The National Strategic Plan for HIV from the years of 2017-2022 is aiming to reduce new HIV infections, improve care, treatment, and support for those with HIV/AIDS (UNAIDS, 2006). With a goal such as this, it is important to first understand the situation and approach it in the angles that are affecting the health issue. Religion, religious beliefs, and affiliation to a religious organization are factors that have profound impacts in society and play a major role in the spread of HIV, especially in a country like South Africa. When questioning the role religion plays in HIV/AIDS within the context of South Africa, it is crucial to recognize the major impacts it plays in society, and how it affects the social, economic, political, and cultural factors that affect the HIV/AIDS epidemic (Koeing, 2012).
As we investigate this topic, it is important to first clarify terms that will be used and their definitions in relation to this paper. Religion will be defined as an entity constructed by beliefs, religious officials, objects and places, morals and values, and practices (Beyers, 2010). HIV/AIDS-related stigma will be defined as the branding or labeling of an individual or a group of individuals as not worthy of inclusion in a community or the process of devaluation as a result of their association or living with HIV/AIDS (UNAIDS, 2003). Discrimination will be defined as enacted stigma or the negative actions from the stigma that aim to devalue the individual or group (Nyblade and MacQuarrie, 2006).
The fight against HIV/AIDS has been argued to be slowed and enhanced by religion. This has been a result of perceptions on sex, sexuality, condom-use, spiritual counseling, stigmatization, discrimination, and stereotyping, and the approach or lack thereof to sex education. The global fight against HIV/AIDS has experienced an interesting twist with accusations that the faith community instead of helping, has worsened the issue, contributing to the spread of the virus rather than the prevention if it (Speicher & Wilson, 2007). With this in mind, I would like to answer the questions: How does the role of Christianity shape the HIV/AIDS epidemic in South Africa?
Biblical view: Christian churches are seen to be limited in their approach which can be more pragmatic in the preventing the spread of HIV. The role of the church in controlling the epidemic and more importantly, preventing the spread of HIV, has been fraught with much controversy. There have been many pushbacks from individuals, groups, and organizations to and from Christian communities with the approach that the church is taking. In the Christian faith, there is a notion that the onset of HIV is due to a sinful action. However, with the different ways HIV/AIDS can be transmitted, not all transmission would be considered a sin. This has caused the church to be seen as insensitive to the needs of people. Many people claim that the church is not helping the people it is supposed to serve (Muula, 2010). Bible verses that support this notion of serving are numerous, two of which are “But if anyone does not provide for his relatives, and especially for members of his household, he has denied the faith and is worse than an unbeliever” in (1 Timothy 5:8, English Standard Version) and “But if anyone has the world’s goods and sees his brother in need, yet closes his heart against him, how does God’s love abide in him?” in (1 John 3:17, English Standard Version).
The biblical text followed by Christian denominations is often used in both sides of arguments. To understand the viewpoints of Christianity, I think it is important to note where their views are coming from rather than assuming that such a view is being acted upon. According to C. S. Lewis, the biblical purpose of sex is for reproduction. However, he makes sure to keep in mind that “the centre of Christian morality is not here. If anyone thinks that Christians regard unchastity as the supreme vice, he is quite wrong. The sins of the flesh are bad, but they are the least bad of all sins. All the worst pleasures are purely spiritual.” When Christians approach the HIV/AIDS epidemic, Lewis shares that because not everyone are Christians, they cannot be expected to live Christian lives that adhere to Christian morals and views (1952).
The HIV/AIDS epidemic is largest in South Africa with 19% of those living with HIV residing in South Africa. To add, key populations that are most affected are sex workers with a prevalence of the virus at 57.7% and gay men and men engaged in sex with men at a prevalence of 26.8% (UNAIDS, 2016). This is different from the statistics of the continent of Africa as the common mode of HIV spread is through heterosexual intercourse (Muula, 2010). Due to the population that is most affected by HIV, stigma is often associated in South Africa with those living with HIV/AIDS.
