A Covenant to Care: Recognizing and Responding to the Many Faces of AIDS in the U.S.A.
United Methodists have been in ministry since the beginning of the of the HIV/AIDS pandemic. They have followed the way of healing, ministry, hospitality, and service shown by Jesus Christ. According to the Gospel of Luke (4:16-21), Jesus identified himself and his task with that of the servant Lord, the one who was sent to bring good tidings to the afflicted, hope to the brokenhearted, liberty to the captives, and comfort to all who mourn, giving them the oil of gladness and the mantle of praise instead of a faint spirit (Isaiah 61:1-3). God's Word calls us to a ministry of healing, a ministry that understands healing not only in physiological terms but also as wholeness of spiritual, mental, physical, and social being.
The Context of Caring Ministry in the United States
In recent years, AIDS in the United States has received less media attention, but that does not mean the disease has gone away. Though medical drugs can prolong the life of people who have been infected, there is no cure for AIDS. Not only must our commitment to ministry continue, but it must also expand, particularly in the area of prevention education.
HIV/AIDS affects and infects a broad cross-section of people in the United States and Puerto Rico: all ages, all races, both sexes, all sexual orientations. The cumulative number of AIDS cases reported to Centers for Disease Control (CDC) through December 2001 is 816,149. Adult and adolescent AIDS cases total 807,074 with 666,026 males and 141,048 females.1
In the early 1980s, most people with AIDS were gay white men. Overall incidences of new cases of AIDS increased rapidly through the 1980s, peaked in the early 1990s, and then declined. However, new cases of AIDS among African Americans increased. By 1996, more cases of AIDS were reported among African Americans than any other racial/ethnic population. The number of people diagnosed with AIDS has also increased among Hispanics, Asians/Pacific Islanders, and Native Americans/Alaska Natives.2 In 2001, the rate of adult/adolescent AIDS cases per 100,000 population was 76.3 among African Americans, 28.0 among Hispanics, 11.7 among Native Americans/Alaska Natives, 7.9 among whites, and 4.8 among Asians/Pacific Islanders.3 Though national surveillance data does not record the hearing status of people with HIV/AIDS, the Department of Health and Human Services believes that deaf and hard of hearing people have been disproportionately infected with HIV.4
As of December 2001, according to CDC estimates, 850,000 to 950,000 people in the United States were infected with HIV. One-quarter of these were unaware of their status! Approximately 40,000 new HIV infections occur each year: about 70 percent men and 30 percent women. Of these newly infected people, half are younger than 25. Almost half of the men are African American, 30 percent are white, 20 percent are Hispanic. Among newly infected women, approximately 64 percent are African American, 18 percent are white, and 18 percent are Hispanic. A small percentage of men and women are part of other racial/ethnic groups.5 No longer is HIV a disease of white gay men or of the east and west coast; it has not been for more than a decade. In 2001, 39 percent of persons with AIDS were living in the South, 29 percent in the Northeast, 19 percent in the West, 10 percent in the Midwest, and 3 percent in the U.S. territories.6
United Methodist churches, districts, and conferences can help to stop the spread of HIV/AIDS by providing sound, comprehensive, age-appropriate preventive education, including information that abstinence from sex and injection drug use is the safest way to prevent HIV/AIDS. In addition, the church can provide grounding in Christian values, something that cannot be done in public schools or in governmental publications on HIV/AIDS.
