Special Feature:
The Catholic Church
and the HIV/AIDS
Pandemic in Kenya: An Exploration of Issues
Catherine N.
Machyo*
Abstract
HIV/AIDS has been
declared a national disaster by the Kenya Government. Available data from
the National AIDS Control Council (NACC) indicates that more than two million
people in the country are living with AIDS, and close to 200,000 new infections
occur every year. It is obvious that HIV/AIDS presents a major challenge to
society as a whole. This article explores the Catholic church's response to
the pandemic. It briefly describes its role in HIV/AIDS prevention, including
training, awareness programmes, production and distribution of educational
materials. It then examines critical issues in the church's response. Finally,
it discusses the challenges ahead.
Introduction
The magnitude and
impact of HIV/AIDS in Kenya is not only a major public health problem and
development challenge, but also it is increasingly creating a negative socio-economic
impact. The realisation that the country is losing about 700 of its people
daily made the Government to declare HIV/AIDS a national disaster. More than
one million people have died since 1984, leaving close to one million orphans
(NACC Strategic Plan, 2000). The report further indicates that by mid-2000,
more than two million Kenyans were living with HIV. In one year alone, close
to 200,000 new infections occur in the country. The majority of the infected
are young people between 15 and 49 years.
Socio-economically,
the epidemic causes a loss of about Kshs. 200 million daily – a cost that
does not include lost working hours and the worsening of the poverty among
an already impoverished populace (NACC Strategic Plan, 2000). The report further
indicates that the disease will also have a great impact on the population
growth, which may stagnate, and even reverse if the eight million Kenyans
projected to die of AIDS by 2002 do in fact die. Eight million is about one
third of our entire population, the biggest percentage being in their productive
years. This means that as a country we cannot develop and indeed are facing
a national catastrophe.
Through pastoral
care, social ministry, education, and prevention programs, the Catholic Church
is strategically placed to facilitate and help concretise and put structures
in place for an adequate and dynamic response.
In July 1997, the
Daily Nation newspaper carried an editorial containing an explicit critique
of the response by churches to the scourge. It called for religious leaders
to become actively involved in the promotion of AIDS awareness in Kenya as
the disease was spreading among their followers, including pastors. The editorialist
argued that the churches should relax their hard-line stand on issues such
as promotion of condoms and family life education in schools in the interest
of a more effective battle against AIDS. The editorial concluded that Church
leaders were not actively involved in the promotion of awareness and that
they did not realise how rapidly the disease is spreading in Kenya. The impression
given was that it was the Government alone that was bearing the brunt of the
battle against the AIDS pandemic. The churches appeared reluctant to join
forces with the Government in this vital campaign.
The Catholic Church's
Response to HIV and AIDS
The Catholic bishops
in Kenya, in their pastoral letter of December 1999, acknowledged the challenge
HIV/AIDS poses for the country. They called for a recognition of the moral
dimension of the disease and a co-ordinated effort between the Government,
the youth, Christian communities, civic authorities, the media, health care
workers, teachers and educators in seeking solutions to the HIV/AIDS pandemic.
"… working together
with all concerned, we hope to alleviate in all ways possible the moral, physical
and spiritual suffering caused by the disease. We therefore exhort you in
the words of our Lord Jesus Christ, Fear not, I am the first and the last;
I am the living one! I was dead, but now I am alive forever and ever. I have
authority over death and the world of the dead". (Revelation. 1: 17-18)
The basic response
of the Catholic Church to the pandemic has come from its role as teacher.
Conferences of Catholic bishops as well as theologians have utilised the onset
of HIV/AIDS as an occasion to reinforce traditional moral teachings and values,
especially with regard to sexual behaviour and marital relationships.
Some of the major
strategies being undertaken by the Catholic Church are:
1. Prevention initiatives
2. Provision of care for people living with
HIV/AIDS
3. Pastoral counselling
4. Care for orphans
Prevention Initiatives
AIDS Awareness
Program
Many members of
the Catholic Church have consolidated their efforts to promote AIDS awareness
programs in the communities within which they operate. These vary from the
simple integration of AIDS information into ordinary preaching and instruction,
to the elaborate information, education and communication (IEC) programs.
The efforts are directed at the provision of facts on AIDS, how the epidemic
is spread and the education that equips people with skills necessary to change
their life styles. Sexuality is dealt with in the light of the Church's moral
teaching and the Biblical principles that govern it. Awareness is also created
among the afflicted and their families on the subject of dying and preparing
for death.
