Book Reviews

Catholic Ethicists on HIV/AIDS Prevention

Ed. J Keenan New York: Continuum, 2000 Purchase this book through Amazon Associates

Reviewed by Rev. Jim Mitulski

The title of the work belies its value and is also subversively appealing. As I was writing this review I discussed it with HIV activists, public health officials and fellow Protestant clergy, groups who rarely talk to each other. All were quick to offer a smart remark, dismissing the likelihood there could be anything of value in a book written by Roman Catholics about HIV prevention. All three groups are wrong. This book lays the necessary groundwork for an agenda of mutual self-interest if we are serious about ending the spread of AIDS as we enter the second generation of living with it.

Reading Catholic Ethicists made me realize how seldom the disciplines of religion and public health ever speak to each other. How many of us ever take the time to read the secular literature on AIDS prevention, teen pregnancy, mental illness, drug addiction, or the many other public health issues that deeply impact our ministries? This book makes a start at bridging the disciplines of public health and theological reflection.

Keenan begins with the simple observation that how we define a problem will also define the solution. He identifies that Catholic moral theology can be used to determine a prevention-oriented strategy, or it can also be used to undermine it. And, in a statement that is bold for a member of a tradition that can be punitive toward dissenters, he forthrightly states "certain moral positions adopted by church personnel are at odds with some relatively effective HIV-prevention measures favored by Catholic health workers involved in the pandemic" (p. 13).

We hear from thirty-eight Roman Catholic authors who remind us that HIV disease exists throughout the world. It disproportionately affects the poor, women, children and in every society those who are socially marginalized. In the United States, these populations include gay men, injection drug users, and sex workers, and are disproportionately found in communities of color. Globally HIV primarily affects heterosexuals. This is increasingly true in the United States, though infection rates may be rising again in some gay communities.

The first part of the book is devoted to practical situations in multi-cultural contexts. By reading about HIV prevention in India and Brazil, we broaden our knowledge and our sympathies. We also gain ideas to try here. The similarities and the differences are illuminating. A pastor considering the possibility of hosting a needle exchange site at her/his church will want to read "Come, Ye Disconsolate: American Black Catholics, Their Church, and HIV/AIDS" by Diana L. Hayes and "Needle Exchange in San Juan, Puerto Rico: A Traditional Roman Catholic Casuistic Approach" by Jorge J. Ferrer, S.J.

An entire section is devoted to counseling issues, encouraging the counselor in defining personal values, a vital task prior to working effectively with people with HIV, their friends, family members, and sexual partners. "Australian Parents of Young Gays and Lesbians: Support and Protection" by Peter Black, C.S.S.R., describes the painful tension in which Catholic counselors are required to work in avoiding approval of homosexual behavior. In "An American Catholic Hospital Sponsors a Support Group of Gay Men" by John Tuohey, we see how a clinic tries to dodge the charge of "cooperating in the performance of sexual acts considered intrinsically disordered." Ethicists call this casuistry, and public health officials characterize it as equivocation; everybody engages in it.

The second half of the book, "Fundamental Moral Issues for HIV Prevention," will be useful to the minister seeking to construct a moral theology consistent with Protestant principles. In this task, Lisa Sowed Cahill's "AIDS, Justice and the Common Good" comes closest. She draws heavily on the values of liberation theology, which are congruent with our own Protestant tradition of the Social Gospel.

The six female authors have less concern with defending traditional moral theology. The international and multicultural perspective of the many cases examined is a refreshing alternative to the US bias of previous Protestant theological reflection on HIV. Only Jose Antonio Trasferreti in "Encountering A Brazilian Man Abandoned in His Illness" mentions the need for the church to provide spiritual solace to transgender persons. To its credit, the book incorporates the stories and to a lesser extent the voices of people with HIV; but, as a gay man with HIV, I was disappointed that no self-identified gay or HIV-infected people appear to be included as contributors. In articulating ethics, the social location of the affected person is powerfully important.

Catholic Ethicists takes us somewhere new. Letty Russell broke new ground in her work with the National Council of Churches chronicled in The Church with AIDS: Renewal in the Midst of Crisis (Westminster/JKP, 1990). I participated in those meetings, which challenged the churches to embrace the sick and dying out of compassion. I'll never forget the dozens of NCC delegates crowding into our tiny sanctuary in San Francisco's gay neighborhood so they could observe an AIDS Healing Service, and I'll never forget their surprise at discovering a room full of fervent and pious gay Christians whose faith sustained them through an unspeakable time, without any help or attention from the mainline denominations. All we sought then was their presence when we felt abandoned by family, church and society. We did not press the churches in examining the role they played in fostering the spread of AIDS by their reluctance to talk about sex and drugs, and by demonizing people with HIV: gay men, sex workers and injection drug users.

Michael J. Christensen, at that time a Nazarene minister, made the same pitch to evangelicals in The Samaritan's Imperative: Compassionate Ministry to People Living with AIDS (Abingdon, 1991). Out of necessity and desperation we settled for "hate the sin but love the sinner" as an acceptable strategy among Catholics, and a more subtle discourse among Protestants that polite people don't talk about the circumstances that lead to AIDS. Nobody wanted to talk about the social structures of poverty and prejudice in which the virus thrives. Catholic Ethicists calls us beyond that to a more complex conversation. The writers struggle with how to prevent the spread of HIV/AIDS and still remain true to dearly held theological positions, while critically revisiting those positions when they are both pastorally and epidemiologically unsound.

Before you mention AIDS in a sermon again, try this exercise: read "Targeting AIDS Prevention and Treatment Toward HIV-1 Infected Persons: The Concept of Early Intervention" by Donald P. Francis et. al, (JAMA, November 10,1989-Vol. 262, No. 18) — and use it as a source of theological reflection. Or go to www.sfaf.org or www.hivstopswithme.org and acquaint yourself with the resources there. Professors, assign the JAMA article as well as this book to your seminarians. It is as important that they be able to read and apply this literature as it is for them to exegete scripture.

Catholic Ethicists on HIV/AIDS Prevention couldn't be timelier. June 5th marks the 20th anniversary of the first mention of AIDS in the Center for Disease Control's Morbidity and Mortality Weekly Report. This book identifies what must become the church's most urgent priority at this point in history: prevention, not just treatment. For Keenan, et. al. public health is theology, and every minister can apply this insight to her/his own context. Public health officials warn us that if we're not resourcing prevention to the same extent that we're resourcing treatment we will live with this tragic epidemic for many generations to come. Our system of care is more equipped to treat people once they're infected than it is to prevent ongoing infection. The same is true in the religious world. The days when HIV-positive children are not welcome in Sunday Schools are mercifully past. But rare is the church that makes condoms available at the coffee hour, or that is willing to risk the social and legal censure of supporting a needle exchange project.

Lives are at stake, and the credibility of the church depends on our ability to talk about the issues of HIVprevention in ways that are consistent with our liberal tradition as these Catholic authors do with theirs. Listen, as these authors do, to what people with HIV are telling us about poverty and access to health care, about sexism and racism. Let's find ways to talk about and support condom use and needle exchange with our parishioners and with the vast numbers of the unchurched and the post-churched so that twenty years from now we are not faced with a third generation of people living with HIV/AIDS, locally or globally.

—Rev. Jim Mitulski

© 2001 Christian Century Foundation. Reprinted by permission from the July 18-25, 2001, issue of the Christian Century. Subscriptions: $49/yr. From P.O. Box 378, Mt. Morris, IL 61054.1-800-208-4097.

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