It is Mercy I Seek

I recalled looking in vain during the kerkuffle of president Mbeki’s alleged AIDS denialsm, and because I could not find supporting evidence for it I decided to stay out of the noise. Then first came judge Edward Cameroon’s autobiography, the first among Mbeki accusers to admit that the president never actually denied HIV was the cause of AIDS, though he regretted the president’s attitude towards the topic; and so on and so on. Ronald Suresh Roberts in his competent book Fit To Govern: The Native Intelligence of Thabo Mbeki dedicate two chapters into refuting such allegations, and he is very convincing.

‘Mbeki’s sin was to reject a drug-based intellectual protectionism in favour of a free exchange of ideas on the proper solution to AIDS pandemic, including but not limited to drugs alone.’ So says Roberts in the book, and I’m inclined to believing him. Roberts quotes numerous people, institutions, and organisation, like WHO (World Health Organisation) who have come to understand that ‘you cannot separate prevention from treatment.’ Somebody corrects me if I’m wrong but isn’t that the consistent step taken by the Roman Catholic Church from the beginning, which most people are now starting to realise is the best of all possible ways to fight the pandemic. Yet I don’t see Roberts stating that on his book.

It was sad how the practical solution towards fighting the AIDS pandemic was hijacked by racial, political, religious or cultural agendas whose used and abused the forefront of TAC (Treatment Action Campaign) in this country. There was even a time of folly when condoms were preached as a pinnacle solution; but graciously sanity seem to be return among most activist.

I’m not sure why the message of behavioural change seemed to fuel mistrust and prejudices among most AIDS activists initial. Perhaps it had something to do with the fact that they thought AIDS was the result of promiscuous behaviour. Whatever the case sanity is returning to all of us now; we’ve realised that among the best way to combat the pandemic is behavioural change.

A person who is looking for real solutions about AIDS must look at what is happening at ground level and make up her/his own mind. It is daily becoming clear that an effective and meaningful approach will come from experiences gained in ground level. It was the measure of our petty shallowness that we allowed petty issues to stand on the way of combating this pandemic together. We reached a stage where, due to assumptions about simplistic solutions or idealized notion, we talked at, not to, each other.

AIDS activists, most from Western NGOs, tend to come with naive assumptions that all individuals are free to make empowered choices about their worlds. And their African counterparts, for the sake of salvaging superficial pride, like to deny the obvious and fiddle while the continent is burning. Meantime, the graveyards are filling very quickly. We shall not even come close to denting the epidemic until we find an approach that seeks to take into account the complex social, cultural and economic factors that influence behaviours and the real conditions of choice in our respective societies.

Too often behavioural change is taken as individual prerogative. Most people assume we are autonomous individuals who can make informed choices based on in-depth understanding of the facts on the ground. But too often people don’t kow, or sometimes don’t even care about facts. AIDS education is not enough to turn the pandemic around. Facts on the ground, for instance, show that most people who’re HIV positive in our country (South Africa) already knew the rudimentary of AIDS education but ignored it.

In my hometown there’re about eighteen black medical doctors; six of them—I’ve been confidentially told by my cousin who works with an organisation that spreads AIDS education in the schools of the region—are HIV positive; and two have a full-blown AIDS. Even if I were to take what she says with some salt and assume half of that number it is still too much. Why, if AIDS education is so effective? The crux of the matter is that the rate of transmission of the HIV virus is highly determined by behavioural habits. There’s no running away from that fact.

Another erroneous assumption is that everyone in African communities wants to be, or is already, sexually active from early ages. This stereotyped attitude on the part of, especially Western AIDS workers, prompts negative responses from black Africans who feel affronted by the generalisation. In fact, there’s a growing number of South African youth, especially girls, who—through mostly the influence of mostly “born-again” congregations—prefer waiting for their wedding day for their first sexual experience.

My sisters who was twenty-four years when she married a few years ago was a virgin. My other one who is even older than her is still one because she says she is waiting for her husband. This sort of delaying sexual experience helps in the fight against AIDS. These girls, though born and bred in the township, are no longer easy victims of the promiscuous tendencies that increase a person’s exposure to the HIV virus. Admittedly these girls are still in a minority but it is growing especially mostly the educated and religious.

The immense social and cultural pressures to conform to accepted stereotypes remains one of the major general factors for the spread of HIV in the country. There’s the rate of promiscuity among the affluent, like the example of the doctors above, which spreads the virus at an alarming rate. Economic pressures are a factor working against receiving diagnosis and treatment, mostly among broken, poor families. The interchange of sexual partners among migrant workers, who spend months on end far from their spouses and family support system; and who’re plunged into unbearably harsh working and living conditions by exploitative local or multi-national employers, is another factor.

All-too-often AIDS education has failed to take this wider picture, opting instead for simplistic prevention strategies. Those efforts are doomed to failure, even in the short term. A fuller understanding of HIV prevention that identifies three “layers” (impact, risk reduction and vulnerability) in the pandemic has been promulgated by the Catholic Church from the begining. HIV prevention strategies must address all three layers if they are to be effective.

