February 21, 2013
No, we're not all HIV positive. But we all are at risk for acquiring HIV. In recognition of this fact, theologian and bioethicist Robert Doyle teaches a graduate course that examines HIV not as a moral issue in itself, but as a major global epidemic with moral questions embedded in the ways communities respond. He's also the author of a forthcoming paper entitled "We Are All HIV Positive: A Catholic Social Teaching Response to the HIV/AIDS Epidemic."
While many in the HIV community have have had mixed-to-negative experiences with the Catholic Church as an institution, Doyle is invested in showing the positive points Catholic theology can bring to a conversation around treating those living with HIV. In his course, "Theological Ethics and HIV," Professor Doyle asks his students to articulate the reach and scope of the HIV epidemic; identify current political and religious responses to the epidemic; and wrestle with the epidemic's moral implications for faith communities.
Professor Doyle is a visiting assistant professor and the graduate program director at the Bioethics Institute at Loyola Marymount University. He sat down with TheBody.com to discuss teaching HIV in a classroom setting; what theology and ethics can bring to a discussion of HIV and health care; and how an "us vs. them" mentality is fueling the HIV epidemic.
How did HIV become a part of your academic life? Did you have any previous experience as an HIV advocate?
Professor Robert Doyle
The interest began when I took a class as a graduate student earning a master's degree in theology. I took a class in HIV/AIDS, probably five or six years ago. It was fascinating to study it from an academic standpoint. I was asked about three or four months ago if there was any class I'd like to introduce, and I thought that it would be really interesting to teach a class like that on my own.
I don't have any personal experience with HIV/AIDS. But as a theologian, I found that religions have various approaches to the epidemic, and I was fascinated with the responses -- some being more positive than others. I thought, by offering a course based in theological ethics, it would give me and students an opportunity to examine just what these positions are, why some of these positions are positive, why some of the positions are negative, and begin to analyze and to unpack some of the theological responses to HIV/AIDS.
I looked at it from a Catholic position, particularly because that tradition has a body of teachings that are more organized than other traditions. It was easy to see the various responses within that particular tradition. So that's where I'm coming from, particularly in a course like this.
At the very beginning of your paper, which is titled "We Are All HIV Positive: A Catholic Social Teaching Response to the HIV/AIDS Epidemic," you talk about the "us/them" mentality that's driving the epidemic. What do you think inspires the "us/them" mentality in people? Do you think it's just a natural human response?
The interesting thing about HIV/AIDS is that somewhere in our thinking, there is still a sense that this is just a disease associated with gay men and intravenous drug users. For whatever reason, there's this idea that morality is attached to it. You get this disease for doing an "evil act." Because of that, I think it paints a different picture than other diseases. When you talk about someone with cancer, it's not "us vs. them." Because we somehow still attach this sense of morality to HIV/AIDS, it's "Oh, you must've done something wrong, and that's why you have this disease and I don't." There's still that separation there, and that's the focal point of that paper, is trying to debunk some of those myths by examining women, African Americans, impoverished people in this country. It's recognizing that it's not just an issue of morality, or just an issue of gay men and intravenous drug users.
Some people I know call what you were just talking about the "dignified diseases." That there's a sense of dignity attached to certain diseases, especially certain types of cancer. Even within cancers, there's a kind of hierarchy, like breast cancer is very dignified, but if you smoke and get lung cancer, it's less dignified. People would ask, "Why were you smoking?"
Yes, and I think that's exactly what creates the "us vs. them" mentality.
What are some of the course objectives for this class? What do you hope students will absorb? What are some potential real-world applications of this information for students who are bioethicists?
I have a few goals. One is to raise awareness of the HIV/AIDS crisis. To really see how it's impacted people in this country. Not just the typical groups that we were just talking about. But that it's far reaching. And it's unlike any epidemic that we have ever seen in this country. It is not confined to a particular gender or a particular race, or a particular socioeconomic group. It really encompasses all of those. The first thing is to raise awareness that it's not just something we can throw money at, or throw drugs at, and realize that it's an epidemic that has consequences among all different types of groups.
The other thing that I want to explore in the course is the diverse responses to the challenges posed by HIV/AIDS, so that we begin to see, as I mentioned at the start of the interview, how some groups within the Catholic Church have responded positively and reached out to those with HIV/AIDS, and why other groups have responded differently, let's say. Also, I want students to be able to analyze critically what's been presented. Why have groups responded in different ways? Why has there been an "us/them" mentality? Why is it that various groups and socioeconomic classes don't receive as much support? They can begin to see that this is a unique epidemic that requires extraordinary responses.
The four principles of Catholic social teaching are extremely important to your paper, and to being a Catholic today. One of them is "solidarity." In what part of your class will you address the history of activism, especially that of ACT UP and Treatment Action Group, which were about solidarity during the darkest times of the epidemic?
We're certainly going to explore those. I have a couple of weeks built into the course where we look at the gay community's response to HIV/AIDS, but I think that's just a small part of activism, particularly today. By and large, the gay community has done a good job of handling the HIV/AIDS epidemic, raising awareness, promoting health within the community, promoting testing. I think it's other communities that haven't done as great a job.
Part of what I'm talking about in terms of solidarity is not looking at one particular group, but looking at all these groups where HIV/AIDS has had an impact and exploring how those communities have engaged, or perhaps not engaged, with the epidemic.
