Abstract
Dedication
Acknowledgements
List of Acronyms
List of figures
List of tables
1. Chapter 1
1.1 Introduction
1.2 Background of study and problem statement
1.3 Activities of churches in HIV/AIDS
1.4 Role of men in HIV/AIDS
1.5 Men’s involvement in care and support
1.6 Research aim
1.7 Research objective
1.8 Hypothesis
1.9 Research questions
2. Chapter 2
2.1 Literature review
2.2 National HIV/AIDS policy 1999 document
2.2.1 Multi-sectoral approach to HIV/AIDS and problems
2.2.2 Upholding of human rights
2.3 Lack of clear theology on HIV/AIDS
2.4 Lack of training in psychological counseling for pastors
2.5 Lack of focus in the provision of care
2.6 Lack of capacity in resources to allow for an alternate approach to care
2.7 The education gaps
2.8 Knowledge on sexuality
2.9 Holistic pastoral training
2.10 Capacity building for care givers
2.11 Exposure to local cultural values
2.12 Holistic care for the affected and infected
2.13 Fighting stigmatization
2.14 Financial support for medical care
2.15 Social support-support groups
2.16 HIV/AIDS and development
3. Chapter 3
3.1 research design
Site
Ethical considerations
Sampling
Data collection
Data collection tools
4. Chapter 4
Data analysis, presentation and interpretation
Figure
Table 1 Age groups of respondents
Table 2 Levels of education attained
Table 3 Occupation and responsibilities
Table 4 Position in church and experience
Table 5 Formal training in HIV/AIDS
Table 6 Ascertaining if support given gets to
Table 7 Role of the church
Table 8 Problems encountered
Table 9 Place for those suffering with HIV/AIDS
Table 10 Pastor’s time to visit the sick
Table 11 HIV and AIDS management
5. Chapter 5
Discussion, conclusion and recommendation
5.1 Discussion
5.2 Conclusion
5.3 Recommendations
5.4 Further studies
References
Appendix 1
Appendix 2
Figure 1 Percentage of questionnaire response rate
Table 1 Age groups of respondents
Table 2 Levels of education attained
Table 3 Occupation and responsibilities
Table 4 Position in church and experience
Table 5 Formal training in HIV/AIDS
Table 6 Ascertaining if support given gets to
Table 7 Role of the church
Table 8 Problems encountered
Table 9 Place for those suffering with HIV/AIDS
Table 10 Pastor’s time to visit the sick
Table 11 HIV and AIDS management
The study sought to evaluate the role of men in HIV and AIDS management in the Evangelical Lutheran Church in Zimbabwe, Harare, Mbare Congregation. Questionnaires were used to gather data from the respondents. An analysis of data collected suggests that there is need for the church to engage its congregants to more information in HIV and AIDS awareness through its teachings. However there is need to train the pastors first before they are ordained and sent out to work with parishioners and congregants
The researcher recommended the introduction of training of pastors in HIV and AIDS issues and that man as decision makers should also be involved in caring, and all management and mitigation issues in relation to HIV and AIDS issues
This project is dedicated to the memory of my late mother Mrs. W. Shoko, whose support and inspiration still lingers and to my loving father, Rev. A. Shoko, a pillar of support and strength
My sincere gratitude is due to Dr. Mufishwa, my supervisor, for the assistance and comments he gave me during the course of writing my project. I also would like to thank my family for the support rendered and understanding my absence from the family table and my employers for giving me the support and time needed to attend to my studies
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A number of years have passed since the publication of the first report on what was to develop on the AIDS pandemic. During those years, HIV has spread at an accelerating rate in every continent and AIDS now affects every country in the world. In June 2006, recognizing the progress made in recent years in the global response to the pandemic, United Nations Member States took the bold step of committing themselves to the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2015, (Kelly, 2010). This in turn requires that the response at international, national and local levels be stronger, more strategic and better coordinated.
Statistics for the end of 2009 indicate that around 33.3 million people are living with HIV, the virus that causes AIDS. Each year around 2.6 million more people become infected with HIV and 1.8 million dying of AIDS, (UNAIDS, 2010). The worst affected region is sub-Saharan Africa, where in a few countries more than one in five adults is infected with HIV. The epidemic is spreading most rapidly in Eastern Europe and Central Asia, where the number of people living with HIV increased by 54.2% between 2001 and 2009.
Kelly (2010) also concurred with the UNAIDS report as he indicated that the number of people living with HIV world wide rose from around 8 million in 1990 to 33 million by the end of 2009.The region of sub Saharan Africa shows that a total of 1.3 million is also infected and some are living with HIV/AIDS.
Sub-Saharan Africa is more heavily affected by HIV and AIDS than any other region of the world. An estimated 22.5 million people are living with HIV in the region, around two thirds of the global total. In 2009 around 1.3 million people died from AIDS in sub-Saharan Africa and 1.8 million people became infected with HIV. Since the beginning of the epidemic 14.8 million children have lost one or both parents to HIV/AIDS, (UNAIDS, 2010).
