Fighting Aids in Africa

The Catholic Church runs some of the best Aids programmes in Africa. This pioneering work has not been publicised. A writer and commentator on development issues, author of Aids and the African Churches, stresses its value.

LAST YEAR I spent six months on research into Christian responses to the HIV epidemic in eight countries of sub-Saharan Africa. Back in England, I read the media reports of the United Nations International Aids Conference, held in Durban. I saw no acknowledgement that the Catholic Church has been doing some of the finest and most respected Aids work in Africa.

Earlier in the year, I had called on a friend at the United Nations Aids programme. Could she suggest some church-run schemes for me to visit? Of the seven she proposed, five were Catholic. One was the Youth Alive programme at the Kamwokya community in Uganda, on which Youth Alive in 15 African countries is modelled; another was the eastern deanery programme in Nairobi, where I met Lena, who voluntarily visits mothers dying of Aids, and works with them on plans for their children to be placed with family members when their time comes; another is Mekdim, the Ethiopian Catholic secretariat?s organisation of people with HIV-Aids, whose founding father is an ex-policeman; another is the Ndola diocese?s Aids programme with its teams of volunteers, one of which is coordinated by Sr Jacinta, who lives in a shanty town on the Zambian copperbelt. Then there was the archdiocese of Dar es Salaam?s Pasada programme, where I found an exuberant young woman from the youth team standing in front of a class of 13-year-old girls and teaching them the importance of saying no to importunate men. All the teachers say I?m so beautiful, she sang, and the class chorused: But I say no because I?m too young. The bus conductors say I?m so beautiful . . . But I say no because I?m too young. The kids in the classroom loved it, and others out in the yard started to sing along.

The Catholic Church joined the struggle against Aids back in the early 1980s, when the epidemic first emerged from the shadows. Church mission hospitals and clinics, which already provided a substantial proportion of health care in sub-Saharan Africa, were at the forefront. When the hospitals proved incapable of meeting the needs of the growing numbers of sick, the Churches, especially the Catholics and the Salvation Army, found that their existing methods of home-based care could be adapted to the new demands, providing realistic treatment and prevention in situations of poverty ? a model widely followed by other organisations.

But by the mid-1990s, the number of sick and dying people had increased drastically. Now the Churches are activating their worshipping communities to tackle the local needs of sufferers and their families, their carers, and the orphans. Here again, existing Catholic networks of small Christian communities within parishes have provided a framework. Johannes, dying of Aids in a Tanzanian slum, told me: The best thing in my life, I waited for until I was almost dead. It has been the small Christian community in this place, and the way we sing and pray together. I feel I am not alone.

Unfortunately, the media have largely ignored the pioneering role the Catholic Church has played in the development of services for people with Aids, and have focused instead on Catholic difficulties about Aids education and the use of barrier methods to limit transmission of the disease. These difficulties are real. The Church?s approach to condoms is generally considered, by makers and implementers of national policy, to be unhelpful. Faithful Catholics are perceived to be dying because they obey their Church?s outright ban on the use of condoms. Centralised and unheeding, this Church is assumed to be oblivious to the scale of suffering at pastoral level, and to be failing to respond to the realities on the ground. As a result, individuals with HIV and their families have an agonising choice: if they want to honour the bond of marriage and at the same time avoid causing the possible death of those they love, then they cannot also live and die as good Catholics within the Church. Outraged by this scenario, Catholics may display an extreme defensiveness about their Church?s record on Aids, rather than pride in its achievements.

Attitudes in the Christian Churches are changing, however. In most African countries, the Churches have now agreed to avoid damaging public condemnations of government policy. Some bishops? conferences are beginning to show a greater understanding of the realities of human relationships. There is growing evidence that greater freedom of movement is being given to (or taken by) Catholic counsellors or clergy, particularly in the case of couples where both have HIV, or where one is infected and one is not. The justifiable fear that condoms encourage promiscuity is being offset by recent studies among students suggesting that condom distribution does not increase the level of sexual activity, but does reduce the number of sexually-transmitted infections and unwanted pregnancies among those who are already sexually active. Africans value life, said a priest friend from Kenya. Rome is promoting death by denying condoms to married couples when one or other is infected, or to young people who are going to have sex anyway. If only just one bishop would stand up and say this.

Very many Africans, Christian and otherwise, have resented the emphasis on condoms by outside agencies, regarding this as an intrusive and unrealistic Western answer to an African problem. But it is indefensible for church leaders and clergy to resort to harmful and unfounded myths (of which Africa has more than enough already) in order to make the point. These are the words of a Ugandan bishop, with whom I talked in June 2000: I?ve never held a condom, and I don?t know what it looks like. But some people I know used them and they had five children, three of them disabled. The condom is porous, and what you get when you use it is damaged sperm, and then you get disabled children. My head reeled. Abstain, he cried, that is the Christian message. But this is an emergency. A more balanced and truthful approach would acknowledge that the condom must, for the time being, be a key resource in HIV prevention, while resisting any suggestion that it is the whole answer.

In badly affected countries, death is everywhere, especially among young wage-earners. Some 12 to 13 women are infected for every 10 men. The majority of the dead leave young children. Why bother with these people?, everyone said when Dr Anne Merriman started the Hospice Africa movement. They?re going to die anyway. But in organisations with this philosophy, many of them run by Catholic Sisters, dying people are able to see the final months of life as a creative spiritual experience which whole families share.

A year ago today, I had dinner with a good friend, a Catholic Sister who runs a diocesan Aids programme. Such work, she said, changes people. She went on: Christianity is about what is true and real, and about the hope that lives deep beneath the truth. It is about generating light out of darkness and life out of death.

Amen, I thought.