A school without a teacher. A home with no parents. Thousands of communities in Africa, Asia, and other developing areas of the world face this outcome from the greatest development, socioeconomic, and health crisis in history: AIDS.Millions are infected with HIV, the virus that causes AIDS--roughly 50 million according to Dr. Gro Brundtland, Director-General of the World Health Organization. Hundreds of millions more are at risk for the virus itself and billions for the effects of AIDS on the family and society. Grim projections into the next 10 years of the number of AIDS orphans spawned by the AIDS crisis reach 44 million. AIDS is the number one killer in Africa and number four in the rest of the world.Gathered at the XIII International AIDS Conference in Durban, South Africa, more than 12,000 of the world's leading scientists, health care and social workers, government and community leaders ask themselves, "What more can we do?" Many begin plenary sessions and workshops stating, "I said this already eight years ago … "Despite the rally cry of the conference, "Break the Silence" (referring to the lingering stigma and inaction surrounding AIDS), the mood is somber. Little satisfies the thirst for a cure or easily administered and cheap treatment. Prevention remains the critical component to control of the epidemic.
Science breaks Silence
Bits of hope spring from the fact that in the developed world, AIDS may now be treated as a chronic disease among people and nations that can afford treatment and keep to a tight drug regimen. Drug combinations completely reduce detection of the virus in the body. But we know the virus does not disappear entirely. It merely hides and is able to change it's configuration to avoid detection by drugs. As soon as medications are stopped due to toxicity, expense, or poor compliance, the virus bares an ugly presence again. Some are exploring an alternative approach of a cyclic protocol, intentionally interrupting drug treatment for a season to make the drugs more tolerable and less expensive. Results are promising, not leading to compromise in improving the health of HIV-positive persons. This will surely be under consideration as possible approaches for developing countries.Research for an AIDS vaccine continues for prevention, for protection of a sexual partner, or for prolonging life. Much work needs to be done before results of clinical trials of vaccines presently under study in Africa, North America and Asia are available. It will be years before a vaccine is feasible, but the drive to produce what will likely be a variety of vaccines relating to the different genetic types of the virus is firmly on the global agenda. Even when a vaccine is available however, most of the world will not have easy access. A cacophony of voices at this conference demanded that vaccines be available to all nations at an affordable cost. Yet vaccine compliance even for childhood immunizations for polio or tetanus is a challenge in many developing countries, sometimes for something as simple as lack of refrigeration.The study and treatment of new drugs to prevent the spread of HIV to infants born to HIV positive mothers was clearly one of the most significant highlights of the conference. This option is already feasible for many mothers and infants in the developed world. While affordability (about $4 per HIV-infected mother) is no longer the barrier to preventing mother to child transmission of HIV as it once was. Still it is out of reach for most mothers in the hardest hit countries where per capita health spending for some is less than $5 a year. The drugs are not available in most countries, let alone in remote rural clinics. A devastating complication rises from the fact that HIV may be passed from an HIV positive mother to child through breast milk. Withholding breast milk from infants in Africa may well bring death sooner than AIDS.
Behavior Breaks Silence
For some imminent leaders in the world of HIV/AIDS research and treatment, breaking the silence through behavior change is elusive after two decades of fizzled hope to curtail the crisis.But behavior not biology is what this epidemic is about. We would have no AIDS today if yesterday we lived as God has always intended us to live. But none of us do. AIDS is about relationships with God, between husband and wife, between young people, within the community of Christ's church, within the community outside the church. We all must admit failure. Our sin is the silence that screams in our soul of a lost love with God and faithfulness to His law. That law commands us to love God and to love others before ourselves and to act on that love. That law releases life, rather than binds us to lust.A radio message developed in Kinyarwanda by the World Relief Rwanda AIDS team expresses our vulnerability and Christ's ability to change behavior. Uwifashe ashobora kwirekura. Ariko ufashwe na Yesu aramukomeza! The general translation is, "The one who holds himself or herself by trying to be abstinent or faithful to their spouse on their own may fail. But the one held by Christ is firmly held."It is not only sexual behavior that must change to make a global difference in this crisis. Behavior that insulates rather than activates is just as deadly. Nelson Mandela in his closing speech at the conference stated, "Action is required. Every day inaction costs thousands of lives." He spoke from a platform of deep concern for one out of every two youth in South Africa who will die of AIDS and where 200 babies are born with HIV every day. "Let us not equivocate," he continued, "a tragedy of unprecedented proportions is unfolding in Africa. AIDS today in Africa is claiming more lives than the sum total of all wars, famines and floods, and the ravages of such deadly disease as