The social and economic consequences of the AIDS epidemic are widely felt, not only in the health sector but also in education, industry, agriculture, transport, human resources and the economy in general. The AIDS epidemic in sub-Saharan Africa continues to devastate communities, rolling back decades of development progress. This has also impacted on the provision of health care, antiretroviral treatment, and support to a growing population of people with HIV-related illnesses.
According to the Dube (2003) both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in Namibia, Zambia and Zimbabwe around 10-15% of adults are infected with HIV. Southern Africa is the worst impacted by AIDS; in South Africa the HIV prevalence is 17.8% and in three other southern African countries, the national adult HIV prevalence rate now exceeds 20%. These countries are Botswana (24.8%), Lesotho (23.6%) and Swaziland (25.9%).
West Africa has been less affected by HIV and AIDS, but some countries are experiencing rising HIV prevalence rates. In Cameroon HIV prevalence is now estimated at 5.3% and in Gabon it stands at 5.2%. In Nigeria, HIV prevalence is low (3.6%) compared to the rest of Africa. However, because of its large population it is the most populous country in sub-Saharan Africa, this equates to around 3.3 million people living with HIV, (UNAIDS, 2010). However adult HIV prevalence in East Africa exceeds 5% in Uganda, Kenya, and Tanzania as indicated in the UNDP, (2008) report.
The UNDP report further indicates that HIV and AIDS are having a widespread impact on many parts of African society which include the effect on life expectancy and it has erased decades of progress made in extending life expectancy. Average life expectancy in sub-Saharan Africa is now 52 years and in the most heavily affected countries in the region life expectancy is below 51 years. It also has an effect on households especially when families lose their income earners. In other cases, people have to provide home based care for sick relatives, reducing their capacity to earn money for their family. In all affected countries, the epidemic is putting strain on the health sector because as the epidemic develops, the demand for care for those living with HIV rises, as does the number of health care workers affected, (UNDP, 2010).
Schools are also heavily affected by AIDS and this is a major concern, because schools can play a vital role in reducing the impact of the epidemic, through HIV education and support. The HIV and AIDS epidemic has dramatically affected labor, which in turn slows down economic activity and social progress. The vast majority of people living with HIV and AIDS in Africa are between the ages of 15 and 49 and in the prime of their working lives, (Ham, 2004). The HIV and AIDS epidemic has already significantly affected Africa's economic development, and in turn, has affected Africa's ability to cope with the epidemic.
In many parts of Africa, as elsewhere in the world, the AIDS epidemic is aggravated by social and economic inequalities between men and women. Women and girls commonly face discrimination in terms of access to education, employment, credit, health care, land and inheritance. These factors can all put women in a position where they are particularly vulnerable to HIV infection. In sub-Saharan Africa, around 59% of those living with HIV are female, (Ham, 2004). In many African countries, sexual relationships are dominated by men, meaning that women cannot always practice safer sex even when they know the risks involved.
Furthermore, Zimbabwe is experiencing one of the harshest AIDS epidemics and the first reported case of AIDS in Zimbabwe occurred in 1985. By the end of the 1980s, around 10% of the adult populations were thought to be infected with HIV, (UNAIDS, 2005). This figure rose dramatically in the first half of the 1990s, peaking at 26.5% in 1997. The UNGASS, (2010) report also indicates that according to government figures, the adult prevalence was 23.7% in 2001, and fell to 14.3% in 2010.
Although the National AIDS Co-ordination Programme (NACP) was set up in 1987 and several short term and medium term AIDS plans were carried out over the following years, it was not until 1999 that the country’s first HIV and AIDS policy was announced. At the same time, the government introduced an AIDS levy on all taxpayers to fund the work of the NAC. While these measures have had a positive impact, the government’s response to HIV and AIDS has ultimately been compromised by numerous other political and social crises that have dominated political attention and overshadowed the implementation of the national AIDS policy. The NAC has also been constrained by poor organization and a lack of resources.
Efforts to prevent the spread of HIV in Zimbabwe have been spearheaded by the NAC, non-governmental, religious and academic organizations. Prevention schemes have been significantly expanded since the turn of the millennium, but remain critically under-funded. In addition to the impact of mortality, it is believed prevention programmes aimed at behavior change and the prevention of mother to child transmission have also been instrumental in bringing about a decline in HIV prevalence, (Hallett, 2006).
In 2006 the Ministry of Education, Sport and Culture, and UNICEF initiated an in-service training scheme of primary and secondary school teachers in HIV and AIDS life-skills and counseling. The UNGASS report, (2007) also indicates that by the end of 2007 around 2753 primary and secondary schools had been reached by the scheme and outside of school, efforts to educate and inform people about HIV and AIDS which are often organized by NGOs have used a number of different means to convey prevention messages, including television and radio, drama, and community groups.
