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AIDS:
A Worsening Crisis Challenges Church and Society
In a moving account of AIDS in one affluent California town, the video "The Los Altos Story" describes three people infected with HIV, the virus that causes AIDS. One of these people, a senior citizen and a longtime resident of Los Altos, has for many years played Santa Claus at Christmas. With tragic symbolism, this situation reminds us that AIDS is not somebody else's disease or worry. AIDS touches all kinds ot people, even a gentle man who played Santa Claus. HIV/AIDS is our disease, a disease of the human family. For many of us, this fact may be difficult to accept fully. Because AIDS first spread in the homosexual community in the United States and also among those using drugs, some of us see AIDS as their disease. There may even be elements of prejudice in our reactions. By presenting the facts about HIV/AIDS, this Update challenges the misconceptions, ignorance and intolerance, even as the Vatican and U.S. bishops have done. It also discusses our Christian call to compassion regarding the AIDS crisis. The relationship of AIDS and HIV We now know many basic facts about HIV/AIDS. We also know that we have much to learn as research continues. AIDS (Acquired Immune Deficiency Syndrome) is caused by HIV (Human Immunodeficiency Virus). This virus attacks certain white blood cells called T-cells, eventually destroying the person's immune system. As a result, the individual can suffer from many diseases which a healthy immune system would reject. It is this stage of the disease—with its low T-cell count and eventually many infections—which is technically defined as AIDS. One of these "opportunistic" infections finally kills the person. The AIDS virus, HIV, is spread in several ways: sexual contact (including heterosexual and homosexual intercourse), exchange of blood (especially through sharing dirty needles for piercing, tattoos, steroids or drugs) and the birth process (an infected mother can transmit the virus to her infant). HIV, then, is spread when certain body fluids are transferred from an infected person: in semen, vaginal fluid, blood, breast milk, as well as in the process of birth. HIV has also been transmitted through blood transfusions, but improved screening in the U.S. has almost completely eliminated this danger. HIV is not spread through casual contact: touching or hugging, sneezing or spitting, using bathroom facilities. We must note that in one sense HIV is relatively hard to spread (only several means are possible), and yet these very means are found in very ordinary activity (sexual intercourse) and in frequent, addictive behavior (intravenous drug use). Once infected with HIV, a person is able to infect other persons, even though the infected person shows no signs of the disease. Indeed, we now know that the incubation period—the time from HIV infection to the development of full-blown AIDS—can be very long, even more than 10 years. Yet throughout the incubation period, an HIV-positive person can transmit the infection to others. As this Update is being written, experts are stressing several points that must be kept in mind: 1) a cure or vaccine is not likely to be developed soon; 2) early diagnosis and treatment and new drug therapies, however, may significantly slow down the progression from infection to full-blown AIDS; 3) HIV infection is properly understood as a chronic disease, that is, a long-lasting illness which eventually gets worse. AIDS was first described in 1981. Since then scientists have done extensive research. Combination anti-retroviral drug therapies have dramatically slowed the progression of AIDS for many people. Blood screening has made blood transfusions much safer. Many researchers warn us, however, that no quick technological solution for AIDS will be found. HIV is a virus that mutates easily: There are different strains of HIV. All this makes the development of a vaccine extremely difficult. Realistically, then, we must confront the reality of AIDS and the prospect of living with HIV/AIDS. The suffering has spread The extent of AIDS is staggering and the human suffering involved overwhelming. Statistics constantly change, but the following numbers give some sense of the magnitude of this global epidemic. In 2000 an estimated 34.3 million people are infected with HIV. Forty percent of this number are women, an increase from 25 percent in 1990. Worldwide, more than 70% of infections are due to heterosexual intercourse. Nearly 19 million people have died from AIDS. People do