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Vital Strategies for a Global AIDS Response: Pope John XXIII's Pillars of Peace

Robert J Vitillo
Issue 18, April 2006

The following is an edited version of an address delivered by Rev Robert J Vitillo at Georgetown University, Washington, U.S.A. It was delivered as part of the Pacem in Terris Lecture Series - 24 October 2005.

Introduction

Let us take a few brief moments to recall the global context into which Pope John XXIII unveiled his Encyclical carrying the English title of Peace on Earth on 11 April 1963. The first half of the twentieth century already had seen two world wars and conflict in Korea that caused millions of deaths, including efforts at genocide, as well as untold destruction of property, cultural heritage, and social infrastructure. During the cliff-hanging Cuban Missile Crisis, which occurred some six months before the release of Pacem in Terris, Pope John XXIII took the extraordinary measure of a public appeal on Vatican radio in an attempt to de-fuse the stand-off between U.S. President John F. Kennedy and Soviet Premier Nikita S. Krushchev. To the shock of many in the Curia Romana, Pope John departed from the carefully nuanced text prepared by the diplomats in the Vatican's Secretariat of State and made his own emotional and heart-felt appeal, We beg all rulers not to be deaf to the cry of humanity.

The Pillars of Peace

I am quite certain that Blessed John XXIII, were he to address the present-day threat of HIV and AIDS, would re-awaken that same appeal and issue it not only to the rulers of the world but to all the members of the human family. The global response to this pandemic requires much more than sentinel sero-prevalence studies, the expansion of health services, massive education programs focused on behavior change, and social support services for the survivors of those who already succumbed to AIDS-related illnesses. All those measures already are being taken and have met with only limited success. Thus I am convinced that the missing link in the global AIDS response is the authentic human development made possible through the four pillars of peace proposed by John XXIII: truth, justice, freedom, and love.

Lest I be accused of exaggerating the links between HIV and AIDS and world peace and security, let us see what the international experts have to say about this matter. In fact, elevated sero-prevalence rates among military and law enforcement personnel cause grave concern in many countries:

• In Russia, between 1995 and 2003, the number of soldiers found to be HIV-infected increased from .1 per 100,000 to 40 per 100,000;
• In Mozambique, new recruits cannot be trained fast enough to replace police dying of AIDS-related illnesses;
• In Ethiopia, a sero-survey among police officers' wives found one-third of them to be HIV-positive.

However, the linkage between HIV and security extends far beyond the number of those in the military or police forces living with the virus; it reaches the very core and infrastructure of human society. In the year 2000, the United Nations Security Council declared, in its Resolution 1308, that the spread of HIV and AIDS can have a uniquely devastating impact on all sectors and levels of society and if unchecked, may pose a risk to stability and security. In December 2004, the High-Level Panel on Threat, Challenges and Change, convened by United Nations Secretary General Kofi-Annan warned that generalized AIDS epidemics can:

• erode the ability of countries to govern themselves and to provide essential services as a result of the loss of needed populations, not only in uniformed services, but also in key public and private sectors;
• change the pattern of savings, investments and consumption, since families have to alter their household priorities in order to care for sick members;
• alter the very nature of family and multi-generational relations, since grandparents are called upon to care for orphans and again become the primary income generators.

It is regrettable that, to date, the implementation of Security Council Resolution 1308 has focused more on educating UN Peacekeeping troops and other military personnel about the dangers of indiscriminate sexual activity than on promoting authentic human development. Such an alternative emphasis could make possible a much more profound and stable peace as was envisioned by the man known as good Pope John:

Peace on Earth which [people] throughout the ages [have] so longed for and sought after can never be established, never guaranteed, except by the diligent observance of the divinely established order and yet there is a disunity among individuals and among nations which is in striking contrast to this perfect order in the universe.

