"Come unto me all ye that labor and are heavy laden and I will give thee rest." As a Christian and a proponent of social justice for all, I have some questions regarding churches' response to AIDS.
I've enjoyed ten years of working in faith-based organizations (FBOs) that fight AIDS, and have seen much to inspire, educate, and horrify me. I'll base my comments on human rights and love, both of which are biblical principles, even if "human rights" isn't stated in those terms in the Bible.
There is a lot that is compelling about the work of FBOs in AIDS and a lot that, while compatible in theory, is quite contradictory and damaging in practice. Because FBOs have received millions of dollars from the U.S. and other nations, and from other funding sources such as the Global Fund to Fight AIDS, it is critical to examine how they are working and what their impact is on nations, communities, families, and individuals.
The Bible offers a clear mandate to care for people in need of help and to attempt to balance the scales of justice. Matthew 25:40 says, "Whatsoever you do unto the least of these, you do unto me"; Micah 6:8 states, "What do I require of you to live justly"; and 1 John 3:17 asks, "If anyone has enough money to live on and sees a brother or sister in need and refuses to help -- how can God's love be in that person?"
So it is not surprising that in sub-Saharan Africa, Latin America, and the Caribbean, FBOs provide up to 40% of all health care, and churches are present in many communities. At times there is no other health institution of any sort. In the U.S. there are also many faith-based health centers and other HIV service providers. The sheer presence and capacity of FBOs puts them in a good position to offer a range of services. Also, in many communities in Africa, Latin America, the Caribbean, the U.S., and to some extent Asia, there are very high percentages of Christians -- so the influence that FBOs and faith leaders have in the community is significant, for better or worse.
My first entrée to global work in AIDS was through an FBO. I was focused on supporting home-based care and hospices through Interchurch Medical Assistance World Health and its member organizations (a variety of mainline Protestant churches). The reach of these churches and FBOs into communities was tremendously helpful -- outreach workers were there for families and individuals in need of support and comfort in their final months. I also witnessed how the spiritual component offered great comfort, resulting in a peaceful death for many.
I've also seen churches have a very positive influence in the policy arena. The United Methodist Church, Lutheran Church, Church World Service, and others invested significant resources in policy analysis and mobilizing their congregations to advocate for increased funding for AIDS, as well as related issues like debt cancellation, which afforded countries the flexibility to assign more resources to health programs.
Similarly I've seen the establishment of the African Network of Religious Leaders Living with AIDS, which has worked to destigmatize HIV by having religious leaders speak out, offering messages of love and compassion, without judgment. Cristo Greyling and Gideon Byamugisha have encouraged language such as "The Body of Christ has AIDS" to signify that when one of us is infected, we all are, and that we need to address AIDS as a community issue -- not singling people out for blame.
In the last two years of my work with IMA World Health, I managed the organization's PEPFAR (President's Emergency Plan for AIDS Relief) treatment program. In theory, this should have gone well. FBOs have the reach, health facilities, relationships, and understanding of communities -- all of which should lead to a successful endeavor.
Indeed, the infrastructure afforded by the extensive networks of faith-based hospitals, clinics, and mobile units was a fantastic resource. Several of our partners were already successfully running treatment programs using generic drugs. At first the glut of resources and the prospect of being able to serve the hundreds of thousands in need of treatment was all very exhilarating. But those of us who were concerned about nuance came into conflict with the restrictions on reproductive health services, the inability to use generic drugs, and the "Anti-Prostitution Loyalty Oath," which restricts how organizations can use their funds to engage in speech or programs related to sex work. I found that many FBOs were not ready to buck the system on behalf of those they were supposed to serve. This strongly interfered with my ability to work, and I found myself in constant conflict. So, hundreds of thousands are receiving treatment through FBOs, and that's a good thing. But I put this on the cusp of the "What Hasn't Worked" section because I still ask, "At what cost?" and "Could we have done it better?"
In their AIDS response, churches have clearly been constrained by judgment and dogma. Kay Warren of the Saddleback Church rightfully pointed out, "The Church is more known for what it is against than what it is for." A friend of mine, Dazon Dixon Diallo of SisterLove in Atlanta, once said she wants to make a bumper sticker that reads, "Jesus Please Come Back and Save Us from Your Followers!" The words of Martin Luther King Jr. are also very apt: "Yes, I see the Church as the body of Christ. But, oh! How we have blemished and scarred that body through social neglect and through fear of being nonconformists."
On one hand there has been judgment regarding people with HIV and rhetoric around "the wages of sin equal death" and "you reap what you sow." At the 2008 Ecumenical Advocacy Alliance in Mexico City, one religious leader spoke of the condemnation and judgment she has faced since declaring her HIV status. There has also been stigma around certain high-risk populations, leading to damaging programs or outright neglect.
There are many examples of the influence of conservative Christian ideology and personalities on policy development. When PEPFAR was being designed, there were multiple forces influencing its policies, such as the Institute for Youth Development and the Children's AIDS Fund, which had an ideology rooted in conservative Christianity. This challenge to the separation of church and state should have been revealed early on and dealt with head on. Instead, it led to policies that didn't follow the scientific literature or the actual experience of gender inequality and other dynamics. Ideological polices masqueraded as evidence, like the Anti-Prostitution Loyalty Oath and the emphasis on HIV prevention through abstinence and fidelity to the exclusion of the proven effectiveness of condoms.
The gender inequality in many churches also permeates the societies where they are influential. This has played out in messages stating that being faithful is protection against HIV, when for many married women this is a death sentence. Both partners have to be HIV negative and monogamous for this to be effective. Yet people are offered simple messages without caveats. Church-based instruction on submission to one's husband has led women to stay in relationships with unfaithful husbands and to suffer violence at their hands. Often, churches do not offer guidance on the protection of women, focusing instead on the "sanctity of marriage" and "'til death do us part," regardless of the risk to the often powerless woman.
