God, AIDS, Africa & HOPE

Stefan Hippler

Judge not – The pointless categories of guilt and innocence

It’s one of those lectures you don’t forget in a hurry. Prof. Marc Cotton, a steering committee member of HOPE Cape Town, delivers it to the staff of City Park Hospital in Cape Town. It is 7am and his listeners are still rubbing the sleep out of their eyes. He is lecturing on general socio-medical issues related to HIV/Aids. The stream of dense facts and figures nearly drowns out the peculiar story of 14 children. As an aside, Prof. Cotton reports that all of these 14 young patients are HIV-positive, but their parents are HIV-negative. The children come from different areas, but they have one thing in common: they were all hospitalised for lengthy treatment of various illnesses. Prof Cotton doesn’t need to offer a conclusion; the inference is obvious.
This incident contradicts the general notion that infection is always due to sexual contact – a prejudice that is also widespread in church circles. When we meet an infected person, all of us instinctively wonder: How did it happen? Our terminology betrays us. We prefix our references to affected children with the word “innocent”. That makes it so much easier to be compassionate. But with adults there is always the question of guilt. We might not say it out loud, but it’s in our thoughts.

It cannot be disputed that HIV is chiefly transmitted through sexual activity. But there are other possible causes of contagion, such as blood transfusions or transmission during birth. The case of these 14 children should counsel us to be more vigilant in our assumptions and to curb our imagination.

A biblical verse might help us: “Judge not, lest you be judged” (Matthew 7:1). Our perceptions should not be clouded by questions about how, where and why somebody was infected. We should be guided only by seeing the infected person as our brother or sister, to suffer with them in compassion. In our speculations about the origins of contagion we nurture the seeds of stigmatization. When Jesus, in Matthews Gospel, speaks about the final judgment, he places among the saved those who visited the poor and captive, who clothed the naked and fed the hungry. Christ doesn’t talk about the events that led these people to their pitiable circumstances. He judges nobody. Nor should we. All people with HIV deserve our unqualified support, like these 14 children Prof Cotton told us about in his lecture.

Translation  from the book:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, Aids, bartholomaeus grill, book, cape town, Catholic, catholic church, Church Matters, gott-aids-afrika, hiv, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, moral theology, oekonomia, people living with the virus, pope, sexuality, south africa, stefan hippler, theology, Theology

Stefan Hippler

The last birthday  –  Little Fareed’s death – a common outrage in Africa

Fareed* is emaciated and he breathes heavily. For a ten-year-old boy he weighs too little and his eyes seem far too big for his face. And yet, Fareed is one of the luckier children. He has been admitted into a hospital, the Ithemba ward at Tygerberg Hospital. Fareed’s sister has sat by his bedside for days. She holds his hand, helps to change the bedding, comforts him.
When I meet Fareed for the first time, volunteers have just made up his complexion with base. His big, sunken eyes look at me with quiet determination. Fareed has a yearning desire: he wants to have a birthday party. He was there when a little girl in the next room had a birthday party, organised by colleagues from HOPE Cape Town. It had a cake with candles and presents and all the trimmings. He would like that too.
But there is one problem: Fareed will not live to see his next birthday. He has only days to live.

We decide to grant him his last wish anyway. We bake cakes, buy gifts, and decorate the room. And two days later we celebrate his “eleventh birthday”. Fareed cannot get up, so all the children are gathered around his bed, the birthday cake with burning candles on the side-table. We help him to unwrap his presents – he is too weak to do even that. Our chorus of “Happy Birthday” sounds more like a swansong. I struggle to hold back my tears, as does everybody else. It is a cheerful horror party which I won’t forget as long as I live. But little Fareed is happy. A smile frequent smile floods across his face; he doesn’t have enough strength to animate his joy. A week later Fareed dies.
These beautiful memories are distorted by a rage that this child had to die because at the time the medications which might have relieved his suffering and extend his life were unaffordable. It was an unnecessary, senseless death. And yet it is this particular death which revitalise me in times of despair, when I’m about to give up, when the sheer enormity of the suffering I see threatens to crush me. Fareed, a fleeting acquaintance in my life, has seared himself into my heart with a scorching intensity. When doubts start to take over, I think about him and remind myself why I am involved: on behalf of Fareed and all the children and adolescents I have watched suffering and dying from Aids, some in calm serenity, others crying in pain. Every such child, every such adolescent, represents the dying cries of the crucified Jesus in our times.