The Search for Truth in Understanding the Global Situation of HIV and AIDS

Before a Society can be considered well-ordered and consonant with human dignity, it must be based on truth And so will it be, if each [person] acknowledges his [or her] own rights and his [or her] own duties toward others. (Pacem in Terris, #35)

In the course of my rather unique global ministry, I often have encountered massive denial and misunderstanding about the roots and impact of this pandemic. In almost every country I have visited, some well-meaning medical professional or cleric has pulled me aside to inform me that HIV really arrived there from the neighboring province, or territory, or is limited to the foreigners or diverse ethnic groups, since, of course, our people do not do the kinds of things that spread AIDS! It is just such a lack of, or distortion of, truth whether intentional or truly mistaken that prevents the global family, and faith communities as well, from mobilizing the necessary knowledge, commitment, and resources to address the HIV pandemic.

Another pervasive misconception about HIV and AIDS is that it is no more alarming than other global health problems. In a speech given at the London School of Economics, Dr. Peter Piot, Executive Director of UNAIDS, warned:

This pandemic is exceptional because there is no plateau in sight, exceptional because of the severity and longevity of its impact, and exceptional because of the special challenges it poses to effective public action.

Dr. Piot substantiated his claim with the following points:

• The pandemic has broken with the general pattern of diseases and natural disasters, which usually create their own brutal equilibrium, eventually enabling societies to cope. AIDS, so far, appears to be doing the opposite.
• Thus, in Botswana, Swaziland, and other parts of southern Africa the HIV prevalence rate among adults is around 40 per cent and still rising.
• in country after country, the tipping point is being reached after which AIDS no longer remains concentrated in so-called 'hot spots' but becomes a generalized explosion across the entire population.
• By 2006, eleven sub-Saharan countries will have lost more than every 10th person in their labour force to AIDS and, by 2010, five countries in this region will have lost more than every fifth person in their labour force.
• AIDS will slow the rate of poverty reduction in Cambodia by 20 per cent every year between 2003 and 2015.
• Prejudice and discomfort about how HIV is transmitted are, unfortunately, still so widespread that they continue to silence many leaders, not just political leaders but also civil society leaders.

Only in the pursuit and communication of complete and undistorted truth, can we ever hope to mount an effective campaign against the spread of HIV and AIDS. In this regard, we might see the words of Pope John XXIII as prophetic when applied to the situation of today's pandemic:

It is essential, therefore, that the instruction given to our young people be complete and continuous, and imparted in such a way that moral goodness and the cultivation of religious values may keep pace with scientific knowledge and continually advancing technical progress.

The Imperative of Justice in confronting the destructive impact of HIV and AIDS

Human society, as we here picture it, demands that [women and] men be guided by justice, respect the rights of others, and do their duty. (Pacem in Terris, #35)

The poorest, most marginalized and oppressed members of society are also the most vulnerable to the threat of HIV and the tragic consequences of AIDS. They are deprived of access to the preventive education, care, treatment, and support which they urgently need.

Such inequitable access is intimately linked to the personal and family well-being, or lack thereof, among those affected by the pandemic. Availability of combination, anti-retroviral therapy is a particular case in point. One can easily identify a cause-effect relationship between the 3,000,000 deaths due to AIDS last year and the lack of availability of anti-retroviral medications among those living with AIDS in low- and middle-income countries. For this reason, the World Heath Organization developed its 3x5 Initiative to work toward the provision of anti-retroviral medications to three million people in developing countries by 2005. The success of this initiative might be considered partial since, as of June 2005, only one million people had received treatment, but, to the contrary, I would agree with the following assessment made by executives of the World Health Organization and UNAIDS:

From crowded metropolis to isolated village, structures are being put into place that allow hundreds of thousands of people to access a level of medical care that, just a short time ago, was unimaginable.

Global funding for HIV and AIDS programs has increased significantly, from $300 million in 1996, to $6.1 billion in 2004, much of that due to the formation of and support for the Global Fund to Fight AIDS, Tuberculosis, and Malaria, as well as bi-lateral efforts such as the U.S. President's Emergency Program for AIDS Relief (PEPFAR). By the year 2007, however, approximately US$20 billion will be needed in order to meet a range of needs. Just in case some of you question how the global community can generate the funds to provide such medications and services to so many people, let us not forget that an estimated $52 billion per year is spent in the United States in order to cope with the medical consequences of obesity.

