Hearing the Challenge of the AIDS Pandemic

A Moral Theologian Tells his Story

From New Directions in Sexual Ethics by Kevin T. Kelly, Geoffrey Chapman, 1998, Ch. 1

I had just returned from spending three weeks in Uganda to gain some first-hand experience of the reality of HIV/AIDS in the developing world. It had been a privileged, though very disturbing, experience and had made a deep impact on me. After a good night’s sleep to get over my jet-lag, I was sitting in the chapel in the Little Company of Mary house in Ealing, thinking about the experience of the past three weeks – a kind of debriefing prayer session. Four words were uppermost in my mind as I sat there – ‘poverty’, ‘women’, ‘sexuality’ and ‘limitations’. These seemed to sum up the challenge of what I had experienced in Uganda. I was also thinking about the readings for the Mass that morning. They were on the theme of speaking the word of God with integrity and how this can create division and even bring suffering and persecution! It was while all this was going on in my mind that the idea of writing this book came to me.

Later that morning I was due to have a session with Ruth McCurry, from Geoffrey Chapman, to explore the possibility of my writing a book on contemporary moral problems. One of the contemporary issues 1 was intending to cover was the AIDS pandemic and its ethical dimensions. However, in my debriefing session in the chapel the idea began to form in my mind that perhaps, given my gifts, experience and limitations, the book should be totally devoted to this topic. Moreover, it should not be a purely academic study. Rather it should be a Church-challenging and pastorally helpful study which would be supportive of people committed to working in the AIDS field. It would need to be written at a fairly popular level since part of its purpose would be to heighten awareness among people at large and encourage them to take this issue on board. However, at the same time it would need to be academically sound since it would be challenging some of the cultural and Church presuppositions and power-structures which seem to be part of the problem.

One of my companions on my visit to Uganda was Dr Maura O’Donohue, a Medical Missionary of Mary sister who worked in Ethiopia during the worst famine years. From 1988 until February 1997, Maura headed the AIDS section at CAFOD (Catholic Agency For Overseas Development). The AIDS pandemic had come on CAFOD’s agenda because it was beginning to have a catastrophic impact on development policies in the developing world. Most of the people dying were young adults on whom the development of a country depended so much. For some time Maura had been challenging me (and other moral theologians) to face up to a number of key ethical issues being unearthed by the AIDS pandemic. Through her I was invited to become a member of the CAFOD AIDS committee. That was my first real exposure to the enormity of the HIV/AIDS pandemic and its increasing threat to many developing countries. My Uganda exposure experience was also shared with Dr Mary McHugh, chair of the CAFOD AIDS committee. CAFOD was keen that we should both be better equipped for our work on the committee.

Uganda was chosen for our ‘exposure’ visit since the HIV/AIDS pandemic has reached catastrophic proportions in that beautiful but long-suffering country. According to a 1996 CAFOD report, ‘in a population of 18 million it is estimated that there are 1.9 million people infected with HIV, However, Uganda is only the tip of the HIV/AIDS iceberg (a curiously apt image, remembering Britain’s first introduction to AIDS on television!). The mid-1996 world figures for HIV/AIDS infection are 21.8 million, of whom 94 per cent are in developing countries. Most of these live in sub-Saharan Africa and South and South-East Asia. At present, the pandemic in South and South-East Asia may be growing at a pace reminiscent of sub-Saharan Africa in the early 1980s, but may have an even greater potential for spread, given the adult population of nearly 1 billion people as compared with 225 million in sub-Saharan Africa. It is estimated that the number of those infected with HIV in Asia will rise from 3.5 million in 1996 to 12 million by the year 2000. The vast majority of these are in India and Thailand. Moreover, it is now estimated that at least 75 per cent of cumulative HIV infections in adults have been transmitted through heterosexual intercourse.

It would be misleading to give the impression that the HIV/AIDS pandemic is occurring only in the developing world. That is not so. This is brought out in an unpublished letter to The Tablet, written by Martin Pendergast, convener of CAL (Catholic Aids Link) and for many years Health Service Commissioner of HIV, Sexual Health and Drug Misuse services in North East London. Speaking from a wealth if experience in the United Kingdom. Martin challenges an editorial in The Tablet (13 May 1995) seeming to imply that HIV/AIDS is no longer a major issue of concern in the UK:

The gist of your argument seems to suggest that the front line of HIV/AIDS is ‘over there’, wherever ‘there’ happens to be. Certainly, the impact is catastrophic in the developing world . . . The UK’s relative success in holding HIV and AIDS incidence at lower levels than many Western European countries with large Catholic populations has been due to a sustained, integrated prevention, diagnostic, treatment and support programme over the past decade, underpinned by a high degree of confidentiality. Those of us who work together to stem this pandemic often feel like Canutes. It does not help to be told, even by implication, that the front line is elsewhere. The very nature of a pandemic is that it is here, and here, and here. This does not mean accepting an inevitable tide of further transmission and illness. Rather it involves discovering and developing ways of responding to new needs in different populations. Sadly, many parts of the Church so often speak and act as if they and the epidemic are in very different places.