Impact emphasises the essential link between care and prevention. Keeping those affected by HIV in good physical, emotional and economic health for as long as possible. It is an essential component of prevention as it helps avert the decline of families into poverty and the stigmatisation that fans the pandemic.

Risk reduction involves providing individuals and communities with an accurate and full understanding of the risks of infection. It means helping people to acquire the skills and resources to make changes in their personal or professional lives to minimise these risks. This means enabling people to adopt measures, based on the fullest scientific evidence available, that afford them immediate protection, partial or complete. Typical risk reduction strategies include abstinence, mutual fidelity, having one sexual partner, and condom use. Because the sexual route is not the only source of infection, it means also ensuring safer blood transfusions, drug injecting and antenatal and delivery practices.

Reducing the risk of infection is not about choosing one or other option randomly to suit social or religious pressures. It is preferable to think of it in terms of a continuum running from high-risk activities to those carrying low or even no risk. Reducing risk is a process of moral education in which people come to see what risks their behaviour entails and continues until they take steps to reduce that level of risk in their circumstances. Any strategy that enables a person to move from a higher-risk activity towards the lower end of the continuum is a valid risk reduction strategy.

For a Catholic, like myself, this strategy is based on sound theological principles. For the non-religious it might be based on more traditional values, like the consideration of lobola (bride’s worth), which is higher for virgins. What is important is that we identify values which individuals subscribe to and use them effectively as weapons against the AIDS pandemic. There’s hardly any culture that does not understand the value of abstinence, chastity or faithfulness to one partner.

Sometimes people make choices that fall short of these ideals. That’s when moral compassion is called upon. It is useless, even cruel, for a Catholic, for instance, to insist on the evil of condom use for a person whose psychological understanding has not reached or refuses to acknowledge the wisdom of Catholic ideals. Or to expert a married partner not use condom when another is already affected.

Vulnerability requires HIV prevention strategies to address the fact that, too often, people’s behaviour does not change until their wider circumstances change—like gaining a higher moral conscience. Any attempt by an individual to carry out their chosen risk reduction strategy constitutes behavioural change for that person. Church-based programmes, with their prophetic role in seeking the social transformation that will enable personal growth, must help people to grow more fully in their God-given identity.

Discriminating against those who do not follow the Church’s teachings will gain us nothing. What is important is finding ways of curtailing behavioural choices of those who are vulnerable to infection. All initiatives that aim to reduce vulnerability are, and must be, recognised as essential components of a fuller HIV prevention strategy. The Church, with its rich body of doctrine and the theology of Catholic social teaching, has always demanded that its members denounce the injustices of the world and work to redress imbalances. We cannot sit around folding our hands while the pandemic sows death in our communities because we insist on our moral high ground then.

Promoting abstinence might mean upholding the value of not having sex until marriage, while also recognising that for some young adults abstinence might mean only delaying the age of first sexual encounter beyond the more physiologically vulnerable teenage years. In another sense, promoting abstinence might also mean waiting until one is in a more stable relationship. Worse still, we might not always succeed in getting our message through on others; but it does not mean we should leave them to the devil; it is mercy that I want said Christ after hearing all these things.

Faithfulness might mean the exhortation of mutual fidelity on married couples, while also acknowledging that, in another context, the component of faithfulness might mean fidelity to a single long-term partner or fidelity to a strategy of reducing the instances of casual sex. In the end sexual preference must depend on the moral conscience of the individual.

The data is clear that condoms, when used correctly and consistently, reduce but do not remove the risk of HIV infection. This fact cannot be excluded from, or misrepresented in any information on risk reduction strategies, regardless of the political or moral position of those promoting them. Condom campaigns have been particularly effective with groups at the highest risk—prostitutes, for example—who may have few if any other realistic options for reducing this risk without them. But facts show also that condom campaigns have been considerably less effective in the general population as a public health strategy. Hence I condemn the “condoms only” or even “condoms mainly” campaigns for the general population that have often been promoted with the same dogmatism as some “abstinence only” campaigns. These similarly distort information.

A complementary and collaborative approach for the dismantling of mutual prejudices deplores the obstructive positioning, judgementalism and dogmatism of opposing factions that too often feature simplistic polarised approaches. If we are to conquer the AIDS epidemic we must find a way of reconciling solid science and good community development practices with established and evolving moral teaching.

The Catholic Church is deeply rooted in local communities throughout the developing world, and is a major contributor to the struggle against AIDS in the countries worst affected by the pandemic. The Church is therefore well placed to promote a more holistic understanding of prevention and to foster reconciliation between opposing factions, drawing these towards an attitude of mutual acceptance and collaboration. The challenges of the pandemic are urgent and compelling; the challenges of the Gospel are no less so for Christians. The Church, rightly so, does not take her moral standards from the values of the world. But as Christians, we have to find a way of mercy while standing firm on our moral understanding, or the future generations will hold us to account on both.