A question may be posed about whether all this funding really does make a difference in the lives of poor people. In response, I would like to share a personal testimony. During a June 2005 visit to Uganda, I simply could not identify what was different about the surrounding sights on the road between Entebbe Airport and Kampala a road that became familiar to me during previous visits to the country. The same red clay was causing dust to be spread everywhere; the same crowds of people could be seen walking along the roadway, carrying on their heads the heavy bundles for essential daily living; the same broad waves and smiles of children were ubiquitous. It was only after riding for many miles that I realized the difference: no longer could coffins be seen as the most prominent items for sale in the local markets! In the early 1990s, the omni-presence of coffins along the roadways definitely signaled the major but sad economic growth industry in this country. My intuition about decreasing death rates was confirmed during my visit to the Kamwokya Catholic community, located in a slum at the outskirts of Kampala. There I rejoiced with the poor but proud residents who told me of their death-resurrection experience. Because they now had access to ARVs, those who once were at death's door could now return to work and farming, provide for their families, and were themselves serving as staff and volunteers in AIDS care, support, and treatment programs and in HIV prevention education.

The Catholic Church has assumed a forceful role in advocating for a just solution to the inequities in treatment access. In his statement to the UN Special Session on HIV and AIDS, held in 2001, Javier Cardinal Lozano Barrag President of the Vatican's Pontifical Council on Health Care, clearly stated:

An important factor contributing to the rapid spread of AIDS is the situation of extreme poverty experienced by a great part of humanity. Certainly a decisive factor in combating the disease is the promotion of social justice, in order to bring about a situation in which economic consideration would no longer serve as the sole criterion in an uncontrolled globalization.

In May 2005, I was privileged to serve on the Holy See Delegation to the World Health Assembly, during which meeting, Cardinal Barragpointed out that, on a worldwide basis, the total annual budget for medicines is estimated between U.S. $50 and $60 billion per year, and then urgently asked why only 0.2% of this budget is dedicated to respiratory illnesses, tuberculosis, and diarrheal diseases, all of which have a disproportionate impact on poor and low-income people. The Cardinal could have found his question unnecessary had the world taken better heed of the admonition of Pope John XXIII:

on the international level: some nations may have attained to a superior degree of scientific, cultural, and economic development. But that does not entitle them to exert political domination over other nations. It means that they have to make a greater contribution to the common cause of social progress.

During his address to same 2005 World Health Assembly, Microsoft President Bill Gates conveyed the impression that he was reading from a page of Catholic Social Teaching:

In my view and there is no diplomatic way to put this: The world is failing billions of people. Rich governments are not fighting some of the world's most deadly diseases, because rich countries don't have them

Let's be frank about this. If these epidemics were raging in the developed world, people with resources would see the suffering and insist that we stop it.

That is why I express the sincere hope that the alumni of Georgetown University will leave these hallowed halls not only fortified with the political, administrative, commercial, and technical skills to advance the struggle against HIV and AIDS but also animated by the cardinal virtue of justice that demands equitable sharing of the resources in such efforts. For, as Pope John Paul II, reminded us:

What is at stake is the very meaning of scientific and technological research, of social life and of culture, but, on an even more profound level, what is at stake is the very meaning of the human person.

Respect for Human Dignity and Freedom Essential Resources to Eliminate the Spread of HIV and AIDS

... Human society thrives on freedom, namely on the use of means which are consistent with the dignity of its individual members, who, being endowed with reason, assume responsibility for their own actions. Pacem in Terris, #35

One root cause for the spread of HIV can be found in the imbalance of power in gender relations. In addition to being up to six times more vulnerable than their male partners to contract HIV through sexual activity, women all too frequently face particular oppression at the hands of men and thus are prevented from realizing their God-given human dignity and freedom. Thus, in many countries, women become infected at significantly higher rates than men and at a much earlier period in their lives.

Let us examine more closely some tragic trends in this regard:

Women are confronted almost daily with their relative lack of control over personal health and sexual activity as well as over the sexual activity of their partners. They cannot negotiate, still less refuse, sexual relations within marriage. At the present time, marriage constitutes the greatest risk factor for a woman in Africa to contract HIV.

Poverty all too often forces women and children to enter into prostitution to support themselves and their families, and in some circumstances, families even sell their children into prostitution in order to pay off debts or to advance the family's financial security.