I have tried to keep Martin’s warning in mind throughout this book. Nevertheless, as the statistics already quoted clearly demonstrate, it cannot be denied that the pandemic has been having an enormous Impact on many developing countries. This was initially the case in sub-Saharan Africa. However, more recently the HIV virus seems to be spreading rapidly in India, Asia and Latin America. In many of these Cultures women, and often their children, become infected with HIV mainly because of their sexual, social and economic subordination. Preventive work based solely on change in sexual behaviour is doomed to failure. Change has to occur at a deeper social level.

I soon began to see what had become obvious to Sister Maura and her AIDS co-workers at CAFOD, namely, that injustice against women in its different manifestations is a major underlying factor in the rapid spread of HIV/AIDS in developing countries. Even at this early stage it is worth spelling this out in more detail.

WOMEN AND HIV/AIDS

In 1994 a paper entitled Women and AIDS was published jointly by the World Health Organization and the United Nations’ Development Programme in consultation with the UN Division for the Advancement of Women. In its initial summary the report presents a very disturbing picture of the rapid spread of HIV infection among women, mainly in the developing countries:

From being almost absent from the AIDS epidemic in the 1980s, women infected with HIV now number more than six million -with another one million women becoming infected this year. By the year 2000, over 13 million women will have been infected and 4 million of them will have died.

Although HIV infects both men and women, it seems that it is now increasingly affecting women in a disproportionate manner. The above report points out that this is due to three principal factors – the sexual subordination of women, their economic subordination and their special vulnerability due to the specific nature of female biology.

The first two of these factors, the sexual and economic subordination of women, are rooted in the denial of the full and equal dignity of women. Among the more specific ways in which these two factors actually contribute to the rapid spread of HIV/AIDS the following would seem to be most common and the most influential.

1. ‘Double-standard morality’

In many cultures it is assumed that men are not bound by the same standards of morality as women. Women are expected to be virgins when they come to be married and, once married, they must be faithful to their husbands. Men, on the other hand, are expected to be sexually experienced when they approach marriage. This experience comes from their visiting prostitutes, a practice which is regarded as fairly normal and acceptable for many young men. As mentioned in one of my diary entries later in this chapter, in some places it is even one of the elements built into a stag party or its equivalent before marriage. After marriage, if the husband begins to tire of his wife, it is common for him either to seek comfort from prostitutes or to have a ‘minor wife’, with or without the consent of his first wife. No such licence is permitted to his wife. As a woman she must remain faithful to her husband. Because her economic and social security may be entirely dependent on him, she may find it less threatening to keep quiet and not. complain, rather than challenge her husband and risk his leaving her or putting her out.

The practical effect of this double morality with regard to women and AIDS is that, in a country where HIV is spreading within the heterosexual population, it is very possible that a woman living in accord with an ethical standard of virginity before marriage and complete fidelity within marriage will still find herself infected with the virus by her husband. Possibly the first indication she will have of her infection will be the tragic news that her child has been born with the virus. This news is shattering at a whole variety of levels. Her child’s life will almost certainly be short and painful. Her own health and life expectancy is seriously threatened, as is that of her husband. The future of her other children is now put at risk, due to the likelihood of their losing both their parents. And her husband’s infidelity to her is now confirmed. Prior to the news of her child’s infection, for her to suggest to her husband that they should practise ‘safer sex’ in order to safeguard her own health as well for the sake of her children would probably be unthinkable. It would implicitly be challenging her husband’s fidelity and it would be assuming an equality in sexual bargaining power which is denied her by the ‘double-standard morality’ ethos.

2. Use of younger girls for ‘safe’ sex

This ‘double-standard morality’ which accepts more permissive sexual behaviour by men implies that many men are involved in multi-partner sexual activity. This in itself is high-risk behaviour in terms of HIV/ AIDS. However, some men who think they may not be infected with the virus are now tending to approach younger girls on the assumption that they will be virgins and so will not be infected themselves. For a variety of reasons these girls may be under great pressure to accede to their requests. They might be seen by their parents as a good source of income for the family since their education is viewed as of lesser importance than that of their brothers. Or perhaps their parents have already died of AIDS and they have to carry responsibility for their orphan-headed family. A ‘sugar daddy’ can be a god-send for a young girl in such a plight. Even if the young girl is at school, acceding to her male teacher’s request might be the only way she can get the required pass to continue her education. A similar scenario is becoming more common within the sex industry. Young Virgins’ are in great demand because of their providing an opportunity of safe sex for their male clients. It is reported from certain parts of Burma, for instance, that, unlike the Chinese, parents are rejoicing over the birth of a girl baby. She will be a good source of income when she is old enough to be sold to a brothel in Thailand! All these scenarios constitute ways in which these young women are likely to become infected with HIV by the people abusing and exploiting them. Moreover, the risk is all the greater due to the fact that, biologically, women are more vulnerable to HIV infection than men. That is particularly true of young girls since their immature cervix and relatively low mucus production presents less of a barrier to HIV

3. Sexual subordination of women and the sex industry

The sexual subordination of women makes the sex industry more socially acceptable, even though this does not imply that women engaged in the sex industry are given any social respect. This again is where the double standard operates. It is acceptable for men to be customers (‘men will be men’) and to buy the services of the women involved. But the prostitutes themselves are said to be living on ‘immoral earnings’ and, in some countries, are even criminalized.

