February 6, 2011

HIV/AIDS stigma in Africa: Is the church part of the problem or part of the solution?

By Catherine Campbell, Morten Skovdal and Andrew Gibbs
Institute of Social Psychology, London School of Economics and Political Science

HIV/AIDS-related stigma is one of the key drivers of the AIDS epidemic in many settings. Stigma prevents many people from seeking proper information about how to protect their sexual health, accessing services when they are ill from AIDS, and adhering to their medication.

Where does the stigma come from?
Stigma is rooted in a number of factors. Chief amongst these is a sense of social embarrassment about sex – closely related to conservative social moralities inherent in many societies. Such moralities play a key role in the social control of women and young people by adult men.

This is often manifested in social systems in which female sexuality is strictly controlled by husbands or boyfriends, and where young people are expected to remain celibate. The latter is often an unrealistic expectation; there are few cultures and contexts in which youth do not engage in some form of sexual activity, albeit often in secret. Women are expected to remain faithful to their husbands.

On the other hand, people pay lip service to the ideals of male fidelity to their wives. But, it is often the case that men feel free to have multiple partners and extramarital sex – implicitly condoned behavior, as long as men are discreet about their activities. This is particularly the case in macho cultures committed to the notion of men possessing irrepressible sexual urges.

Despite these perceived social norms, women and young people have always engaged in “illicit” sexual activity, but have generally done so in secret. The AIDS epidemic has disturbed this situation by making it increasingly impossible for many sexually active women and youths to keep forbidden relationships secret  -- given the very obvious signs of the illness, especially in its later stages. The resulting stigma is driven by social outrage directed at people affected by AIDS, who dared to challenge adult male control of their behaviour. Stigma becomes a patriarchal society’s symbolic punishment for those who dared to challenge the status quo.

HIV-positive men are despised and stigmatized because they have failed to be discreet in their sexual transgressions, and are no longer worthy of respect or dignity. Furthermore, machismo is associated with a healthy and potent male sexuality. A man whose sexuality has become ”diseased” becomes an object of contempt rather than secret admiration.

The church’s role in fueling HIV/AIDS-related stigma
Many have associated church teachings with the types of male-dominated conservative sexual moralities referred to above. The Bible preaches that wives should obey their husbands, that women should not engage in extramarital sex, and that young people should do what they are told (in this case, “abstain” from sex).

Against this background, our recent paper in AIDS and Behavior (click here to view journal article) examines the literature on church responses to AIDS. In the majority of studies we reviewed, the church perpetuated the stigmatization of people with HIV/AIDS through its moralistic attitudes and its support of conservative gender ideologies.

Many churches insist that extramarital sex is “sinful;” some even go so far to say that AIDS is God’s punishment for sexual transgressors. Such negative attitudes often lead to denial of AIDS in public church settings, creating a setting in which church members living with AIDS are reluctant to disclose their HIV status – leaving people to suffer the disease’s terrible emotional and physical ravages completely unsupported by what was likely their most significant social network. Furthermore, many churches have also propogated that condoms are for sinners only, thus playing a very negative role in HIV prevention efforts to increase condom use.

However, this is not always the case. There is evidence that, in some cases, the church has played a key role in supporting members living with or affected by HIV/AIDS This role includes visiting the sick, praying for them, and offering them varying forms of practical help. There are even a few cases when churches have spoken openly against the stigmatization of victims of AIDS, encouraged their members to use condoms, and emphasized the need for the sick to be loved and supported, rather than judged and rejected.

The call for a new kind of theology
More work must be done to understand why some churches have been able to develop loving and supportive attitudes toward those with AIDS, as well as a constructive and responsible approach to the public health/prevention agenda; while others have continued to preach hate, anger, and rejection of the sick. Our research suggests that some churches have been able to transform their values and attitudes and provide non-stigmatizing care and support for people affected by HIV/AIDS. We urgently need to develop case studies that help us explain how and why this has been possible in some cases.

We conclude by referring to an important article by Dr. Beverley Haddad, a South African cleric, who has argued that there is an urgent need for churches to develop new theologies. These interpretations of the Bible would assist church leaders in developing a more confident and positive role for the church to respond constructively to AIDS. Such theologies could, for example, challenge stigma by emphasising those aspects of the Christian message that advocate the forgiveness of sinners, the empowerment of women, a compassionate understanding of how poverty limits women’s sexual choices, and recognition of the innate dignity of all human beings.

Current church responses to sexual morality and AIDS are based on a very selective emphasis on particular parts of the Bible – and a neglect of others. We conclude our paper by challenging religious leaders to work harder to develop a theologically sound response that will provide a pathway for more tolerant and loving attitudes toward those who are vulnerable to, or affected by, AIDS. The Bible is full of examples of love and compassion for 'sinners', including prostitutes among others. It is also replete with examples of women’s potential for leadership and wisdom, and of the grace and wonder of youth. In the absence of the aforementioned theology, many church leaders and members will continue to struggle to develop constructive responses to AIDS that are consistent with the partial and selective interpretation of Christianity that dominates many church responses to date.

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