Missionary Stan Young (not his real name) would later describe it as having been handed a death sentence. He had been feeling fine, pretty much recovered from his bout with hepatitis B, when his stateside doctor suggested his blood be tested for the human immunodeficiency virus (HIV)—the AIDS virus. If, the doctor reasoned, Stan had contracted hepatitis B through unsterilized dental equipment, he might have picked up AIDS as well. The disease is epidemic in the African city where Stan and his wife are stationed.
Seated in the doctor’s office days later, Stan was informed he had tested positive for the AIDS virus. Following the shock and devastation came the questions. Would he contract the disease? Should he go back to Africa? Whom should he tell? What would people think?
Hundreds Infected?
At least six missionaries registered with the Johns Hopkins School of Public Health have faced the same dilemma, though AIDS is hardly epidemic in the missions community. Nevertheless, mission agencies are realizing they must develop policies to protect their missionaries and to deal with those who become infected.
The doctor who serves as a medical consultant for Stan’s mission believes hundreds of missionaries may be infected with the virus. Speaking privately because of Stan’s desire for anonymity, the physician admitted that in the absence of medical studies, no one knows for sure how many missionaries carry the AIDS virus.
However, he plans to ask other missionaries when they return on furlough about medical and dental work performed on them overseas. He wonders whether all missionaries should be tested when they return on furlough.
Missionaries most at risk, says another missionary physician, are medical personnel involved in surgery, obstetrics, renal dialysis, dentistry, and laboratory technology. Epidemiologist David Sorley, who has served for nearly 12 years in Africa, says these are the people who must count the cost of serving Christ in areas where the disease is prevalent.
Prevention For Missionaries
Missionaries on regular assignments are at a relatively low risk for contracting AIDS. However, hospitals in most of the developing world still cannot afford equipment for HIV testing of donated blood. Disposable needles, common in the Western world, are unknown in much of the Third World; and reusable needles may not be properly sterilized. In some areas, therefore, missionaries who receive blood transfusions or injections may be at risk.
However, those who travel and work in even the worst-affected areas can do much to lower their risk of infection. Last fall, World Vision produced and distributed an educational manual to field and support offices in more than 50 countries. The organization asked field offices to appoint committees to educate staff as well as other volunteers who work with them on projects. The field office is also to make sure staff members and their families have access to safe injections and a pure blood supply. In many countries this is no easy task.
One much-discussed option in areas where HIV blood testing is unavailable is the “walking blood bank,” a pool of healthy blood donors who could be counted on to give blood in emergencies. The concept is not without its dangers. “Just because a person is a missionary doesn’t mean they don’t have the virus,” warns Dr. Rufino L. Macagba, Jr., manager of World Vision’s International Health Program. “It is a delicate issue, because people would have to be tested regularly in order to ensure a pure supply of blood.”
The “walking blood bank” also presents a moral dilemma to mission agencies. The practice may rekindle the notion of elitism among missionaries. Should you exclude local Christians from the program? asks one mission leader. Yet, as the number of people in the group expands, the danger of infiltration by the AIDS virus multiplies.
Other precautions are more straightforward. Some mission agencies ask staff who travel to carry kits including sterile disposable needles and syringes, and heavy-duty rubber gloves for use in assisting accident victims who have suffered cuts. They tell them not to accept untested blood or blood products unless their life is in danger. “If only one bottle is needed, it probably isn’t needed at all,” says Macagba.
Thorny Issues
Prevention issues may be the easy ones for mission agencies. The really thorny concerns have to do with identifying and handling missionaries who test positive for AIDS. Some agencies are considering mandatory testing of all personnel. Others object to testing on moral grounds or because of the high cost of the tests.
Once a missionary tests positive for AIDS, a whole new set of concerns arises. Confidentiality is a key issue. On one side are those who believe an individual’s right to privacy supersedes even the sending agency’s need to know. At the opposite pole are those who advocate informing everyone who relates in any way to the affected missionary.
To agencies with missionaries who are already affected, this is not an academic question. “We would like to askour missionary to be as open as possible,” says one mission official. “We think it is best to be public about this. But if the missionary doesn’t want it known, what should we do?”
Most mission agencies do not yet have policies on AIDS. A draft document prepared at the conclusion of a conference on AIDS sponsored last fall by MAP International outlines the issues and offers some guidelines to agencies. Dr. Richard Crespo, director of health training for MAP International, organized the conference, euphemistically entitled, “Contemporary Issues in Medical Missions.” The title was deliberately innocuous. The year before, when the conference was first planned, sentiment in the American evangelical missions community was solidly against even discussing the disease.
“The scene has changed dramatically over the last 12 months,” says Crespo. “Now mission agencies are talking about these issues quite openly. There is hardly any negative reaction.”
Most mission agencies still do not incorporate AIDS information and education in candidate-orientation programs. Crespo believes agencies must inform new missionaries about the prevalence of the disease in the areas where they will be stationed. They should know how to prevent infection and what to do if they become infected.
So far, mission agencies report no perceptible decrease in the number of missionary recruits for areas known to be rife with AIDS. Career-missionary recruitment continues at pre-Ams levels. However, some short-term workers have withdrawn their applications after hearing about the prevalence of the disease in the areas they were scheduled to visit.
Most observers believe more missionaries will become infected with the AIDS virus. Testing positive for AIDS is not, however, as Stan first feared, a death sentence. The latest report by the U.S. National Academy of Sciences concludes that between 25 and 50 percent of those who test positive actually contract the disease within five years. It is possible he will never develop the disease.
In spite of the AIDS threat, no one is suggesting missionaries should withdraw from a sick and helpless population. “I am pleased by the pro-active stance of many mission agencies,” says Crespo. “This is a tremendous opportunity for mission agencies to minister to people in need. Christians who are brave enough to reach out and touch these needy people with a word of hope and spiritual renewal are a powerful witness to Christ.”
By Sharon E. Mumper.