Although prostitutes arc often blamed for the spread of HIV/AIDS, they themselves will almost invariably have been infected by their male clients. For the most part, they will rarely be in a position to be able to insist on the use of condoms by their male clients. Consequently, because their trade involves them necessarily in multi-partner sex and because the risk for them is magnified by their biology as (young) women, they are very much at risk of HIV infection. The tragedy is that many of them will have come into the sex industry out of sheer poverty or at least as the only way they can generate sufficient income to care for their dependants. In many cultures it is the girls in the family who are expected to look after their parents and younger siblings. This burden is further aggravated by the likelihood that they may also have children of their own. When a woman labouring under such heavy pressures discovers that she is HIV positive, she finds herself in a Catch 22 situation. Naturally, faced with the possibility of her dying in the not-too-distant future, her prime concern will be for her children and dependants and how to make provision for them while the opportunity is still open to her. Hence, she might well keep secret the fact that she is infected so that she is able to continue operating for as long as possible.

4. Female genital mutilation and other cultural practices affecting women

At the end of her novel, Possessing the Secret of Joy (London, Vintage, 1993), Alice Walker mentions that it is estimated that ‘from ninety to one hundred million women and girls living today in African, Far Eastern and Middle Eastern countries have been genitally mutilated’ (p. 266). I am told that female genital mutilation as practised in some parts of Africa yields a total of ten million new cases of mutilation each year! This practice leaves women, especially young women, more at risk of HIV infection due to a number of reasons, the main one being the fact that it leaves them with permanent scar tissues which are open to abrasions in the course of sexual activity.

Cultural practices which involve multi-partner sex also increase the risk of HIV infection. In some cultures it is still acceptable for a husband to ‘lend’ his wife to a guest as a mark of respect, although, thankfully, this practice seems to be dying out. Another ‘traditional’ custom still found in some countries is wife inheritance in which a wife is ‘inherited’ by her husband’s male next of kin. In some cultures the law restricts property ownership and inheritance to men. This only reinforces women’s economic dependence on male relatives and can leave them defenceless in the face of sexual practices which can put them at risk of Sexually Transmitted Diseases (STDs) and HIV infection. Similarly laws governing marriage, divorce and child custody can prevent women leaving a relationship, in which they or their children are being sexually abused and thus exposed to the risk of HIV infection.

In most cultures, it is women who are left to bear the burden of caring for any family members who develop AIDS. Often they them-selves may also be HIV infected. When there is no financial support and little support from the wider community, this leaves the women carers very vulnerable, since they may be labouring under enormous psychological and emotional pressures as they watch their loved ones dying and are fearful for the future, both for themselves and for the family. Where AIDS is rife, they may also have to carry the additional burden of caring for the orphaned children of dead relatives. Their desperate situation can obviously leave them vulnerable to men who are willing to offer economic help in return for sexual favours. Once again this is a dangerous scenario in terms of the spread of HIV/ AIDS.

5. Low priority given to women’s education

Girls are expected to look after the home and care for their ailing parents. Hence, they are frequently denied the possibility of a full education. This deprives them of learning to look critically at their own culture and judge whether certain tribal customs violate their true dignity as women. Hence, they are more likely to accept their sexual, social and economic subordination simply as part of their lot as women. And even when a girl gets the chance of a full education, she may be forced to have sex with her male teacher or educational official in order to get a credit or to gain entrance into college.

6. Migration

Frequently, husbands, forced to work away from home, will have few qualms about going with prostitutes while they are away or even having a more stable relationship with a woman in the locality in which they are working. This increases the possibility of husbands bringing back HIV infection to their faithful wives. Increasingly, too, in some economies in the developing world, women are finding that they need to go abroad as migrant workers in order to support their families or to attain sufficient economic independence to be able to set up home on their own. However, such women may find themselves I subject to a system of sexual barter if they are to be able to obtain employment or continue in it. Sexual favours might also be asked in exchange for entry or residence permits, or in order to get transport to their employment.

THE ‘PRO-WOMEN’ CHALLENGE TO THE CHURCH AND TO CHRISTIAN SEXUAL ETHICS

Although the examples given above may not be found everywhere in the developing world, my own listening to women in Uganda, Thailand and the Philippines has convinced me that they are disturbingly widespread. A similar picture emerges in CAFOD reports of visits to many developing countries and in other first-hand accounts both written and oral, I have been given of the situation of women in these lands.

