World AIDS Day

A sermon delivered at the Unitarian Universalist Congregation (Blacksburg, VA), December 7, 2008, by the Reverend Christine Brownlie.

2008 World AIDS Day has come and gone. Did you notice? Probably not, and I imagine that for most people it must seem that the disease itself has come and gone as well. Can you recall the last time you actually saw someone with a red ribbon pinned to his or her shirt or jacket? I can’t. Nor can I remember the last time some big name celebrity broke our hearts by revealing that he (it was always a male) had contracted HIV/AIDS. Thanks to research and the new treatments that have been developed, this former killer has been tamed and is nothing to fear. At least that’s the attitude that’s common to those of us who live in the “developed world.”

Medical science has come through with treatments that extend the lifespan of men and women who’ve contracted this once fatal illness. Now we even have drugs that hold down the nasty symptoms for most people. Today, if you are fortunate enough to live in the United States or Europe, and if you have a generous health insurance policy, and if you have a supportive cadre of loved ones and friends — and in many communities if you’re white — life with HIV/AIDS is no longer the horror story it once was. But for millions upon millions of people around the globe, this disease brings physical and emotional suffering, poverty, shame, and a horrible death. I would offer you some numbers that I find disturbing and disheartening.

The United Nations agency, UNAIDS, estimates that 30 to 36 million people are living with HIV/AIDS. 74 percent of these infected people live in sub-Saharan Africa. By the year 2010, five countries (Ethiopia, Nigeria, China, India, and Russia) with 40 percent of the world's population will add an additional 50 to 75 million infected people to the worldwide pool of the disease.

Sadly, HIV/AIDS is a "disease of young people" with half of the 5 million new infections each year occurring among people with ages of 15 to 24. 10% of these cases result from injecting drug use; 5 to 10% are due to sex between men; and 5 to 10% occur in healthcare settings. Sex between men and women accounts for the remaining number— around two-thirds of new infections. The number of women who have contracted HIV/AIDS has increased significantly over the years, and the latest estimate that I could find claims that 19 million women are living with HIV/AIDS. One researcher called this trend the “feminization” of the disease.

I found the following statistics on a Web site maintained by a charity Avert. Let me warn you that these numbers are also very discouraging.

During 2007, approximately 2.7 million people became infected with HIV/AIDS. The year also saw 2 million deaths from AIDS. This was a high global total, despite efforts to increase the availability of antiretroviral (ARV) therapy.

All these dire statistics might cause us to feel sad and discouraged. We might wonder what we can do in the face of these overwhelming numbers. But for some us, the sadness is mitigated by the recognition that this terrible disease is almost totally preventable in adults. We might wonder why so many people fail to take responsibility for themselves. It’s true that in some cultures, a woman really doesn’t have the “right” to refuse her male partner’s desire for sex, but in many relationships, the act is consensual. And there are other realities that might bring on a sense of compassion fatigue when it comes to this issue. Who can feel sorry for the man who contracts AIDS from a sex worker? What about the woman who takes a chance with an unfaithful husband or a man she cares for even though he refuses to use the condom she offers to him? As for people who share needles used for drugs, well, they’re really a lost cause anyway.

That kind of attitude may sound harsh, but I have heard people respond to stories and reports about the suffering of adults with AIDS with harsh words. I suppose the situation is similar to the responses that were made when smokers who were dying of cancer or people who became severely over weight tried to sue the tobacco companies, or the purveyors of fast food. How often did these folks hear words such as these: “You made your own choice and now you have to live with the consequences.”?

There may well be some truth in that hard-hearted response. But there is a large segment of the world’s population that faces the harsh consequences of AIDS though no fault of their own. These blameless victims are the children of mothers who carry the disease. The Unitarian Universalist Service Committee (UUSC) estimates that roughly one-third of the babies born to HIV positive mothers will be infected during pregnancy, delivery, or through breast-feeding. There are drugs to prevent this, but fewer than 10% of pregnant women are offered these treatments. There are also drugs to treat these infected infants. The most widely available drug, cotimoaxole, could cut the pediatric death rate in half at the cost of about 5 cents per day per child. But less than 1% of the children who need this medication have access to it.

A significant number of the children born to HIV positive mothers do not contract their mother’s illness, but often they too face a bleak future. The UN-AIDS agency estimates that, currently there are 14 million AIDS orphans and that by 2010 there will be 25 million children who have lost at one or both parents to AIDS.

The majority of these children live in Asia or Africa. Some of these children live with the surviving parent, usually the mother, who may herself be dying of the disease. Because of the shame and fear that surrounds this illness, her children may be forced into the role of caregiver. After her death the children who cared for her face an uncertain future. Family members may take them in. If they are lucky, these surviving children are cared for and treated well. In countries that have a high rate of deaths from AIDS and other diseases, these relatives may be caring for a number of children, and living in terrible poverty. Sometimes children live with their siblings who are still very young themselves and unable to provide the love and guidance that all children need. Often children are separated from their siblings and sent to live far from one another, which greatly increases their loss and grief.

