ETHICAL AND THEOLOGICAL CHALLENGES PRESENTED BY HIV

ETHICAL AND THEOLOGICAL CHALLENGES PRESENTED BY HIV/AIDS

As the HIV/AIDS problem continues to take its multifaceted charge on humanity, particularly in Sub-Saharan Africa, Fr. Micheal J. Kelly, S.J., offers in this article, an insightful, analytical and comprehensive exploration of ethical and theological challenges presented by HIV/AIDS.

Part I

HIV/AIDS AND LIFE

HIV/AIDS is about many things. Clearly it is about suffering and healing, dying and death. But it is also about sex and living and originating new life. For very many, especially women, it is about coping and managing on an inadequate or non-existent income. For others, it is about caring for children who have no one to look after them, while at the same time it is about caring for old people whose adult children are no more. Together, the disease and the epidemic that has resulted from it cover almost every aspect of human life. As they do so, they give rise to a whole host of ethical and theological questions.

In many cases, HIV/AIDS highlights and magnifies the ethical implications of existing situations, such as widespread poverty or the unjust treatment and exploitation of women. In other cases, HIV/AIDS raises new issues with ethical dimensions, such as in the areas of stigma and discrimination or access to antiretroviral drugs (ARVs). In many circumsta-nces, responding to these issues implies two judgments that tend to strengthen each other:

- This should not be it is unethical.

- This must be changed; it makes the HIV/AIDS situation worse.

Areas of ethical and theological challenge presented by HIVE/AIDS would include:

1. Protecting truth, and excluding denial and stigma.

2. Remedying the status of women and correcting gender imbalances.

3. Doing something about the sinful conditions of the unjust distribution of wealth, wide-spread poverty, and oppressive globalization.

4. Ensuring the protection of human rights that are threatened by HIV/AIDS.

5. Understanding sexuality and dealing with its practice.

6. Reconciling the demands of confidentiality with those of the public good.

7. Ensuring the comprehensive practice of personal and communal responsibility both to and by those who are HIV infected.

8. Balancing the competing demands of AIDS treatment and HIV prevention when it comes to the allocation of resources.

A few of these issues are dealt with below (if readers want more, a further article can deal with the remainder).

STATUS OF WOMEN AND GENDER IMBALANCES

IV/AIDS has a disproportionate effect on the lives of women. On physiological and health grounds they are at greater risk of becoming infected with the virus. On social and economic grounds they are more vulnerable to infection. And when HIV/AIDS is present in a household, women are likely to carry the larger share of the burden and to be more extensively affected.

There can be little doubt that HIV/AIDS is increasingly becoming a disease with the face of a woman or girl. In the words of Stephen Lewis, the UN Secretary-General’s Special Envoy for HIV/AIDS in Africa, “the pandemic is now, conclusively and irreversibly, a ferocious assault on women and girls worldwide”. Theological this is not as it should be. Scripture tells us that “male and female God made them. In his own image and likeness God made them.”

On Social and Economic Grounds They are More Vulnerable to Infection. There is no question here of one being subordinate to the other, of one carrying a heavier burden than the other. There is no theological reason for the concentration of AIDS among women.

Neither is the “feminization of AIDS” ethically right. The Universal Declaration on Human Rights affirms, “All human beings are born free and equal in dignity and rights”. But until such time as women’s full dignity as human persons and their full equality with men is proclaimed and practiced in every walk and stage of life, this article will remain a pipedream. Humanity will remain out of harmony with its best aspirations. It will not be true to itself.

Meanwhile, women and girls will remain at the epicenter of the HIV/AIDS epidemic. The relationship of respect, mutuality and equality between woman and men will continue to be violated. In practice, the inherent human dignity of women will be denied. An unethical approach will be maintained and HIV/AIDS will continue to flourish.

POVERTY

IV/AIDS has never been a democratic disease. Although in its early days it occurred more among the better –off, it settled down fairly quickly to targeting the poor and vulnerable. The poor are at higher risk of HIV infection; the poor are more vulnerable to HIV infection; and the disease makes the poor poorer.

In circumstances of personal poverty and underdevelopment, HIV transmission occurs more easily while the period of HIV infection prior to the emergence of clinical AIDS tends to be shorter. Circumstances over which they have virtually no control put the poor at higher risk of HIV infection.

Such circumstances include a greater likelihood of untreated STIs; absence of information on their own HIV status or that of their sexual partner; the increased possibility of high-risk behavior because of difficulties in accessing and storing condoms correctly as well as major constraints in using them properly; and economic pressures to resort to the sale of sex to generate household income.

In addition, many factors that are almost entirely outside their control make the poor more vulnerable to infection. Long prior to HIV infection, their immune system may be weakened because of their low health and nutritional status, their limited access to health care, their inability to meet the costs involved in accessing health services, and their increased exposure to other health hazards, such as malaria, TB, or gastro-intestinal problems.

The poor constitute the majority of those who migrate from place to place in seek of labour and better living conditions. But only too often they replace joblessness, overcrowding, poor housing, inadequate sanitation, and poor health and educational facilities with similar situations elsewhere. In this way, they carry the burden of their HIV vulnerability with them.

Clearly this is not the way things should be for forty percent and more of humanity. God did not make the world so that things should be like this. Equally clearly, the continuation of such a situation will not serve to roll back HIV/AIDS.

The concentration of wealth in the top 5-10 percent of a society; half-hearted poverty reduction programmes; the application of globalization measures in ways that are to the disadvantage of poorer countries; the continued siphoning off of financial resources to debt repayments; the brain drain that eats away the human capacity of poor countries; maximizing profits at all costs; corruption and cronyism at all levels.

Although in its early days it occurred more among the better-off, it settled down fairly quickly to targeting the poor and vulnerable. Mismanagement, poor governance, and poor and unconcerned leadership that is crippling the potential of many poor countries; the concentration of efforts and resources on the retention of political power; internal and international conflicts and wars -- all play their part in maintaining the poverty of peoples and thereby all play their part in maintaining or worsening the HIV/AIDS situation. Each one of these situations is unethical; it is not as it should be.

Each serves to maintain the unethical situation of mass poverty in a world plentifully supplied with means and resources. Each contributes unethically to the prolongation of the wretchedness of HIV/AIDS.

THE UNDERSTANDING OF SEXUALITY