On HIV/AIDS, religion, and public health

Over the years I have lost many to HIV/AIDS: family and friends. I can’t tell you how many, though. I stopped counting a while back. However, I can tell you that, because of the impact of HIV/AIDS on my life, I know what stigma is. I know what it is like to watch people sink into depression, lose hope and die because those who matter most to them have rejected them. 

HIV/AIDS as we have experienced it in the East African context has struck the family as a whole: men and women in their prime and young children have been the typical victims. Our AIDS story has had much to do with heterosexuality. So one can’t simply label HIV/ AIDS a “gay disease” as has tended to happen in the US. Our governments have had to address AIDS as a national crisis because it has stricken the mainstream.

In nations such as the US, where the tendency has been to associate the disease with sexual and ethnic minorities, I get the distinct sense that little mainstream urgency has been attached to the fight against AIDS. There are certainly men, women, and youth who have devoted their lives to fighting this apathy. But, unfortunately, there are also others who tend to view HIV/AIDS as a form of punishment for “breaking God’s laws” on sex and sexuality. Of course, this is not a uniquely American view. I have also encountered it among some people of faith in the East African context.

My interactions with those who have expressed these troubling views have led me to think about just how limited this particular religious approach to human problems is. I’m talking about a specific interpretation of the Christian teachings on sex and sexuality. The idea is that, if everybody limits themselves to following these teachings and only engages in sex within the context of heterosexual marriage then sexually transmitted infections (STIs) such as HIV/AIDS will cease to be a problem. In other words, the only way to curb the spread of HIV/AIDS is to be a “true” Christian.

That is all well and good, except that never in the history of humankind have all members of a given community adhered strictly to its religious teachings: A “true” Christian can get infected with HIV/AIDS even if he or she is firmly heterosexual, married, and faithful. For one, there is such a thing as a cheating spouse. Secondly, infection can be transmitted through rape. Yet another situation that facilitates the spread of infection is transfusion with infected blood and blood products. Yet another is the use of unsterilized medical equipment. The list goes on and on.

Those who persist in seeing HIV/AIDS as a form of divine punishment conveniently forget how closely interconnected we all are. As a result of these interconnections, HIV/AIDS does not discriminate. When you are exposed to the HIV virus, it does not ask whether you are “saved,” pray regularly, give alms to the poor, fast, or obey God’s law. If your defenses are weak, it penetrates them and infects your body whether you are rich or poor, young or old, “innocent” or not, devout or otherwise.

Keeping all of this in mind, how useful is it that a significant number of religious leaders have a simplistic approach to dealing with HIV/AIDS? How useful is it that they condemn it as a sinners’ disease, oppose the use of condoms under all circumstances, and oppose most forms of sex education? Simply put, their actions are not useful. In fact, to the extent that they influence public policy, they end up endangering everybody in the community.

Knowing this, I think that those of us living and working in communities stricken by HIV/AIDS should persist in emphasizing that it is treated by government and health organizations as a public health issue, not a moral issue. From a public health standpoint, we can speak about HIV/AIDS in its complexity. We can also talk about risks, prevention, and treatment. Importantly, we can make an effort to protect everybody.

What is the place of religion in all of this? Well, I honestly think people are entitled to believe whatever their religions teach them. However, I also think their beliefs should be directed towards governing their personal lives and setting moral standards for their religious communities. They should not be imposed on the broader national population as public health policy.

Further reading
"Education, honest dialogue key to halting spread of AIDS," by Chris Carlin and Debra Stanley, 1/17/07, http://articles.southbendtribune.com/2007-01-17/news/26826941_1_hiv-prevention-hiv-testing-new-aids-cases
"HIV and AIDS stigma and discrimination," http://www.avert.org/hiv-aids-stigma.htm 
"Public health approach to combating HIV/AIDS," http://www.searo.who.int/LinkFiles/RC61_12-pa_Item-14.pdf
"HIV/AIDS stigma: an impediment to public health," by Ronald O. Valdiserri, MD, MPH, March 2002, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447072/pdf/0920341.pdf


This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

On societal disapproval of young mothers

The blog post by toradora entitled "I'm Young & Pregnant, But I'm Certainly Not Stupid" is quite the read. In it, toradora describes people's reactions to the fact that she is a young mother.