malaria. It is devastating families and communities; overwhelming and depleting health care services; and robbing schools of both students and teachers."The Scriptures speak of the death silence brings. "Speak and act as those who are going to be judged by the law that gives freedom because judgment without mercy will be shown to anyone who has not been merciful" (James 2:12). The Pharisees were convicted of their judgment when confronted by the Savior as they sought to kill the adulterous woman. But what compassion could those religious leaders have shown? How might they have helped the woman, not just condemned her?The church in Africa as well as North America wrestles with these same temptations. It is easier to preach than practice compassion. Rev. Gideon Byamugisha, an Anglican pastor living with AIDS in Uganda states, "Another uniqueness that the church brings to the AIDS problem is the role it can play in addressing discrimination against people with AIDS and the stigma attached to those with AIDS. When church leaders accept one with AIDS among themselves, they set a powerful example for their parishioners. The actions of the church leaders often carry more influence than leaders outside the church can in a community." Rev. Byamugisha himself sets the example as he leads a comprehensive care and counseling program for families affected by AIDS operating from his own church.World Relief discovered a disturbing reality in Rwanda that care for those with AIDS is often not provided in hospitals or even by healthy adult family members, but by children and grandparents. A unique step-by-step home care manual was published for caregivers as young as 10 years. The manual will not mildew on mud floors because the demand for home care is overwhelming and the resources for meeting that need outside the home are nonexistent nearly everywhere. The church must act in this vacuum and be there to train family members in simple home care, enveloping homes with Christ's love.Care has been an issue that has gained momentum at this conference. While much of the breaking news was around vaccine research, many have realized in this course of this week that even if a vaccine were discovered today, there are still 38.5 million who are already HIV positive for whom a vaccine is too late. Many came to terms with the fact that AIDS is going to be a long-term crisis. And that providing compassionate care for the sick and dying and the orphans left behind is going to be a monumental task.But unlike vaccine and drug research and even prevention messages, care is often an unpleasant task. Ministering to the sick and dying is taxing in the best of situations, but in the midst of poverty and non-existent health care, it is often dirty and foul smelling. This reality has not stopped the church in the past to fill this role and we are seeing as more churches get excited about an AIDS ministry that it will not stop them today.Nelson Mandela ended his speech with this statement: " I have been asked on many occasions which of the states of the world has the greatest leader. My heros are not necessarily men and women with title, but humble men and women that you find in all communities. It is (these) men and women you find in all communities who have chosen to fight the greatest challenges. Socioeconomic issues like poverty, education, disease, literacy. Those are my heroes. If any head of state is like this he is my hero."Mandela's statement once again points to the great opportunity the church has to ministry the love of Jesus Christ in a hurting world.
Breaking Silence Barriers
Silence all too often surrounds sexuality and discussion with our youth, our spouses, and in our counseling sessions before marriage. It is contrary to our church traditions to speak of sex, despite the fact that an entire book in the Scriptures speak beautifully and boldly of God's design for sex. Breaking this silence in biblically and culturally sensitive ways remain one of our biggest challenges. It can be done. MAP International found church leaders from indigenous churches in Kenya, some of whom have several wives, able to mark a movement toward monogamy and open discussion of sexual issues with young people when confronted with the reality of AIDS.
The Final Word
The conference climaxed with a ballet of swirling dancers to the music of Handel's Messiah, "And He must purify." The words were barely audible, but the truth cannot be silenced. As God purifies our hearts, our actions, and our inactions, our homes and lands will find healing.
Debbie Dortzbach is World Relief's HIV/AIDS program specialist.
Christianity Today interviewed Dortzbach on AIDS in Africa a few months ago. The article, 'Sexual Revolution' Speeds Spread of HIV Among Africans, appeared on ChristianityToday.com February 4, 2000See more on Debbie Dortzbach at the Wheaton College Archives and ReligionToday.Our earlier coverage of the AIDS crisis includes:'Have We Become Too Busy With Death?' | As 4,900 people die each day from AIDS, African Christians are faced with the question. (Feb. 4, 2000) Books & Culture Corner: An Open Letter to the U. S. Black Religious, Intellectual, and Political Leadership Regarding AIDS and the Sexual Holocaust in Africa (Jan. 24, 2000) Africa: Fidelity Urged to Fight AIDS (July 12, 1999) I Am the Father of an AIDS Orphan (Nov. 17, 1997)Yahoo!'s full coverage area on the Africa AIDS epidemic (separate from its full coverage areas of AIDS research, and AIDS/HIV news) includes links to daily news stories, resourceful Web sites, editorial and opinion pieces published in the mainstream media, audio and video articles, and more.World Relief's future Web site will have more on AIDS and the church. For now, a preview is available.
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