God, AIDS, Africa & HOPE

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

Stefan Hippler

Unstained by real life  –  Why good intentions often fail in the face of African realities

We are celebrating Mass at Kolbe House, the University of Cape Town’s Catholic chaplaincy. This Sunday we Catholics recall Mary’s Immaculate Conception. It is a real challenge to explain this theme to students. A stainless conception – how is that supposed to work? What is that priest talking about? Related questions come up during a small workshop after the Mass. Of all days, it is on the feast day of the Virgin Mary that we are scheduled to discuss HIV/Aids and sexuality. I notice a poster on the wall. The poster, which bears the logo of the Southern African Catholic Bishops’ Conference (SACBC), was developed in cooperation with the Association of Catholic Tertiary Students. Beneath the image of a black cross with a red Aids ribbon is the slogan, “ABCD Lifestyle campaign: Catholic youth responds to Christ’s call”.

The acronym is an allusion to the ABC strategy which is being used around the world to promote HIV/Aids prevention, but which is also controversial because it neglects women and girls. As explained earlier, it stands for “abstain”, “be faithful”, and “condomise”. The students’ association’s approach to the first two points is identical, but it takes the opposite direction on the third recommendation and adds a fourth one. On the poster, C stands for “Change your lifestyle”, and D issues a warning: “Danger of not living your life to the fullest”.

So the students are called to chastity, asked to resist not just the enticements of Eros but also a series of other temptations. The content of that series of temptations takes me by surprise: crime, corruption, drug use, pollution and vandalism. I’m puzzled as to how sexuality and criminality can be linked in one breath. Even the reference to fidelity leaves a strange taste in the mouth. The young person is being challenged to be faithful to their bodies, families, friends and parish, but concepts such as girlfriends or boyfriends, life partners, wife or husband are not mentioned. And then C and D: change your lifestyle or you’ll risk not being able to live your life “to the fullest”, in line with the Gospel of St John (10:10). Because one might be a criminal. Or a drug addict. Or a litter bug. Or because you could be infected with HIV.

That is quite something from a Catholic organisation. How exactly do we know that a person with HIV cannot live her life “to the fullest”? Isn’t that a rather audacious presumption which contradicts our faith that for God nothing is impossible?

So we go through the poster, point by point, and I ask the students for their comments. Most of them contemplate the content of the poster for the very first time. They respond, hesitantly and cautiously – they are not used to discussing such things with a priest. He might be very nice, but he is still a representative of the institutional Church. Gradually the unease lifts, and it turns out that nobody here likes the link between sexuality and crime. And they are all reflecting on why a person with HIV should not be able to live a full life. Because they die so quickly, says a student. And because they can’t have children, adds another. Conclusion: the Church tries to give guidance but causes confusion.

I take this bizarre poster to the next meeting of the archdiocese of Cape Town’s Catholic Aids Network, and vent my anger. That sparks an exciting debate. What should all the children born with HIV think of being placed on the same level as criminal offenders? What are they supposed to think of being prophesied an unsatisfying life because they cannot live it “to the fullest”? Our meeting spontaneously resolves to write two letters. The first will be addressed to Cardinal Wilfrid Napier, at the time the bishop conference’s president. We want to know from him whether the content of the ABCD poster was ever collegial passed in line with the conference’s principle of consensus – after all, it bears the SACBC logo. The second letter will be sent to the priest who is responsible for the students’ association’s poster, asking him to clarify the meaning and purpose of this campaign.

It takes weeks before we receive a reply. The first comes from the cardinal. He explains that he is not responsible for the poster and never actually saw it in detail. Just how the SACBC logo found its way on to the poster will remain a mystery. Cardinal Napier suggests that we ask the originators directly. But that turns out to be not that simple. The priest at first doesn’t respond. When, after further approaches, he does, his answers are as vague as we had feared. Nobody is really accountable for it, we learn. And what these posters communicate to people with HIV, well, nobody really thought about it. Should I be angry? Or should I console myself with the idea that sometimes such things are just “typically Catholic”?

But considering that most Aids education campaigns fail or are misdirected, just how are we going to reach the youth? What can we do to stifle the rate of new infections? What kind of strategy is the Catholic Church in South Africa developing for the next five years? First we cared for Aids orphans. Then we opened clinics and hospices. Now we are concentrating on the distribution of medicines. But what are we going to do next? We haven’t arrived at a satisfactory answer yet.

But let’s look at that poster again. It recommends that black students should develop their conscience and live their culture. But we haven’t even started to understand African culture, and often know nothing about it. I’ll try to demonstrate this with three examples.

Among traditional Xhosas, one of the dominant nations in South Africa, it is quite common that a man will take four wives. So if he “lives his culture”, he breaches the Christian requirement for monogamy. But his aim is to produce many descendants, because not only does that ensure the survival of his clan, but also that he will be cared for in old age. I began to understand that principle through the experiences of an employee of HOPE Cape Town. She was about to become the second wife of a man, and was already pregnant with his child. But her future husband died shortly before the wedding. When I asked how her family was coping with these circumstances, her answer astonished me. The most important thing, she said, is that he now has a descendant. Her parents had already been concerned that at her advanced age she had still been without child.

The second example concerns sexuality. Those who live their African culture categorically don’t speak about it, and even less so about Aids. Even Nelson Mandela, the brave freedom fighter and South Africa’s first black president, would refer to it only marginally. Once, after his retirement, he pointed out that for men of his standing, brought up according to traditional values, speaking about sexuality isn’t easy. For a true African it is non-negotiable that body fluids will have to be emitted during sexual intercourse, and the use of a condom would preclude that. And many African cultures maintain the custom of dry sex. Men don’t want the woman’s vagina to be moist during intercourse because that supposedly enhances the experience. But it also significantly increases the risk of HIV infection.

The third example concerns illness and healing. A complex universe of gods, ghosts and ancestors still form the mind of many Africans. The ancestors exercise a strong influence on daily life – they protect or curse and reward or punish their descendants. And because every illness is a sign or call from an ancestor, the living individual is not responsible for it. The healing is the sangoma’s job. The traditional healer has the secret wisdom and knows the rituals to beat the sickness. His patients will consider themselves healed as soon as the symptoms of the ailment disappear. In terms of the asymptomatic phase of HIV, during which the immediate effects of the infection soon disappear, this philosophy can have fatal consequences.

One could raise more examples. I mentioned just three to demonstrate that the advice to live one’s African culture is just thoughtless. And that’s how many suggestions on the ABCD poster seem: thoughtless. Unstained by reality. But reality demands that we face different challenges if we want to fight the virus effectively. The African relationship to sexuality, to gender roles, to death, to traditions must be modified; African men must change. Africa needs a mental revolution.  And the church must learn, that universal and unique moral teaching might mean trouble for specific regions.

The Poster: ABCD

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