Thursday, August 6, 2009

"My Wife is HIV Positive--What Can I Do?"

(Note: this blog contains some fairly explicit material regarding sexuality, HIV, and condom use. Parental guidance is suggested in its use.)

“My wife is HIV positive, and I am not” a participant in our Tanzania seminar offered at 6:30 pm on the opening day. “What can I do?” Our seminar had begun at 9:00 A.M. “African time” (11:00 by the clock), and while we had not put in quite eight hours of work, the group was very tired. I’d been answering questions about HIV for several hours and this question offered a great segue to a discussion on condoms, so I wanted to hold it until the next day.

“That’s a great question,” I offered. The rest of my answer brought down the house: “Don’t have sex tonight and we’ll talk about that first thing tomorrow morning.”

The next morning the group offered three possibilities for the inquirer (whom I learned later was asking a hypothetical question and was not disclosing the status of his wife who was sitting next to him when he asked):
1. Divorce his wife.
2. Stay married and don’t have sex.
3. Stay married and take the risks of sex with an HIV-infected wife.

No one offered a fourth suggestion. After a long discussion of Jesus’ teachings on divorce and Paul’s teachings on sexuality and marriage, everyone agreed that the first suggestion was not legitimate, the second was totally unfeasible and the third was not very desirable either. But no one suggested condom use. Finally, as I continued to entreat the group for a fourth alternative, a very old man who had showed up for the first time on the morning of the second day offered in a subdued but firm voice, “Condoms”. After he confirmed his answer a little bit louder, I turned to the group and asked for their thoughts about his suggestion. It was a hard sell.

The very idea of condom use in any context sometimes quickly heats up the conversation among many Bible-believing church leaders in Africa, though it is always an area we explore in our seminars. “Condoms are the cause of the HIV epidemic,” suggested one participant. Several heads nodded agreement, and then another chimed in, “We didn’t see much HIV until condoms became freely available; then people started dying right and left.” This answer is listed as an incorrect choice on the pre and post test I did not utilize in the Tanzania seminar, but this was the first time it had ever been suggested so explicitly by one of our seminar participants.

Most church leaders simply associate condom use with illicit, extramarital sex, and thus find them sinful in and of themselves. It is often difficult for these church leaders to see that condoms might have a legitimate use, and it is hard for them to see that using a condom doesn’t even make Biblically illicit sex more sinful. So I borrow from Canon Gideon Byamugisha, an Anglican Priest who addresses the issue well. Canon Gideon points out that sex may be licit or illicit, safer or not so safe, two concepts that are not equivalent, (though admittedly not totally independent). Licit sex, sex within marriage, is usually safer than illicit sex, but only if your partner is known to be negative and unexposed to HIV. In a society where 15-25% of the adult population is infected with HIV and there are means of transmission other than sex, assumptions shouldn’t be made. In a case where one’s spouse is infected with HIV, licit sex can still be safer or not so safe.

Similarly, illicit sex, sex outside marriage, is always illicit whether a condom is used or not. Condom use does not make extra-marital sex illicit. It is sinful on its own merits. Though condom use does make illicit sex considerably safer, it is no absolute guarantee of safety. Unless one believes that the only way God can punish people for illicit sex is through the transmission of HIV and other sexually transmitted diseases, and that condom use is thus somehow thwarting God’s punitive will, then condom use should not be seen as wrong, certainly not during licit sex, but really no more so in illicit sex. And innocent children and faithful spouses might be spared. We point out Jesus’ stated objective “not to condemn the world, but to save the world” which suggests that the work we should be doing is the same.

“But aren’t you killing a new baby when you use a condom?” someone asked during the South African seminar. A careful review of the anatomy and physiology of conception and pregnancy reveals that a new being is not formed until after the union of egg and sperm, so preventing that union through condom use is no different than not having sex. In fact, condoms are probably the least likely of all birth control methods to working by interrupting the pregnancy process after the union of sperm and egg.

“But isn’t wasting sperm sinful?” another inquires, and we go back to Genesis 38 to look at Onan’s condemned use of birth control (no, he didn't have a condom, but read the story if you're having trouble remembering the details). Again, a careful review of the text reveals that Onan’s sin lay in the failure to fulfill his social duty to his brother, his unwillingness to be a good family member. If he had never had sex with his sister-in-law he would have been just as guilty under the rules of his society. An older brother in our Tanzania seminar group shares the physiologic fact that one sperm out of millions fertilizes the egg, demonstrating that God is not worried about “wasting” sperm. Some feel the earth is not yet full and that we must still fulfill God’s creation command to “fill it up”, but a reminder of children dying of malnutrition and Paul’s note that those who don’t care for their own are worse than unbelievers convinced many that mankind had probably fulfilled that mandate.