According to the International Religious Freedom Report, there were more than 4,000 African Independent Churches alone of which more than ten million people were members (U.S. Department of State, 2006). These African Independent Churches were typically Zionist or Apostolic churches and attracted people living in both rural and urban areas. In 2016, 15% of South Africa’s population considered themselves not affiliated with any formal religious organizations. However, in 2016, we find this percentage to have decreased with 11% considering themselves without a religious affiliation (Lehohla, 2016). This shows that religious institutes have a hallmark in the lives of many South Africans. With its large presence in society, it is important to understand religions and the ways in which they affect and shape individuals, society, their beliefs, and how this influences their health and views of it. However, we are presented with many challenges due to the complexity of religions and their influence on sexual behavior at an individual and societal level.
South Africa presents a dynamic mix of religions as all major world religions are represented in the Rainbow Nation. This includes Judaism, Islam, Hinduism, Christianity, and Buddhism. Christianity, however, is predominant, with 78% of South Africa’s population identifying under Christianity (Lehohla, 2016). In 2001, of the individuals that considered themselves followers of the Christian religion, 41% were Mainline Christians. These denominations consisted of the reformed churches, Anglicans, Methodists, Presbyterian, Lutheran, Roman Catholic, Orthodox, and the United Congregational Church of South Africa. The second most popular Christian denomination was African Independent.
Condom-use: With 78% of South Africa’s population related to the Christian faith and beliefs, it is important to understand to what extent Christianity played a role in South Africa and how Christianity has influenced the HIV/AIDS epidemic. One large argument to the Christian approach is their view on condom usage or lack thereof. It is said that condom use is a public health issue and not a spiritual issue. However, to claim that HIV is solely a medical issue without taking into account contextual factors such as religion, culture, economy, and the sociopolitical factors would be naïve. Condoms are an important tool when preventing the spread of disease making them a vital part of HIV prevention. There as a decline n HIV incidence from 2000 to 2008 in 15-29-year-olds by 27% in the STI-HIV model. The most significant factor that was found to be correlated was the increase in condom usage. Even more profound, the ASSA2003 model indicated a 31% decrease in incidence rates among that age group (Johnson et al, 2012). However, the issue of condom use can be found heavily in religion.
The mode of prevention implemented in South Africa is the ABC approach: sexual abstinence, be faithful, and consistently and correctly use a condom (Muula, 2010). This comes from the knowledge that multiple and concurrent partnerships help increase the spread of HIV in Africa. The Catholic church opposes condoms due to the church’s view on the sanctity of life and a condom’s contraceptive effect. Pope Benedict XVI stated that condoms could worsen the transmission of disease (Benagiano et al., 2011). However, the Catholic church does allow for condoms to be used within marriage if one person has HIV. This viewpoint comes from the idea that protection will preserve the partner’s life.
Sex education: The church has suggested committing to the following: providing education in which there will be information of prevention of HIV, fighting against the use of drugs as well as the sale and spread of drugs, supporting sex education in which teaches include sexuality to be between a man and women within a marital agreement, and promoting biblical concepts of sexual intimacy. This would include promiscuous activity and other sexual activities that would increase the risk of HIV transmissions such as multiple sexual partners and unprotected sex (Muula, 2010). It is important to note the language that the church uses when describing certain actions as negative connotations have been placed with many vocabularies in this area of discourse due to the Christian moral standpoint. These words include promiscuity and adultery. When having a dialogue with fellow members of St. Stephens Bible Church in Claremont, Cape Town, the youth leader, Jarrett, stated that people have become number to HIV education because of its receptiveness in schools and organizations. He found the differing situations to condom usage interesting but did not mention his personal view. However, located in the handout for a Sunday morning service was a meeting to discuss sex. St. Stephen’s Bible Church is part of the Reformed Evangelical Anglican Church of South Africa (REACH-SA). REACH-SA has congregations in various locations of South Africa and is involved in social projects such as caring for AIDS patients.
Sexual education is found to best work when tailored to societal ways. According to “AIDS Africa,” there are two approaches that societies typically take. The first approach involves equipping individuals at a young age before sexual interaction with knowledge, materials for more pleasurable sex, and moral standards. The second approach involves creating taboos related to sexual relationships outside of marriage and using culture and religion to enforce these ideas. This can play out by following Christianity’s view of sex within monogamous marriages. Research has found that both approaches work in keeping HIV incidence low but only in certain societies. For example, the first approach works well in the Netherlands while the second approach in Muslim countries. The second approach will not work well in societies where there is much sexual freedom. Sex education with a focus on HIV/AIDS/STIs, and reproductive health, when combined with life skills development, has been found to delay sexual activity and encourage healthier sexual behavior (Jackson, 2002). Jackson suggests that faith-based organizations implement sex education but when doing so, maintain strict sexual ethics.
