The Church's Response to AIDS

"The Only Institution That Assists People Up Close and Concretely"

VATICAN CITY, JUNE 11, 2011 (Zenit.org).- Here is the address given by Archbishop Silvano Tomasi, the Holy See’s permanent observer at the U.N. offices in Geneva, at a May 27-28 Vatican meeting on “The Centrality of Care for the Person in the Prevention and Treatment of Illnesses Caused by HIV/AIDS.”

The archbishop’s speech was titled “The International Role of the Catholic Church in the Prevention and Treatment of HIV/AIDS.”

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It is with much gratitude to Archbishop Zygmunt Zimowski, President of the Pontifical Council for Health Pastoral Care, and in fraternal solidarity with him, that I share these reflections on the Church’s important role at the level of the wide range of inter-governmental and other global institutions engaged in the response to the HIV and AIDS pandemic. Before initiating this discussion, I also wish to greet, with particular respect and recognition, Mr. Michel Sidibé, who is responsible for leading the Joint United Nations Co-Sponsored Programme on AIDS and who seizes every opportunity to acknowledge and thank the Catholic Church and other faith-based organizations for their unique and uncompromising contributions to the struggle against this urgent health crisis.

1. From the time that the AIDS pandemic was first identified, during the early 1980s, the immediate engagement of various religious orders, diocesan and national Caritas organizations, and other Catholic Church-inspired institutions in response to the health, social, and pastoral needs of the people living and dying with AIDS-related illnesses, has been widely known and documented. Thus it was no surprise that the Holy See, and Catholic Church-related international organizations would be most interested to share their experiences and insights with the emerging global coordination of the public health response to the challenges posed by HIV and AIDS. The Holy See representation in Geneva monitored the establishment of the Global AIDS Programme (GPA) at the World Health Organization. Given its prioritization of the pandemic, in 1987, as a major focus of reflection and action, Caritas Internationalis regularly attended the Management Committee meetings of the GPA and, on occasion, was consulted by its first Director, Dr. Jonathan Mann and his expert staff, with regard to “lessons learned” in the field by Catholic organizations serving the sick and dying as well as the surviving loved ones of those whose lives had been so tragically affected by this threatening and complex epidemic. It is highly likely that the sensitivity of Dr. Mann to the human rights and social determinants of the ever-increasing spread of HIV was influenced by his consultations with Catholic Church-related programmes that saw the situation in a holistic manner, including the social, economic, emotional and spiritual dimensions of the persons living with or affected by HIV, rather than from a merely medical or scientific perspective.

Since the establishment of UNAIDS, in 1995, as a Joint Programme, including co-sponsorship of ten different UN agencies, the Holy See, as well as several Catholic Church-inspired organizations, such as Caritas Internationalis, Catholic Relief Services, and the Associazione Papa Giovanni XXIII have participated, as observers, in the semi-annual meetings of the UNAIDS Programme Coordinating Board. In a similar manner, these same Catholic structures are called upon for contributions to various Working Groups, planning mechanisms, and development of policy and practice guidelines, not only by UNAIDS, but also by its various partner agencies.

In 2006, Caritas Internationalis, with the encouragement of the Permanent Observer Mission of the Holy See to the United Nations and Specialized Agencies in Geneva, cooperated with UNAIDS and the World Health Organization to convene some 70 representatives of Catholic Church-inspired organizations with major engagement in the global response to HIV and AIDS. On that occasion, transparent, and open dialogue was held between the workers “in the vineyard” in some of the most rural and isolated HIV prevention, treatment, and care programmes in low-income countries and the officials of the above-mentioned UN agencies. This convening greatly advanced the understanding of the public health experts concerning the breadth and depth of the Church’s response to this pandemic and opened doors to collaboration among the Church, government, and international organizations at regional, national, and local levels.