In the light of the picture presented above, it would seem unrealistic and even harmful to suggest that the only real solution to the HIV/AIDS pandemic lies in the traditional ‘faithful to one partner sexual ethic. That offers no help to many women. For them, what is lacking is the very foundation without which such a sexual ethic is virtually meaningless. As long as their full and equal dignity is not accepted in theory and in practice, many of the norms of this traditional sexual ethic are likely to work against the well-being of these women and may even prove to be the occasion of their becoming infected by HIV.

It would seem obvious that there will be no substantial alleviation of the plight of women oppressed in these various ways until there is a cultural shift to accepting the full dignity of women and adapting cultural norms so that the relationships of women and men are able to be lived out in true equality and mutuality. I am very conscious that such a statement from a Christian theologian in the West can smack of cultural and religious imperialism. Criticism of any culture tends to be more credible if it comes from within that culture. That is why I believe that, if the Church is to respond to the serious moral imperative of working for the cultural integration of the full and equal dignity of women, it can best, and perhaps only, do this by giving all the support it can to women and women’s movements within that particular culture who are working to bring about such an integration. Nevertheless, because power in the Church as presently constituted is almost exclusively wielded by men, the women and women’s groups mentioned above may well have experienced the Church itself as part of the injustice they are trying to overcome. Where this is the case, the Church must face up to its own internal need for conversion by listening humbly to the experience of these women as they tell it themselves. In this connection, the justice dimension of sexual ethics must be taken on board by the Church, An awareness of the plight of women suffering sexual exploitation or trapped in the sex industry highlights this justice dimension. However, the Church must accept that it has implications for the entire held of sexual ethics. For instance, it would be a much more credible witness to the Gospel if the Church was renowned for its opposition to female genital mutilation rather than for its opposition to the use of condoms.

This brings up an even more fundamental point. In the light of the serious injustice suffered by so many women in the sexual sphere, it would seem that at this point in history a Christian sexual ethic should be ‘pro-women’ before it is ‘pro-marriage’; Adapting the words of Jesus, this means recognizing that marriage is made for women, not women for marriage. Of course, it could be objected that women are not the only persons whose well-being is involved in marriage. That is true. In its pristine form the principle should read: marriage is made for persons, not persons for marriage. However, the AIDS pandemic is making us aware that the persons whose well-being may be least protected within the institution of marriage are women – particularly wives, but also daughters. This has been true over many centuries but, in our ‘time of AIDS’ the consequences of this injustice have become even more horrendous.

Today women, and men too, are becoming more aware of this institutionalized injustice. In fact, during the International Women’s Year in 1975, Paul VI described this emerging consciousness among women of their full dignity as human persons as one of the ‘signs of the times’. By his deliberate choice of this phrase, given special significance by John XXIII, he seemed to be implying that God was revealing to the Church a new dimension of our understanding of the Gospel message of liberation through this worldwide phenomenon of growing awareness on the part of women. This ‘sign of the times’ is why, in our age, the principle, ‘marriage is made for persons’, directs our attention particularly to the plight of the many women for whom marriage offers the prospect of oppression rather than of liberation and fulfilment. This same principle also challenges any culture where the very institution of marriage itself, in its current form, contradicts the respect owed to women in view of their full and equal human dignity. The inculturation of the Gospel in such a culture must necessarily be subversive of the institution of marriage as it exists in that culture. As already mentioned, this subversion will probably only be brought about through the heroic opposition of women within that culture who have a critical awareness of the inhumanity of the institution of marriage in their society.

However, the sexual and economic subordination of women is not restricted to the developing world. It is still experienced by many women in the West, though perhaps with less severe consequences than in many developing countries. Moreover, as we shall see in Chapter Three, a similar patriarchal approach to women also operates in the Church at large and perhaps most strikingly within the Roman Catholic Church. Moreover, this is not merely a brief aberration within the history of the Christian community. It has been a constant in Christian thought and practice from the earliest centuries, even though Christian feminist writers are now reclaiming the strands of an alternative and more enlighted tradition which has struggled to coexist under the prevailing patriarchal ideology. However, the dominant mind-set right from the very early days in the Church has taken for granted the inferiority of women.

WIDENING THE AGENDA: THE NEED FOR A RENEWED SEXUAL ETHICS

While I was still early in the process of absorbing all this, CAFOD invited me to attend a meeting of English-speaking moral theologians New York. In a paper I gave to initiate one of the discussions, stated that one major challenge of the HIV/AIDS pandemic to the Churches and to moral theologians concerned the need to develop a lore satisfactory sexual ethic. I suggested that such a sexual ethic would need to be constructed along the following lines:

1. It would need to be a sexual ethic which makes faithful sexual loving attractive to people and is based on values accessible to the thinking of ordinary men and women. If such a sexual ethic could be articulated in sufficiently positive language, it might help in limiting sexual intercourse to faithful sexual relationships. This would not be due to any fear of AIDS, nor because constrained by any external pressure from Church teaching, but because of the attraction of such a life-style if it is seen to be the way to achieve the greatest happiness as sexual persons.

