SEMINAR on AIDS and MINISTRY, 18-19 January, 2003,
ARU Hostel, Kampala
Speaker: Sr. Dr. Myriam Duggan
Sr. M. Conroy introduced the speaker.
Sr. Dr. M. Duggan, FMSA, came to Nsambya Hospital in 1969 and left Uganda in
1998. She is well-known as the one who gave hope and opened the way forward
for the total care of so many Persons With AIDS (PWAs). She is currently the
Superior General of her Congregation.
SUMMARY
We are living a special moment in salvation history. AIDS calls for a two-fold
response:
a) a gospel response of reaching out in love -
b) b) a call of conversion/turning towards God.
HIV/AIDS IS TRANSMITTED THROUGH:
· 1) Sex (heterosexual and homosexual)-
· 2) Mother to baby: in the womb, at birth and through breast-feeding.
· 3) Blood transfusion.-
· 4) Intravenous drugs (they are coming to Uganda)-
· 5) Cuts, scarification, needles, tattooing.
Reference was made to the Surveillance Report from the Ministry of Health.
Persons living with AIDS: more than one million. Women: 531,000. Men: 413,591.
Young women are more vulnerable due to anatomy, physiology and social factors.
Women are more prone than men to infection.
There is a peak at age 29. There are many deaths from 29 to 34 years of age.
Studies made at antenatal clinics show a gradual decrease in HIV prevalence
but what about rural areas? Education and information reduce prevalence. We
need a lag period to assess progress and full benefit of this fact. Better not
be complacent.
CARE OF HIV POSITIVE PERSONS
The gospel response starts when the persons are told they are HIV+. They need
counselling/love/support, not rejection and stigma. They often experience shame
especially in the Church. Stigma comes from a judgmental attitude You are
sick because of sex.. We judge sexual sin more than any other sin and then
we condemn. A midwife nun could get AIDS without promiscuity. Let us meet people
where they are now.
Pre-test and post-test counselling
If the test is negative behaviour counselling is required. It is about sex outside
marriage, how to behave to protect your life, keep the test negative. HIV positive
persons go through the five stages of the grieving process: denial, anger, bargaining,
depression and acceptance (Dr. Elizabeth Kubler-Ross). Pastoral care consists
in supporting the person / walking with her / being a friend on her spiritual
journey / praying together for courage and strength. Use God's word to console
them.
HIV positive persons can become mobilisers and help others.
Care in early stages/care of HIV positive persons who are still healthy,
for ex. married with young children. We can invite them to put things right
in their life. People start getting sick and wonder whether they can keep their
job. They need a meaningful employment according to the stage of the sickness.
Legal counselling is required. The future of the children and the spouse
has to be considered. Legal documents are needed for women to inherit. If the
husband is sick, make sure he writes a will so that the house/land may go to
wife and children. Those involved in home care can provide official forms.
The Women Lawyers' Association is very helpful.
An adequate diet enables PWAs to live longer. They have to change life style,
get adequate rest. Antibiotics are given for opportunistic infections.
Nevirapine given to pregnant pos. mothers prevents transmission from mother
to child. Some babies get infected through breast-feeding which lasts too long.
A healthy mother should breastfeed for 6 months.
Antiretroviral drugs prolong life but they are costly. Poverty increases
in the family. Some patients cannot afford these drugs or they cannot tolerate
them. An infrastructure is needed to monitor closely the use of these toxic
drugs: the monthly CD4 count is costly. Some patients relapse, some improve
(start again to work).
CARE OF ADVANCED STAGE OF SICKNESS (medical, nursing, material help,
legal advice)
Poverty/destitution may set in. Some die of hunger not of AIDS. Some get evicted.
The patients need on-going support through the sacrament of presence/prayer/Word
of God.
Home-based care programme should be linked with the hospital where
patients go from time to time. The y need 10 t0 20% medical care, 80 to 90%
some other care.
Family income-generating programmes connected with home care are a must: sewing-machine,
chicken, pigs. etc.. widows, orphans, grandparents try to cope with no income.
Hopelessness may set in: people need help, make them feel they belong to the
community (TASO, drama group etc). Life is short but let us encourage people
to do good things before they die.
CARE OF DYING
On-going support, relief of pain, sacrament of presence. A dying young person
feels rejected./lonely . Put them in touch with the love of God. Tell the dying
What do you want to say/to do before you die? What do you want to put right?
Offer to see a priest. Patients get to know Christ through their sickness. You
care to pray with me so you love me, some say. Encourage people around to
pray with the patient, using the Word of God. Have a holistic approach. Pray
with Moslem patients too. Pastoral workers can help the sick to pray. Not to
leave the dying alone. Be there for them. Train volunteers to help the dying
through listening skills, Word of God.
The bereaved also need support and consolation.
People have a limited budget to buy medicines, to meet funeral expenses. It
is good to set limits. One cannot go to all the funerals.
Community programmes
Volunteers are needed. To be a volunteer you need financial security so these
volunteers cannot work full-time. A core staff is needed to administer the programme.
As regards volunteers mutual expectations should be clarified. Men and women
can be volunteers for various tasks such as shopping, making wills etc...
AIDS IN MY RELIGIOUS COMMUNITY
The priests and sisters who have AIDS fear to be judged, outcast, rejected.
How did they get it? work? behaviour? What would Christ do? Let us empathise
with them, be active and compassionate listeners. Shall we tell the community?
After a while it cannot be hidden any longer. Let us give them our unconditional
love, our presence, without condemning and judging whatever the mistake. Hard-heartedness
is worse than human weakness.