Stigmatization: One large issue with the approach churches have on HIV/AIDS is the stigmatization and stereotyping that is often associated with those found positive with the virus. Because HIV is a sexually transmitted disease, this does create gray lines as to how religious institutions should approach the complex issue. Laager mentalities among church members may be taken where barriers, both psychological and physical, are formed to separate those with the virus from those without the virus. This mentality that HIV-positive individuals were either sinful or unbelievers is suggested after results of a survey involving 1,352 South Africans indicated that more than one third of surveyors were found to believe that individuals not following a religion were more likely to get HIV than those affiliated with a religion. Almost one fifth of surveyors indicated that they believed AIDS was a punishment from God (Van Dyk, 2010). This mindset can be understood by looking at the Zephaniah 1:17 when it says “I will bring distress on mankind so that they will walk like the blind because they have sinned against the Lord. And their blood will be poured out like dust” (English Standard Version). However, many Bible interpretations involve more than just finding a text that suits a specific idea. Those that were found to believe this had a lower educational status and came from rural areas of South Africa. This mindset suggests that individuals are taking on the God role by placing meaning to suffering. The survey strongly indicates that within a religious circle, many people continue to stereotype people with HIV/AIDS. Therefore, religious groups and institutions should actively fight against stereotyping people living with HIV/AIDS.
Counseling: When dealing with HIV/AIDS counseling form a religious approach, it is vital to understand the viewpoint of the individual by the spiritual counselor. Because a large majority of South Africans adhere to a traditional African religion, often mixed with aspects of Christianity, it is important to understand their beliefs. Some denominations of Christianity is a syncretism of traditional African religions, and this has to be taken into account. For example, in traditional African religion, a disease is often linked to not just natural agents but witchcraft or ancestral actions. When a disease is found linked to a natural agent, it is seen that there is a deeper connection present and there is a search for what is seen to have really caused the disease. For example, this could be a person that has sent the disease. As so, it is important to understand traditional beliefs in spiritual perspectives when working with individuals who have contracted HIV. It is difficult to persuade an individual to change their belief about sickness and suffering as it would involve changing the individual’s worldview. This is perceived as insensitive and supports the notion of working within an individual’s spiritual framework as opposed to challenging it (Jackson, 2002).
Statistics: A survey involving 1,352 South Africans from a variety of ethnic groups representing 16 different religious institutions helps us understand more of the positionality of South Africa’s people as it relates to HIV/AIDS. From this survey, 1/3 of participants were unwilling to seek help from their religious leaders if they were found to be HIV positive. Those who were more active in their religious affiliations were individuals most likely to seek spiritual counseling (Van Dyk, 2010). 21% of participants would not have sought their religious leaders for help stated their reasoning to be their shame. This suggests that stigma within the church body about HIV positive people is still present and that in order to properly care for members, religious leaders should learn to be more approachable and not present negative views that hinder people from seeking help. 19.7% of participants believed that their pastor or priest would not have been able to assist them if they were to seek their assistance. However, more than half of surveyors, of which were more actively involved in their religious affiliation, considered religious institutions to be doing their best to assist HIV-positive people. About 1/5 of participants stated that religious institutions were not doing an adequate job fighting the epidemic. This belief is raised from views of how abstinence should not be the only message preached and how prayer seems to be all that the church does to help. (Van Dyk, 2010).
Religion will continue playing an important role in health. With the church’s large community reach in South Africa, especially that of the Christian faith, it is important to address the issues of HIV/AIDS from many angles and investigating what areas religious institutions can improve upon – eliminating stigmatization and discrimination, hosting sex education talks, engaging in prevention and education programs, and creating a more compassionate congregation that cares for the needs of HIV-positive individuals in addition to their spiritual needs. The HIV/AIDS epidemic should be fought from all fronts and this means that religious institutions will have to recognize their weaknesses and make intentional actions that marry their moral beliefs with what researchers have found statistically about HIV/AIDS.
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