There are large social and economic gaps between women and men in Zimbabwe, and these inequalities have played a central role in the spread of HIV. Constrictive attitudes towards female sexuality contrast with lenient ones towards the sexual activity of men, resulting in a situation where men often have multiple sexual partners and women have little authority to instigate condom use. Sexual abuse, rape and coerced sex are all common, and as the economy deteriorates more women are turning to sex work as a means of survival, (Mail & Guardian Online, 2010). Prevention campaigns that emphasize safe sex and abstinence often fail to take into account these realities, and are more applicable to the lives of men than those of women.
Churches in Africa, rooted in communities, are influential institutions which can be a force for transformation, bringing healing, hope and accompaniment to all people affected by HIV. AIDS competent churches in Africa need to demonstrate the ‘ministry of presence’, as they have the responsibility to assist orphans and widows found in such situation through home visits, food distribution, educational support and HIV/AIDS education among others.
Visiting orphans and vulnerable children in their homes is a key characteristic of a church ‘with ears’ for it is absolutely crucial for churches to ensure that children remain within their families as much as possible. The best way to serve vulnerable children is to strengthen the capacity of families and communities to care for them. AIDS competent churches pay home visits to families who are catering for orphans and vulnerable children. Chitando, (2007) suggests that feeding the hungry is a Christian duty and responsibility. The HIV epidemic in most parts of Sub-Saharan Africa has led to the emergence of many hungry households due to the loss of productive labor that has resulted in decreasing yields in some countries. Furthermore, households headed by children and grandparents often lack the labor necessary to ensure adequate yields and as a result, many orphans and vulnerable children face starvation and malnutrition. Many churches are doing a commendable job in distributing food to orphans and vulnerable children.
Churches should also strive to ensure that children’s rights to education are upheld. Churches also are involved in the provision of HIV education to youth in school and to those who might have dropped out. AIDS competent churches ensure that community leaders fully appreciate HIV education for all young people, including orphans and vulnerable children. Moreover, the church has also a leading role in denouncing the abuse of children, including the abuse of children within their own institutions. In line with the biblical mandate to defend the rights of orphans and widows, churches in Africa also consistently uphold the rights of orphans and vulnerable children in the era of HIV. At the local level, some churches have been actively involved in assisting orphans and vulnerable children. In Zimbabwe, the Salvation Army Masiye Camp in Bulawayo established a Mobile Law Clinic. This has been a positive intervention, as it has enabled children to obtain birth documents.
Men are influenced by cultural norms regarding manhood, some of which are very negative in the context of HIV and AIDS for social, cultural and economic reasons, (Dube, 2003). Man are often in a stronger position in a relationship with women, this gives them more control in deciding when, how and where to have sex as well as whether or not to use condoms. Because of their position man can be good advocates for behavioral change and social responsibility. Attitudes, tradition and culture affect men’s sexual behavior as in most cultures boys and men do have more sexual partners as compared to girls and women. Some traditions can result in increased rate of HIV and AIDS infection. And this include polygamy, circumcision, inheritance, tattooing.
The concept of masculinity differs from one society to the other, depending on the socio-cultural situation. It is defined as a set of attributes, values, functions and behaviors that are considered normal conditions of men in a given culture, (Geissler, 2004). In most societies masculinity is culturally constructed. The socialization of boys and men regarding sexuality is one of the areas of masculinities that are of major concern to day, in face of the HIV/AIDS, especially in Africa. Most men and boys are socialized to believe that they are entitled to have sex and that it is natural to have many partners. Boys and men are socialized to believe that sex is their right and that they are entitled to it whenever they want it, (Wainaina, 2006). Girls are socialized to be submissive, service oriented and self-sacrificial. They grow up believing it is their duty to serve and satisfy men. Some women believe the lie that it is natural for men to have many partners or to exercise power over them. Even when they know their partners are involved in risky behavior, they lack the power to negotiate safe sex and to say no to irresponsible men. Polygamy is an accepted norm by both women and men in many societies; and multiple partners are justified as a form of informal polygamy.
Wainaina, (2006) further, alleges that culture plays an important role in the spread of HIV/AIDS. Practices such as widow inheritance, polygamy, female genital cutting, early sexuality and dry sex affect the individual’s risk of contracting or transmitting HIV. Some men use violence to make their partners have sex with them. Sex coercion happens in and outside the home. Younger girls are forced or enticed into sex relations with older men because these men believe that young girls are free of the virus. In the recent past cases of violation of baby girls by adults have greatly increased, and as the pandemic ravages communities there is no end to the atrocities being committed by many in situations of despair, and who are looking for cure even in the most unlikely places.