2. It would also need to be a sexual ethic which acknowledges that faithful sexual loving is a desirable and good pattern of life for homosexual persons (linked to the need for self-acceptance and a sense of self-worth which features so strongly in ‘gay spirituality’). Such a sexual ethic could give an attractive alternative to multi-partner and temporary relationships. Once again the drawing power of such an ethic would not lie in any fear of AIDS but would flow from the recognition that such loving and faithful relationships are good and desirable. The affirmation by the Church of the goodness and desirability of such loving and faithful relationships could be a support and encouragement to homosexual persons striving to achieve them.

I finished my contribution by insisting that a world ‘living positively with AIDS’ could be a very healthy world. This is because living positively with AIDS means accepting the challenge which the pandemic of AIDS is making to our world community. It is a challenge to change our ways radically on three different but closely related fronts by (1) promoting economic justice for all; (2) dismantling patriarchy; and (3) formulating a satisfactory person-respecting sexual ethic.

The first of the these three challenges does not feature largely in this book. That is not because I view it as less important but simply because he focus of this book is specifically on sexual ethics. However, it is touched on in the Epilogue in connection with Professor Richard Parker’s inspirational paper to the 1996 9th International Conference on Aids in Vancouver. Even a renewed sexual ethics which incorporates respect for the full and equal dignity of women will have little effect in combating HIV/AIDS if it is not accompanied by a radical attempt to tackle the root causes, personal and structural, of poverty in our world.

After all, most of the causes I listed earlier for the rapid spread of HIV infection among women in developing countries can be linked together in some way or other under the umbrella title of the ‘feminization of poverty’. It is poverty which drives many women into prostitution or, worse still, leads their parents to sell their young daughters into the sex industry. It is poverty which forces men to leave their wives and families and seek work far from home. It is poverty which causes women, even married women with children, to leave their families in order to find work abroad to support them. It is poverty which is occasioning the breakdown of many local communities and their cultures which, despite their inherent patriarchy, still have certain built-in safeguards to protect the dignity of women. It is poverty which lies behind the gross underfunding of medical services in many developing countries. In many developing countries, for instance, the health service lacks the funding to test all blood supplies used in transfusions. This means that, in practice, the right to infection-free blood is non-existent for women in these countries. This same poverty factor can also render meaningless the right of these women to adequate health care once they become HIV positive.

The more I have learned about the AIDS pandemic, the more convinced 1 have become that this pandemic is helping to open our eyes to some implications of the Gospel which until now have only been latent but which today are beginning to be seen as enormously important. The process of hearing these ‘new, yet old’ calls of the Gospel is linked to our growing awareness of certain evils which have permeated human life over the centuries and to which as Church we seem to have accommodated ourselves down the ages. Somehow the AIDS pandemic is exposing these evils in their true colours and their horror and destructiveness is becoming clear, if we only have eyes to see with.

In no way am I suggesting that AIDS had been sent by God to open our eyes to these Gospel values. That would be a blasphemous suggestion. AIDS is a human catastrophe of global magnitude and can rightly be described as one of the major evils of our day. Nevertheless, paradoxically, good can come from evil. Just as a fatal air-crash can reveal a dangerous design fault in an aircraft, so the AIDS pandemic seems to be revealing some major flaws in the social construction of man—woman gender roles, in the ethical evaluation of our sexual relationships, in our global approach to social justice, and in the way we handle the creative potential of the present moment.

As Edward Schillebeeckx reminds us, God often speaks to us through the ‘contrast experience’ of our inhumanity towards each other (cf. God, the Future of Man, London, Sheed & Ward, 1969, p. 136). The voice of God is heard in the cries of suffering caused by such inhumanity. The AIDS pandemic is making us more attentive to God’s voice corning to us through the cries of women living with HIV/ AIDS. The ‘contrast experience’ consists in the denial in practice of their full human equality and in their sexual exploitation. In the midst of the inhumanity of this situation, the cry of God’s creative Spirit is heard: ‘Become more truly human’. Salvation today is inextricably bound up with hearing this cry. Out of the tragedy of all the suffering and dying of AIDS can come a new step forward in the salvation of our human family. To close our ears to this is to refuse to listen to the Gospel speaking to us today.

This conviction has been with me throughout the writing of this book. That is why, when my publishers suggested the title New Directions in Sexual Ethics, as a link with my previous book, New Directions in Moral Theology, I insisted on the sub-title Moral Theology and the Challenge of AIDS. Although I was uneasy because the ‘New Directions’ title on its own seemed to promise more than I could deliver, my main worry was that such a title gave no indication that my fundamental concern in this book is with the challenge of the HIV/AIDS pandemic. The sub-title helps to keep the spotlight on the HIV/AIDS pandemic and its challenge to all of us, in the Church and in society as a whole.