Toradora highlights people's venomous comments and their condescending attitudes towards her. To me it's interesting to read her description of her experience because it confirms something that I have observed time and again: people are opinionated to the point of being offensive when it comes to parenting, even when they have no idea who they are talking to or what they are talking about. In the twinkling of an eye, absolute strangers can turn into "moral police," and proceed to lecture and insult hapless parents on subjects as diverse as breastfeeding, adoption and childbearing age.

Toradora's "sin," as perceived by the strangers in her story, is that she gave birth to her first child when she was 19 years of age. Now, in her early 20s, she is pregnant with a second child. She is quick to clarify that she does not fit the stereotype of a teen mom who "fell victim" to an unwanted pregnancy. Rather, she was engaged when she first got pregnant, and she and her fiance were thrilled about the pregnancy. Now, she and he are married, have a healthy child, are financially stable, and are looking forward to the birth of their second child. But they still are still subject to the disapproval of strangers and acquaintances who are convinced they know better.

Concisely, toradora sets the issue in context:

My grandmother was 19 when she was engaged, 20 at marriage and 21 when she had her first child. My mother was similar, as were most of my aunts and uncles and other extended family. When did it stop being acceptable for a woman to have children before a career if she wanted to? Or before 25 years old? When did it become unusual to marry young? I have qualifications. Several in fact. I'm married. I did all the things that should have made it "acceptable" for me to have a child. But people still see my age.

And that is the issue I must highlight today: How is it that, within one or two generations, our perspectives of life have changed so drastically? When did we become too narrowminded to recognize that it can, in fact, be normal for a young adult, 19 years old, to choose to get married and have kids, and to be matter-of-fact about it? I recognize that the statistics don't favor early marriages. I also recognize that many in their late teens make unwise decisions concerning marriage and raising families that quickly become untenable. But let's set aside the generalities and talk about individuals. Just because early marriage is unsuitable for many, it does not follow that it is unsuitable for all. Rather than stereotyping, why not set aside our prejudices and take people on their own terms?

Early marriage is a legitimate life choice when it is not the result of coercion or imposition by another, and when it is allowed by the law. This is especially the case in some religiously conservative communities, which recognize that it is unrealistic to expect the majority to abstain from sex until they are 29 or 30 years old. Mainstream society tends to prolong childhood into the mid-thirties and onward, indicating that it is not ideal to settle down and have kids until then. And this may very well be true for many, but it is not true for all. Some people are better off marriying at 32, some are better off not marrying at all, some are better off marrying at 19, etc. Assuming that one or another should apply to all people just does not comport with reality.

One of the unfortunate things about the prejudices that toradora highlights is that, when they manifest at the institutional level, they can lock people like her out of healthcare opportunities that, ideally, they should have access to:

So many times I had to fight to not be signed up for "young mother" programs instead of the mainstream programs. I don't have anything against these programs for what they are, but they were lacking in information, restricted, heavy on counseling and basic life skills, like hygiene classes. They were classes for the many young mothers in my community that simply "don't know." For instance the young mothers birthing classes went for two one-hour sessions and only covered a third of the topics that the mainstream ones did (which went for six two-hour sessions) -- and no, you could not take both. Because I refused the dumbed down class, I was refused all classes.

If anything, this is an indicator that one must be more thoughtful about how he or she approaches others' decisions on parenthood. Being well-intentioned is not enough, after all, we have all heard it said that the road to hell is paved with good intentions. Rather, one must also take pause and recognize that others are not mere statistics or pawns in some larger ideology; they are individuals with their own stories to tell.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.