Organized by the Zygon Center for Religion and Science and the Lutheran School of Theology, this gathering focused their in-depth experience as counselors, physicians, and care providers on the biggest challenges facing the HIV/AIDS epidemic today: denial and fear.
The reluctance—and sometimes outright refusal—to talk about sexuality, sexually transmitted disease, and prevention tactics are the root causes behind the continued proliferation of this deadly disease.
The Rev. Dr. James Echols, President of the Lutheran School of Theology at Chicago, opened the conference with an invitation for all professionals to partner together, regardless of affiliation and religious conviction, and discuss the challenges presented by HIV and AIDS. He emphasized the importance of being able “to contribute to the wholeness of life that all of us seek.”
Twelve years ago, Echols noted, people were still leery of being in the presence of infected persons. While education has increased the comfort level, there is still a stigma attached to the illness. Much of this stems from the prevalence of infected homosexuals when HIV first came to light.In the early years, said Rabbi Joseph Edelheit, professor of religion and director of Jewish studies at St. Cloud State University in Minnesota, HIV and AIDS brought the gay community out of secrecy but put them into the public realm of shame and stigma. Some members of the clergy at that time attributed the illness itself to homosexuality, which they considered a sin.
“It was 25 funerals of gay men who had been alienated by the Jewish community that changed my thinking about doing commitment ceremonies of gays and lesbians,” said Edelheit, pointing out that monogamy—in heterosexual as well as homosexual relationships—is one effective preventive measure.
Infected heterosexuals are often equally stigmatized, as are uninfected care providers. Edelheit attributes this to ignorance and denial, stating that education and an increased level of comfort will help dissipate the guilt, shame, and stigma that are associated with HIV and AIDS.
William A. Johnson, MD, medical director of Luck Care Center and VITAS Innovative Hospice Care and assistant professor in the Department of Internal Medicine at Rush Medical College, provided an overview of HIV from a scientific standpoint. He dispelled myths about the causes of HIV and AIDS and addressed the importance of early testing and diagnosis. HIV tests, explained Johnson, do not detect the virus itself; they detect the body’s antibody response to HIV. Because antibodies may not produce for three to six months after infection, an infected person may not test positive for several months. Johnson noted that, while 90% of cases do test positive within the first three months of exposure, a negative test may offer a false sense of security. “If it’s negative, come back in three months and get another test. And if that’s negative, come back in another three months. That’s what we should be telling people when we counsel them,” he advised.
Some states require testing for prisoners. While Johnson is opposed to mandatory testing, he believes that prisoners should be offered an HIV test and counseled. “You really want to teach about prevention. You really want to teach about the risk, and you want to prevent the spread of HIV.”Arthur Moswin, MD, medical director of Michael Reese and Provident Hospitals, discussed the basics of prevention. Latex condoms, he noted, are 98% effective at preventing the spread of HIV. He added that sexually active teenagers who have received comprehensive sex education are more likely to use condoms than those who have only been taught to abstain. One problem is that teenagers are more concerned about preventing pregnancy than about preventing sexually transmitted diseases. Moswin warned that nonoxynol-9, a spermicide that may help prevent pregnancy, actually decreases a condom’s protection against HIV. “Condoms equal safer sex. Condoms do not equal safe sex,” emphasized Moswin.
While some people have had multiple exposures to the virus and have not become infected, for others a single exposure can change their lives forever. Mario Smith, who tested HIV-positive 15 years ago, spoke about how he contracted the virus during his first sexual encounter. AIDS has rendered him blind, but Smith remains active in the community, including working as music director at his church. “HIV is a part of me,” he said. “So I don’t live with HIV; it lives with me.” Smith and Katherine McCullom, who contracted the virus from her ex-husband, work to educate others about the disease, hoping to help save others from their predicament.
“They don’t realize they help me too,” said Gwen Currin. Currin has volunteered for the past 18 years in AIDS pastoral care, where she met Smith and McCullom. She emphasized that infected persons need compassion, love, and understanding, just like everybody else.
“AIDS is an illness,” stressed Dr. Melvin Gray, professor emeritus of psychiatry at Midwestern University. “It’s not a sin, and it’s not being possessed by the devil. It’s the far right wing that has turned this into a religious issue. It’s not. It’s an illness.”
Still, fear continues to keep people from addressing the issue. “Phobia is an emotional blockage that prevents us from talking,” said Rev. Jeremiah Wright, pastor of Trinity United Church of Christ. Homophobia and belief in traditional healing methods are serious problems in the church, he stated. “We’re talking biology, not theology,” he noted. “It’s pitiful where we are as a church and as a nation when it comes to the subject of AIDS.”
In order to educate church communities about HIV and AIDS, church leaders need to feel comfortable with the topic themselves, and this is often difficult because this is a sexual disease. “The church can’t deal with homosexuality because we can’t deal with sexuality,” said Wright.