LISTENING TO EXPERIENCE

To share my feeling of urgency about the need for the Church to respond adequately to the HIV/AIDS pandemic, I would like to quote a few passages from my Uganda diary. These excerpts might give readers a taste of the HIV/AIDS ‘exposure’ I experienced on my visit to Uganda.

The first excerpt describes a visit with one of the Home Care teams from Kitovu hospital to a little centre in the village of Kabonera in the district of Masaka:

At Kabonera everyone gathered at the house of Gerard, who is the community co-ordinator, supervising 30 community workers, all volunteers like himself. Bobo, one of the two nurses on the Home Care Team, held her clinic out of doors, round the side of Gerard’s little house. It was very hot that afternoon, so we had to keep moving our chairs to stay in the shade. Each patient would sit on one side of Bobo, while I sat on the other side of her. Bobo got their permission to explain their medical records to me and also their circumstances at home.

The first to come looked a very old man but was only 52! His wife had been married before and, unknown to him, her first husband had died of AIDS, He only discovered this later when she also died of AIDS. The rest were all women, except for two children who were both brought by their sisters. All but one of the women were AIDS widows who now had AIDS themselves. One of the children was a little girl, aged 8. She looked about 3! She was born HIV+; apparently this accounted for her poor development. Her twin sister had already died of AIDS. Another woman, aged 20, was clearly very afraid. She was having constant diarrhoea. She knew that this had been the beginning of the end for many of her young friends who had died of AIDS. Another woman, aged 40 was in an advanced stage of AIDS. She had 5 children and was clearly worried about what would happen to them.

When everyone had seen either Bobo or Betty, the other nurse, and had collected their medicines from the van (and also food supplies, when needed), those who wanted to got together for a Communion service. Bobo had told me that some might want to go to confession, so we agreed that the best thing would be to incorporate a General Absolution in the Communion service. I found out later that this was unheard of in Uganda! However, it seemed to make sense to the women there. It had been explained to me earlier that part of the local culture was that women are brought up from an early age to kneel before men! This is even taken to the extreme of a wife being expected to serve her husband’s meal on her knees and then to eat her own meal afterwards. Some of the women are trying to change this, since it is symbolic of the inferior position of women in their culture. Since lack of true respect for women is one of the root causes affecting the spread of AIDS, our group were very alert to any signs of this in practice. For the Communion service, the women all knelt down on the bare floor, so I knelt down with them. Since they could not understand English, I got Bobo to explain that part of the rite of Absolution was my going round each of them and laying my hands on their heads. I also got her to explain that I needed forgiveness as much as they did. So I would kneel down in front of one of them and that person would need to stand up and put her hands on my head to include me in the absolution. On this occasion I knelt in front of Bobo while she gave me absolution. This was to reverse their custom and let them see a man kneeling before a woman. At the second Home Care Visit in Kitanga, I did the same thing but this time knelt in front of one of the women with AIDS.

In the jeep on the way back I was commenting on the fact that almost all the AIDS patients were youngish women who were widows. I asked Bobo whether, in view of the degrading attitude to women in their culture, the death of a husband might, paradoxically, have an element of liberation in it. She said that was not so. This was because the husband represented security both as regards finance and property. Moreover, since the tradition is that women cannot inherit property, on the death of the husband the house and the bit of land around it would automatically go to the husband’s brother. It would be up to him whether he allowed the widow and her children to remain living there. Formerly, he would even inherit his brother’s widow and children.

The second excerpt recounts a visit to some Orphans Projects in Rakai. That is the district worst affected by AIDS in Uganda. Of the 8,700 orphans cared for by the Kitovu Hospital Orphans Project, 4,300 of them live in Rakai district. There 75 per cent of the children of ten years and under are orphans.

Our first visit was to an orphan-headed family. The parents had died of AIDS 4 years ago. The children had been looked after by the mother’s sister until she too died of AIDS. The family is headed by a young girl aged 12, who looks after her two brothers, one aged 11 and the other 9. All three are at school, their fees paid for by the Orphans Project. The project has also built them a tiny little house with a bit of ground attached for growing foodstuffs. From there we went to Kisaalizi Primary school. There are 475 children in the school (aged from 5 to 16) and 365 of them are AIDS orphans.

We next drove on a terrible road through a jungle of banana trees and finally came to a little clearing where another orphan-headed family were living. This was a family of 7 children, headed by their sister, aged 20. Their parents had died of AIDS about 3 years previously. They had then been looked after by their mother’s sister. After she too died of AIDS, the eldest girl, aged 25, looked after them – and had a baby herself during this time. Then she too died of AIDS. So now the next eldest sister is in charge. The Orphans Project are helping the family reclaim some of the banana plantation which has gone wild. This will allow them to generate some income for themselves. They are also paying the eldest girl’s fees to train as a teacher.

Our next visit was to another orphan family, this time looked after by their grandmother, aged 84. There were 6 children, the eldest aged 14. Their parents had died in 1990 and 1991. The Project pays the children’s school fees. The granny was thrilled with our visit. She insisted on doing a ‘welcome’ dance inside her little house.

