I went to Malawi earlier this year at the invitation of the Anglican Bishop of the diocese of Southern Malawi to 'help do something about Aids' and was there for 3 months. I have just returned from a second follow-up visit. The following is based on my experience there, not only with the Anglican Church, but also from interviews and observations of the work of other churches.
Aids in sub-Saharan Africa cannot be understood simply as a disease like any other, although some have argued that it should be. However, the scale of the epidemic, the rapidity of its spread, its impact on the economic and social development, the political, cultural and economic context, as well as the theological and moral questions it raises pose particular problems and challenges for the churches. Aids is generally believed to be caused by the HIV virus which is primarily spread through sexual intercourse, almost all of which is heterosexual in the African context. It is also spread through blood contamination (e.g. blood transfusions and shared needles or razors etc) and by vertical transmission from mother to child. However, by far the most common route is the sexual one.
The scale and magnitude of the problem
The magnitude of the problem of HIV/Aids in Malawi is similar to that of neighbouring countries such as Zambia and Zimbabwe. The statistics are frightening. Although it is difficult to get accurate figures (UNAIDS in Malawi estimates that for every reported case there are probably 6-10 cases unreported) some estimates suggest that HIV infection is rapidly approaching one third of the adult population in the 15-49 age range - at least in the Southern Region and in urban areas. One estimate from a USAID study has indicated that up to one half of all nurses and teachers will die in the next 5-7 years. However it is among teenagers that HIV infection is rising most rapidly, and in the age range 15-19, female cases outnumber males by 10 times. At present 70% of hospital beds are occupied by people with HIV related conditions.
It is difficult to convey what these statistics feel like when you are there. Funerals have become a way of life. Driving along the roads everywhere you see signs for coffin workshops as carpenters find it more profitable to make coffins than furniture. I never went out on a field trip into the villages without passing at least one funeral. In one Anglican parish I visited on the lake shore, the priest told me they have between 3 and 5 funerals a day.
The most urgent and pressing problem faced by all the churches is the rapidly increasing number of orphans. At Mpinganjira parish near the lake shore, where I visited, they had registered 2000 orphans aged 0-10! The parish includes six outstation congregations in addition to the main church. Guardians of orphans I met were mostly relatives, often grandmothers or even grandfathers. One old woman told me, 'I have been bringing up children for 50 years and I am so tired now, and my husband is old and cannot do anything'. She had seven grandchildren to care for. She survived by cutting firewood to sell and brewing beer. Other guardians I met were young girls, sometimes no more than 15 or 16 caring for younger siblings. They too had to find ways of earning income as well as care for the children. No possibility of school for them. The magnitude of the numbers and the destitution of many of them is harrowing to see. I met with over 100 orphans in some parishes, most of whom had not eaten that day, and had had to borrow clothes to come and meet me because they were too ashamed to come in the rags they normally wore. Some I talked to wept as they told of the loss of parents, and the loss of brothers and sisters as well, who had gone to other relatives outside their community.
Many people are dying of Aids at home without the benefit of even painkillers or simple antibiotics. In some of the parishes I visited, the recently established Aids committee had raised some money from local resources and contributions of church members to pay for patients to transport them to hospital, but lack of food, soap, clothes or blankets exacerbates their suffering even when medical care is available.
Role of the Churches
Approximately one third to a half of health care services are provided by the churches in this part of Africa, and the churches were among the first to provide care programmes for those suffering from Aids through, home-based care and counselling, often using teams of trained volunteers, supported by the hospitals. Apart from the care services run by Church health facilities, the response from the Churches institutionally has been characterised by a deafening silence - at least until very recently. This is largely true in Britain as well. Because most of the churches in the UK do not want to know about Aids, mission and development agencies have found it difficult to raise money for Aids programmes. Even though there have been real changes in Malawi in the past year in breaking this silence, there is still a problem in speaking openly about Aids. At funerals for example, Aids is usually not mentioned as the cause of death, nor is it usually on death certificates, as the immediate cause of death is the final infection. This is because there is so much stigma and shame attached to this disease, although it is now so widespread that no family has not had a member die from it, and many people now get it who may only have had one sexual partner.
Moreover, Church members are getting Aids along with the rest of the population. In one parish I visited, the priest himself has Aids, which I discovered when I met him. Sadly, although everyone knows (he is in the later stages of the disease) nothing was said, which, in the context of my meeting with the 'Aids Committee', and its commitment to encouraging openness and compassion, illustrates one of the major difficulties. Seeing his wife and children around him, it was particularly tragic that specific pastoral care, counselling and support for them could not be provided because of this silence. In discussing problem areas with some of the volunteers and members of Aids committees, one of the issues they raised many times was how do we counsel people living with Aids, when they do not themselves admit what is wrong with them!
As in other African countries, the Church has regarded Aids as a health problem to be dealt with by the health services, and not something the whole church needs to get involved with as integral to its ministry. When I started the workshop for clergy and church leaders earlier this year I found a real reluctance to discuss Aids (many admitted that they had not wanted to come). I also found some quite judgmental attitudes, such as 'people who got Aids had no one but themselves to blame', or that it was a punishment for sexual sins. There is widespread belief that, as one secondary school student from a church school put it, 'Aids is caused by immorality!'