Youth and Young Adults: AIDS is increasingly affecting and infecting our next generation of leaders, particularly among racial and ethnic minorities. In the United States, HIV is the fifth leading cause of death for people between the ages of 25 and 44. Among African American men in this age group, HIV has been the leading cause of death since 1991. In 1999, among African American women, 25 to 44 years old, HIV was the third leading cause of death. Many of these young adults were infected in their teens and early twenties. At least half of all new HIV infections are estimated to be among people under 25 with the majority of infections occurring through sexual contact.7
Racial and Ethnic Minorities: African Americans, Hispanics and Native Americans have been disproportionately infected with HIV/AIDS. Representing only an estimated 12 percent of the total U.S. population, African Americans make up almost 38 percent of all AIDS cases reported in the country. Almost 63 percent of all women reported with AIDS were African American.8
It is critical to prevent patterns of risky behaviors that may lead to HIV infection before they start. Clear communications between parents and their children about sex, drugs, and AIDS is an important step. Church, school, and community-based prevention education is another step. Youth and young adults must be actively involved in this process, including peer education.
The large and growing Hispanic population in the United States is also heavily affected by HIV/AIDS. In 2000, Hispanics represented 13 percent of the U.S. population (including residents of Puerto Rico) but accounted for 19 percent of the total number of new cases of AIDS reported that year.9
Women: AIDS among women has been mostly "an invisible epidemic" even though women have been affected and infected since the beginning. AIDS has increased most dramatically among women of color. African American and Hispanic women together represent less than 25 percent of all women in the United States, yet account for more than 75 percent of reported cases of AIDS. In 2000, African American and Hispanic women represented an even greater proportion (80 percent) of cases of AIDS reported in women.10 Of newly infected women in 2001, approximately 64 percent were African American and 18 percent were Hispanic.11 In 2000, 38 percent of women reported with AIDS were infected through sexual contact with HIV-positive men while injection drug use accounted for 25 percent of cases. In addition to the direct risks associated with drug injections (sharing needles), drug use is also fueling the heterosexual spread of the epidemic. A significant proportion of women infected sexually were infected by injection drug-using men. Reducing the toll of the epidemic among women will require efforts to combat substance abuse and reduce HIV risk behaviors.12
People who are Deaf, Late-Deafened, and Hard of Hearing: In the United States, as many as 40,000 deaf and hard-of-hearing individuals are believed to be living with HIV disease.13 Health experts suspect that HIV prevalence in the deaf community may be higher than in the hearing community, but comprehensive data is lacking. An indicator is that one in seven deaf people has a history of substance abuse, compared with one in ten hearing people.14 Research has also shown that deaf high school students have much less knowledge about HIV transmission than their hearing counterparts. Because 75 percent of the culturally deaf community uses American Sign Language (ASL) as their primary means of communication, ASL is the most effective means of communication of HIV/AIDS information for this group; but the message must be clear. At a United Methodist HIV/AIDS event in 2002, a speaker noted that deaf people have died and others have delayed medical treatment because they believed themselves healthy when they saw the sign for "HIV" and "positive" conveyed to them in ASL. They thought HIV positive meant "good result" and did not realize that they were being told they were infected.15 It also should be noted that over 98 percent of those with hearing loss, including many elderly people, do not know sign language. In prevention education contexts, assistive listening systems and devices, such as "pocket talkers," should be used to aid those who are hard of hearing.
Older Adults: The number of those 50 and older infected with HIV is increasing at twice the rate of those under 50, according to experts on aging at Baylor College of Medicine in Houston who are targeting older Americans for safer sex education.16 The myth that older people are sexually inactive has produced dreaded consequences. The most prevalent behavior risks for older adults are multiple sexual partners and having a partner with risk behavior. Since they are not worried about pregnancy, older couples are less likely to use condoms and, therefore, increase their risk of infection. Most older people mistakenly believe that if they are heterosexual and don't inject drugs, they cannot get AIDS. Reaching this group of people with HIV prevention messages means exploring avenues such as church, widows' support groups at senior centers, and Golden Age Clubs at community centers and churches.
Drug-Associated HIV Transmission: Since the epidemic began, injection drug use (IDU) has accounted for more than one-third (36 percent) of AIDS cases in the U.S. Racial and ethnic minorities in the U.S. are most heavily affected by IDU-associated AIDS. In 2000, IDU-associated AIDS accounted for 26 percent of all cases among African Americans and 31 percent among Hispanic adults and adolescents, compared with 19 percent of all cases among white adults/adolescents. Non-injection drugs such as cocaine also contribute to the spread of the epidemic when users trade sex for drugs or money, or when they engage in risky sexual behavior that they might not engage in when sober.
