Each issue carries an
Archdiocese of Cincinnati.
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
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
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
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.
is a human illness, not restricted to one group or social class.
AIDS is an ominous presence, calling for the best possible response
from the medical and scientific communities.
of the Church have the responsibility to reach out with compassion
and understanding to those suffering from AIDS.
- The crisis demands of the Church a clear presentation
of its moral teaching concerning human sexuality. Throughout the
document, the bishops stress that the only true response to the
crisis includes behavior rooted in the fully integrated understanding
of human sexuality which grounds the Church's teaching.
- Discrimination against persons with AIDS is unjust
- Society needs to develop appropriate programs, especially
educational ones, to prevent the spread of AIDS. A long appendix
to the document gives many specific suggestions concerning these
- Those who are HIV-positive ought to live in a way that
does not expose others to the disease.
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
Testing. The Many Faces of AlDS recognizes
the need for some testing for the AIDS virusof 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 sexualityand 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.
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
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.
Father Overberg's article "Outside the Camp? Leprosy, AIDS
and the Bible," which develops the scriptural foundations mentioned
in this Update.