The Church's Response to HIV-AIDS in Oceania - Reflections on Three Workshops
Issue 18, April 2006
In recent years The Nathaniel Centre and Caritas-Aotearoa New Zealand have worked in partnership to address the problem of HIV-AIDS in Oceania and the Pacific Islands. To date three seminars have been held: The first was for the Bishops' Conference of Papua New Guinea-Solomon Islands; the second and third seminars were held for priests, religious and laity in Kiribati and in Tonga at the invitation of Bishop Paul Mea, Bishop of Tarawa-Nauru, and Bishop Soane Foliaki, Bishop of Tonga-Niue. The Church is still relatively young in these countries, less than 100 years old in some instances. This youthfulness is most evident in the remarkable vibrancy of these faith communities. Their desire to respond to the growing AIDS pandemic is an illustration of their vitality and is helping to reshape the way in which they live out the gospel.
A number of salient issues emerged from these workshops which underscore the current challenge of responding to HIV-AIDS in Oceania.
The scope of the problem
It is easy to look at figures and not see the faces behind them so that the meaning of AIDS in human terms is misunderstood. A strength of each seminar was the personal knowledge and first-hand experience of AIDS brought by those who were familiar with the human face of the epidemic through their role as nurses, doctors and priests, or as members of families who had lost loved ones to AIDS. Even so, these people were amazed at the extent of the disease. Familiarity with the human faces of HIV-AIDS had not translated into a full appreciation of the impact on their communities. For example, in Papua New Guinea doctors estimate that they risk losing 25% of their population a million people in 9 years. It is also estimated that there will be a 25% decrease in the workforce by 2010. [See Table on page 15 for further statistics of HIV-AIDS in the Oceanian Region]
Even the official statistics, sobering as they are, fail to highlight the gravity of the problem - they are indicative only. There is general agreement that reported cases of HIV-AIDS are merely the tip of the iceberg. For example, in 2002 NZAID reported some 40 cases of AIDS in Kiribati although the actual number of cases was thought to be about 250. Under-reporting of HIV is due to a number of factors including poor accessibility of populations at risk to HIV testing sites, limited testing facilities, and the perception among the general population that they are not at risk.
It is clear that the biological, epidemiological and pathological aspects of HIV intersect with the cultural, social and religious values and disvalues of a particular community. This calls for a unique pastoral response to HIV-AIDS in each country the first step of which is listening to the specific culture and examining the relevant cultural mores that could either influence the spread of the disease or assist in retarding it.
Listening to the culture
Pope John Paul II once described culture as the first voice of the sacred. This means that in any theological and pastoral response to HIV-AIDS the Church must facilitate an open and honest dialogue between the local culture and the gospel. In the document Ecclesia in Oceania (nn. 3-4) we read that the path to deeper faith is not only shaped by leaving behind sin but equally by leaving behind sterile ways of thinking and acting. All cultures and religions have some aspects which have become sterile ways of thinking and acting. All are in continual need of conversion and growth.
The process of authentic listening allows for a problem to be understood and for a clearer definition and focus to emerge so that any pastoral vision is grounded in reality. As the seminars progressed, a sense of possibility and hope took shape as people shared their stories. Initially the magnitude and scope of the epidemic appeared to be overwhelming, but real seeds of hope began to emerge bringing enlightenment and offering a way forward. As moral theologian Leonard Martin, CSsR, says: Moral theology can help prevent AIDS, but only if it learns to listen before it speaks, and only if it learns to discern when to offer milk and when to offer good, red meat.
In this respect, two significant issues that surfaced from listening to the culture were the pre-scientific understandings of the disease concerning its nature and the manner in which it is spread, and the taboo nature of the subject of sexuality which, in turn, has negative repercussions for people admitting that they are HIV positive.
Some participants felt that the Church exacerbated this difficulty while others felt the taboo nature of sexuality in the Church was merely a reflection of the generally taboo nature of sexuality in Oceanian society. Herein lies a great challenge for the Church, namely, to reflect upon the ways in which it has understood sexuality and equally the ways in which it dialogues with different cultural understandings of sexuality. For example some participants said that as polygamy was still legal, the Church had responsibility to understand the different meanings of fidelity and marriage in order to address the factors influencing the spread of HIV-AIDS.
The community and the individual
Somewhat in contrast to Western culture, in Oceanian culture the communal identity is more important than, and even prior to, the identity of the individual apart from the group the individual is nothing. An expression of this is found in the Papua New Guinea concept of wontok wontok literally means one-talk. In a wontok, language and cultural values are shared in a particular community as well as a number of obligations. Within such a system human rights are essentially communal, that is, rights can only be identified within the clan and by the clan. The wontok system strengthens communal bonds and enhances a sense of respect for the elders and reciprocity between families. Unfortunately the same system can impact adversely on the person living with AIDS.
