Is the Religious Sector’s Response to the HIV Epidemic Sufficient?’
The Most RevdDr Thabo Makgoba
Our title for this session is ‘Is the Religious Sector’s Response to the HIV Epidemic Sufficient?’ I shall answer by speaking about the role of faith communities as a necessary and effective partner, not only in tackling HIV and AIDS, but also TB, and across society’s health needs. I will speak as an Anglican, with my colleagues from the Anglican AIDS and Health-care Trust supporting this with practical examples from their work and experience on the ground. Colleagues will offer Catholic, Methodist and Muslim perspectives, from their long experience of working with the poor and most vulnerable. In this way, what may seem a theoretical call from my paper will be ‘earthed’ by the panellists.
Care and compassion towards the sick and the suffering has been the touchstone of most faiths since earliest times. Historically, the emergence of hospitals was strongly influenced by the care provided by Christian Churches, over many centuries. Today close to half of all health services in sub-Saharan Africa are provided by the religious sector.
But this is only part our commitment to holistic human well-being. Christians speak of humanity being created to live in harmony with God, loving him with heart, soul, mind and strength; and to love our neighbours as ourselves. In other words, we, like our God, are concerned for emotional, spiritual, mental and physical well-being of both individuals and communities. Therefore our contribution should be as much about promoting good health and disease prevention, as about responding to ill-health and its wider consequences in our communities.
This care and compassion, in practical terms, means an urgent and vocal commitment on our part to intensifying all our efforts that seek to ensure access for all God’s people, especially the poor and vulnerable, to adequate prevention, care, treatment and support. We cannot do this alone; we must continue working in communities, with those most affected, discriminated, with stigma and are silenced.
Community Engagement and Primary Health Care
It is at community level where the religious sector can perhaps make the greatest difference. Our pervasive grass roots presence allows us to work ‘bottom up’, vitally complementing the ‘top down’ approach that is inevitably part of the national and provincial responsibilities of Governments and Health Departments. And we certainly need to make a difference at the grass roots, if we are to make headway in health promotion and disease prevention as well as caring for the sick. We can do so through continuing our education programmes which help to break stigma, silence and death; and give a voice to people living with HIV. Within general health promotion, we give a particular priority to ensuring access to prevention measures, treatment, and a broad range of care and support to mothers, children and all living with HIV and TB. These are chief amongst the health challenges that we are facing at this time.
I am delighted that we share so much of this vision with our current Health Minister, Dr Aaron Motsoaledi. Last year he launched what he calls ‘a massive primary healthcare campaign’, which is as much about teaching healthy living as it is about caring for the sick. With Dr Motsoaledi, I was privileged to co-chair a national conference on religion and public health last October, which was sponsored by the National Religious Association for Social Development. Out of this, and our continued involvement with the South African National AIDS Council, we are developing various partnerships between government and faith communities. We hope soon to sign a Memorandum with the Department of Health.
My own church has also worked with other governments, including those of the US, UK and Canada, in running community-based programmes. Through the NRASD we are also in partnership with the Global Fund.
In all of these, education and capacity building around good practices in disease prevention and treatment is a key objective. For though poverty exacerbates health problems in many ways, one of the most insidious is the lack of basic education. This is the most significant reason
• why HIV still spreads at unacceptable levels
• why TB, entirely treatable, remains so prevalent
• why people don’t stick with their courses of medicine
• why people are so passive, defeatist, in the face of illness, often only going to clinics when they are seriously unwell
• why so many of us follow life-style practices that increase the risk of us developing serious, even life-threatening, conditions including diabetes, heart disease, and cancer – when so many of these are largely unavoidable.
The great saga around toilets in our recent local elections illustrates the vast task that the country faces in providing adequate clean water and sanitation facilities for our population. This is one area – among others, of course – where the religious sector is pressing the government to do better. But good hygiene habits also have a vital role to play in cutting the close to 100 deaths a day of South African children to diarrhoeal diseases.
It is a truism that ‘Prevention is better than cure’. Teaching people how to live well has always been at the heart of religious activity. So we must ensure that we train religious leaders explicitly to promote good health education – directly and through their congregations – within their local communities, as part of this call to abundant life of heart, soul, mind and body. Jesus said his followers were to be like salt in the world – a tiny amount can make the difference between a tasteless meal and something wholly delicious! We must do the same.