Another major step forward in facilitating greater understanding of the Church’s international activity in response to AIDS has been facilitated by the mapping reports on such activities in Southern Africa (published as a Best Practice report by UNAIDS), of the work of the Dream Project to prevent the transmission of HIV from mother-to-child (published as a Best Practice by WHO), of the survey done by the Joint Commission on Health of Unions of Superiors General on the HIV/AIDS responses of religious congregations throughout the world (designed with support from technical research experts at UNAIDS), and of the various national mapping exercises undertaken at regional level by the Symposium of Episcopal Conferences of Africa and Madagascar, and, at national level, by Episcopal Conferences in such countries as India, Kenya, Thailand, and Myanmar. These studies clearly demonstrate the Church’s significant contribution to this field in such areas as: Prevention, Care, Treatment, Services for Orphans and Vulnerable Children, Advocacy, Capacity-Building, Theological Reflection, Pastoral Care, and Interfaith Involvement. Basic information and strategies to promote implementation of action in these fields of ecclesial action are clearly presented in the publication entitled Pastoral Training for Response to HIV/AIDS, developed by Caritas Internationalis. The book, originally published by Paulines Publications Africa, is available in various languages.

2. The Holy See also has attempted to monitor the establishment, as well as the policy and operation, of the Global Fund to Fight AIDS, TB, and Malaria. Despite the impressive and highly significant burden of care that is assumed by the Catholic Church in response to these three pandemics threatening the human family during this modern era[1], only a very small portion of funds distributed by this innovative structure have, in fact, been earmarked for faith-based organizations. According to a study on this topic, completed in 2008, only 5.4% of Global Fund grants were received by faith-based organizations.[2] We understand that there is slow but steady progress in making more of these funds available to programmes sponsored by the Catholic Church. I believe that Dr. Christoph Benn, who is well known to us in Geneva and who will serve as an expert speaker at this Conference, will be able to offer updated data in this regard. Regrettably, however, there still seems to be much resistance among some international funders to offer support for faith-based responses to HIV and AIDS.

3. Now let us examine areas in which the Holy See and Catholic Church-inspired organizations have successfully influenced global policy and practice related to this pandemic. In all cases, such activity has been undertaken in conformity to the Church’s overall magisterial, diaconal, and pastoral mission.

Much educational energy and expertise has been focused on the area of preventing the further spread of HIV infection. Many governments, public health authorities, and even some UN agencies, have preferred to promote an incomplete “quick fix” prevention approach that almost exclusively relied on the promotion and distribution of condoms. The Catholic Church, on the other hand, insisted on prevention strategies in conformity with its teaching on the dignity of the human person, the sanctity of marriage, and the need for exercising responsibility in intimate human relationships by observing sexual abstinence outside marriage and mutual and permanent fidelity within marriage. This led to false claims that the Catholic hierarchy was an obstacle to effective HIV prevention and even was “guilty” of the AIDS-related deaths of millions of persons. We can be thankful for the courage and the wisdom of experts such as Dr. Edward C. Green who has been able to demonstrate the evidence base that promotion of behaviour change toward more responsible sexual relationships has been much more effective than condom promotion in decreasing new HIV infections.[3]

In this regard, the Permanent Observer Missions of the Holy See in both Geneva and New York repeatedly have emphasized the theme of responsibility in interpersonal relationships in meetings of UNAIDS, World Health Organization, and at the more broad-based Special Sessions on AIDS that were convened by the United Nations General Assembly in 2001, 2006, 2008 and soon to be convened in June 2011. Blessed Pope John Paul II, of revered memory, illustrated this enduring and unalterable value during his address to the Conference on AIDS convened by the Pontifical Council for Health Care Workers in November 1989: “… the Church, sure interpreter of the Law of God and ‘expert in humanity’, is concerned not only with stating a series of ‘no’s’ to particular behavior patterns, but above all with proposing a completely meaningful lifestyle for the person.”[4] This same teaching was re-affirmed most recently by our present Holy Father Pope Benedict XVI, during his interview with the German journalist, Peter Seewald, later published in the book entitled, Light of the World: The Pope, the Church, and the Signs of the Times: “… we cannot solve the problem by distributing condoms. Much more needs to be done. We must stand close to the people, we must guide and help them; and we must do this both before and after they contract the disease.”