not simply waste away from AIDS. The suffering is intense and prolonged. Many diseases, some of them unfamiliar to most of us, attack person with AIDS. Later stages may also include explosive diarrhea, lung infections, blindness and dementia. If individual human suffering is extreme, so is the cost to society. In most countries in southern Africa, at least 10% of the population is HIV-infected. In some countries the percentage is much higher. A generation of young adults is dying before its time, leaving millions of children orphaned, leaving the country without new leaders in business and politics. In the United States, HIV/AIDS is spreading rapidly in Hispanic and African-American communities, which already face a host of problems including racial prejudice, poverty, crime and drug abuse. Confronting these issues and their relationship to AIDS challenges the nation's political will and its commitment to the common good. AIDS raises moral dilemmas HIV/AIDS, then, raises many medical, social and political issues, both nationally and globally, all with profound ethical questions. These complex moral dilemmas cover the life span. The first cluster of moral questions is focused on birth and infancy. Ought HIV-infected women to become pregnant? Is contraception permissible when AIDS is involved? What about abortion? (About 30% of children born to HIV-infected mothers are also HIV positive. Drug therapies, even just AZT, can greatly reduce this percentage.) What is the proper treatment for HIV-infected infants? How can society care for AIDS orphans? A second cluster of ethical questions relates to HIV-infected persons and their relationships. What are their moral responsibilities concerning risky behavior which could infect others? Must previous contacts be informed? How do couples decide about their sexual behavior? What about dealings with physicians: issues of privacy, confidentiality, using experimental drugs? A third cluster centers on the end of life. How much pain must be endured? What kinds of life-support treatment are appropriate? Is euthanasia or physician-assisted suicide an option? Society itself faces another cluster of moral dilemmas. Does the common good of society demand testing for the AIDS virus, and who will be tested: health-care personnel, those with high-risk behaviors, those who apply for marriage licenses, those convicted of crimes, everyone? (In some African countries, a policy of universal testing would, by itself, more than exhaust the entire health-care budget.) What about quarantine? How does society fund and manage research and testing? Is there a moral obligation concerning educational programs in the light of the growing epidemic? What about the effects of prejudice against HIV-infected persons: in housing, parishes, employment, insurance and medical treatment? Must HIV-infected physicians and dentists stop practicing their profession? What about immigration policies? What does society do about scarce resources when there is not enough research, money or people to treat every disease, to do everything for every person? In all these questions, who decides and by what values and norms do they decide? A Christlike response The Catholic bishops of the United States have addressed the AIDS epidemic in two major statements: The Many Faces of AIDS: A Gospel Response, from the U.S. Catholic Conference's Administrative Board in 1987, and Called to Compassion and Responsibility: A Response to the HIV/AIDS Crisis, from the entire National Conference of Catholic Bishops in 1989. These statements, of course, do not solve the crisis or all the complex ethical questions, but they do provide the basic building blocks of an authentically Christian response. The Many Faces of AIDS combines a sensitive understanding of the experience of AIDS along with commitment to the Christian tradition. The statement begins by presenting four different but representative faces of AIDS: a young woman, married, successful in her career but HIV-positive, infected by a previous partner; an inner-city young man who has done drugs; a young professional man, a sexually active homosexual recently fired from his work when his AIDS was discovered; an infant born with AIDS to a mother who was a drug addict. The document then turns to the Gospel to find several significant messages: that the God revealed by Jesus is a compassionate and forgiving God; that every human person is of inestimable worth; that suffering, as terrible as it is, can open up new meaning and life. After considering the facts of AIDS, the bishops draw six major conclusions.