Training
The Catholic Church
provides training for various cadres of church operatives. These range from
leaders such as priests, to youth leaders, social workers, women's groups
and other forms of leadership in the community. This is done through group
training sessions, enabling the participants to training others by disseminating
AIDS information, helping people to accept the reality of AIDS and promoting
compassion and care for the afflicted. There is also the training of counsellors,
which includes those living with HIV/AIDS peer counsellors. The Kenya Catholic
Secretariat works closely with the various implementing agencies within the
Catholic fraternity, and also offers technical and advisory services to them.
Production and Distribution of Materials
The Catholic Church
has produced and distributed materials as part of its AIDS prevention campaign,
for example the Caritas Aids Manual published in 1997. This is a general guide
for those working with and caring for HIV/AIDS patients. Its basic aim is
to help trainers inculcate a positive attitude towards patients. The Medical
Missionaries of Mary (MMM) in 1996 produced a guide entitled AIDS Awareness Workshop: A Guide for Facilitators.
This manual was intended to help those who have attended the MMM AIDS awareness
workshop to facilitate other groups. Many books on the subject have also been
written.
Provision of Care to People Living with Aids (PLWAIDS)
The sheer numbers
of ill people overwhelms health institutions, hence the need for home-based
care for the terminally ill. The provision of direct care to the afflicted
has promoted home-based care programs, which provide an excellent alternative
to the already congested hospitals. MMM provides weekly rations of food and
makes referrals to hospitals. Those who are very sick are visited everyday
and provided with a cooked meal. The program includes the Eastlands Deanery
of Nairobi Catholic Archdiocese and the St. Theresa Church Eastleigh, where
they encourage the community members to help take care of the sick.
The unemployed
face particular difficulties in meeting their basic needs and it is therefore
important to empower those living with AIDS. This is being done by encouraging
income-generating activities such as tailoring, embroidery, handcrafts among
others. Poverty has been linked to the rapid spread of HIV/AIDS.
Pastoral Counselling
The other most
important service offered by the Catholic Church to people living with AIDS
is pastoral counselling. People are helped to grow, develop and understand
their own lives through the scriptures. Various Catholic institutions have
set up centers for this purpose. These centres help in the restoration of
hope, reconciliation and the discovery of a purpose in life. In a survey among
PLWAIDS, Mbugua (1993) found that 72% of the respondents found the spiritual
support offered them a great source of comfort and strength, especially in
dealing with feelings of guilt and fear.
Care
of Orphans
The number of AIDS
orphans is growing rapidly, especially in urban areas. It is estimated that
by the year 2005, their number will be close to one million, (NACC, 2000).
The Catholic Church provides accommodation and food in rescue or crisis centres
for orphans, or for children whose parents are very sick or in hospital. The
problem of HIV/AIDS has also resulted in an increased number of street children.
A number of Catholic institutions have responded to this challenge, for example
the Cottolengo Sisters and Nyumbani Home, who take care of babies who have
been abandoned because of their HIV status.
Emerging Issues
Although the Catholic
Church has implemented many programmes to arrest the spread of HIV/AIDS, significant
issues remain. Some of these are discussed in this section.
Condom Use
Most HIV/AIDS prevention
campaigners in Africa promote the use of condoms as a solution for individuals
who cannot be faithful to one sexual partner in and outside marriage, those
who cannot abstain from sex, or those in a marriage where one person is seropositive.
However, the Catholic Church in Kenya and elsewhere condemns condom use and
recommends sexual abstinence as the best protection.
Despite the known
causal association between AIDS and promiscuity, the media (print, radio,
television, videos and films) have perpetrated pornography in an irresponsible
way. This has helped fuel premarital sex and infidelity resulting in the AIDS
epidemic. In particular, the condom advertisement directed at the youth show
total disregard for truth; it is also offensive and in poor taste. Often the
argument put forth is that condoms will ensure 'safe sex' or at least 'safer
sex'. This to some extent facilitates immoral behaviour. Research has shown
that the condom has failure rates as a contraceptive (Gordon, 1989, Roland,
1993, Baitu, 1998).
The media's promotion
of condom use is an invitation to promiscuous behaviour and leads to recreational
sex and instrumentation of the same. Abstinence is the antidote for the sale
of sex as there is no money in it. The media could help promote moral norms,
such as refraining from smoking (comparing the sexual urge with the smoking
urge). It should become fashionable to abstain from sex before marriage like
it is fashionable not to drink before driving. Role models on healthy sexuality
should be promoted.
