At the start of 2012, it is worth
stopping to reflect where we got to in 2011.
First the good news – new HIV infections
are down, deaths are down, and the number of people on antiretroviral treatment
is up. The
UN High Level Meeting on AIDS in New York last June committed the world to
getting 15 million onto antiretrovirals by 2015, and to zero new infections, zero
deaths and zero AIDS related stigma by 2020.
Hilary Clinton at a recent speech committed the US to work towards an AIDS
free generation, with the recent research findings that antiretrovirals are a
key element in reducing new infections forming one of the planks in that
commitment.
In October a UK
Consortium meeting at Lambeth Palace reiterated the important role of faith
based responses to HIV. In short, it has
been a year where the science, the statistics and even the political will seem
to have been blowing the right way for once.
However, that is not the complete story. For on the downside, funding
is rapidly disappearing, making the likelihood that these high level
targets will be met less and less likely (especially around access to
treatment). There are also worrying signs that faith is not always good news in
the fight against AIDS.
These two stories should come as no surprise – the economic
downturn has hit the whole aid industry hard, and is going to make sustaining
major drives to increase accedes to treatment, care and prevention politically
more and more difficult.
And that faith is not always good news is not news for many
who feel that religious people and institutions have been discriminating against
people with HIV for years, perpetuating stigma.
This situation has changed a lot, and continues to change, but we know
that many people of faith still find it hard to deal positively with HIV. But it is a more specific issue that is of
current concern.
Recent
news stories have highlighted the role of religious healers (particularly
from African Pentecostal and Charismatic Christian traditions) who have been encouraging
people with HIV to stop treatment because they claim that God had healed them
of HIV. Many of these people had
subsequently grown very ill, and some have died. That this happens in many developing
countries has been documented for some time. But there is now growing evidence
that it is a problem here in the UK as well, where the fastest growing churches
are African led and Pentecostal in flavour.
Whether because they are charlatans out for money or (as I suspect in the majority of
cases) well meaning but misguided, pastors and religious leaders in many
traditions are claiming that God has healed a person, and then getting them to
ritually dispose of their medication as a sign of their belief in their
healing. The consequences are a serious
threat to the well being and even the life of the individual, and a potential
threat to public health.
Stopping ARVs can lead to a rapid rebound in viral load,
threatening a collapse in the immune system, but also rendering the individual
much more infectious to sexual partners as well as to their unborn and newborn
children. Furthermore sudden cessation of treatment can lead to viral drug
resistance, limiting future treatment options for the individual and anyone
they may subsequently infect.
There is plenty of evidence
that faith has a part in the healing process. We know that a sugar pill can have similar
efficacy in stopping pain as an analgesic, if the patient believes it is a real
pain killer. The trust and faith that a
patient places in a doctor, nurse or care team can have a big impact on their
subsequent recovery. And it is true that people often cope better with
debilitating conditions when they have been prayed for, or had other interventions
that appear to have no basis in science, but in which the individual has
faith.
If, like me, your world view accepts a God who intervenes in
the physical world to effect cures, the fact that prayer can affect health
comes as no surprise. But even if you
only accept this as a pscyho-neuroimmunological response, it is still not to be
discounted. There is a mounting body of
research on the impact that religious belief and practice (especially within a
wider faith community) can have in have in preventing illness and promoting
recovery, whether or not you accept the existence of miracles.
But to take the leap of taking someone off of medication
with no medical verification is highly suspect.
Such an approach works on an assumption that God does not work through
medical interventions and that only miraculous healings are valid. This is, needless to say a position that is
not taken by Christians, Muslims, Jews or other major faith groups, who have for
centuries held that medicine is not only valid in treating illness, but that the
skills and learning that facilitate it are a gift from God.
In short, this practice is based on a misunderstanding of
both science and orthodox theology. Not
all Pentecostal and African lead churches follow this practice – the majority
would always encourage people to take prescribed medication and only come off
it on the advice of their doctor.
However, there are undoubtedly some churches that do encourage people to
stop treatment in an unplanned and inappropriate manner. This is not unique to
this particular Christian tradition either - there are anecdotal reports of
Muslim faith leaders and traditional religious healers who are also encouraging
treatment cessation, although the evidence of the scale of this in any
religious community in the UK or elsewhere is still very sketchy.
These practices are not something that can be challenged by
just presenting the science behind ARVs and the evidence of their efficacy. The
world view of these faith leaders does not give primacy to scientific evidence
per se. Instead we need to start with challenging these religious leaders to
rethink their theology from within their own faith and using their own
scriptures, and this can only be done by other leaders from within their
tradition. If they can be encouraged by
their peers to see that science and medicine are also God given, only then can
we hope to persuade them that the science is worth looking at and to be
trusted.
At the same time, we need to help the health professions to
understand the world view, belief systems and values of patients coming from a
variety of faith backgrounds. Assuming that your patient shares with you the
same understanding and values about health, illness, aetiology, medicine,
drugs, compliance, etc. is dangerous. We need to help train health
professionals to bridge this gap in understanding, and to get allies within the
faith traditions to work alongside them to communicate with patients.
But above all, we must challenge these healers. Some of them could be allies in our response
to HIV, but at the moment are working against us. But just condemning them will drive them
further underground – instead we (faith leaders, faith based organisations,
secular NGOs, governments) all need to
work together to tackle this head on.
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