* Name changed

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, Aids, bartholomaeus grill, book, cape town, Catholic, catholic church, Church Matters, gott-aids-afrika, hiv, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, moral theology, oekonomia, people living with the virus, pope, sexuality, south africa, stefan hippler, theology, Theology

Stefan Hippler

The lonely shepherd in the Vatican – Catholic moral teaching’s balancing act between faith and science

As part of my morning routine in the office, I read Vatican Radio’s daily e-mail newsletter. I’m not sure if it is aimed at a wider audience, and I wish it was shorter and more concise – and, above all, easier to understand. Let’s take, for example, this summary of Pope Benedict XVI’s meeting with the International Theological Commission in late November 2005 and try, step by step, to make sense of it.

It begins and this is an own translation of the German text:

The revelations of Christ are the fundamental normative principle of theology. Theological study in turn must be conducted in the Church and for the Church in fidelity with the apostolic traditions… The revelations of Christ, the Good News of the Risen Jesus, forms the basis of theology – and it is always to be understood as directed by the official Church.

Further in the text: The work of the theologian must take place in communion with the living magisterium of the Church and under its authority. To regard theology as a private matter for the theologian is to misunderstand that nature. Only within the ecclesiastic community, in communion with the legitimate Shepherd of the Church, does the theological task have a meaning, which, of course, requires a scientific competence but also – and not any less! – spirit of faith and the humility of he who knows that the living and true God, the object of his reflection, infinitely exceeds all human faculties.
If one wished to be uncharitable, one could interpret this as: The outcome of theological inquest can be correct only if it coincides with what the Church teaches. But surely the Holy Father doesn’t mean to say that. That passage just tells us that faith and science need and complement one another. I think the Church’s teaching authority is essential. I agree that theology is not a private matter, but it must move within that grey area between what we understand (or believe to understand) about revelation, and what we still have to learn. The Pope is right when he says that the living and true God exceeds all human faculties, but then that must apply to the faculties of all human beings – theologians included. And the same goes for the “spirit of faith and the humility” of which the papal statement speaks: humility applies not only to the theologian and scriptural exegetist vis-à-vis the magisterium, but also the other way around. It applies even to the highest guardian of the magisterium, the Pontifex maximus.

Theology can be explored only in spiritual freedom. Only within the freedom of God’s radiant children is it possible to advance our understanding of the Almighty’s secret – the origin and purpose of all life – and to fathom God’s unconditional love for us. But isn’t it exactly that freedom which troubles the custodians of the magisterium because it smells more like temporal anarchy than divine order? Could it be that this fear is rooted in the pressures of responsibility – which is entirely honourable – but at the same time making life in the Church difficult and holding us back in our increasingly fast times?
There is no question that the Church must be circumspect and take its time before making material decisions. The Church must also be conservative – for the good of the people, not out of fear of opening the gates to immorality. When I read Church statements, I often wonder why there seems to be so little trust in God among those who should have the most. Where is their longing for the Holy Spirit which blows where it wants to, not where it is ordered?
The pope anticipates these concerns as he continues: Here one might object: Is a thus defined theology still scientific and in conformity with reason? Yes! Rationality, science and reasoning in communion with the Church is not just not mutually exclusive but complementary. The Holy Spirit leads the Church in the fullness of the truth, the Church is at the service of truth, and its guidance is an instruction to the truth.