At the 2008 Ecumenical Pre-Conference in Mexico City, I appreciated the dialogue around gender, and specifically patriarchy, in the church. But there was no space in the program for the LGBT community and its issues -- unfortunate, given the early and continued epidemiology of HIV as well as the continued discrimination against LGBT people. How can there be an entire HIV conference without space for LGBT matters when we have had activists like Sizekele Sigasa and Salome Moosa, champions for HIV justice, who were murdered in South Africa in a vicious hate crime? When we have Solomon Adderly Wellington, a noted gay HIV activist in the Bahamas, murdered? When we have the President of the Gambia vowing to lop off the heads of gay people and criminalize any who offer safe harbor? When we have Steve Harvey, a gay HIV activist from the Jamaica Support Services slain in a country where there are more churches per capita than anywhere in the world? (Jamaica is my country of origin, yet I'm embarrassed to say that I would warn my gay friends about even visiting there, knowing that they risk life and limb due to homophobia.) And when we now have Uganda attempting to pass a law similar to that in Gambia, with the instigation of this legislation allegedly resting at the feet of certain U.S. evangelical churches.
Where are the voices of churches on these issues? Where is the high-profile public statement condemning such heinous hate crimes? Instead, there is much condemnation of same-sex relationships, and the intensity of Christian leaders' words, deeds, and attitudes seem to indicate that they are more concerned about these acts of love than acts of hate. One colleague spoke about being invited to dinner and learning mid-meal that his host was gay. He said, "There I was eating the food ." And this is a person who is in charge of HIV programs for his denomination! A participant in a workshop I facilitated stated that many in the church are only ready to embrace people who are "like us" by whatever notion of self-proclaimed sanctity "we" in the church define ourselves. My purpose here is not to sway those in the church who find a biblical basis to oppose homosexuality but rather to question their application of biblical principles. I ask them, what would Jesus do?
At Rick Warren's 2006 Saddleback Church conference an awkwardly titled session, "Loving Homosexuals as Jesus Would?" led to hopes that this evangelical leader was questioning attitudes toward LGBT people. Instead, it was a panel of speakers from the "ex-gay" movement, not a workshop offering guidance on how churches could be safe spaces that welcome all and uphold justice within a range of beliefs. They went beyond many churches in even holding such a workshop, but they need to take it further.
Does being known more for condemnation of individuals (and cozying up to big pharma and other questionable allies) instead of fighting for justice and human rights match the scene of Jesus in the temple overturning the tables of the money changers? Does it fit with the image of Jesus embracing and blessing a sex worker? His directive to her was to "go and sin no more." Repentance wasn't a precursor for his embrace. His championship of justice was not selective.
One of the conflicts I experienced in my work with the AIDS Relief Consortium was the need to include prevention programs with the treatment work we were doing, as it makes little sense to be doing treatment alone. That would be like trying to plug holes in a dam while more spring open. A group that was in charge of $330 million of AIDS funding was constrained in the prevention resources it could provide. The restrictions came from the ideologically driven PEPFAR guidelines, which mandate how much funding can be used for treatment and what emphasis must be placed on abstinence and fidelity. In addition, the organizational policies of Catholic Relief Services don't allow condom distribution or a full range of reproductive health services.
Many in the church refer to the AIDS pandemic as an "opportunity for evangelism." Ken Isaacs of Samaritan's Purse stated "AIDS has created an evangelism opportunity for the body of Christ unlike any in history." Community Health Evangelism offers a presentation entitled "HIV/AIDS in Asia: A Window of Opportunity for Community Health Evangelism." This is troubling on at least two levels. First, there's the notion that people could be celebrating such a dread disease -- as if it was sent so that they could save more souls. Second, the idea of "bread in one hand and the Bible in the other" could lead to the coercion of people who are in a vulnerable position.
There are critical roles for FBOs that contribute substantially to the well-being of communities, families, and individuals with HIV. Some FBOs have used their influence to advocate for needed policies, including debt cancellation and universal access to treatment. Religious groups have also used their reach in communities to ensure that there is a comprehensive web of support for people with HIV. I applaud these efforts and hope that these initiatives persist and multiply.
But FBOs should establish guiding principles so that everyone knows where each organization stands. I pushed for the establishment of such principles and values at the Pan African Christian AIDS Network. All were enthusiastically in favor. But when we completed the process, it included a clause saying, "Marriage should only be between a man and a woman." I decided then that it was time to bid adieu, as I am an uncompromisingly staunch ally of LGBT rights.
Advocacy conducted by FBOs should be based on principles of human rights. If this is the guideline, the automatic corresponding principle is "do no harm." The judgment-based advocacy that has resulted in such policies as the Anti-Prostitution Loyalty Oath and hateful anti-gay legislation such as that being discussed in Uganda that proposes the death penalty for loving persons of the same sex would not pass the "do no harm" test.
There is a role for abstinence in HIV prevention. It's possible to choose abstinence and it's good to have support in adhering to that choice. But doctrines and societal edicts are not enough if someone makes another choice or if people find themselves in situations where they have little or no choice. People who are in these circumstances need to know the options for keeping themselves as safe as possible.
Finally, let's reward FBOs that are doing good work, replicate those practices, and emphasize these positive models. There are churches that have articulated biblical bases for supporting women's rights and gay rights, and who promote a broad range of social justice issues. There are others who have devoted themselves to treatment, the care of orphans and vulnerable children, economic development, peace work, and hospice care through highly effective work. We need many more like them.
Jacqui Patterson is an activist and policy analyst working on women's rights, racial justice, and public health globally.