The gender division of labor in most societies puts the burden of looking after the sick on women. Often women will care for the men in their families, but if women get infected, they depend on their children or relatives to look after them. Involving men in the prevention, care and support of those living with the epidemic is one of the ways of bringing change. Men are the key decision-makers in all aspects of the transmission and the power to protect themselves and their partners, (Geissler, 2004). Engaging men in giving care brings them face to face with the realities of HIV/AIDS, and the need for change. Men’s participation in dialogue, giving personal testimonies and analysis of things that are happening to men and boys in families and in society is one of the effective strategies that can be used to help those men living with HIV/AIDS and for helping others to change their behavior. In most societies, women have support groups and more openly share information and concerns than men. Creating forums for men to share, discuss and agree on action is an effective way of mobilizing their support and changing their attitudes and behavior (Van Klinken, 2011).
The Men as Partners (MAP) is a multi-faceted intervention designed to engage men in reducing gender based violence and to promote men’s constructive role in sexual and reproductive health, including HIV/AIDS initiative in South Africa. The programme is carried out through a partnership of civil society organizations collaborating with Government and academic organizations, to transform the behavior of men and the norms of masculinity. The MAP is an initiative of the Engender Health and the Planned Parenthood Association of South Africa (PPASA). The programme aims to challenge the attitudes, values and behavior of men that compromise their own health and safety as well as the health and safety of women and children; and to encourage men to become actively involved in preventing gender based violence as well as in HIV/AIDS related prevention, care and support activities (Jackson, 2009).
In several African countries faith based organizations have taken a lead in these initiatives, particularly responding to the growing threat of HIV/AIDS, gender based violence, drug and substance abuse and indiscipline in learning institutions at all levels. Media programmes, production of educational materials, drama and theatre groups are some of the other activities that are gaining popularity. In Kenya, an annual event known as the national drama and music festival is playing a crucial role in mobilizing the creativity of young people in schools through-out the nation in composing songs and drama on the theme of HIV/AIDS.
HIV/AIDS have become a reality in homes and all families in Zimbabwe have experienced the horror of the AIDS suffering and deaths. The situation is beyond imagination given that those who are HIV positive continue to spread the virus in one way or another before they as infected people develop the full blown AIDS.
In Zimbabwe, assistance has always been integrated into the country’s national program to mitigate HIV/AIDS. PEPFAR activities cover all regions and are organized around three main technical areas: 1) strengthening and intensifying systems for prevention, care, and treatment services; 2) developing innovative, evidence-based program models and tools that will be expanded to national scale with leveraged resources; and 3) developing technical and organizational capacity of indigenous organizations to scale up and sustain programs. In addition to contributing directly to the country-led HIV/AIDS program, USAID closely coordinates with other donors to identify opportunities for complementary support of common HIV/AIDS mitigation goals. These efforts have produced active collaborative support approaches with USAID, UNFPA, WHO, the Global Fund, and UNICEF (UNAIDS, 2009).
USAID provides HIV/AIDS support to Zimbabwe both on a bilateral basis and through its Regional HIV/AIDS Program for Southern Africa. The Mission has worked to create synergies with other programs in-country, integrating HIV outreach with other health services. Major emphasis is placed on efforts to address TB-HIV co-infection and integrate family planning services with voluntary counseling and testing (VCT) and PMTCT activities. Program linkages with the humanitarian assistance portfolio include targeted feeding programs for OVC, HIV-infected and affected households, ART recipients, and infants who benefit from the PMTCT program. USAID has also enhanced the capacity of civil society organizations that engage in HIV/AIDS issues. Other USG activities include HIV/AIDS counseling and testing services; social marketing of condoms; strengthening the capacity of civil society to formulate and advocate for improved HIV/AIDS policies; support for community responses to the needs of OVC; and support services for those living with HIV/AIDS. USAID supports PMTCT efforts and scaling up ART interventions. USAID assistance accounts for nearly all male and female condoms distributed through both public and private sector channels in the country, (USAID, 2010).
Mbare area has been a place where many nationalities have been staying and this point can depict that many activities are happening with some prone to HIV/AIDS. The researcher has found out that counseling facilities are provided and the clients are given the choice to choose where they would feel comfortable to have their counseling session taking place. At the Mbare poly-clinic voluntary counseling facilities are also provided and they have been found to very effective in the battle against HIV/AIDS. There is provision of clinical services for opportunistic infections and referrals for ARVs or ART. In addition psychological support is also provided for people living with HIV and AIDS at these places as well through support groups where they are given training on positive living.
There is also the provision of psychosocial support groups that are tasked to provide services like outreach education on HIV and AIDS, educating mothers on prevention from parent to child transmission and behavior change strategies. The prevention of new infections is also one of the important matters the support groups deals with. There have been some strides in the fight against HIV/AIDS as portrayed by provision of many services and high information dissemination. There have been a quite good number of people who have been coming open and talking about their HIV/AIDS status. People living with HIV/AIDS are involved in income generating programmes and are able to sustain themselves and continuously fight against silence and stigmatization on HIV and AIDS.