That’s true, theology and reason are not mutually exclusive – but why, I ask myself, does official teaching time and again exclude science? Why does the Church lack the courage to measure questions of natural law, morality and human behaviour against the latest scientific findings, and to develop the answers in conjunction with these? Why don’t we, as Church, explicitly acknowledge that theology throughout history has been developed, changed, assimilated and corrected? Some adaptations are more recent than often assumed. The dogma of papal infallibility, for example, is not an ancient Church teaching; it was proclaimed as recently as 1870 at the First Vatican Council. And when the first seeds of modern democracy were beginning to sprout and enthused populaces started to agitate for human rights and religious freedom, most Catholic leaders thought this was the work of the devil. Today the Church fervently defends and promotes democracy and human rights.

When I contemplate such issues and look at the Aids pandemic, the paradoxical legacy of Pope Paul V comes to mind. That great Church leader and thinker in 1968 issued the epochal encyclical Humanae vitae about the proper order of the reproduction of human life. The first part in particular is infused with a wonderful and deep spirit. But in the second part, Paul VI squanders a historic opportunity – he closes the Windows of the Church opened just a few years earlier by his predecessor, John XXIII. Modern history of moral theology writes no more tragic a chapter than that of Paul VI’s lonely decision. Ignoring the recommendations made by his own theological advisory commission, and contrary to scientific insights and against the vox populi – the voice of the people – he decided against artificial forms of contraception.
We can only imagine Pope Paul’s torments of conscience and his suffering over this encyclical – and about his fears flowing from the pressures of keeping the huge tanker called Catholic Church on course. I feel for this lonely old man in the Vatican. But I also feel for the millions of believers who despair at his decision. Our Church was torn by it, and the Church has inexorably tried to stitch the rupture since.

But when we theologians in the stillness of our chambers brood over this matter, we must concede that the tear can’t simply be hidden, we have lost authority. And we lose even more credibility when we try to base on science a proscription of artificial means to fight Aids. We cede trust when we claim that the HI virus is smaller than it really is and that it can pass through pores in condoms. By doing so, the late Colombian Cardinal Alfonso López Trujillo believed he had rendered the Church a great service. But pseudo-scientific arguments don’t help; it is much more important to keep alive an uninhibited debate about superior strategies.

The fear of questioning the decisions of a predecessor can be paralysing, because it touches upon the principle of infallibility, and that can obstruct or even prevent the frank treatment of contemporary problems. It’s a horror of the Church’s whole value system starting to crumble if too much of entrenched teachings is reformed, and that the Church would then lose power and influence. For the present pope it is probably also the concern that the rampant relativism in modern society might eat through the last bastions of Christian morality.

But fear is poor counsel. The free use of scientific knowledge, which in Christian terms reveals God’s greatness, would make life much more easy for the Church and for many people – and, perhaps, also godlier. And that is why I wish for greater courage in the fight against Aids.

Translation from the book:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, Aids, bartholomaeus grill, book, cape town, Catholic, catholic church, Church Matters, gott-aids-afrika, hiv, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, moral theology, oekonomia, people living with the virus, pope, sexuality, south africa, stefan hippler, theology, Theology

Stefan Hippler

Health warrior from Europe – Antiretrovirals are indispensable – but not a cure

The little guy was just skin and bones when he was brought into the care of HOPE Cape Town. He was just two years old and HIV-positive. His parents had little hope that he’d ever be healthy again. A few months later they were amazed by the effects of antiretroviral therapy. Their mortally ill son had turned into a lively infant who crawled around excitedly, just like any toddler in the world. The parents regained their determination and hope.

On his third birthday we – parents, relatives and I – stood at the boy’s grave. What had happened?

Initially the strong medication had a therapeutic effect on the boy’s system. But then came the night when he suddenly collapsed. The parents had no money to pay for transport, so they carried him on foot. Hours later they arrived at Tygerberg Hospital. Too late. Shortly after they arrived, the child died – and nobody really knows why. The doctors suspect acidosis (too much acid triggering an imbalance in the blood) caused by the drug AZT. That can happen with children, and the reaction requires timely intervention. But the cause of death was to remain the doctors’ best guess; an autopsy would have been much too expensive.

