African women with HIV: faith based answers might ease the social problems that lead to AIDS

British Medical Journal, Dec 23, 2000 by William Rankin, Charles Wilson

Faith based answers might ease the social problems that lead to AIDS

The international AIDS conference held in Durban earlier this year made the world aware of the global HIV catastrophe and of the need to prevent vertical transmission from mother to child. The fact that women are vulnerable to HIV infection in the first place must be of equal concern. Like women elsewhere, African women are stultified by circumstances largely beyond their control. These include sexually transmitted infections, sometimes associated with "dry sex" practices, and myths touting sex with a virgin as a cure for male HIV infection. The culture of silence surrounding sexual practices in general, the stigma of AIDS, women's lack of control over their bodies, and vulnerability to dispossession by a vexed husband or sex partner are no help. Low literacy rates, lack of information, limited choice, and little access to paid work outside the home result in morbid dependency and crushing poverty that are terrible burdens. Religious leaders and traditional healers should be allies of women, delivering educational and support services against HIV, and strengthen public influences for greater justice.

Tackling the problem will involve educating men to have greater respect for women, increasing awareness of gender based injustice, and changing oppressive social structures. Training women in negotiating skills may help both them and their spouses to obtain HIV testing and counselling. Offering women job training and literacy would be important. Strengthening the position of women in developing countries improves the prospects of children's welfare, as it does that of their mothers.[1 2]

Traditional African healers and birth attendants (midwives) exercise healing functions and adhere to a strong, though conservative, social ethic. Altogether, "the spiritual factor" has often disadvantaged women and people who are HIV positive, but with respectful engagement it has the potential to ameliorate the AIDS crisis. Traditional African healers often regard illness as caused by the nearness, rather than the absence, of the Divine. Prayers urge God's removal to distant realms.[3] Alternatively, illness may be seen as resulting from breach of taboo or offence to ancestors or the community, or from witchcraft or sorcery. The ill person appeals to a diviner for reconciliation with the offended, which would effect a cure.[4 5] The prominence of the "living dead" (the ancestors) in African communities explains the significance of ill children. Children are the way ancestors will be incarnated and by which the community remembers its forebears. A child's death, whether by illness or other cause, is therefore disastrous.[3]

The status of girls in traditional African cultures is limited. Women are marginalised by polygamy and being married to their deceased husband's brother. Taking seriously Africa's health needs means reckoning with traditional healers, traditional culture, and related spiritual assumptions about the nature of illness. The exigencies of the AIDS pandemic itself, however, with the diffusion of Muslim, Christian, and Western cultural influences, increase the likelihood that modified traditional religions will become a factor for positive change.

The heritages of Islam and Christianity contain scriptural and historical warrants for the care of ill people and children and for high standards of justice in judging individuals and societies--even though these religions have also relegated women to second class status.[6-11] Though these faiths have rationalised oppressive policies and practices, they have also inspired efforts to change and if necessary overthrow them. Importantly, religious people and organisations of all types are aware of need, including illness, and can deliver essential medicines, education, and related goods and services to people not easily reached by other means.

The Global AIDS Interfaith Alliance (GAIA) responds to issues like the status of women and facilitates other strategies for HW prevention and health care through religious and interfaith organisations in developing countries. A special priority is to reach remote areas of poverty where HIV infection is increasing. In partnership with Global Strategies for HIV Prevention, GAIA has connected with the Anglican Church of Tanzania, its 17 dioceses (regional jurisdictions) and its health system (comprising 12 hospitals and 35 clinics) in East Africa's largest country--which is often counted among the world's five poorest countries.

In November 2000 a five day workshop and conference of 120 participants in Dar es Salaam--locally planned, organised, and led, and conducted mostly in Swahili--resulted in action plans specific to 17 regions. Information was conveyed by Tanzanian specialists on such topics as gender issues in HIV prevention, basic education about HIV transmission, nutrition education, voluntary testing and counselling, sexually transmitted diseases and susceptibility to HIV infection, the Ugandan experience, breaking down denial and stigma, and the special roles of religious organisations.