The main purpose of these orphans’ projects is to help either guardian-headed or orphan-headed families to be able to reach a fair standard of self-reliance, even, if possible, generating their own income to cover necessities such as school fees, etc. When a young girl is head of an orphan-headed family, she is under great pressure. Poverty means that she has no money to buy things for herself, despite peer pressures from other girls at school. Hence, there is a great danger of her being exploited by older men – sexual favours for little practical gifts. This is a further reason why income-generating projects are so important.

A final excerpt contains parts of three conversations I had in Kampala:

We talked with Francis, the senior counsellor in the Home Care unit, about the danger of Western-style counselling destroying the traditional, cultural structures of elders in the local communities with all their natural wisdom and counselling skills. Francis was very alert to this danger but said that many elders lacked accurate information and knowledge about AIDS. Hence, there was a danger that they might defend negative cultural features (especially regarding women) which help in the spread of AIDS and increase the suffering of women. Also, these elders tend to be men.

Francis was also very frank about some other cultural practices which are now dying out but which were extremely oppressive of women and have certainly left their mark on the man-woman relationship there:

a father would initiate his son’s wife into sex
lending his wife to a male guest or to one of his brothers was a natural gesture of ‘hospitality’ offered by a husband
when a husband died, his brother inherited his wife.

After this, we had a most interesting conversation with two young women, Helen and Celia. They confirmed everything Francis had been saying. However, they made it clear that women were beginning to stand up against the repressive side of their culture. But they admitted that many women are still stuck in the cultural pattern of dependence, being little more than servants to the husband and all his family. They also pointed out that often men are still trapped in the cultural attitude of thinking that they are not ‘worthy men’ unless they have produced children. (And unless worthy men, they do not deserve a fitting family burial! I wondered about the implications of this for celibacy!) This attitude has implications for men who are HIV+. They still need to produce children and so insist on having sex with their wives. We also talked about rape and sexual violence. Helen and Celia said that because some women were beginning to refuse sex to HIV+ men, some of these men were looking for alternatives in the weaker section of the population – with a consequent increase in child sexual abuse and rape. Both Helen and Celia saw a change coming mainly through the economic independence of women, which in turn was helped by education and activities such as income-generating projects and women’s self-awareness groups.

Later in the day I talked with a non-Ugandan priest about the position of priests with regard to AIDS in Uganda. I picked up the impression that AIDS was fairly widespread among the clergy and that many young priests had died from AIDS (‘perhaps 25 per cent in some parts’). He also confirmed what I had heard before I came to Uganda, namely, that many priests in this and other African cultures find celibacy alien to them and are either living openly with ‘wives’ or else are having sexual relations with a number of women. Many seminarians too are sexually active. He even mentioned a case in which a doctor was giving a talk to seminarians about AIDS and the only question they seemed interested in was what were the safest condoms to use!

Six months after my visit to Uganda, I had the privilege of visiting Bangkok for a meeting of Asian theologians on HIV/AIDS. Afterwards, I stayed on for two extra weeks to get some personal experience of the AIDS scene in Thailand and the Philippines. I also wanted to meet some involved Catholic women’s groups and listen to their views. As with my Ugandan experience, my visit to Bangkok and Manila confirmed everything Maura O’Donohue had been saying about inferior status of women in society and how this was contributing to the rapid spread of HIV/AIDS. Again, a few excerpts from the diary of my visit might help readers share a bit of my experience. The first gives some points from a round-table discussion with a group of women in Bangkok:

(1) Everyone seemed to agree that the status of women in Thai culture – and in the Church – was that of second-class persons. Hence, they stressed that one of the main ways this could be challenged and changed was through giving young women a good education. The main thrust of this educational focus lies in forming young women who will have an ability for critical analysis so that they can evaluate the influences on their lives and so see where change is needed and where culture needs to be challenge and transformed. Sumitra was very strong on this point. She saw this as the major role of a Catholic school in a Buddhist society. I was fascinated by her emphasis, since she is the first lay head of the major Catholic girls’ school in Bangkok and at least 90 per cent of her 1.800 pupils are Buddhist.

(2) Due to the poverty of families in the agricultural area where the local means of livelihood have been destroyed by the country’s economic policy, girls are having to come to the cities to earn a living and often the only way to earn a ‘living wage’ through prostitution. Some are even sold into prostitution by their parents and brothers. Also, many girls become prostitutes out of a sense of duty to their family.

(3) Sumitra quoted a Christian Brother in charge of a large Boys’ School as saying that there is no point in struggling against the cultural tide. Prostitution is simply part of the cultural scene in Thailand. For most young men their first sexual experience will be with a prostitute and the double standard morality practised by men takes it for granted that married men can continue to frequent prostitutes. As long as that remains the case, the sex industry will continue and it will be the only source of income for many women. Others in the group confirmed this picture of Thai culture. It was claimed that 80 per cent of Thai men went to prostitutes. Vichai., a young Jesuit sitting in on the meeting, told the story of his first day at university. Apparently, the opening talk to the freshers included the recommendation to go to a prostitute that first evening. I remembered too that at the consultation someone had pointed out that at the Stag Party on the eve of a wedding the groom is expected to visit a prostitute.

