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Editorial

Gordon Nary

October 1997

In our association's efforts to build an alliance between physicians and communities of faith to address the healthcare needs of the disenfranchised, I often find myself, like some medieval tonsured monk, in a useless debate over how many angels can dance on the head of a pin -- although in this instance, it is how many people with HIV/AIDS can dance around a conservative's definition of sin. This ulcer-causing dialog has forced me to consider the various dimensions of sin as metaphor for HIV disease.

Myth and metaphor are more accepted in Eastern than Western philosophy as paths of knowledge. Myths are created to help explain the unknown. In creating myths we draw upon our imagination and possibly atavistic memories to intuit universal truths. Metaphors by comparison are not created. They already exist and are chosen because they parallel realities.

Some theologians divide sin into sins of commission and sins of omission. A sin of commission is the harmful consequence of an action. A sin of omission is the harmful consequence of a failure to act. So a sin of commission is a valid metaphor for antiviral cross-resistance because cross-resistance is essentially the consequence of a specific act -- the way in which antivirals were used in the past. Antiviral monotherapy could also be another example of a sin of commission. A sin of omission could be a metaphor for the failure to initiate the most effective combination antiviral regimen or to fund such a regimen for the poor.

Original sin offers another series of related metaphors. Some theologians claim original sin is "transmitted" in a maternal-fetal model similar to the transmission of HIV to neonates. In the Biblical myth, it was Eve who infected Adam by her disobedience of God's dictum, the punishment for which was the loss of unity with God and the natural order, a loss that was transmitted through Eve to their offspring in perpetuity. However, in HIV disease it is usually Adam who infects Eve who in turn transmits the infection to their child. Some religious conservatives claim that this is an example of children paying for the "sins of their fathers." Such anthropomorphic statements seem to better illuminate the nature of humanity than the nature of God.

Here is where the metaphor of sin gains some weight. A Christian epistemological construct asserts that sin against the Infinite can be eradicated only by Infinite reparation, ie, Christ's death as the Infinite reparation for Adam and Eve's sin against the Infinite. This metaphor may illuminate the reality of current combination antiviral strategies.

Anthony Fauci, the popular, perpetual pontiff of NIAID, was quoted in the August 13 New York Times, predicting as high as a 50 percent failure rate of current antiviral combinations. Others have predicted that all our current antiviral strategies will eventually fail within five years. Do these troublesome projections reflect that we are missing the "infinite" antiviral or the antiviral Messiah that will serve as the salvation of the world of those with HIV disease? Will all current antiviral agents leave a permanent imprint on the immune system-the logical metaphor for the soul? Will the limitations of antiviral therapy be the theological equivalent of forgiveness without restoration of innocence? Will Fauci prove to be a Jeremiah whose lamentations, if heeded, could change the course of the plague? Or will he prove to be a St. John whose revelations of the Harlot of Babylon signal the end of the world of many with this disease?


©1997, Medical Publications Corporation




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