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April 01, 2010

Faith-Based Organizations and the HIV/AIDS Pandemic

David P. Pusateri

Among a host of controversial issues that envelop HIV/AIDS is the role religion plays in combating and responding to the disease. Often lost in the storm of opinions is that freedom of religion and belief throughout the world is perhaps one of the most significant arrows in the human rights quiver that has been overlooked, under-examined and, frankly, too easily denigrated in the ongoing battle against HIV/AIDS. The fact that 70 percent of the world’s population identify themselves as members of a faith community (according to the Joint United Nations Programme on HIV/AIDS [UNAIDS]) begs the question regarding what impact religion has on the pandemic.

This issue was front and center at a conference held last September at the University of Notre Dame—HIV and the Rule of Law: Human Rights at Home and Abroad. Co-sponsored by the American Bar Association AIDS Coordinating Committee and the Center for Civil and Human Rights at Notre Dame Law School (among others), representatives from the Muslim community, Catholic Relief Services, and the National Episcopal AIDS Coalition came together to draw attention to the role of faith-based organizations (FBOs) in the battle against AIDS and to explore how the approach of FBOs to the HIV/AIDS pandemic could be enhanced. What is perhaps most obvious is that religious belief has a powerful impact on those affected by the disease because communities of faith play such a significant role in influencing behavior and attitudes. In Africa, Christianity and Islam, the predominant religions, have enormous followers, and the attitudes and lifestyles of members are greatly influenced by their respective religions and the values they teach. Religious leaders have the power to mold opinions and influence behavior in ways that directly affect the severity of the disease.

We all also are familiar with the negative effects of religion on the disease, in which unconstructive positions, sometimes bordering on self-righteous zealotry, are not helpful. Uganda introduced the Anti-Homosexuality Bill of 2009, which includes the death penalty for those practicing homosexuality. Influenced in part by American evangelicals, whose teachings demonize lesbian and gay people and even advocate that they can be “cured,” the bill has ignited a cultural war there. The New York Times reported recently that the United States, among others, is demanding that Uganda’s government drop the proposed law, saying it violates human rights, although a Uganda government official said, “Homosexuals can forget about human rights.” Jeffrey Gettleman, Americans’ Role Seen in Uganda Anti-Gay Push , N.Y. Times, January 3, 2010.

When religion negatively influences legislation as it has in Uganda, stigmatization, access to one’s HIV status, and treatment suffer. Speaking at the Notre Dame conference, Dr. Memoona Hasnain, author of Cultural Approach to HIV/AIDS Harm Reduction in Muslim Countries ( Harm Reduction Journal, 2005) and associate professor at the University of Illinois College of Medicine, pointed out that Muslim countries, previously considered relatively protected from HIV/AIDS, are today facing a rising threat. The social stigma attached to HIV/AIDS that exists in most societies is even more pronounced in Muslim cultures. As in other cultures, the stigma prevents those at risk from coming forward for counseling, testing, and treatment. Moreover, safe disclosure for persons infected with the disease often conflicts with the existing social, cultural, and religious underpinnings of Muslim societies. “In the Muslim World, religion defines culture and the culture gives meaning to every aspect of the individual’s life,” writes Hasnain. Issues such as gender inequality, stigma, and misconceptions about the disease are contentious and require particular attention when designing HIV prevention programs in Muslim communities.

According to Hasnain, some Muslim “religious scholars are taking a more flexible stance and justify the provision of the use of condoms and clean needles through the Qur’anic and Hadith passages. They reason that the sanctity of life is greater than the sin of condom use and that this strategy can be used as a short term measure, permissible under a state of emergency.” Hasnain points out that an urgent need exists for legislative and social changes to protect the legal rights of the infected and suggests that the message needs to be spread that “being a good Muslim can include taking care of those infected by HIV” and that it would be helpful in combating the spread of the disease.

Pope Benedict XVI took a widely reported different approach regarding condoms last spring when he commented that, while the Roman Catholic Church was at the forefront of the battle against AIDS in caring for those affected by the disease through its multiple health ministries, “[y]ou can’t resolve it with the distribution of condoms. On the contrary, it increases the problem.” The Pope said a responsible and moral attitude toward sex would help fight the disease. The Pope and the Roman Catholic Church’s stance, while controversial, received a positive nod of sorts from Edward C. Green, director of the AIDS Prevention Center at the Harvard Center for Population and Development Studies, who stated that “[t]he best evidence we have supports the Pope’s comments.” Mr. Green claimed that reducing “concurrency,” or the custom of engaging in two, usually long-term, sexual relationships at the same time, was the key to successfully combating the AIDS pandemic.

What is lost in the condom debate, however, is that FBOs such as Catholic Relief Services and the National Episcopal AIDS Coalition have provided crucial support for more than two decades for HIV and AIDS ministries throughout the world. In many cases, FBOs were the first to respond to those suffering from AIDS, providing services, education, and care. Further, because they provide a significant portion of the care in developing countries, FBOs reach the most vulnerable populations living under the most difficult circumstances. FBOs have been recognized as central contributors toward assisting those suffering from the disease. In fact, a 2007 report released by the World Health Organization concluded that greater coordination and better communication was urgently needed between organizations of different faiths and the private and public health sectors. It pointed out, for instance, that 30 to 70 percent of the health infrastructure in Africa is carried out by FBOs, yet there is little cooperation between these organizations and mainstream public health programs.

Religion’s voice in its communities and its ability to stimulate grassroot responses allow FBOs to have a critical role in impacting the prevalence of HIV/AIDS throughout the world. One conclusion from the Notre Dame conference was that leadership and education are urgently needed by FBOs. This conclusion was echoed by UNAIDS’ Interfaith Coalition when it distributed its Guidelines for HIV Prevention Messages for Muslim Faith-Based Organizations in Nigeria . In the guidelines, UNAIDS points out that HIV and AIDS prevalence in Nigeria has declined from 5.8 percent in 2001, to 5.0 percent in 2003, to 4.6 percent in 2008. The guidelines point out that this reduction was achieved, in part, by campaigns promoting morality and wholesome sexual behavior, including abstinence among young adults. UNAIDS concluded that FBOs “have contributed greatly to this achievement . . . Religious leaders are highly regarded and are always revered and referenced by their followers. Hence, religious leaders have a critical role to play in the prevention, control and impact mitigation of HIV and AIDS considering the influence and authority exerted by them.”

David P. Pusateri

David P. Pusateri is managing partner at the Pittsburgh Office of McGuireWoods, LLP. He is also a member of the ABA AIDS Coordinating Committee.