ln coming to these conclusions, The Many Faces of AIDS addresses five personal and social dilemmas: prejudice, personal responsibility, testing, treatment and insurance. Briefly, this is what the document says about each: Prejudice. The statement strongly rejects all forms of prejudice. Because all human life is sacred, the bishops call for the elimination of stereotyping, isolation and condemnation of persons with AIDS. Instead, the epidemic challenges followers of Jesus (and all people of goodwill) to express courage and compassion, to walk with those who are suffering. Responsibility. To the person with AIDS, the statement speaks both comforting and challenging words. People with AIDS are encouraged to continue leading productive lives in their community and work, and their right to decent housing is reaffirmed. People with AIDS are also reminded of their grave moral responsibility not to expose others to the virus. Even those who are simply "at risk" ought to be tested and if engaging in intimate sexual contact or in other risky behavior, act so that others will not be harrmed. Testing. The Many Faces of AlDS recognizes the need for some testing for the AIDS virus—of persons engaging in high-risk behavior, for example. Widespread mandatory testing is rejected as inappropriate and ineffective at this time. The document supports voluntary testing as long as certain safeguards are met: sufficient counseling, confidentiality, avoiding discriminatory uses of the results. Related to screening is the issue of quarantining people who are infected with the virus. The bishops oppose such action, reaffirming the nation's civic heritage of extreme restraint in restricting human rights. Treatment. The document expresses concern that some health-care professionals are refusing to provide medical or dental care to persons with AIDS. So the bishops urge the professionals to respect the moral obligation to provide treatment for all persons. Insurance. Although they recognize the conflict of interests in the question of insurance, the bishops advocate strongly for those who are excluded from health insurance coverage. They call on the government to provide additional funding for these people. They also encourage collaborative efforts by government and Church agencies to provide adequate funding and care for all persons with AIDS. The bishops find in this dilemma the fundamental weakness of the nation's health-care system and so repeat their call for the development of adequate and accessible health care for all people. The Many Faces of AIDS also acknowledges fundamental societal problems which must be addressed if AIDS prevention is to be effective. Such realities as poverty, oppression and alienation make it difficult for many to live life fully and drive people to drugs or short-term physical intimacy as a means of escape. Recalling their pastoral letter Economic Justice for All, the bishops remind Church and society of their responsibilities to eradicate those realities which destroy the quality of life. Called to Compassion and Responsibility reaffirms all these key ideas and emphasizes authentic chastity and abstinence from intravenous drug use as the only adequate means to prevent the spread of the HIV epidemic. The statement stresses five calls: to compassion, to integrity, to responsibility, to social justice, to prayer and conversion. These five calls clearly summarize the bishops' guidance concerning the AIDS crisis and suggest directions for answering the pressing ethical questions. The life and teachings of Jesus shape the Christian's response to the epidemic. Faith helps us to appreciate and value the unique dignity of every person, for all are created in God's image. The experience of death and resurrection gives us a perspective on the meaning of suffering. The Christian tradition's rich understanding of the full meaning of personhood challenges our culture's trivialization of sexuality—and calls instead for respect and responsibility. Prayer urges us to conversion, turning away from ignorance and intolerance and to caring action for those in need. This action must be embodied in many ways: in research and health care; in just public policy concerning testing, confidentiality and discrimination; in appropriate care and counseling for persons with AIDS and for their families as they confront pain, anger and isolation; in changing social and economic structures that foster the spread of AIDS. The future Many AIDS researchers warn us that there will be no quick technological fix for this global epidemic. Moreover, we have not yet seen the full impact of the disease; things will get worse. Suffering and death, especially in the developing world that cannot afford the new drug therapies, will continue to increase at an alarming rate. The impact on the development of society will be devastating: education, health care, business and government will not have enough qualified people to provide services. What response is necessary? How can we move from facts and documents to committed action? First, we must recognize the reality of AIDS, not yielding to the temptations of lack of interest or, worse, of intolerance. This first step is possible for all of us, as individuals and as local Church communities. Parish programs can help us search out the facts about HIV/AIDS, discuss the ethical issues and examine our consciences about prejudices in our thoughts, conversations and actions. Second, we must compassionately care for persons with AIDS. Such care is not limited only to physicians and nurses. We must ask ourselves: How can I respond to this worsening crisis now? Again, there are many opportunities for ourselves and our communities to get involved. We can volunteer with a local HIV/AIDS agency, visiting persons with AIDS, perhaps running errands or providing some basic supplies like food. Or at least we can support those who can do this. Church communities can organize different kinds of support systems for persons with AIDS and for those who love them: transportation, child care, meal programs, counseling and bereavement groups. Such ordinary but real human care provides significant help and mirrors God's faithful love. Third, as Church and as society, we must develop ways to prevent the spread of HIV/AIDS, especially through education and behavior modification (simple to state, but extremely difficult to achieve). Both educators and those encouraging new behavior must recognize the great variety of values, cultures and pressures which shape and limit people's choices. What possibility, for example, do many women in Africa have of changing oppressive cultural expectations regarding sexuality? Or in the United States, what real freedom does a person hooked on drugs have? And what influence comes from the culture of oppression and despair in which that person lives? Programs will have to be creatively and sensitively targeted for vastly different audiences. For the indefinite future, we will be living with HIV/AIDS. As the crisis worsens, we indeed have an urgent need for understanding, justice, reason and deep faith.
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