However, although all the support and programs are conducted through the government and other churches, the ELCZ in particular at Mbare congregation has not been doing much to show the biblical concern for those infected and affected. Despite that some church members have been affected hence this implies that the church is also infected. The church has then to strengthen its teachings on care, support and prevention and involving men becomes imperative as man are influenced by their cultural behavior.
The Evangelical Lutheran Church in Zimbabwe was founded in 1903 by missionaries of the Church of Sweden Mission and African evangelists from Natal (South Africa). It began with educational work to enable converts to read the Bible. Medical work was added in 1915, thus completing the three-fold ministry of Christ of preaching, teaching and healing. It aims at becoming a self-supporting and self-propagating church that cares for the sick and suffering and exercises the ministry of diakonia, and strives to overcome ignorance and superstition through sound education.
The church has four hospitals, two of which have been designated Districts-Referral hospitals by the government. One has also a nursing school. The church runs four primary and seven secondary schools, of which six have an "A-level" component. Nine of the schools have units for visually impaired and hearing-impaired pupils at primary, secondary and high school levels.
Some of the constraints and challenges the church is facing are the shortage of pastors and senior medical staff, the HIV/AIDS pandemic, unemployment, poverty and high inflation. The ELCZ through it partners is actively involved in HIV/AIDS Awareness, Prevention, Home Based Care Programme, and Care of AIDS orphans by providing them with shelter and education. Also related to this priority is the training of Home Based Care volunteers, Counselors, and the establishment of Voluntary Counseling and Testing Centers in all church Hospitals and peri-urban centers.
However they are also faced with the challenge of declining health care services due to economic factors. There is need to contribute towards making health care accessible to the ordinary folk in the village, this is becoming more important today due to the HIV/AIDS pandemic. Drugs, staff and equipment are in serious short supply due to foreign currency shortages and the critical shortage of nurses is affecting though the church has one training school. It is also affected by lack of personnel and modern equipment to run the school of nursing.
The ELCZ and the Lutheran Communion in Southern Africa (LUCSA) member church leadership, which included leaders of women and youth groups, participated in the Pan-African Lutheran Church leadership Consultation on HIV and AIDS held in Nairobi in 2002. The participants themselves at that Consultation solemnly committed themselves and their churches to:
- Advocate and break the silence on HIV & AIDS
- Become healing community through prayer and action
- Learn and teach themselves and their communities about HIV and AIDS
- Provide care, prevention and counseling
- Further develop their theological understanding of the challenges of HIV and AIDS
- Fight poverty and work towards securing the live hood of people living with and effectuated by HIV and AIDS
This was aimed at exposing church leaders to other AIDS action/prevention programs in the region to enable them to break the silence, fight stigma and discrimination and provide accurate information on HIV & AIDS. Capacity building / training in all aspects of the HIV & AIDS ministry to enable member’s churches to be meaningfully involved in the fight against HIV & AIDS and also to equip pastors with knowledge and skills for the care of persons living with HIV and AIDS (PLWHA) and those affected. It was also a strategy to raise awareness on survival skills workshops for persons living with HIV & AIDS, promoting opportunities for open dialogue across age and gender groups and to provide youth training that integrates HIV/ AIDS, life skills and Information technology (LUCSA, 2010)
The challenges posed by HIV and AIDS on the African community have become tormenting and endemic. Governments, Non-Governmental Organizations (NGOs), Churches and Faith Based Organizations (FBOs) continue to carry out various initiatives to tackle these challenges. However, in this whole picture, the burden for care and support still rests on the shoulders of women and men remain in the sidelines providing little to no assistance.
Churches have challenges in addressing HIV and AIDS issues because of lack of openness on the topic. Men remain in the background, not participating in any such activities, and yet it is one of the Gospel mandates of the church to care for the sick and the needy hence there is a need for any challenges that the church is facing to be solved so as to address HIV and AIDS challenges in the community.
The church is also affected by HIV and AIDS, hence it needs strategies to address the silence, stigma and discrimination attached to the subject and take part in providing care and support to those infected and affected. The church is limited by lack of a focused capacity to provide support, care, counseling, and management and to finance an HIV and AIDS initiative. However, in all areas including in Mbare, the church plays an important role as a safety net, hence it is in a good position to work on HIV and AIDS issues. It can also provide men an entry point into the provision of HIV and AIDS support services.
1. To identify the role of men in church.
2. To identify the gaps in the church’s response to HIV/AIDS pandemic.
3. To come up with the ways to help the church in addressing HIV and AIDS from a pastoral perspective.
The Hypothesis is that the Lutheran Church lacks the capacity to be usefully involved in care giving for HIV and AIDS.