Informing Minds, Transforming Behaviour
Such teaching is not just to inform minds – it must also transform behaviour. Studies regularly show that in South Africa we have very high levels of awareness about HIV and TB – but this has been slow to change sexual and social behaviour. In Uganda, the most significant prevention measures came through person to person communication at grass roots level, in which religious networks played a key role. We must mobilise our people to persist in doing the same – and indeed, within the Anglican church we are particularly aiming to do this, for example, through the Siyafundisa (‘Teaching our Children’) Peer Education and Life Skills Education programmes, funded by PEPFAR. Recent studies are finally beginning to show, thank God, a reduction in infection rates among young people.
Of course, it must be admitted that churches and other faith communities have not always played a positive role in relation to education on HIV and AIDS. Let’s face it, the religious sector has found it hard to talk more constructively around issues of sex, which is so often something of a taboo subject. For too long we fuelled stigma, and with it ignorance and denial, all of which contributed to the disease’s spread. But as we learn to speak more openly, honestly, and constructively, about these diseases and the factors around them, so we can help society as a whole to deal with them in this way.
I think, for example, of a man who, after wrestling with his status, admitted openly that he was HIV +ve, even though he was a monk, and supposed to be celibate. By acknowledging publicly that he was ‘only human’, he discovered that he was able to come alongside people, and genuinely engage with them in a way he never could if they had not been able to identify with him in the way they now did. There are many other good news stories of where changing church attitudes have helped change community attitudes. I leave it to my colleagues to give practical examples from their work on the ground.
These examples, will, I hope, demonstrate that making a transition from being part of the problem to being part of the solution has required first of all a commitment to ensuring our faith leaders are well-educated in the facts and appropriate attitudes. We must continue to also tackle patriarchal distortions in our own teachings that too often collude in the abuse of women and children, which is also such a damaging part of community health and well-being.
People on the Ground
The presence of churches and other faiths in every community can help in the battle for good health in other ways. We can support Government by offering places where community-based health officers and nurse-practitioners can provide essential primary care at village level; or hold mobile clinics; or connect patients with mobile phone-based ‘telemedicine’. A consensus is emerging that these are cheap and effective ways of significantly boosting health care.
All these are over and above the care networks and programmes that so many of us already run to support those infected and affected by HIV, AIDS, TB and other illnesses. Let me mention the Anglican VanaVetu (‘Caring for our Children’) Programme, funded by DFID and PEPFAR, which aims to ensure that orphaned and vulnerable children receive appropriate care and support to grow to their full potential. It provides counselling, education, care and support to communities and also trains people to respond to their needs.
Caring for Souls
But, as I draw to a close, let me say something about the religious sector’s unique and necessary contribution. For we are far, far, more than just another social development organisation that can assist governments in their uphill task of promoting good health. Medicine can treat the body, but physical well-being is intimately linked to spiritual and emotional health.
All of us are mortal – yet death is increasingly one of society’s last taboos. Too often we behave as if it were an unsubstantiated rumour – until, of course, it faces us. Then people need our support, our care, our clear proclamation of the love of God that encompasses both this world and the next. One task of faith communities is to help everyone to live with honesty, and face death without terror or despair – setting people free to make the most of their lives in generous loving relationships with those around them.
An ancient prayer asks God to grant us a ‘good death’. I have to say that where people have dared to face their dying, by putting their hand in the hand of God, trusting him and finding his gift of peace, that they are amongst the most healed people – healed emotionally and spiritually – that I have ever met.
It is not only the sick, the dying, and their nearest and dearest for whom we care, and for whom we pray. We can also provide health professionals with spiritual and emotional support. Sometimes, in their stressed and demanding lives, it can make the world of difference to receive a ‘good listening to’ when they need it; to know they are valued; to know that they too are upheld in our prayers and those of our communities.
This week we mourn the passing of Ma Sisulu – who, among her many gifts and achievements was a dedicated nurse. We need to value nurses as we did when she trained – and resource them to make the difference that she and her generation contributed to our country.
So may God bless our discussions here; and bless us in the lessons we take home and share with our own communities. For most of all, we pray that he will make us communities of blessing to those around – especially those in greatest need. Amen
The Most Revd Dr Thabo Makgoba is the Anglican Archbishop of Cape Town and Metropolitan of the Anglican Church of Southern Africa. This adddress was given on 8 June 2011 at the 5th South African HIV and AIDS Conference in Durban Together with Dr.Motsoaledi (Minister of Health) he co-chairs the NRASD and Health Ministry initiative to improve primary health care through education