4. The Church has not confined its attention to teaching about HIV prevention; it has equally engaged itself in advocacy to eliminate discrimination against those living with or affected by HIV, especially any such rejection or marginalization based on the false premise that AIDS might be a “punishment” sent by God. Thus the words of the Episcopal Conference of Southern Africa, written in 2001, have resonated in the magisterial instructions of bishops in many other countries: “AIDS must never be considered as a punishment from God. He wants us to be healthy and not to die from AIDS. It is for us a sign of the times challenging all people to inner transformation and to the following of Christ in his ministry of healing, mercy and love.”[5]

5. Inspired by the Gospel Imperative of prioritizing the needs of the poor and vulnerable, the Church consistently raised its voice to point out and insist on a just solution to the inequitable distribution of resources made available in the global response to the HIV pandemic. Blessed Pope John Paul II expressed his urgent concern about this matter in his letter to then-United Nations Secretary General Kofi Annan on the occasion of the first UN Special Session on AIDS in 2001. He recalled the words of the Second Vatican Council regarding the common destination of goods[6] and then launched the following urgent plea: “On account of this social mortgage, included in international law by the affirmation, among other things, of every individual's right to health, I ask the rich countries to respond to the needs of HIV/AIDS patients in poorer countries with all available means, so that those men and women afflicted in body and soul will be able to have access to the medicines they need to treat themselves.”[7]

Again Pope Benedict XVI re-affirmed these same concerns when he emphasized, in 2006, during his address to the participants in the 21stInternational Conference promoted by the Pontifical Council for Health Pastoral Care when he noted, with much concern, “… the importance ofcollaboration with the various public bodies so that social justice may be implemented in this sensitive area of the treatment” and care of infectious diseases such as HIV and tuberculosis and the urgent need of “fair distribution of resources for research and treatment, as well as the promotion of living standards which help to prevent the occurrence and limit the spread” of such illnesses.[8]

In order to assure that these words are put into practice, the Holy See, as well as several international organizations of Catholic inspiration, including Caritas Internationalis, Associazione Papa Giovanni XXIII, the International Catholic Child Bureau, and religious congregations with representation to the United Nations, have monitored carefully and provided input to United Nations processes promoting flexibilities in the application of intellectual property rights, the promotion of Universal Access to prevention, treatment, care and support of persons living with or affected by the HIV pandemic, and special attention to the rights of children affected by HIV and other diseases by ensuring access to early diagnosis and “child-friendly” treatment for such illnesses.

6. The Church could never ignore its essential mission as Pastor to the People of God. Thus the Holy See emphasizes the spiritual needs of people in its interventions at the United Nations and in other inter-governmental fora. In the Constitution of the World Health Organization, the definition of health extends beyond medical interventions and social determinants to include a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[9] In its comment on the “Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development” during the Seventh Session of the Council on Human Rights, the Holy See delegation recognized “as well, the need to assure access to spiritual assistance among those conditions which guarantee the full enjoyment of the right to health.”[10] It also seized the opportunity to take issue with claims in the Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health that “few human rights are absolute,” [11] and to insist that “no compromise can be made with a person’s right to life itself, from conception to natural death, nor with that person’s ability to enjoy the dignity which flows from that right.”[12]

7. My conclusion will be brief, because I believe that our Holy Father already has summarized the theme of this presentation in a clear and unquestionable manner, and so I will close by quoting once again his comments to the journalist, Peter Seewald: “… [T]he Church does more than anyone else. And I stand by that claim. Because she is the only institution that assists people up close and concretely, with prevention, education, help, counsel, and accompaniment. And because she is second to none in treating so many … [persons living with or affected by HIV and AIDS], especially children with Aids.”[13]