1. What is the role of men in church?
2. What are the teachings of the church in response to HIV and AIDS?
3. How can churches mobilize men in their overall response to HIV and AIDS?
The fight against HIV and AIDS displays broad based multi-sectoral responses, as proposed in the National HIV and AIDS Policy Document of 1999. This policy is a guide for the government ministries departments, the private sector, non-governmental organizations, the churches, communities, and community based organizations including support groups for people living with HIV and AIDS, the media and international collaborating partners.
HIV and AIDS have been addressed through a multi-sectoral approach coordinated by the National HIV and AIDS Council (NAC). It is expected that all sectors, organizations and communities are to participate actively in the fight against HIV and AIDS. The National AIDS Policy serves as basis for this approach.
Human rights and dignity of people are important despite their status. The policy document ensures that people living with HIV and AIDS are protected. This is aimed at fighting against discrimination and stigmatization. In addition, the National Policy encourages knowledge aimed at changing the attitudes of the general public on PLWHA.
According to Khathide (2003:3-4) the concept of the past theology makes the African theological student to fail to address the present HIV and AIDS problem. Christian theology does not contribute at all positively to the solution of HIV and AIDS and other African problems. Furthermore, Khathide (2003:4) echoes that spiritual needs are as important for the body as bodily needs are for the soul.
Consequently such acknowledgement will help people understand the scourge of HIV and AIDS in holistic manner. The above view is also supported by Anderson (2001: 39-47) who argues that the soul and the body are one and they need to be treated equally.
The consequences of lack of a clear theology on HIV and AIDS are grave. Some people believe that HIV and AIDS is a punishment from God. It needs to be pointed out that HIV and AIDS is not a judgment from God as by now many people are aware that there are various ways in which the disease can be spread. We agree with Reid (1987:30) that “we need therefore, to be clear that individual cases of AIDS should not be considered to be individual visitation of a vengeful God”
In the Old Testament, the prophets were always keen to speak up for those who had no voice and whose opinions were discounted. Prophets were actually the voice of the voiceless and guided Israel in pointing out inconsistencies and injustices. For example, the prophets` had deep concern was for the poorest of the poor, for the dispossessed and dejected. Equally Jesus in his preaching and ministry says he came:
“…. To announce the good news to the afflicted…to proclaim liberty to captives, sight to the blind, to let the oppressed go free, to proclaim the year of the Lords favor” (Lk 4: verse 16). The church has the responsibility in this age of HIV and AIDS to speak up against the stigma and discrimination, the lack of equity in medical provision, the vulnerability of women and children. ``
We argue then that this battle against HIV and AIDS ought to be everyone’s battle. There is need to mobilize ourselves to bring to our brothers and sisters affected by HIV all need the necessary material, care, moral and spiritual support.
It has been realized that so many people infected and affected by HIV and AIDS have been living in a hopeless state. Some have even taken away their lives as they see life not worth living because they see God lacking in their lives. Therefore, the need for capacity building for the pastors in the Church in this area would make them to be more effective in the battle against HIV and AIDS by providing effective pastoral care. There is need to bring a message of hope to all affected and infected that God is a caring, loving, and forgiving father.
There is need for a clear theology about God, to emphasize the point that He is the God that loves beyond AIDS. He is never a curse nor a condemnation to hell. Due to lack of proper theology on AIDS, some pastors have contributed to the stigmatization of people living with HIV and AIDS.
In most instances, pastors lack skills in counseling. This is so because in some cases most theological training did not address these areas of concern today. The nature and duties of the pastoral office are very important. Unfortunately most pastors lack skills and knowledge on HIV and AIDS counseling and yet it is their duty to provide pastoral care and speak publicly in solidarity with the poor and the oppressed.
In this era of HIV and AIDS pastors are tasked to visit the sick and distressed, provide counseling, bury the dead, and unfortunately due to their lack of training in psychosocial counseling the church’s battle against HIV and AIDS and their interventions are less effective. The Church is there to show it self who really it is through its perfected works (Patton 1993:14).
Therefore, by having proper training and skills on HIV and AIDS counseling, the pastor would be able to bring the message of hope to people with HIV and AIDS. A message that echoes love assuring the infected and affected that God remains committed to his people. This is explained well by his identity and his purpose. For example God says, “I am who I am (Exodus 3 verse 1-15). This is similar to when Moses encountered with God he was on the burning bush, where he was instructed to go to Egypt and save the Israelites who were being oppressed by King Pharaoh. God said to Moses “I have seen the suffering of my people”. There is no doubt that when the pastor is well empowered with the knowledge and skills he/she will pass the message of God to His people ``I have heard their cry. I knew their suffering and have come down to deliver them “(Exodus 3: 7-10). Here we see the God of action. He is an exodus God, and the whole faith of the Jewish people was built and founded on their communal experience of this profound God.