Stigmatized by their families and society at large, many orphaned children end up living in gangs on the streets of towns and cities. Hungry, helpless, and unprotected, they are exploited by the sex trade or forced to serve in the guerrilla armies that exist in many African nations. Some are sold into slavery and work long hours in dangerous and/or monotonous jobs.

Even if they are taken in by loving surrogate parents, these young survivors tend to have a high incidence of severe emotional and psychological problems: anxiety, depression, anger, and low self-esteem. The majority of these orphans have had little guidance or training in the basics of living in society. How will these neglected uneducated children rise to the demands that all those living in these struggling nations will face in the coming years? The majority of these potentially future leaders have received little guidance in the basics of life or getting along with others. Many have been forced to leave school, or have never had the opportunity to get any education at all. None of this bodes well for the already troubled and struggling nations of Africa or the world at large.

There are some who rightly point out that this focus on HIV/AIDS blinds us to the bigger need. The truth is that there are many children in Africa, Asia, Latin American, Russia, and America who suffer from terrible illness, neglect, and malnutrition. Given the right resources, many of these problems are fairly easy and cheap to address. Why should we be so concerned about the children who are stricken with AIDS?

Let me add another concern to the mix: one that could affect us all very soon. In many countries, the HIV/AIDS epidemic has fueled a dramatic resurgence of a deadly form of tuberculosis that is largely drug-resistant. The combination of drug-resistant TB and HIV makes it harder to diagnose the illness, and it makes treatment more difficult. Hence TB has become a leading cause of death for people with HIV/AIDS.

Add to this mix the problem of health education. In many parts of the world people are unaware of just how either disease is spread. Many don’t know that TB can be cured. Due to stigma, lack of information, and the prohibitive cost of accessing care, many patients do not seek out or fail to complete TB treatment, despite the risk of a developing drug-resistant form of TB that threatens to transform a curable disease into an untreatable plague.

According to the reports released in 2007 at a world conference on lung health, virulent strains of extensively drug-resistant TB are now spreading worldwide, posing an especially mortal danger to those living with HIV. The disease has put additional strain on health care systems that are already strapped by the impact of HIV/AIDS. Governments have been slow to increase budgets and personnel.

OK, now that I’ve dragged you into this pit of despair, you’re probably expecting me to lift your spirits with some ideas of how we can help. I will give you some resources to investigate. But I have to tell you that the issues and problems leading to this tragic epidemic are systemic and global. The fixes are small and local. This doesn’t mean that we shouldn’t engage with this issue, but there are complexities that we need to consider.

But let’s get to the hopeful part first. There are a number of international organizations that are hard at work to rid the world of AIDS. You can find them on the Internet. I’m not going to recommend any because I haven’t had time to do the research to learn which agencies are most effective, but you might decide to support one or more based on your own resources and sense of priorities.

We as a congregation could decide to become a “Red Ribbon” congregation through the UUA Global AIDS Coalition. Those of you who were involved with our congregation in 2006 might recall that we supported one Red Ribbon Congregation with a donation from the proceeds of our Service Auction. We gave 8000 to First Parish in Lexington MA to support their work with Communities Without Borders. This agency is comprised of several groups that provide support to AIDS orphans in two communities in Zambia.

We could also choose to participate in a program called “Every Child is Our Child” through the UUA United Nations Office. Like the UUSC, this program also works with other local groups to support a program in Eastern Ghana that funds he education and health insurance of children in the area. Their most recent achievement is to fund the education of 160 children who have lost one or both parents to HIV/AIDS.

We can also advocate for programs that educate and support health care and education for women and girls to give them reliable and effective information about the prevention of HIV/AIDS and unwanted pregnancy.

We need the same kinds of programs in our own country for young people, especially those who live in primarily African-American and Latino communities. The other group that seems to be at risk is, believe it or not, our elders. Thanks to the new drugs that address what is discretely referred to as ED in television commercials, there’s been an increase in the rate of all kinds of sexually transmitted diseases in older people

There are no easy answers, or quick fixes. I find hope in the possibility that the new administration will have a greater concern for Africa. It is essential that women who live in countries where HIV/AIDS is a scourge have access to safe methods of birth control and medical abortions. Men and women of all ages all over the world need to be educated about this disease, and the barriers of shame and secrecy must be broken down that people who need help will get the care they need.

World AIDS day cannot be passed over with a shrug and a bout of compassion fatigue. The facts that there is no easy solution and that there are other equally tragic illness that plague the developing world are not reasons to ignore AIDS. As Unitarians Universalists who proclaim the worth and dignity of every person, we need to consider how we may become allies is the fight against HIV/AIDS and the dehumanizing suffering that it brings to so many.

May it be so.