A community wanted to look after their member dying of AIDS. People watched
the witness.
In some cases funds are needed to help sisters whose relatives have AIDS.
PRE-TESTING FOR POSTULANTS AND NOVICES, BEFORE PRIESTHOOD AND RELIGIOUS LIFE
It is part of the routine medical examination and remains confidential. The
candidate needs counselling before getting the results. Let us do what is the
best thing in the interest of the candidates once we know their background and
behaviour.
Some young sisters got AIDS through rape. It happens that some HIV positive
men want to get rid of the virus with virgins. Women all over the world
should avoid lonely situations.
Pregnancy might be a consequence of rape. Abortion is never justified. Two wrongs
never make a right.
TOTAL CARE OF ORPHANS
It is advisable to discuss this care with the parents before they die and with
the extended family. The government did not want orphanages but the extended
family find it heavy.
Adoption can be a solution. Orphans can be in families but should not be abused
or exploited as slaves. Households can be formed with war widows (artificial
families). Men are needed as father figures. Let the religious Congregations
get together to handle orphans more effectively, find donors. The parish or
the community can help a lot to assess the real needs and run a project. The
house mother could receive a monthly allowance: food, clothes, school fees are
needed. Social workers monitor in the home and in the school. It is better to
keep brothers and sisters together, and organise counselling for children and
for the carers. The children have to be helped with their grief, their fears
and their needs. Otherwise they take to the streets where they might sniff drugs.
BEHAVIOUR CHANGE AN ON-GOING PROCESS
Many young people die. AIDS could be prevented by addressing the root causes,
by making the right choices.
Statement of belief (formulated at the Dakar Conference, in 1991): we believe
that individuals and whole communities have the inherent capacity to change
attitude and behaviour. The power to fulfil this capacity is often denied or
is not exercised............
This power must now be recognised, called forth and supported from both within
and without. This will enable people to initiate and change and sustain behaviour
that promotes a healthy state of mind, body, spirit and environment. A critical
component in this process is a supportive response to those living with HIV
in the community.
Transmission of HIV: 90% through sexual contact, 7% through prenatal transmission,
1% other means. Recommended: no sex outside marriage, no premarital sex. The
Baptist Community says True love waits (remain pure until marriage). We have
the answers but do we have the will to make changes? Behaviour change is required.
The process is explained in Sr. Kay Lawlor's book Behaviour change process-Education
for life, published after the Dakar Conference.
How behaviour changes:-know and accept the present reality-choose and commit
self to a possible new behaviour-act. etc..
1.Exploring life 2.New picture 3.Action
Telling the story Alternative behaviours What can be done ?
Your values Critiquing How to do it ?
Focusing Choice and commitment Do it
Which values have been overlooked ?
Many topics can be tackled in discussions and role play.
Sexuality is misused in discos and nightclubs. What happens when a girl says
no to sex? What is the influence of alcohol and drugs on your family? It is
good to get in touch with the feelings experienced while watching role play:
shame, anger, etc... and also reflect on the attitudes. The faith dimension
is brought about with Scripture texts Gal.5.- Proverbs ch.5.- Dt.30:15-20.
To control AIDS control alcohol. Two choices are offered: -continue in the same
way.- change in order to protect my life and others' life. If a lot of people
focus on behaviour, AIDS decreases in Uganda. What will your village be in 10
years if you continue?- Where will you be in 10 years' time?
Alternative behaviours can be proposed
What are the results when the husband is not a drunkard? When girls keep their
virginity? When you have new values in your life?
Critiquing
I over drink and I have sex. I drop alcohol and I lose friends but I get new
ones. I get involved in something else.
Youth alive offers the support which is needed. Parents and teachers also
need training to become facilitators. Various programmes exist: Adventure
unlimited for primary schools, other programmes for secondary schools.
Education for life is being used in Zimbabwe , Zambia and South Africa.
Offer workshops on character formation, abortion, etc.
The programmes should include on-going character formation. Negative peer pressure
(to be one of the group, have sex/drugs/alcohol) can be turned into positive
peer pressure (for virginity). Musical and drama festivals when several schools
compete are most helpful. Songs and videos also bring the message. For example
behaviour change can be introduced in Gaba Seminary to help seminarians with
their pastoral work. At the same time it will have an impact on their own life
as well.
Youth alive has worked with prostitutes.
The prevalence of AIDS has decreased in Uganda. Is it due to behaviour change
or the use of condoms?
CONDOMS ARE NOT 100% SAFE.
They decrease the risk but the risk is far too high.
Failure rate of condoms is 13% in preventing pregnancy and one can only
get pregnant 2 or 3 days per month. It is 25% with teenagers.
Breakage rate is 7% for new condoms in USA, 11% in Ghana.
Condoms may leak or slip. They should be stored in a cool and dark place. Moreover
they protect the man more than the woman. They may be defective or expired.
As regards condom use one can consider the lesser of two evils: save some physical
lives, while working on attitudinal changes. 87% success but 13% failure. We
need to get good morals back into society without accepting the lowest common
denominator. We should promote family life and respect for women, not only avoid
AIDS. Promiscuity makes people die spiritually.
Let us maintain a distinction between a teaching situation and a counselling
situation. In a counselling situation with a discordant couple (one spouse
is positive, the other is negative) the spouses could tell each other By
using a condom I put your life at risk by 13% or 15%. Let them do the very
best they can do in their situation. I might die, I want my spouse to stay
alive for the sake of our children. Then, what about having separate bedrooms?
We need to be pastorally sensitive: there is a difference between talking to
young people and talking to a group of grown-ups. There are exceptions. There
is room for compassion.