One of the exciting developments in my recent visit was that I was asked by the government if I could help in getting a closer working relationship between government and the churches. The government has recognised the importance of the role of the churches in controlling the spread of Aids and wanted to work more closely with them. There is a growing awareness now that the churches have the potential for being a powerful force for change in attitudes and behaviour, which has, as yet to be recognised by the churches themselves.
The Challenges for the Church
The Church's attitude to the Aids crisis is critical in controlling the epidemic in Southern Africa. Moreover, this applies to attitudes to HIV/Aids worldwide. The Church has always struggled with the tension between the two 'words' spoken by Jesus to the woman taken in adultery: 'Neither do I condemn you', and 'Go and sin no more'. To which should we give the most emphasis? It seems we are unable to say both simultaneously, as Jesus did. In practice, how can we reach out in compassion to those suffering from Aids, and at the same time condemn the behaviour that leads to infection without appearing to be judgmental?
Another of the issues for the African church is how to deal with intolerable suffering - how to make sense of pain. The question 'where is God in this Aids epidemic' shouts at you when you see it close to, so how do you live with it day by day? How can the Church be equipped spiritually to deal with this level of suffering and deprivation, with the enormous orphan problem and the poverty and destitution of so many? Many of the volunteers I met spoke of the difficulty of going on visiting those living with Aids when they often didn't even have food, or basics like soap, let alone medicines. The volunteers themselves are poor and feel ashamed to visit without taking something. It takes a particular kind of compassion to continue to visit someone when you feel powerless to provide the material help they so badly need. How can they be supported in this solidarity of presence?
To say 'The Body of Christ has Aids' is saying more than that the Church has Aids. The Christ who takes on our flesh and shares our suffering, the Christ who identifies with the hungry, the sick and the prisoner, is surely to be encountered in the person living with Aids. Finally, perhaps the most important challenge to Christians in Britain is to do with the North/South divide and the growing economic inequality and injustice. Campaigning for debt relief, for reform of international trade rules which work against the poor, for a change in the way intellectual property rights are applied which prevents access of poor countries to needed technology and medicines, and for increases in international Aid are crucial in the fight against Aids. However, it is not just the poverty of a country like Malawi. It is the poverty of the church also. The Churches have great potential for influencing the spread of Aids in Sub-Saharan Africa, and are poised to play this crucial role, provided they can be both encouraged and resourced. That is the challenge to the Church here in the UK.
This article is an edited version of a longer paper produced by the late Susan Cole-King. Please contact the MMA HealthServe office if you would like a copy of the full version:
healthserve@cmf.org.uk
Aids in sub-Saharan Africa cannot be understood simply as a disease like any other, although some have argued that it should be. However, the scale of the epidemic, the rapidity of its spread, its impact on the economic and social development, the political, cultural and economic context, as well as the theological and moral questions it raises pose particular problems and challenges for the churches. Aids is generally believed to be caused by the HIV virus which is primarily spread through sexual intercourse, almost all of which is heterosexual in the African context. It is also spread through blood contamination (e.g. blood transfusions and shared needles or razors etc) and by vertical transmission from mother to child. However, by far the most common route is the sexual one.
The scale and magnitude of the problem
The magnitude of the problem of HIV/Aids in Malawi is similar to that of neighbouring countries such as Zambia and Zimbabwe. The statistics are frightening. Although it is difficult to get accurate figures (UNAIDS in Malawi estimates that for every reported case there are probably 6-10 cases unreported) some estimates suggest that HIV infection is rapidly approaching one third of the adult population in the 15-49 age range - at least in the Southern Region and in urban areas. One estimate from a USAID study has indicated that up to one half of all nurses and teachers will die in the next 5-7 years. However it is among teenagers that HIV infection is rising most rapidly, and in the age range 15-19, female cases outnumber males by 10 times. At present 70% of hospital beds are occupied by people with HIV related conditions.
It is difficult to convey what these statistics feel like when you are there. Funerals have become a way of life. Driving along the roads everywhere you see signs for coffin workshops as carpenters find it more profitable to make coffins than furniture. I never went out on a field trip into the villages without passing at least one funeral. In one Anglican parish I visited on the lake shore, the priest told me they have between 3 and 5 funerals a day.
The most urgent and pressing problem faced by all the churches is the rapidly increasing number of orphans. At Mpinganjira parish near the lake shore, where I visited, they had registered 2000 orphans aged 0-10! The parish includes six outstation congregations in addition to the main church. Guardians of orphans I met were mostly relatives, often grandmothers or even grandfathers. One old woman told me, 'I have been bringing up children for 50 years and I am so tired now, and my husband is old and cannot do anything'. She had seven grandchildren to care for. She survived by cutting firewood to sell and brewing beer. Other guardians I met were young girls, sometimes no more than 15 or 16 caring for younger siblings. They too had to find ways of earning income as well as care for the children. No possibility of school for them. The magnitude of the numbers and the destitution of many of them is harrowing to see. I met with over 100 orphans in some parishes, most of whom had not eaten that day, and had had to borrow clothes to come and meet me because they were too ashamed to come in the rags they normally wore. Some I talked to wept as they told of the loss of parents, and the loss of brothers and sisters as well, who had gone to other relatives outside their community.