HIV prevention and treatment, substance abuse prevention, and sexually transmitted disease treatment and prevention services must be better integrated to take advantage of the multiple opportunities for intervention-first, to help uninfected people stay that way; second, to help infected people stay healthy; and third, to help infected individuals initiate and sustain behaviors that will keep themselves safe and prevent transmission to others.17
The Challenge for Ministry
Across the United States, in churches large and small, pastors and laity have asked, "What can my church do?" Churches can build on areas which are already doing well; they can covenant to care. Churches and other United Methodist organizations need to continue or begin compassionate ministry with persons living with HIV/AIDS and their loved ones. In terms of prevention education, United Methodists have an opportunity to teach not only the facts about HIV transmission and how to prevent infection but to relate these facts to Christian values. Congregations can do HIV/AIDS prevention education in broader contexts, such as human sexuality and holistic health, as well as addressing societal problems, such as racism, sexism, addiction, and poverty. We call on United Methodists to respond:
1. Churches should be places of openness and caring for persons with AIDS and their loved ones. We ask congregations to work to overcome attitudinal and behavioral barriers in church and community that create stigma and discrimination of persons with AIDS and their loved ones. Congregations can offer Christian hospitality and become arks of refuge to all. We must remember that:
- * the face that AIDS wears is always the face of a person created and loved by God;
- * the face that AIDS wears is always the face of a person who is someone's mother or father, husband or wife, son or daughter, brother or sister, loved one or best friend;
- * the face that AIDS wears is always the face of a person who is the most important person in someone else's life.
2. Each congregation and annual conference, through their Church and Society committees, should mobilize persons for legislative advocacy at the local, state and national levels to support for HIV/AIDS initiatives in the United States. These advocacy efforts will be strengthened through partnerships with organizations/coalitions who are currently involved in this issue.
3. Educational efforts about AIDS should use reliable medical and scientific information about the disease, transmission, and prevention. Spiritual resources must also be included to enable people to address issues related to discipleship, ministry, human sexuality, heath and wholeness, and death and dying. Education helps to prepare congregations to respond appropriately when they learn that a member has been infected by the HIV virus or diagnosed with AIDS. It can lead to the development of sound policies, educational materials and procedures related to the church school, nurseries, and other issues of institutional participation. Prevention education can save lives.
4. Each congregation should discern the appropriate response for its context. Ministries should be developed, whenever possible, in consultation and collaboration with local departments of public health and with other United Methodist, ecumenical, interfaith, and community-based groups concerned about the HIV/AIDS pandemic. Congregations can organize to provide spiritual, emotional, physical and/or financial support to those in their community who are caring at home or elsewhere for a person who has AIDS. Projects might include observing events such as World AIDS Day (December 1) and the Black Church Week of Prayer for the Healing of AIDS (first week in March), sponsoring support groups for people with AIDS and their loved ones, developing strong general church programs for children and youth that also include AIDS education, pastoral counseling, recruiting volunteers, and offering meeting space for community-based organizations, including groups trying to overcome substance abuse and sexual addiction.
5. The United Methodist Church has a congregational HIV/AIDS ministry called the Covenant to Care Program, whose basic principle is "If you have HIV/AIDS or are the loved one of a person who has HIV/AIDS, you are welcome here." We commend those who have been in ministry through this program and recommend "Covenant to Care" to all United Methodist organizations. More information is available on the General Board of Global Ministries' Web site at http://gbgm-umc.org/health/aids/.18
See Social Principles, ¶ 162S.
From The Book of Resolutions, 2004. Copyright © by the United Methodist Publishing House. Used by permission.