In the end, several of the four planning groups in the Tanzania seminar listed education in condom use as part of their plans for combating HIV. Did they get it? Will they teach it? Or were they just saying that because of my dogged insistence? Condoms will not solve the AIDS crisis, and they are not the primary means we suggest for HIV prevention. They are certainly not the cause of the epidemic, however, and there are instances where condom use would help even licit sex to be safer for committed and faithful married couples. How then did one partner in such couples become infected? More about that next time.

Saturday, August 1, 2009

John: Infected and Affecting Others--for Good

John was not the average participant at our most recent seminar in Nduha, Tanzania, about 1.5 hours south of Mwanza, Tanzania’s second-largest city. (Mwanza lies on the southern shore of Lake Victoria near the borders of Kenya and Uganda with Tanzania.) John had known he was infected with HIV for several years, and had been on anti-retrovirals (ARV’s) for most of that time. According to Kevin Linderman, the missionary who was our primary contact for this seminar, John had frequently made casual public remarks about his medications in contexts that revealed his status, but John had never had the occasion to openly address the problem of HIV before other church leaders. Our seminar provided just such an opportunity.

One of the most powerful events in our five-nation teaching tour in 2005 was a presentation by the female president of the Kenyan Association of Religious Leaders Infected with or Affected by AIDS (KenAReLAA). We shared with John about the positive effect of her talk on the church leaders attending that seminar, and asked if he’d like to address his group. While encouraging him with the thought that his presentation could be equally powerful, I offered him the option of just answering some questions about his feelings about the disease and its effect on his relationships, and we assured him that he should feel under no obligation to speak at all. We left him to think about it overnight.

The next day John told us he was ready to speak. I thought he was just going to answer some questions, but when he got the floor he took off. Though I can’t tell you all (or even most) of what he said (my translators were more interested in listening to John than telling me what he was saying) I can tell you that it was powerfully delivered and captured the attention of our group. Among other things, he addressed the problem of the prejudices of his friends and neighbors. John said he knew many people were wondering what woman he picked this up from. John answered with the testimony of his life.

“When I planted the church in your village,” John asked, indicating one of the participants, “did I pick up a woman there? And when I planted the church in your village,” he asked another, “what woman did I pick up there? And how about your village,” he asked another. “When I planted the church there was I with a woman?” John had planted churches in many villages, and his faithfulness to his wives was as evident as his evangelistic skill. He had come to those villages on behalf of the King of kings, and his life reflected that commitment.

Yes, John had been a polygamist. His first wife had died some years ago (perhaps of HIV-related infections), and he had divorced his third wife after repeated instances of unfaithfulness on her part, perhaps another opportunity for infection. He now lives faithfully with his second wife, who was present in the seminar and who avidly supports the many facets of his ministry. John is now a grandfather, and through his encouragement his children have all been tested and found to be negative for HIV.

I asked John how long he took to reveal his HIV status, which was discovered during hospitalization for a nasty leg infection that wouldn’t get well. He told his immediate family about two months after the diagnosis, then his extended family after a year. He began to tell other church members after about two years. The reason for his delay: fear; fear of rejection. While some of his relationships have suffered since his diagnosis, John’s aggressive defense of his life’s record has stood him well, and the unquestioning support of his family has been an added comfort.

Our seminars attempt to address the stigma of HIV infection in several ways:
1. Recognition that all of us are sinners, whether we have HIV or not.
2. Recognition that those who have sinned in ways other than sexually are just as much sinners, and thus in need of God’s grace as those who have sinned sexually.
3. Recognition that there is good evidence that a great deal of the HIV in Africa, at least early in the epidemic, was acquired through other than sexual means (more about this in a later blog).
4. Recognition that our task on earth as the Body of Jesus Christ (the church) is to invite all sinners back to God for healing, not condemnation. This was Jesus’ work, which he did not only in word, but also in his attitude and social behavior, and which he expects us to continue as his followers.
5. Recognition that those infected with HIV are in great need of care in many ways: socially, physically, mentally, emotionally, and often spiritually and financially, and that the church is the best institution to deal with these needs because it is really the only institution that can deal with all of them.

John’s participation in this seminar added a very special dimension to it. He is a respected leader of the churches in his area and the father of many of them. His ministry has the opportunity to acquire additional power for the Kingdom as his weakness (his HIV infection) becomes a Kingdom strength, a point for connection with his neighbors whose lives are being crushed by their HIV infection, no matter how they acquired it. It is a blessing to know John and to count him a friend and partner in the work we are doing.