Shame: HIV, Death, and the Body of Christ

He glided behind me as he passed the front desk. I didn't have to be there, and he didn't need to stop there, but he seemed to avoid being seen. Somehow I knew he was my last patient of the day. We hadn't met, but as I perused his slim chart, it was evident there were problems. We'll call him Mr. P. The amount of HIV virus in Mr. P's blood had dropped, but not nearly as fast or far as it should have. There were suggestions that he had been on several medications since his infection was discovered, but the documentation was not all there. Then there were his current meds. All of them, nearly a month's worth in most of the bottles, had been last filled seven weeks ago: one bottle was nearly full, another was dosed at half the amount it should have been, and there was only one pill left of one of the meds. "And I don't get paid until Friday," he said from under the bill of his cap. "That's when I can refill it." Three more days. Missing a single dose of your HIV meds each month can increase the risk of resistance developing over the year by 10-15 percentage points. This man, like many of our patients, needed help taking his meds.

He looked to be in his 60's or 70's, but he said he was only 45. As we talked about his disease and what was going on, he wouldn't look at me. On several occasions I asked him to, and he did. Briefly. And then the head was down again, the bill on the cap shading his eyes, hiding his face from my attempt to know him.

"How has this disease affected your life?"

"It's affected me a lot. I'm angry. Angry a lot. I don't know how I got it," the voice spoke from behind the cap.

"Does anyone else know about your disease?"
"My sisters. They know."

"And they've handled that OK?"

"Uuuuh-húh. Oh-Kay. One of them is ok. One of them, she has me drink out of a plastic cup." There was a silence.

"And then . . . she throws it away?"

"Uuuuh-húh," the voice swung up in affirmation.

"But my other sister, she's ok. She feeds me. Lives across the road from me."

His brother-in-law had brought him to the clinic, the husband of the sister "across the road". Without lifting his face Mr. P affirmed that the in-law knew of his disease and that he would sign a release for me to talk with the brother-in-law and sister. I went over a number of things with them, separately, in person with the brother-in-law in Mr. P's presence, and then on the phone with his sister after he'd left. We talked about the CD4 lymphocyte, what that white blood cell normally does, how HIV infects it, then destroys it while diverting the CD4 from its primary mission of protecting us to the role of producing more HIV viruses. We talked about resistance, and the need for adherence to the medication regimen, the need to use a pill box, and possibly for someone to assist him. Then I mentioned to Mr. P's sister his hidden eyes.

"He won't look at me," I began.
"No. He won't look at anybody. Me neither."

"Has he always been this way, or just since he knew he was infected?"

"Just since he's been infected."

Then it hit me! He's ashamed! He's ashamed to be infected with HIV. He's so ashamed that he can't look at anyone. For those who don't know, he's afraid they'll learn, as if by looking into his eyes they would see deep within his brain the "HIV" in red letters, stenciled on the gray matter of his mind. For those who do know, he's ashamed. I was almost overcome with anger and sadness at this man's situation, this man who is now almost Gollum-like, shriveled and be-deviled, his "image-of-God" humanity defaced more than usual because of this disease, the way others deal with him because of the disease, and his fears of what he might receive. Head down he tries to hide in his own dark cave between the bill of his cap and the flaps of his partially zippered jacket. It may be that some of his shame is due to his guilt for how he caught the disease, but that is not my impression. Yes, few know, but of those who do, only two treat him well, treat him . . . normally. And he is overcome with anger, fear, and shame.

This shame, and the fear of it, immobilizes people around the world, keeping them from getting tested in a timely fashion when treatment is most affective and complications are least likely, driving them into caves of despair when they know they are infected, afraid of rejection, loneliness and death, not the stopping of that pumping muscle in their chests, but the death of their spirits through loss of interaction with the rest of us who've been imparted spirits from the One who is Spirit. These fearful ones have not known Him, except through those whom He has created, those He seems to have given life, and now the "living" will, thinks Mr. P, withdraw and leave him absolutely alone, dead. Those who claim to live forget that it is their privilege, their responsibility, at precisely this moment to offer life.

I praised Mr. P's sister and praised God in her presence because she is accepting him, affirming him, loving him, she and her husband. When I see him again I will inquire about shame and if it is confirmed I'll discuss the possible why's of it. If he is guilty, I will offer him the forgiveness that God has given me. "Your sins are forgiven you." "Neither do I condemn you. Go, and cease your life of sin." That is how the Lord dealt with shame. And he has sent us to do the same.

Meanwhile, I am saddened and angered by the way we are, "we" being what too often passes for church, community, and even family in this man's life. That which should be gracious, loving, offering forgiveness, even at the cost of its own life, but rather is too often, especially in this situation, proud, exclusive, condemning: polished, beautifully painted gift boxes full of dead men's bones. "If you were blind, you would not be guilty of sin; but now that you claim you can see, your guilt remains."

Lord, do what is necessary to open eyes, minds and hearts, to impart fear where it needs to be, and courage where it needs to be, so that this disease may be stopped not just in its destruction of bodies, but in its destruction of souls, its defacing of your image in those you made to bear it. Teach the church to be your body, courageous not only in righteous living but also in gracious offering of forgiveness, love and hope, that men and women may know they are loved by you, and can truly live in you.