During 2003, my work in the area of HIV/AIDS and education brought me to many parts of the world.  I covered at least 120,000 miles and spent more than 250 hours in the air, travelling to workshops, conferences and meetings in Africa, Asia, the Caribbean, Europe and the United States.  As I developed material for my own presentations, heard other people speak, and discussed issues with concerned women and men from all walks of life, this travel meant two things for me.  It confirmed some of my existing perceptions and it gave me new insights into HIV/AIDS.  This is part one of a set of articles that shares some reflections arising from both of the above.

FEATURES OF THE EPIDEMIC

My overwhelming experience was of a problem that was fundamentally the same everywhere.  It was obviously much larger in size in Southern and Eastern Africa, but the basic features were similar wherever it occurred.

Wherever I went I found the same story of HIV/AIDS hitting hardest at the weakest in society.  The major sufferers were women, children, the poor, prisoners, hard drug users, men who have sex with men.  Everywhere there was concern about how prevalent the disease was among the young and what could be done to protect them.

In countries where transmission occurs mainly because of the way drug users share needles, it was mostly young men who were infected.  But in all other countries, the disease was much more prevalent among young women.  In Zambia, for every two young men (aged 15–24) who are infected, there are somewhat more than five young women in the same age group, while in Malawi the proportion is somewhat less.

Everywhere the message was that the epidemic was destroying homes, families and economies.  In infected families, incomes were falling and the ability to cope was being stretched to a breaking point.

Countries and communities had adopted many strategies for responding to the disease as it affected the health and activities of individuals, and for responding to the epidemic as it affected whole sectors of society.  But there was almost a sense of futility about these responses.  The overall impression was one of disarray, inadequate understanding, and piecemeal response.  People   seemed  to be timid, confused, uncertain, feeling that they were powerless, wanting to do something constructive but not quite sure what.

Stephen Lewis (the UN Secretary-General’s special envoy for HIV/AIDS in Africa) spoke to African religious leaders in 2002 about “a curious and distressing lull in the battle, … a cumulative feeling of inertia rather than energy, of marking time”.  That sums up accurately the situation as I saw it in various parts of the world.

SILENCE, STIGMA AND DISCRIMINATION

Almost universally, the disease seems to be shrouded in a thick cloak of silence and practical denial.  To some extent silence and denial are a protective human response to situations that are excessively stressful.  Years ago, the poet, T. S. Elliott, reminded us that “humankind cannot bear too much reality”.  But trying to cover up the existence of AIDS, as occurs worldwide in families, communities, and countries, will never lead to mastery over the disease or its impacts.  In fact, denial and silence are ways of suppressing or distorting truth.  They do not fit in well with the Lord’s promise that “the truth will set you free”.

Likewise, stigma and discrimination are rampant across the globe.  Essentially, stigma occurs when I make a negative judgement about another person because that person differs from me in a way that I disapprove.  Because of this, I reject, discredit, disregard or under-rate the person and try to keep him or her at some social distance.  Stigma is irrational and harmful, but very powerful in supporting the roll-out of every aspect of HIV/AIDS.  As with denial and silence, it distorts the truth and makes an individual disinclined to seek the truth.

Even as recently as January 2004, a report on conditions in the United States stated that stigma and ignorance continue to hound people living with HIV/AIDS, through denial of medical treatment, violations of privacy, deprivation of parental rights, workplace discrimination and not being admitted to nursing homes or residential facilities.

In Nairobi, government schools discriminated against children who were HIV positive by refusing to admit them.  Thankfully, however, this discrimination ended on 9^th January 2004 when Nyumbani Orphanage (founded and run by Angelo D’Agostino, S.J.) secured an agreement in the Nairobi High Court under which public primary schools would admit such children.

One common and almost universal manifestation of this stigma is the attempt to dissociate oneself from HIV/AIDS, to see it as somebody else’s problem and not one’s own.  Depending on one’s perspective, the disease is envisaged as something affecting commercial sex workers, men who have sex with men, the poor, women, migrant workers, injecting drug users, and so forth.  There is much less readiness to see that it is something that affects everybody,  a  situation  for  which everybody has a responsibility.

If we look into our own hearts we will very likely see the way we too have tended to treat HIV and AIDS as something affecting people “out there” and not something that belongs to us intimately and personally.

The prophet Isaiah saw the very opposite of this stigma (and the accompanying discrimination) in the Suffering Messiah: “Ours were the afflictions he bore, ours the sorrows he carried.  But we, we thought of him as someone punished, struck by God and brought low.”  (Isaiah 53:4)

Much stigma seems to arise from the almost universal tendency to associate HIV infection with immoral sexual practices, homosexuality, and injecting drug use.  In condemning the sin, people also condemn the sinner.  As a person from Grenada put it, “it was felt that (you) deserved what you got by being gay or promiscuous or just bad”.  Strangely, however, in many parts (including Zambia and neighbouring countries), widespread support and care for people living with HIV/AIDS co-exists with stigma and discrimination.  Thankfully, when the need is great, the Good Spirit of compassion acts more powerfully in human affairs than the evil spirit of condemnation.

HIV/AIDS-RELATED KNOWLEDGE

There is great variation within countries in people’s knowledge of HIV/AIDS.  In India more than half of the urban residents seem to know something about the disease, but it is different in the rural areas, with their large populations.  Here, considerably less than half may never even have heard of HIV or AIDS.  In general terms, where prevalence is high, most have heard of AIDS, but where it is low, more than half may never have heard of it.

There is much ignorance, however, on how HIV is transmitted and how to protect oneself against infection.  For example, a participant at a high level meeting in Thailand showed little understanding of the way HIV is passed from one person to another when she asked whether it is safe to use a scissors that had previously been used to cut the nails or hair of an HIV-infected person.  Also, a very large number  of  people  either  do  not know or deny the possibility that a healthy-looking person could be HIV-positive.  In Tajikistan only 8% of teenage girls knew that a healthy-looking person could have HIV, while in neighbouring Kazakhstan, only 12% knew that abstinence from sexual intercourse protects against infection.

But even in Zambia, where the prevalence level is high, less than half the women know that abstinence can protect against infection; only one-third of the men know that being faithful to an uninfected partner can protect them; and almost 40% of both men and women do not know that a person who has HIV can look healthy.  Clearly there is still a great need for education campaigns that will overcome what could be lethal ignorance.

(Part II on Women, Child Abuse and Sexuality continues... Next article)

Michael J. Kelly, S.J.
Luwisha House
Lusaka