The condom basically
is not the central issue. Rather, it is the promiscuous behaviour associated
with it that pollutes the sanctity of sex and which uses the condom to escape
from the consequences of sin. While it may reduce the consequences of sexual
promiscuity, it is as much a part of the problem as it is a solution. Responsible
biblical choices can be made through counselling and teaching.
The Catholic Church's
opposition to condom use should be seen in the light of its moral teaching,
which emphasises sexual abstinence before marriage, and fidelity after marriage.
According to Shorter and Onyancha (1998), abstinence before marriage and chastity
within marriage are emphatically highlighted as moral imperatives for Christian
discipleship and as indispensable means of honouring marriage.
Discrimination and Stigmatisation
It must be admitted
with much regret, that the Church's faith community has not responded as fully
as possible to this challenge (Shorter and Onyancha, 1998). Many pastors are
still fearful of physical and social contact with persons with HIV/AIDS since
they persist in their ignorance about modes of transmission. Some religious
leaders are extremely uncomfortable with issues related to sexuality, which
are closely linked to the disease. Others lack the 'right words' to use when
ministering to a young man or woman who is facing death.
The fact is that
many members of the Church, because of their human frailty, still try to distinguish
between the 'innocent' and the 'guilty' persons with HIV or AIDS. They try
to define the criteria for God's 'unlimited' mercy and reconciliation, and
to close the doors of our communities to those whom they consider to be too
'unorthodox', 'sinful' or 'unnatural' in their behaviour or orientation. In
the light of this, the teaching Church is obliged to re-examine the consistency
and credibility of messages it communicates in both words and practice.
In their pastoral
letter of 1999, the Catholic Bishops of Kenya call upon Christians to overcome
any prejudice they feel towards AIDS victims. They pointed out that apart
from being contracted through immoral behaviour, it could be got through other
ways. AIDS is not different from cancer or malaria. Like other disease, it
causes suffering and death.
Looking at AIDS
patients as sinners condemned by God as if we have a right to judge them as
wicked distorts reality. It is a known fact that even infants and faithful
spouses have contracted AIDS. Are we going to be like those who once asked
Christ while pointing at the man born blind, "Rabbi, who sinned? This man
or his parents for him to have been born blind?" We should remember Jesus'
answer, "Neither he nor his parents sinned. He was born blind so that the
works of God might be displayed in him" (John 9: 2-3).
We have no need
to fear. AIDS means much suffering and hence we should not look down upon
those who suffer. As the Apostle Paul wrote, "There must be no passing of
premature judgment. Leave that until the Lord comes: he will light up all
that is hidden in the dark and reveal the secret intentions of men's hearts."
Far from encouraging passivity, this outlook urges us to act decisively, and
more so in these times when there is no cure. For those who have no hope for
a future life, AIDS will seem like a curse and a good reason to keep a safe
distance from those who have it. For those with a Christian faith, it is an
encounter with grace, prompting us to be generous and to love others as Christ
loves us, even going to the extent of risking our lives.
Breaking the Silence on HIV/AIDS
Maluleke (2000)
acknowledges that there is an orderly theological silence over HIV/AIDS. He
suggested that one of the reasons is that it is an ugly, relentless and chaotic
epidemic. He suggests that may be the silence in the face of AIDS is because
we have to confront two issues which the Church and our inherited cultures,
both Western and African, have been unable to handle openly and constructively,
namely sexuality and death. However, the silence is not complete, because
those with full-blown AIDS are 'speaking' to us and among us. How could we
fail to see? How could we not hear? Are the 'safe' and patronizing ways of
some Christians the best responses we can muster in the face of so massive
and so fundamental a human crisis?
A report on the
AIDS conference held at the Vatican in December 1999 indicates that bishops
and priests were unhappy that the disease is too big a problem to discuss,
especially because there exists a significant amount of HIV amongst the clergy.
The silence also
is noted among doctors who are not prepared to talk about it. It is further
manifested in funeral announcements in Kenyan dailies – most indicate the
cause of death as accidents and not AIDS, which is in most cases presumed
to be the cause. This ultimately prevents access to counseling and feedback
on prevention.
Aids and Poverty
HIV/AIDS is a problem
in poor countries because of poverty. Its spread is not only a medical issue,
but also a social dilemma. Containing the spread of AIDS lies partly in a
nation's ability to improve the standard of living for all its citizens, and
less so in its ability to deal with the infectious nature of the virus. It
is difficult to live a moral upright life when there is no proper housing,
no schools in which to educate children, no security from thieves, and no
means of finding stable employment. Unless people have reason to live and
have prospects of seeing their honest work bear fruit, why should they worry
about death? Perhaps the AIDS crisis tells us how poor we have become and
not, as some suppose, how ignorant our people have become.