Sexual violence in many societies can be a contributing factor to the spread of HIV. Worldwide, one in five women is a victim of rape or attempted rape at least once during her lifetime, and more women between the ages of 15 and 44 years are killed or made infirm by violence than by cancer. In Kenya, a nation-wide study of 12- to 24-year old women found that one in four is forced into intercourse as a first sexual experience. In South Africa, an estimated 370,000 women are raped every year. A Canadian study revealed that 17.8% of women respondents reported sexual abuse (rape or attempted rape) before the age of 16 years.

In his message to the 1995 United Nations Fourth World Conference on the Concerns of Women, held in Beijing, Pope John Paul II committed the 300,000 social, educational and caring institutions of the Catholic Church to give priority to women and young girls, especially the poorest. During his greeting to the General Assembly of the World Union of Catholic Women's Organisations, held in 2001, he reaffirmed that commitment:

Working together, you must seek to provide increasing material and moral support to women in difficulty, victims of poverty and violence.

These sage papal exhortations may need some bolstering actions, however, in order to reduce the vulnerability of women to HIV infection. During a recent workshop that I facilitated in Togo, I heard the disturbing testimony of a woman, whose husband had infected her with HIV and who, after being widowed at 23 years of age, was deprived by her in-laws of her home and all her possessions and then was left to fend for herself and her newly-born child. I reflected, during that seminar, with priests, women religious and lay pastoral workers on what additional measures might be needed to avoid such all-too-frequent occurrences. They insisted that projects of economic self-sufficiency for women were the most effective means to assure that women remain free of HIV.

The Mandate of Unselfish Love in a Time of HIV and AIDS

[Human Society] demands, too, that [people] be animated by such love as will make them feel the needs of others as their own, and induce them to share their goods with others, and to strive in the world to make all alike heirs to the noblest of intellectual and spiritual values. Pacem in Terris, #35

The lessons of history taught by experience with previous pandemics should have clearly demonstrated that good public health policies require acceptance and non-judgmental care and support for those affected. Yet, I feel compelled to report that attempts to "cast out" those affected by HIV disease - from villages, hospitals, educational institutions, and faith communities - have been experienced in virtually all parts of the world and among all racial and ethnic groups, as well as in all social and economic classes. Sadly, some priests and ministers have refused pastoral care and church burial to the HIV-infected. Many governments at one time or another have enacted policies of forced isolation and restriction of travel by HIV-infected persons, while others have tolerated, and even encouraged, violence toward such individuals.

These discriminatory policies tend to create fear and secretive activity, even among those who already have basic knowledge about the pandemic. In southern Africa, a study on needle stick injuries in primary health care clinics found that nurses did not report the injuries because they did not want to be tested for HIV. Research carried out in four Nigerian states, reported that 10% of care providers refused to serve HIV-positive patients and 20% indicated their belief that many people living with HIV had behaved immorally and deserved to be infected. Such attitudes and actions do not occur only in developing countries. Just recently, a man living with HIV in the United States told me of his experience with a nurse in a local hospital. His intravenous line became disconnected and there was a significant amount of bleeding at the IV site, but the nurse panicked because she knew of his HIV status. She ran out of the room, refused to care for him and even neglected to instruct him about applying pressure to his own wound in order to decrease the loss of blood.

Pope John Paul II made frequent and emotional appeals to avoid discriminatory treatment of people living with HIV and AIDS. In his visit to AIDS patients in the United States (1989), he held out the unconditional love of God himself as the guideline to be followed:

God loves you all, without distinction, without limit He loves those of you who are sick, those suffering from AIDS. He loves the friends and relatives of the sick and those who care for them. He loves all with an unconditional and everlasting love.

The bishops of the Southern Africa Catholic Bishops' Conference leave no room for any possibility of stigmatisation or marginalization based on the false premise that God has willed AIDS for sinful individuals:

AIDS must never be considered as a punishment from God. He wants us to be healthy and not to die from AIDS. It is for us a sign of the times challenging all people to inner transformation and to the following of Christ in his ministry of healing, mercy and love.