Many people are dying of Aids at home without the benefit of even painkillers or simple antibiotics. In some of the parishes I visited, the recently established Aids committee had raised some money from local resources and contributions of church members to pay for patients to transport them to hospital, but lack of food, soap, clothes or blankets exacerbates their suffering even when medical care is available.
Role of the Churches
Approximately one third to a half of health care services are provided by the churches in this part of Africa, and the churches were among the first to provide care programmes for those suffering from Aids through, home-based care and counselling, often using teams of trained volunteers, supported by the hospitals. Apart from the care services run by Church health facilities, the response from the Churches institutionally has been characterised by a deafening silence - at least until very recently. This is largely true in Britain as well. Because most of the churches in the UK do not want to know about Aids, mission and development agencies have found it difficult to raise money for Aids programmes. Even though there have been real changes in Malawi in the past year in breaking this silence, there is still a problem in speaking openly about Aids. At funerals for example, Aids is usually not mentioned as the cause of death, nor is it usually on death certificates, as the immediate cause of death is the final infection. This is because there is so much stigma and shame attached to this disease, although it is now so widespread that no family has not had a member die from it, and many people now get it who may only have had one sexual partner.
Moreover, Church members are getting Aids along with the rest of the population. In one parish I visited, the priest himself has Aids, which I discovered when I met him. Sadly, although everyone knows (he is in the later stages of the disease) nothing was said, which, in the context of my meeting with the 'Aids Committee', and its commitment to encouraging openness and compassion, illustrates one of the major difficulties. Seeing his wife and children around him, it was particularly tragic that specific pastoral care, counselling and support for them could not be provided because of this silence. In discussing problem areas with some of the volunteers and members of Aids committees, one of the issues they raised many times was how do we counsel people living with Aids, when they do not themselves admit what is wrong with them!
As in other African countries, the Church has regarded Aids as a health problem to be dealt with by the health services, and not something the whole church needs to get involved with as integral to its ministry. When I started the workshop for clergy and church leaders earlier this year I found a real reluctance to discuss Aids (many admitted that they had not wanted to come). I also found some quite judgmental attitudes, such as 'people who got Aids had no one but themselves to blame', or that it was a punishment for sexual sins. There is widespread belief that, as one secondary school student from a church school put it, 'Aids is caused by immorality!'
One of the exciting developments in my recent visit was that I was asked by the government if I could help in getting a closer working relationship between government and the churches. The government has recognised the importance of the role of the churches in controlling the spread of Aids and wanted to work more closely with them. There is a growing awareness now that the churches have the potential for being a powerful force for change in attitudes and behaviour, which has, as yet to be recognised by the churches themselves.
The Challenges for the Church
The Church's attitude to the Aids crisis is critical in controlling the epidemic in Southern Africa. Moreover, this applies to attitudes to HIV/Aids worldwide. The Church has always struggled with the tension between the two 'words' spoken by Jesus to the woman taken in adultery: 'Neither do I condemn you', and 'Go and sin no more'. To which should we give the most emphasis? It seems we are unable to say both simultaneously, as Jesus did. In practice, how can we reach out in compassion to those suffering from Aids, and at the same time condemn the behaviour that leads to infection without appearing to be judgmental?
Another of the issues for the African church is how to deal with intolerable suffering - how to make sense of pain. The question 'where is God in this Aids epidemic' shouts at you when you see it close to, so how do you live with it day by day? How can the Church be equipped spiritually to deal with this level of suffering and deprivation, with the enormous orphan problem and the poverty and destitution of so many? Many of the volunteers I met spoke of the difficulty of going on visiting those living with Aids when they often didn't even have food, or basics like soap, let alone medicines. The volunteers themselves are poor and feel ashamed to visit without taking something. It takes a particular kind of compassion to continue to visit someone when you feel powerless to provide the material help they so badly need. How can they be supported in this solidarity of presence?
To say 'The Body of Christ has Aids' is saying more than that the Church has Aids. The Christ who takes on our flesh and shares our suffering, the Christ who identifies with the hungry, the sick and the prisoner, is surely to be encountered in the person living with Aids. Finally, perhaps the most important challenge to Christians in Britain is to do with the North/South divide and the growing economic inequality and injustice. Campaigning for debt relief, for reform of international trade rules which work against the poor, for a change in the way intellectual property rights are applied which prevents access of poor countries to needed technology and medicines, and for increases in international Aid are crucial in the fight against Aids. However, it is not just the poverty of a country like Malawi. It is the poverty of the church also. The Churches have great potential for influencing the spread of Aids in Sub-Saharan Africa, and are poised to play this crucial role, provided they can be both encouraged and resourced. That is the challenge to the Church here in the UK.
This article is an edited version of a longer paper produced by the late Susan Cole-King. Please contact the MMA HealthServe office if you would like a copy of the full version:
healthserve@cmf.org.uk