You talk about how the four principles of Catholic social teaching must work together to address the HIV epidemic. The four principles are: "dignity of the human person," "preferential option for the poor," "responding to structural sin," and "solidarity." Can you talk about how they're all interconnected, for someone who may not know?
The underlying principle is this idea of human dignity. If we recognize that, by our very nature, all of us have human dignity, then the other principles fall into place. If someone else is suffering, then we have this duty to respond to them in solidarity.
A disease like HIV/AIDS hits poor people hardest, so standing in solidarity -- recognizing the human dignity of people living in poverty with HIV/AIDS -- we certainly should have a preferential option for them. When we talk about the distribution of health care resources, for instance, whether it's pharmaceutical drugs or access to testing, we need to make sure that communities that are poor receive these resources. I think, in that sense, they're all connected, starting with the idea of human dignity.
Your paper talks about poverty, and the ways poverty puts a person at risk for HIV transmission. And then, you have the "preferential option for the poor," which is the idea that the poor are God's people, and those people to whom we must respond. Do you feel as if there's a "preferential option" for HIV-positive people packed in there somewhere?
I think, just given the nature of how HIV/AIDS has affected impoverished people in this country, we can make the case that there ought to be preferential options for the poor with HIV/AIDS, because it is a disease that, without proper treatment and access to drugs, is deadly. Those groups that don't have access to those lifesaving treatments are the ones we should certainly pay attention to.
What do you think theologians can bring to the HIV/AIDS conversation that isn't' there right now?
This notion of solidarity is really something that theologians, many of us in the Catholic tradition, talk about quite frequently. It breaks down this "us vs. them" mentality. I think that's one of the principles we can bring to the conversation.
We can also bring the notion of breaking down stereotypes, breaking down barriers, breaking down misconceptions of teachings so that we understand that there are really no teachings that say, "We ought not to treat people with HIV/AIDS." That's in line with solidarity, but it's a separate piece.
A theology class on HIV is not something that people often think of. Religion is so important to so many people, but then there are some people who are not on board with organized religion.
Offering a class like this is extremely important, because it allows us to have discussions that students may not otherwise have in relation to HIV/AIDS, from a theological standpoint. As I mentioned, oftentimes there are instances where religions have been used to harm people with HIV/AIDS -- not physically, but perhaps by not reaching out to them the best they could. I think a class like this can highlight what the teachings actually say.
One of the things I do love about theology is that it's applicable in a lot of different situations. You talk in your paper about distribution of resources; in the U.S. Conference of Catholic Bishops' Economic Justice for All, they talk a lot about redistribution of resources. In this instance, it applies to pharmaceutical companies, or even just the way we manage health in this country. How do you think, generally, theology can respond to health care issues?
I think theology offers the principles that we've talked about, but there's another principle called "the common good," which recognizes that we all ought to be making contributions to the good of everyone. Sometimes, that may mean that some of us have to give up a little bit or pay a little bit extra, to help those that may not have access to some of those drugs. So, by distributing drugs to those who are poor, I think it actually contributes to this overall notion of the common good. When those who are least off are taken care of, we all benefit -- a notion that I think is quite foreign to us in this country.
You start your paper off with a lot of data from the U.S. Centers for Disease Control and Prevention: There are 300 million people in the U.S., and about 1.2 million of them are living with HIV, so it's about 1 in every 222 people. If you break it down, that 222 people can pay for one person's medication; it won't be a huge burden on everyone.
I think principles like "the common good," or "solidarity," recognize that decisions such as access to drugs ought not to just be economic. We have a duty, based on our human dignity, to provide those drugs to those in need.
Can you explain "structural sin"? This notion is part of the health care conversation, but it's not a term you hear every day.
"Structural sin" is the idea that the structures we have in place take care of those who already have access to those systems. An example of structural sin is that there's nothing within our health care system right now that provides for those who have the least access. This structure we have, just by the way it works, ignores those who need access to care the most. Particularly with HIV/AIDS, it's definitely worth examining how we can change those structures to provide for those who need drugs or access to care and allow them to flourish.
Can you talk about "human flourishing," and what you think are the structures in place that stop human flourishing?
It's connected to that idea of the common good. We "flourish" -- and there are a lot of definitions of the word flourish here, but you can imagine what it means to flourish as a human -- when we have those things that allow us to best achieve our capabilities. Health is one of those. When we are healthy, we flourish. And the notion of the common good helps with that flourishing.
In line with solidarity, we are moving closer to this idea of taking care of one another. It ties into the idea of structural sin. When there's a structural sin in that someone cannot afford drugs, then they can't flourish, because they're not healthy. They're all sort of tied in together in that notion. The "common good" is that umbrella term that creates the system where we can all flourish.
As we wind down this interview, is there anything that you'd like to say, or you'd like our readers to know?
The interesting thing, and one of your questions alluded to this, is that theology and religions can actually have a positive role to play in breaking down some of the barriers that still exist in relation to HIV/AIDS, and by having conversations like this -- not just jumping to the conclusion that religion and theology should be excluded from the conversation about HIV, but actually inviting theologians to the table to have conversations about HIV/AIDS -- can actually be beneficial.
This transcript was lightly edited for clarity.
Mathew Rodriguez is the editorial project manager for TheBody.com and TheBodyPRO.com.
Follow Mathew on Twitter: @mathewrodriguez.