The effective action mobilized by the Catholic Church in response to the global HIV pandemic has delivered care and set an example. An additional good news is the announcement made today in relation to the effectiveness of anti-retroviral treatment both in prolonging life and improving the quality of life among those already living with the virus and the efficiency of such treatment in preventing the further spread of HIV. However, the fact is that there still is a long way to go: 33 million people throughout the world are living with HIV; for every one person who gains access to the life-saving anti-retroviral medications, two are newly-infected with the virus, 7,100 each day; presently, 10 million who need these medicines have no access to them and a recent study done by Catholic Church-inspired funding and technical assistance agencies revealed reports from their partner organizations in low- and middle-income countries that international funding cutbacks and flat-lining have resulted in significant delays in receipt of promised funding, insistence on fulfilling previously-established outcomes with less funding, restrictions on accepting new patients into the treatment caseloads, and much uncertainty with regard to future sustainability of life-saving anti-retroviral programmes.[14]

The Church as a community of faith, hope and love cannot rest in its mission of service directed to place each and every human person at the centre of the global response to HIV and to engage in stronger advocacy and cooperative efforts to assure that all such persons “might have life and have it to the full.”[15]

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[1] A 2007 Study conducted by World Health Organization and others indicated that between 40% and 70% of health care in sub-Saharan Africa is delivered by faith-based organizations.

[2] Report by Dr. Christoph Benn, Director of External Relations, Global Fund to Fight AIDS, TB and Malaria, during a Conference on “Scaling up Involvement of Faith-based Organizations in Global Fund Processes, held in Dar-Es-Salaam, April 2008.

[3] Edward C. Green and Allison Herling Ruark, “AIDS and the Churches: Getting the Story Right”, First Things, http://www.firstthings.com/article.php3?id_article=6172 ; Edward C. Green, Broken Promises: How the AIDS Establishment Has Betrayed the Developing World, ISBN 978-1-93-6227-00-6, Sausalito, California, USA: Poli-Point Press, LLC, 2011.

[4] Pope John Paul II, Address to the IV International Conference of the Pontifical Council for Pastoral Assistance to Health Care Workers, “The Church Faced with the Challenge Of Aids: Prevention Worthy Of The Human Person and Assistance In Complete Solidarity,” 15 November 1989.

[5] A Message of Hope from the Catholic Bishops to the People of God in South Africa, Botswana and Swaziland, 30 July 2001.

[6] Gaudium et Spes, 7,1, which also was mentioned by Pope John Paul II in Centesimus Annus, 30.

[7] Message of Pope John Paul II to the Secretary General of the United Nations, on the occasion of the Special Session on AIDS of the UN General Assembly, 25-27 June 2001.

[8]http://www.vatican.va/holy_father/benedict_xvi/speeches/2006/november/documents/hf_ben-xvi_spe_20061124_pc-health_en.html

[9] Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

[10] Charter for Health Care Workers, #40, Pontifical Council for Health Pastoral Care, Vatican City, 1995. http://www.healthpastoral.org/pdffiles/Charter_06_Chapter2.pdf

[11] Document A/HRC/7/11, 31 January 2008, #63.

[12] Intervention of H.E. Archbishop Silvano M. Tomasi, Apostolic Nuncio, Permanent Observer of the Holy See to the United Nations at Geneva at the 7th Session of the Human Rights Council, Item 3: Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development, 11 March 2008

[13] Benedict XVI, Light of the World: The Pope, the Church, and the Signs of the Times - A Conversation with Peter Seewald, Ignatius Press 2010, ISBN # 9781586176068, pp. 117-119.

[14] “Keeping Commitments for HIV and AIDS: Access for All to Treatment, Prevention, Care and Support,” A Position Paper from the Catholic HIV and AIDS Network (CHAN), April 2011.

[15] John 10:10