Economic growth
is strained in the face of the epidemic. Predictions are that by the year
2000, the gross domestic product will be 14.5 percent less than it would be
without AIDS. General standards of living will be affected by the disease
(NACC, 2000). As AIDS claims the heads of households - most of them bread
winners - their dependents, among them children, will bear the brunt of the
loss. As children assume responsibilities as heads of households with virtually
no economic base, we can expect an upsurge in poverty.
Although no one
is immune from AIDS, it is the poor who are most at risk. Africans are no
more promiscuous than Europeans for example, but they are much poorer and
therefore more vulnerable to the AIDS epidemic.
Socio-Politics of HIV/AIDS
The AIDS epidemic
is not unrelated to economic exploitation. There are many reasons to question
the applicability of the AIDS dogma by the West in Africa. The West talks
about Africa, sometimes accurately. However, is the West able to talk with
Africa? Is the West patient enough to listen to Africa? Does the West think
there is anything to listen to?
Voicing concern
over the West's condemnation of President Mbeki's questioning of the relationship
between HIV and AIDS, Downing (2000) takes note of a letter to the editor
in the Guardian which read:
"Anyone who visited
Southern Africa's rural communities will be painfully aware that the solutions
of programs that work in London, Paris, Frankfurt and New York will not work
there. The media are doing President Mbeki, and the search for an effective
response of the AIDS tragedy in Africa a great injustice by insinuating that
by asking questions rather than regurgitating the 'truth' as seen from the
developed world's perspective, he may be doing international efforts a disservice".
Downing further
questions some of the interventions that are being carried out to combat the
HIV/AIDS scourge. As Africans we are saying that there is need to break the
silence, but this cannot be done when we send subtle messages about the disease.
It is the only disease for which there is pre-test and post-test counseling,
which essentially adds to the stigma. Also, the idea of confidentiality contradicts
our goal of breaking the silence.
Prevention is a
'business' especially for condom manufacturers. There is also the business
of pharmaceutical firms which are offering Africans a reduction in the price
of anti-retroviral drugs. There are already doubts as to whether these pharmaceutical
firms are genuinely out to participate in improving the public health of poor
countries, or whether theirs is a deliberate effort at shifting the focus
from prevention campaigns to the 'business' of treatment.
Gender and Powerlessness of Women in Africa
The spread of AIDS
among women and children is greatly enhanced by the cultural and economic
powerlessness of this group. It is now clear that women have borne the brunt
of the epidemic, especially young girls in their teens (15 to 19 years), who
are six times as many as their male counterparts. Older men turn to younger
girls for sex under the misconception that they are AIDS-free (NACC, 2000).
Even the ones who are not infected are affected in that when parents succumb
to the disease they are forced to look after them, often without sufficient
information, medication or support.
Gender biases become
more accentuated as infected women bear the brunt of rejection more than their
male counter parts do. The property of deceased spouses is sometimes appropriated
by family members who may not recognize the widow and children. The Kenyan
bishops in their pastoral letter of 1999 acknowledged the vulnerability of
women to HIV/AIDS. They reaffirmed support to better their conditions, especially
by providing education, training opportunities and income generating opportunities
for them.
Cultural Beliefs and Traditions
HIV/AIDS must be
understood in the context of cultural beliefs. Many in Kenya believe that
AIDS has come because some cultural practices have been abandoned. (Dortzbach,
1998).
Cultural practices
vary. Some are beneficial in AIDS prevention while others perpetuate its spread.
The beneficial ones need to be enhanced and others changed or modified. Culture
is so integrated into everyday life and beliefs that it is sometimes difficult
to separate the beneficial practices from harmful ones.
Some practices
like faithfulness in marriage and instruction on sexuality to the youth during
initiation are practices that should be encouraged since they contribute to
family preservation. However, some practices, for example wife inheritance
and circumcision, may facilitate transmission of the HIV virus. In other communities
AIDS is seen as a curse or witchcraft. Such practices need to be changed.
In order for change to occur, when a crisis such as HIV challenges culture,
there is need to understand the issues at hand and provide alternatives, for
example to wife inheritance. There is also need to interpret cultural traditions
in the light of scripture.
The Way Forward
The Church must
concentrate its efforts on educating and informing its people about prevention.
