness, from evil and fear of death.
19

Reflecting on the AIDS pandemic in Africa, the Bishops of Southern Africa
proposed in June 1990:
Perhaps the AIDS crisis is God's way of challenging us to care for one another,
to support the dying and to appreciate the gift of life. AIDS need not be merely a crisis: it
could also be a God-given opportunity for moral and spiritual growth, a time to review
our assumptions about sin and morality. The modern epidemic of AIDS calls for a
pastoral response.
20

AIDS often involves alienation and separation between the person with the
disease and every surrounding system. We are challenged to be reconcilers, helping to
restore a sense of wholeness to broken relationships between the patient and those near
to him or her. We must build a sense of trust and caring. This requires education, and a
change of heart. If the yardstick of our faith is unconditional love, particularly love of
those whom society regards as outcasts, then our response to people
suffering from AIDS will be a measure of our faith.
21
This must be for those infected and
affected by AIDS.
Bibliography
Bishops of Southern Africa, AIDS: A Christian Response, June 1990 from
http://www.oikoumene.org/en
Caldwell JK, et al: African Families and AIDS: Context reaction and potential
Interventions; Health Transition 1993: 3: 1-16.
Crabb, Lawrence J Jr. Basic Principles of Biblical Counselling. Grand Rapids,
Michigan: Zondervan, 1975.
Gerkin, Charles V. Introduction to Pastoral Care and Counselling. Nashville:
Abingdon, 1997.
Ghana Bishops' Conference. Pastoral Statement on AIDS, October 1990 from
http://www.oikoumene.org/en
Global HIV/AIDS report. A joint WHO/UNIADS report. Geneva: World Health
Organization, 2003.
Gregorios, Paulos Mar. Healing- A Holistic Approach. Kottayam: Orthodox Seminary,
1995.
http://www.oikoumene.org/en
http://www.unaids.org
Materu, Rose. Martin Luthers teachings on care giving in crisis times: A challenge
to mens involvement in the context of HIV and AIDS in the Northern Diocese
of the Evangelical Lutheran Church in Tanzania.
Mathew, Rev. Abraham. Paradigm Shifts in Contemporary Pastoral Care:
Challenges and Prospects for Christian Ministry in In the Masters Service:

19
Paulos Mar Gregorios, op. cit., 64
20
Bishops of Southern Africa, AIDS: A Christian Response, June 1990 from
http://www.oikoumene.org/en
21
Ghana Bishops' Conference. Pastoral Statement on AIDS, October 1990 from
http://www.oikoumene.org/en
Re-imagining HIV/AIDS ministry from the perspective of the infected & the affected Page 6

Reflections on Christian Ministry in honour of Rev. Dr. M. V. Abraham.
Kottayam: M.T.T.S., 2011
Nolte, Ellen and Martin McKee Eds. Caring for people with Chronic Conditions
Berkshire, New York: Open University Press, 2008.
Nurnberger, K. Martin Luthers message for us today: A perspective from the South,
Pietermaritzburg: Cluster Publications, 2005.
OseiHwedie K., AIDS on Individual, Family and Community: Psychosocial issues.
Social Development in Africa 1994: 9/2: 31-43.
Semguruka, Elizabeth Marton. Living with HIV/AIDS; Womens Perspectives
Regarding Care/Support Provided in Dar Es Salaam, Tanzania - M.Phil.
Dissertation. Norway: University of Oslo, 2004.
Siwila, L. Care-giving in Times of HIV and AIDS, when Hospitality is a Threat to
African Womens Lives: A Gendered Theological Examination of the Theology of
Hospitality in Journal of Constructive Theology, 13/1, (2007): 69-82.
Vankatwyk, Peter L. Spiritual Care and Therapy: Integrative Perspectives. Waterloo:
Wilfrid Laurier University Press, 2003.
World Council of Churches, AIDS and the Church Hearing on AIDS from
http://www.oikoumene.org/en