Yahweh frees his people and enters in their struggle for life. Likewise Yahweh frees his people and enters in their HIV and AIDS struggle. It is through the use of scriptures that people learn that God of Israel is the holy one who enters the drama of life. The same God can enter the drama of life and be with people affected and infected with HIV and AIDS. God promises his people that his love will never leave his people. “My love shall never leave you “Isaiah (4:31),” he shall not abandon and destroy. You, nor forget the covenant “(Deuteronomy (4:31). There is no doubt that God has made a promise with his people and he will not forget or go back on his promise, his word is a word that can be trusted (Jer 3:11, 13, 31:20, Hosea 11:1 and Isa 49:15) using the above scriptures it highlights that in today’s situation of the HIV and AIDS pandemic God is with us. God’s love shall never leave us.
Most care is focused on patients who are mostly Institutionalized: on hospital beds or hospice, often leaving the affected mostly spouses and children without any or little attention. It is therefore vital that there is a holistic approach to the HIV and AIDS problems.
Moreover, it is the duty of a pastor to ensure that love, acceptance and forgiveness are communicated to both patients institutionalized, and those at home or spouses and children who are affected. Prayer for the persons and families affected by HIV and AIDS should start from the families, community and then out to the Church or Parish. It is in recognizing, Christ in the Eucharist and the faith community that people can see and welcome God in all other people.
The most and effective ministry and out reach to persons suffering form HIV and AIDS is the one to one contact made by individuals parish members. Consequently it is the duty of the pastor to help the parishioners to see that when neighbor’s, associates and friends suffer a serious illness, the parish must be active in its witness as compassionate healer and friend.
There has been a lot of emphasis on home based care and sometimes institutionalized hospice care which have yielded much result. However, the researcher is of the view that there are still some gaps created in that, when people are institutionalized or are cared for at their own homes, mostly the burden is on the affected families, distancing the community. For this reason, it is argued that instead of hospice and home based care, there is need to promote the aspect of community care. According to Zulu (2001:6), African people value community life so much. They believe that individuals are shaped by society in which they live. People express themselves best in the community because it is the community that shapes a person that accords persons the opportunity to discover their self, and sets the challenge of living to their potential. Each person belongs to the community. As a result to ``be`` or to ``belong`` is to participate in one’s community. Thus Africans see life as life in the community. Therefore, the infected need to be taken care by the community as this will remove alienation and often stigma. In this aspect of care the whole community is involved, instead of the family and the care provider(s).
It is through the pastor that the aspect of community care can be effectively promoted. However, there is always lack of material resources to promote such care.
This section deals with Educational gaps in HIV and AIDS fight. Educational gaps are understood as the areas where education is lacking in the Church’s battle against HIV and AIDS. Education is a vital weapon in the battle against HIV and AIDS. For example, awareness campaigns have played an important role not only encouraging people to be tested but has also provided them with correct information concerning the virus and made people to continue to live a normal positive life. Education, replaces despair with hope, self-condemnation with re-assurance, fear of having been bewitched with proper facts about HIV and AIDS, and fear of contracting the disease through casual contacts with the sick with facts on how such care should be provided.
The Church has been playing a leading role in the battle against HIV and AIDS in Mbare. However, the Church has not adequately been able to handle the case of sexuality openly and honestly. However, the researcher is of the view that there is need to re-examine this position. Hence the church encourages individuals to value marriage and takes the family as a community of persons which is the first human society. The church encourages the sacrament of marriage; one wife and one husband until death parts them. The Church needs to open up discussions, particularly marriage and sexuality as it is cardinal to fight against HIV and AIDS. It cannot ignore the prevalence of sex outside marriage taking place such Issues of infidelity, pre-marital sex and small house saga as they perpetuate the spread of HIV and AIDS.
Khathide (2003:1) indicates that Sexuality is often a taboo subject in the Churches or is discussed only in the general terms of broad morality. In most case people often find that when they talk about sex in public they are faced or ``Don’t talk about sex we are Africans`` with comments such as ``Don’t talk about sex we are Christians`` It is only through open discussion that people will open up to such language and end up deepening their knowledge and skills on how to handle sexuality in a mutual way. Hence the Church has first to listen and acquire enough knowledge and skills on HIV and AIDS in order to be an effective teacher. It needs to be accurately and well informed and to continually keep itself up to date.
The church needs to reflect on what the spirit is teaching it through HIV and AIDS pandemic. Otherwise ignorance, suspicion and prejudice will prevail. In truth the Church require far more education on theological reflection on the nature of pandemic in order to be more effective. This is why one could still raise the question: why is that there are not more biblical scholars and theologians in the developing world and elsewhere who are reflecting seriously on HIV and AIDS pandemic? There is need for the church to look into the above question and take action. It is also important to remember Jacobs` dream people struggle to find God in the Context of HIV and AIDS but God reminds people that they are standing on holy ground; God is present in life’s experience. (Gen.28:10-16) It is through having this knowledge that people who are hopeless due to HIV and AIDS pandemic will have hope in God.