(4) Also, it was stressed that the educational system has tended to form ‘yes’ women – and Christian education has often aggravated that tendency. Usanee said that the same was true with regard to the family. Parents want ‘yes’ children, especially in the case of girls. Once again the stress was on changing to a more critical approach to education. The thought struck me that, when this is seen as so crucial to the empowerment of women and so necessary in breaking the shackles of women’s oppression (and therefore such a vital part of Christian education in ‘a time of AIDS’), what a tragedy it is that part of officially approved Catholic formation is to inculcate a ‘yes’ attitude to Church authorities. This seems to contradict the heart of what the Gospel demands for today. I could not help thinking of Margaret Farley’s hermeneutic principle: whatever works against the promotion of the true dignity of women cannot be a true interpretation of the Gospel or part of the work of redemption.

The second excerpt summarizes some of a conversation I was privileged to have with three highly committed Filipino women in Manila, all of them working full-time for Church agencies:

They all agreed that the inferior status of women was a major issue to be faced. It was built into Filipino culture which in turn merged with Catholic life-style here. Poorer women especially have the control of their bodies taken away from them. Poverty and the need to care for their family drives some of them into prostitution where they are treated as sex objects and have no bargaining power to protect themselves. Quite apart from prostitution, the prevailing attitude among men who are married is that they have the right to demand sex and women feel themselves obliged to give in to this. Among the poor there is a lot of physical violence and wife-beating in relationships; among the more educated the violence tends to be psychological and emotional. Although men may give the money they earn (not all of it!) to their wives for housekeeping, this does not operate on the level of a mutual partnership. It merely imposes on women the burden of having to make ends meet on inadequate means and leaves them open to blame when the money runs out. Basically, marriage is a culture of ownership. Double standards operate too. Women are expected to be virgins when they marry, whereas men are expected to have had sexual experience. Women even collude in this by seeing such prior sexual experience as something desirable in a man. Going to a prostitute tends to be seen as an acceptable way of sexual initiation for a man. Even within marriage, casual extra-marital relationships seem to be tolerated for men, but not for women.

The final ‘exposure’ experience I would like to share from my visit to Bangkok and Manila is a meeting with a young Filipino woman whom I will call Maria. (I have promised to respect her anonymity.) Maria herself told me her story. While still young she was raped by her father. This terrible experience left her feeling unclean and worthless and fit only for the rubbish dump. She felt she was now sub-standard. Moreover, as is usually the case with the eldest daughter, her parents expected her to be responsible for looking after her younger sisters and brothers, as well as providing for themselves. Maria felt this obligation all the more since she wanted to safeguard her young sisters from her father.

She tried a variety of jobs but the pay was never enough to support them. Eventually; like so many other girls in her situation, out of desperation she was forced into prostitution through sheer poverty. Her decision could hardly be called a free choice; it was the only way to earn enough to support her sisters. The way Maria put it to me was that she felt so worthless and unclean, she had nothing to lose by becoming a prostitute. It was all she was good for – and it would help to save her sisters. As she was saying this, I could not help thinking of I the words of Jesus. ‘Greater love has no one than to lay down one’s life for one’s friends.’

Inevitably Maria became infected with HIV Paradoxically, this brought her into contact with a Catholic organization which made it possible for her to give up working as a prostitute. She now helps this organization with its AIDS-prevention educational work. Maria is also spending a lot of time helping men and women in the more advanced stages of full-blown AIDS. Not only is this exposing her to other infections due to her compromised immune system. It is also making her face the suffering and physical degradation that is almost certainly to be her lot too. Maria spoke very openly to me about this prospect lying ahead for her, probably in the fairly near future. She said she trusted God absolutely and knew he would be with her through whatever horrors she had to face. As she was speaking I was almost moved to tears by her deep faith and utter trust in God.

Hate the sin and love the sinner is the pastoral advice we are given. In Maria’s case, that could be interpreted as meaning that we should hate Maria’s sin of becoming a prostitute but love her, the sinner, I believe that would be a serious misreading of the situation. It came home to me very forcefully as I listened to Maria that she and the many other women whose story is similar to hers should in no way be regarded as sinners. They are the victims of sin. They are the victims of the sin of the men who abuse them and of the widespread sinful attitude that regards women as inferior to men, a sinful attitude shared by many in our own country and even in our own Church. It is a structural sin that I, and my fellow male clergy, collude in to a greater or lesser extent. Maria and many women like her are also victims of the institutionalized injustice of an economic system which has destroyed the livelihood of the farming communities that most of these women come from and reduced them and their families to abject poverty. The roots of that structural sin are found more in the West than in developing countries like the Philippines.

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