It is necessary for information to be disseminated prudently and responsibly
to avoid ungrounded uncertainties or needless fears. Despite this, we must
not be too optimistic about the role of knowledge and cerebral consciousness
in the changing of human behaviour. The assumption that more and better knowledge
automatically influences human behaviour needs to be revisited. Non-governmental
AIDS organizations all over the world are beginning to conclude that prevention
campaigns have not yielded the success that is commensurate to the effort
and money put into it. What this might be saying to us is that, perhaps we
need to redefine what we mean by knowledge, so that 'knowledge' and awareness
move beyond the cerebral and beyond the realm of said to be done and hidden
to the public (Maluleke 2000). Knowledge should not just be cognitive.
There is also a
need to address the training of the clergy who are faced with this huge and
seemingly overwhelming task of dealing with the HIV/AIDS pandemic. From the
report on the conference at the Vatican on HIV/AIDS in December 1999, bishops
in their group sessions acknowledged that the religious lacked the skills
that the pandemic posed. Ngumi (2000) in a baseline survey confirmed the same.
It was noted that
in a case in Uganda, there was a need to equip the clergy with a formation
program as they refused to care for HIV/AIDS patients under the belief that
they were all prostitutes. The program and curriculum should instill in the
clergy the necessary knowledge, attitude, and skills to serve the community
more effectively in the struggle against HIV/AIDS. In addition, they should
be equipped with skills in program planning, development, implementation,
and evaluation. The focus should also be to equip them with leadership and
management skills in community resource development and mobilization. This
would address the issue of community participation in home care of the sick
and of orphans. There is also a need to develop skills in training of trainers
for maximum multiplier effect. This may be done formally in theological institutions
or informally at the community level. This is a challenge to our theological
institutions that claim that HIV/AIDS issues have been infused in their theological
subjects. Given the urgency of the matter, there is need to evaluate these
programs and see whether they do indeed equip the clergy with adequate skills
and knowledge to respond effectively and sufficiently, because while we hold
discussions about HIV, people are contracting the virus while many are dying.
Efforts should
be made to address dangerous traditional customs and practices connected with
the spread of the pandemic such as female circumcision, wife sharing and inheritance,
sexual and economic subordination of women. As Baitu (2000) has stated, apart
from emphasizing sexual abstinence before marriage and chaste living in marriage,
the Catholic Church should assist in animating African traditional structures,
such as the family, the neighbourhood, and the village community which used
to uphold moral values, encourage and support them in their difficult task
of serving as instruments of behaviour change essential for arresting the
spread of HIV/AIDS.
The attitude of
the Church towards those living with AIDS should be based on witnessing God's
unconditional love and not on passing judgment. The Christian response to
the AIDS pandemic is not only medical and social, it is primarily about the
extension of God's grace. AIDS highlights the need for restoration in our
relationship with God and with each other. Conversion and repentance are not
primarily the duty of other people, but our own obligations. Churches can
do this by starting support groups. These groups can reach out to people living
with AIDS in their communities, demonstrating a truly Christian care and love.
The church needs to start movements like 'Friends of People Living with AIDS".
These movements could be modeled on already existing organizations dealing
with medical issues, such as the Head Foundation, among others. Such organizations
could be charged with the responsibility of raising funds for AIDS orphans
and also educating the community to avoid discrimination. The Church's great
legacy from Jesus Christ is one of healing from all dimensions: physical,
psychological, social, environmental, moral and spiritual.
Conclusion
Jesus told his
followers that they were to be both the 'salt of the earth' and 'light for
the world' (Mathew 5: 13-14). It is not extra-ordinary, therefore that Christians
should understand their vocation as including teaching human society how to
live and being examples to the rest of humanity.
This article describes
the response of the Catholic Church to the AIDS pandemic, and explores emerging
issues. The disease is a complex problem that requires comprehensive, multi-faceted
solutions. The Church has established several programmes to address it. She
now faces the crucial challenge of sustaining the momentum and carrying its
programmes forward.
The Catholic Church
has a duty to form the character and morality of its members. The most effective
way of fighting the HIV/AIDS pandemic is through behaviour change, and inculcating
moral and spiritual values. Sexual abstinence before marriage and chaste living
in marriage are the most effective ways of preventing the spread of HIV/AIDS.
* The author is a lecturer
in the Department of Education at the Catholic University of Eastern Africa.
Her specialisation is in curriculum development. Prior to her current position
at the university, she was a lecturer at a teacher's college where she taught
education. Her research interests are in civic education, HIV and AIDS, and
gender.
Correspondence
Catherine Machyo
Department of Education
Catholic University
of Eastern Africa
P O Box 62157
Nairobi, Kenya
Fax 891084, Email:
research@cuea.edu
Bibliography
| 