“To talk about HIV and AIDS, you have to talk about sex, and in our churches we don’t talk about sexuality,” said Rev. Alberta Ware, Director of Church and Community Mobilization for The Balm in Gilead, Inc. “And don’t dare bring up homosexuality. If the pastor’s position is one of ‘It’s a punishment from God,’ if the pastor is one who has a problem with homosexuality—and most of them do—they are not going to talk about HIV and AIDS. If the pastor is not educated and comfortable, then the congregation is not going to be comfortable.” However, she added, “there is no one best approach, because there is no one general church.”
Bethsheba Johnson would agree that education is critical in the fight against this disease. A nurse practitioner and winner of a 2002 AIDS Legal Council Award, Johnson is a member of the clinical faculty at the Midwest AIDS Training and Education Center. She spoke to the audience about the global and community impact of HIV, stating that over 39 million people were living with the virus at the end of 2004. The greatest numbers come from sub-Saharan Africa, where an estimated 25 million people are living with HIV and AIDS. Echols noted, “It has been estimated that a whole generation will be lost as a result of this disease.”
“We will have no elders,” Johnson underscored. “Who’s going to teach the people? That’s a problem.” In Africa, she pointed out, HIV is transmitted primarily through heterosexual intercourse. The actual barriers to healthcare, according to Johnson, are the lack of infrastructure and the lack of funding to purchase medications and laboratory tests. These are also problems in China, India, and other parts of Asia.
“Tuberculosis is a big problem [in] developing countries,” she added. “In South Africa, about 70% of people who are HIV-infected have tuberculosis.” While groups such as the World Health Organization, the Clinton Foundation, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are working to improve healthcare in developing countries, Johnson stated that the U.S. is “not doing a very good job” relative to financial expectations.
Back home in the U.S., Johnson noted that African Americans have the highest rates of HIV infection. While African Americans compose 12%-13% of the overall U.S. population, she said, they make up half of newly infected men and 72% of newly infected women. She added that rates among college students are increasing, as is risky behavior in already-infected populations, which has led to further spread of other sexually transmitted diseases and different strains of HIV.
In the first several years of the virus, only four antiretroviral medications were available to patients. Since 1995, however, 19 new products have emerged. Moswin provided an overview of different treatment options and gave a list of combination therapies that should be avoided. “This is sort of like the Ten Commandments,” he joked. If using some of these combinations, he added, “thou wilt get lawsuits.” Adherence, he emphasized, is the most important factor of drug treatment. “In order to succeed, patients must take 95% of doses. Less than this, and the virus is resistant.”
Overall, the workshop offered religious professionals a deeper understanding of the medical aspects of HIV and AIDS. Medical professionals learned how to build upon and utilize their patients’ spiritual strengths. Rev. Ware commented, “This disease takes more than nine-to-five work.” And a partnership between these two groups of caregivers might be the essential link in the battle against HIV and AIDS.
A committee representing both religious and medical professions organized the workshop. The committee was made up of Michelle Agnoli, RN (training specialist, Midwest AIDS Training and Education Center and University of Illinois at Chicago); Dr. Melvin Gray (professor emeritus of psychiatry at Midwestern University); Rev. Dr. Antje Jackelén (director, Zygon Center for Religion and Science and professor of systematic theology, Lutheran School of Theology at Chicago); James Moore, PhD (professor of theology, Valparaiso University); Norma Rolfsen, RN (Program director/family nurse practitioner, HIV Care Program, Research and Education Foundation of the Michael Reese Medical Staff); and Rev. Michael Sykes (Pastoral care coordinator, Michael Reese Hospital; associate pastor, Trinity United Church of Christ).
Organizers hope to make this workshop an annual event. As Rabbi Edelheit stated, “I hope we can have another one of these, because it is only at the end of the day that the conversation can begin.”
Michelle Agnoli, RN
Training specialist, Midwest AIDS Training and Educational Center (MATEC) and University of Illinois at Chicago
Pastoral care volunteer who has worked with AIDS pastoral care for many years
Rev. Dr. James Echols
President, Lutheran School of Theology at Chicago
Rabbi Joseph Edelheit
Professor of religion and director of Jewish studies, St. Cloud State University (Minnesota); former member of the President’s Advisory Committee on HIV/AIDS under President Clinton
Rev. Dr. Antje Jackelén
Associate professor of systematic theology and religion and science, Lutheran School of Theology at Chicago; director of the Zygon Center for Religion and Science
Bethseba Johnson, APN
Nurse practioner, Southside Health Association (Luck Care Center; clinical faculty, Midwest AIDS Training and Education Center
William Johnson, MD
Medical director, Chicagoland Central program for VITAS Innovative Hospice Care; medical director, internal medicine private practice, Johnson Healthcare Providers, Ltd.; medical director, HIV/AIDS clinic, Luck Care Center; and assistant professor, Department of Internal Medicine, Rush Medical College
James Moore, PhD
Professor of theology, Valparaiso University (Indiana);
Norma Rolfsen, RN
Program director/family nurse practioner, HIV Care Program, Research and Education Foundation of the Michael Reese Medical Staff (Chicago)
Arthur Moswin, MD
Rev. Michael Sykes
Pastoral care coordinator, Michael Reese Hospital; associate pastor, Trinity United Church of Christ
Rev. Jeremiah Wright
Pastor, Trinity United Church of Christ