In many ways, Pope John XXIII prophetically envisioned the benchmark for effective care and support to those living with and affected by HIV and AIDS when he wrote in Pacem in Terris:

love, not fear, must dominate relationships between individuals and nations. It is principally characteristic of love that it draws [women and] men together in all sorts of ways, sincerely united in the bonds of mind and matter; and this is a union from which countless blessings flow.

During a recent visit to Vietnam, I witnessed firsthand the blessings that can flow from such a loving response to the daily sting and harmful impact of HIV and AIDS. Despite the delicate Church-state relationship in this country, the government there has requested the Catholic Church to assist with care and support of intravenous drug-users in the terminal stages of AIDS-related illnesses. It is important to note that, until very recently, HIV and AIDS was presented by the Vietnamese government as one of the five major social evils in the country a designation that does not easily engender a compassionate response to those living with this virus. The Catholic Archdiocese of Ho Chi Minh City responded to the government call for help by mobilizing volunteers from religious orders to serve in a so-called drug rehabilitation center located in an isolated and rural area. Upon arrival at this center, I was struck by the joy and peace that seemed to be omni-present among the forty religious men and women from seventeen different religious orders in service there. Much more importantly, however, I heard the testimony of their patients who reported that the sisters, brothers, and priests had literally loved them back to life. Now the Church workers are being challenged by some government officials about their high failure rate since the Church was supposed to help these patients to die but, to the contrary, too many patients are surviving one after another opportunistic infection!

Not all the stories can be reported so positively. Listen to this experience recounted by Fr. Joe Arimoso, SJ, a newly-ordained Jesuit, on mission in Zimbabwe, who was called upon to minister to a woman who was desperately ill:

I looked at Ruth and in that single paralyzing moment I saw the face of poverty, the face of AIDS, I saw that shadowy face of despair hovering over hope. She half opened her eyes and looked at me. When she blinked, a shy teardrop escaped from her left eye. Ruth was crying. A wave of emotion overcame me and I broke down with her. I wondered what was making me shed tears then. Little did I know that I was already grieving for Ruth. She died twenty minutes after I anointed her.

I feel blessed to observe this type of ministry, based both on the highest degree of professional expertise and on compassionate, non-judgmental care, that is provided by Catholic religious orders and organizations in many places throughout the world. I am very pleased to announce that, in January 2006, Caritas Internationalis, in collaboration with the Permanent Observer Mission of the Holy See to the United Nations and Specialized Agencies in Geneva, UNAIDS, and the World Health Organization, will convene various Catholic efforts with major engagement in this field, in order to strategically plan a scale up of the education, care, support, and treatment offered under such auspices. Catholic organizations could be proud of their HIV and AIDS work to date, but much more is needed in order to keep pace with the spread and impact of this frightening pandemic.

Conclusion: If you want to fight AIDS, build peace!

Let us, then pray with all fervor for this peace which our divine Redeemer came to bring us May He transform all [women and] men into witnesses of truth, justice, and love. Pacem in Terris, #171

Perhaps by now, at the conclusion of my lecture, you have discerned the reason for my gratitude upon being invited to contribute reflections in conjunction with this Pacem in Terris lecture series. In his landmark encyclical, Pope John XXIII offered us the building-blocks to mold and shape peace that is lasting, comprehensive, and divinely-inspired the harmonious shalom - of which the prophets and psalmists spoke and sang frequently in the Old Testament of our Sacred Scriptures. The pillars of truth, justice, freedom, and love could serve as equally effective and crucial components for an HIV and AIDS initiative capable of eliminating the root causes of vulnerability to this pandemic and of addressing the crying needs of those already affected. Thus, in conclusion, I add my prayer to that of Pope John XXIII whose encyclical inspired this lecture series and could serve equally well as the inspiration for next World AIDS Campaign:

may Christ inflame the desires of all to break through the barriers which divide them, to strengthen the bonds of mutual love, to learn to understand one another, and to pardon those who have done them wrong. Through His power and inspiration may all peoples welcome each other to their hearts , and may the peace they long for ever flower and ever reign among them.

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Rev Robert J Vitillo is the Geneva based Special Advisor on HIV and AIDS to Caritas Internationalis.

A full list of references for this lecture is available from The Nathaniel Centre on request.

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2006