Education is a very powerful weapon in the HIV and AIDS battle. The education sector has been affected by HIV and AIDS as a big number of teachers and other active in the system, such as inspectors, administrators etc are HIV and AIDS patients and some are dying and the education department is badly affected. This gap created by death is difficult to fill up as there are few enough students who are trained for theology and HIV and AIDS. For example, the death rate among teachers is said to be about 70 percent higher than among the general adult population, and the number of teachers dying from HIV and AIDS is twice as high as the number of teachers completing their teacher training. This great number of deaths also affects the Churches intervention on HIV and AIDS.
The Church is lacking education for all concerning HIV and AIDS, including facts as well as attitudes, urging strongly for the integration of a through study of HIV and AIDS into pastoral training. It is through having knowledgeable pastors that the Church’s response to HIV and AIDS would be more effective. Theologians can be effective weapons in the battle of HIV and AIDS.
Consequently there is a challenge for the Church to examine the formation of those who are going to minister in the context of HIV and AIDS in future. It needs to equip them with sound teaching to be effective in the ministry. People need to be re-educated on their wrong ideas about seeing God as a God who punishes using diseases.
Jesus explicitly rejected the notion that any disease is a direct punishment from God for someone’s sin ( Luke. 13:2-3, 17:12, John 9:2-3) The innocent victims of HIV and AIDS needs to know that there are inequities in this life (Psalm 73). It is surprising that at times the innocent suffer and the wicked appear to be getting away with their sins. This is highlighted by Job who never understood the reason for his affliction.
Therefore AIDS patients must place their hope in God. (Job 9:25-26) It is important to note that there are also some instances within the scripture in which disease is a direct action of God, for example in the life of Gehazi the servant of Elisha (2 Kings5: 27), the teaching of Jesus clearly shows that God does not use disease to punish sin. This is highlighted by Jesus` healing of a man born blind (Ryken 2000:182-184).
The Church’s ability to accompany people suffering from HIV and AIDS is restricted by its lack of knowledge, skills, confidence, and by the problem of shortage of necessary resources. The Church needs education in accompanying those who are carrying the stigma of HIV and AIDS. There has been lack of sensitivity and the fears created by stigmatization. It is through having appropriate approach and resources that the clergy, laity and in particular young people will respond to HIV and AIDS intervention.
However, all this will be done more effectively with the use of education. Both Church leaders and the ordinary people need to be educated in the area of HIV and AIDS focusing in the area of theological aspects. People living with HIV and AIDS may be the most useful resources for the Church. The Church has been failing to make use of the people living with HIV and AIDS to help in the battle against HIV and AIDS. UNAIDS describes people living with HIV and AIDS as the `wounded healer of this era.
To begin with, we need to indicate that culture and religion cannot be separated. According to Dearman (1992:2-3) there is an inseparable relationship between world view, religion and culture since religion is not only an idea or ideological, but it is expressed in cultural symbols, in a specific society, in a real life situation. This means that we need to pay attention to culture as it through it that religion is expressed and vice versa any religion expresses a particular culture. In Africa, most communities do value their cultural practices. This is why it is important to see that when we communicate the gospel to them we need to take into account their cultural context. In the HIV and AIDS fight unfortunately culture is found to be among the contributing factors of the effective prevention of the epidemic. It has also contributed to the stigmatization of people suffering from HIV and AIDS. It is therefore, imperative that the people involved in the HIV and AIDS are exposed to the local culture so as to be effective.
One cannot hesitate to say that Christian theology has, intentionally, reinforced stigma, and increased the likelihood of discrimination. However, Christian theology has also, often, been successful in challenging society’s injustices and encouraging some of the cultural values that are good as well as challenging cultural vales that are not good and bringing peace and change.
This idea is supported by the theological bases on which reformers argued for the abolition of slavery and other notable activities that resulted in bringing peace to the individuals in society. (A WCC Study Document Facing AIDS 1997:36) “God’s word is a word that can be trusted (Jeremiah. 3:11, 13, 31:20, Hosea 11:1; Isaiah. 49:15). This is why the Church has been putting more effort in:
- Challenging beliefs and attitudes in individuals and in society that help to generate ignorance, fear, stigma and dissemination.
- Vigorously promoting human rights and dignity of helping to break the silence of denial. In parish groups, homilies, liturgy the church is not boldly or openly speaking about HIV and AIDS.
- End the ignorance on HIV and AIDS that still prevails and encourage cultural values that are good and throw away those that are not good.
- Bring hope, healing and reconciliation to those infected and affected through the scripture and the use of cultural values that are good.
- Deepen knowledge on African culture and skills on listening to those living with HIV and AIDS and create in communities of faith places of welcome.
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