When a community is strong in the sense of its traditions, it is understandable that any discussion on issues of the causality of disease or other dangers to the community's integrity and well being can be very threatening. This helps to explain why responses to disease typically include denial, blame, punishment, discrimination and stigmatization. In many communities denial was often the first, and enduring, response to the presence of HIV-AIDS. Participants readily understood that denial and blame within society are natural reactions to what they described as the fear of disgrace particularly once an individual's HIV status becomes known. Several participants tied the denial of the AIDS epidemic into the secrecy of the wider culture. One religious sister said, by denial we spread this disease. She continued, and said, I actually wonder if irresponsible behaviour is in fact a form of deni!l!
In many countries facing the AIDS pandemic the stigmatization of patients with HIV-AIDS results in their exclusion from the community. Being disconnected from the group through illness can add to the sense of shame and loss both for the person who is living with HIV-AIDS and for his or her family.
This was poignantly illustrated in each of the seminars. For example, one participant said, the very first patient with AIDS was a Catholic. He came home to die and said before he died, 'It's strange even though my case is being discussed in Parliament - here I am dying more of loneliness than of AIDS' She continued, Only a handful of people came to his funeral and he was buried after just one night at home. Normally many people travel to a funeral and bring food and gifts and help to support the bereaved family. The young man's father still feels the stigma from his son's death because he was the first on the island to die from AIDS. A woman who was HIV positive said, My husband is already dead from AIDS and now I have got the disease from him. Please be kind to my children because they are being teased at scho/l
A particular form of blame views AIDS as a punishment from God. If AIDS is viewed in this way then it logically follows that we can then free ourselves from any concern for our neighbour. Such a view is essentially a denial of the power of Christ to heal and also of the Gospel's power to liberate all people.
These poignant stories, in turn, became the springboard not only for healing in the group but also for the realization that when one member of the Body of Christ has AIDS the whole Body of Christ has AIDS. In turn, this insight led the participants to reappraise their own culture in terms of its potential to bring healing and compassion to all no matter what their condition.
Two further issues of significance that go to the heart of the causes of AIDS and which are very much intertwined are gender and poverty.
Gender and poverty
As the AIDS epidemic has developed over time there has been a growing recognition that social inequalities, poverty and power relations have an important impact on HIV transmission. Relationships between the sexes not simply sexual relationships - affect not only the development of the epidemic but the manner in which individuals and groups respond to it. The inferior status of women in gender relationships fosters risk-taking behaviour of men and exacerbates the special vulnerability of women to the virus across all socio-economic and age groups.
The vulnerability of women to HIV infection is determined by a number of factors. These include their economic dependence on men and their resulting lack of power. Women are vulnerable to sexual exploitation, domestic violence, alcohol abuse, coercion and rape. Where cultural ideas of masculinity emphasise male power to the exclusion of other values, this is frequently expressed in violence. Similarly, where there is emphasis on male sexual pleasure and where men are socialised to be robust, daring and virile, then the culture can, implicitly at least, give legitimacy to males having multiple sexual partners and to their indulgence in risky sexual behaviour.
Simply being married is a major risk factor for women who have little control over their sexual lives at home. The difference in power between men and women curtails women's freedom and expands men's sexual freedom, thereby increasing the vulnerability of both to HIV infection.
Poverty and economic dependence on men often mean that women cannot leave risky relationships, that young girls may be enticed to have sex with older men for money or gifts, or that women may sell sex in order to support their families. The reality for some women in many parts of the world is that they cannot protect themselves from HIV by any method, including those that the Church promotes and those promoted by secular agencies.
Cultures have values which are consistent with the gospel. These values enable communities to both initiate and strengthen pastoral responses to HIV-AIDS. These values include respect of the elders, strong support for family life, hospitality, generosity and a communal lifestyle.
Among the people and in the places of Oceania there is an enormous task of defining the problem of HIV-AIDS in a way that is acceptable and which facilitates open discussion. There can be no articulation of the issues without careful listening a task which is made more complex when one comes from outside the culture and is essentially a guest. The challenge before us in Oceania, while significant, is not impossible, not least because the people who participated in the workshops are clearly a people grounded in the providential spirituality of the land and the ocean. They are also a people of the story who, like any catechumen, have learnt to place their story within the story of the gospel, the story of Christ's redeeming love. Ultimately it is the gospel message of Christ's love that allowed the many dimensions of this issue to be both articulated and understood in a way that was respectful and life-giving for all.
Rev Michael McCabe, PhD
The Nathaniel Centre