The story of the boy illuminates a neglected feature of the HIV/Aids problem. All the drugs that extend and improve the lives of HIV-positive patients were developed specifically for adults. So far medical scientists have not succeeded in establishing the specific side effects of these medications on infants and toddlers on a long term. Millions of Rands are being spent on research in South Africa to study this phenomenon. The money comes mainly from the United States, and if one wished to be spiteful, one might say that South Africa is like a big research laboratory, with minors as guinea pigs, to determine the effects of medicines on children.

This may be exaggerating matters, but research practices do raise serious ethical questions. At what age should children receive treatment? Is it prudent to expose babies to these heavy-duty drugs? What are the effects of therapy in cases where childcare is inadequate, as often happens in townships for many reasons? There is not a single Church document that deals with such ethical issues. Talk about the great benefits of ARVs is not helpful when there is no effective structure to control their regimen (without which ARV therapy is certain to fail).

And yet most experts invest an unwavering faith in a pharmaceutical solution, always obsessions of modern medicine. They declare war on the virus and send their Aids warriors into battle against the virus. But their weapons – cocktails and condoms –often misfire. Many people see no point or reason in preventative measures. They don’t relate to the Western understanding of hygiene. They take the pills with contaminated water. Then they vomit out the drugs because their undernourished bodies cannot handle them. They take their medications randomly or incorrectly because they live in chaotic conditions. There usually is nobody who can supervise and control the essential discipline. Some patients even sell their medications to make ends meet.

At best, the health warriors can reduce the effects of the pandemic. But they cannot fix the causes of the pandemic – mass poverty, ignorance, and sexual domination. Perhaps one needs to be in Africa to fully understand that here Aids is not a medical but an economic, social and cultural problem. But what alternatives can the health warriors turn to? So they continue to place unconditionally trust in ARVs, as if medical therapy is going to be a miracle cure.

HOPE Cape Town was one of the first organisations in the Western Cape to distribute ARVs – and among the first to warn against their inappropriate use. We did so because the haphazard consumption of Aids drugs can create dangerous viral resistances. When our patients go home to their villages in the Transkei, we are left with piles of medications. But they must take the drugs every day at the same time, for the rest of their lives; if they don’t, drug resistance will end  the therapy.

Even people in the Treatment Action Campaign (TAC), South Africa’s most influential Aids activist organisation, see ARVs as the most effective multi-purpose weapon – as if the disease would be defeated if only all patients were taking them. But not all people who are HIV-positive require ARV treatment. And therapy can succeed only if it is carried out with rigorous discipline. Many areas of South Africa lack the conditions for the rigorous regimen demanded by the therapy. There is a lack of clinics, equipment and qualified personnel. So one should be dubious about populist slogans like “Treatment for All”, which raise the hopes of people without the possibility of these ever being met.

Meanwhile studies show that mortality among ARV patients from disordered environments is higher than among those fortunate to have been born into stable circumstances. This shows that medication alone is not a solution: poverty, deficient infrastructure and social conditions are crucial factors in the success or failure of medical treatment.

In light of all this, we have to deal with the epidemic holistically, with an integrated approach. In this field the Church in particular faces a challenge. The HIV/Aids problem calls on the Church to promote its charism of justice and peace in safeguarding God’s creation. The Church should provide leadership in response to this human catastrophe. We, the Catholic Church with its 1,2 billion followers, are a global player with enormous influence. We have a moral obligation to change the face of the earth and to tackle the issue of HIV/Aids constructively. And this global engagement begins with the youngest victims, such as that helpless little fellow whose distressing story I told at the beginning of this chapter.

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, Aids, bartholomaeus grill, book, cape town, Catholic, catholic church, Church Matters, gott-aids-afrika, hiv, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, moral theology, oekonomia, people living with the virus, pope, sexuality, south africa, stefan hippler, theology, Theology