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Date: 30/8/2017
The Body of Christ still has HIV. It’s time to talk.

Jim McManus

Professor Jim McManus is Director of Public Health for Hertfordshire, HIV Lead for the UK Association of Directors of Public Health, President of the Guild of Health and St Raphael and Vice Chair of the Health and Social Care Advisory Group of the Catholic Bishops Conference in England and Wales.

Very shortly, Catholics for AIDS Prevention and Support (CAPS) will be launching a new online film resource, Positive Faith. So what? I hear you ask. Well, these videos will have people living with and affected by HIV, on film, and others, discussing HIV and how it interacts with their faith. Love Tenderly, Act Justly is the name of the longest video within the series. And if that’s not enough, this resource has been funded by an agency of Government - Public Health England – as part of their HIV Prevention Innovation Fund.

A recognition has happened that people of faith understand and at least sometimes mediate their health behaviours, including coping with challenges, through and with their faith. And here we have a video resource. There will be a website, with reflection resources, and other materials and tools.

And I am proud, delighted and constantly moved to have been the Sponsor for this project. Not only have I sponsored at the request of Public Health England and CAPS, but I’ve been able to be an ambassador. It’s been a privilege. It’s been an opportunity for me personally to reaffirm that my faith and my professional public health life can interact positively. It’s been an opportunity for me to promote the scientific evidence behind faith and health. 

I am privileged to know, work with and cherish many people with and affected by HIV. Some of them I have lost, but more and more are alive and well thanks to advances in treatment and care. But the successes of longevity and helping people keep the virus suppressed in their blood bring many more challenges – coping, relationships, inclusion, stigma. I could go on.  And that’s where this resource comes in.

The great theologian Hans Urs von Balthasar talked often of the Church’s ministries as Peter’s (teaching), Mary’s (servant leadership and loving accompaniment) and John’s or Johanine (prophetic, needling the Church’s side to be true to its calling.) I think we’ve sometimes lost the Johanine voice on HIV, and in doing so the Petrine and Marian voices feel a bit out of kilter on HIV.

Several members of the CAPS project are members of the Community of the Cross and Passion, an offshoot of the Passionists – who we must thank for ongoing funding of CAPS and the inspiration of their charism – their particular gift to the life, witness and ministry of the church, and their particular contribution to society. That charism is the mission to love tenderly, include radically, and demand society acts justly to those on the margins. 

And here I come to my key point - people with and affected by HIV are still on many margins, hence the need for this project which I hope will inspire not only video but writing and doing too. That’s one Johanine voice around HIV.

I on the other hand, belong to the Secular Carmelites. Our charism is prayer in and with and for the Church – by which I mean the people not the buildings, and the declaration that God is present in every moment if we but reach to discern that. Our Charism is also often to accompany people on the long and odd journey to relationship with God.  What’s that got to do with HIV, you may wonder?  Well two things:  First, the prayerful heart of the Church must lay to heart the need for ongoing witness, mission and inclusion on HIV.

Second, Thomas Merton once said he thought that occasional moments of great grace in the spiritual life were consolation for enduring months of duff prayer and arid experiences.  That’s perhaps a Marian voice on HIV. To be a real Carmelite you have to have your desert experience, of being in the wilderness. So many people with and affected by HIV speak of many deserts from our many experiences. Sometimes that arid hostile desert has been the very community of God’s people, which rather than nurture and sustain, may exclude or desiccate. People with and affected by HIV have sometimes been the Johanine voice, crying in the wilderness.
These two complementary charisms of inclusion and prayerful accompaniment feel at the heart of this project. It is a truism of the Christian life and witness that out of prayer and encounter with God comes a love for God’s people and a commitment to put that into action. And how and what we pray reciprocally shapes and informs how and what we believe. Meister Eckhart said “what we gather in contemplation we give out in loving action.”  The words attributed to St Teresa put it more popularly “'Cristo ahora no tiene cuerpo en la tierra sino el de ustedes, No tiene manos sino las de ustedes” “Christ today has no body on earth but yours, no hands but yours.”

So there are some key things to understand about the importance of this resource, and what it calls us to do:

    For people of faith, their faith is intimately linked to their health and their lives. There is ample scientific research on that. There is also ample research that being who we are, and being valued for that, is crucial to full humanity. So being able to understand where HIV affects us, whether living with it, being in the family or friendship circle of someone living with it, or seeking to remain HIV negative, must include the faith dimension for people of faith. The petrine voice needs to reaffirm this.

      I’ll be honest, I’m constantly surprised when people think this is a revelation. It says something which is to me obvious about human nature. For those of us of faith we have an aching need for God at our core as the Psalm says “like the deer pants for running streams”, and our public services and faith communities insisting we should compartmentalise bits of that does nothing less than disintegrate us, and dehumanise us. Those who say leave your faith at the door of this hospital but claim to value diversity and personalisation, or leave your HIV at the door of the Church but claim to welcome all, radically undermine the very values they purport to affirm and the scientific evidence behind it; the whole person is called to health, not just the bits we feel we can deal with. Christ said “come unto me all who are burdened” he didn’t specify further. It’s a betrayal if we do not do likewise.

 Our inclusion of people with and affected by HIV must start from encounter with God and encounter with our affected neighbours because of love for God and for them. This is about relationship – God, self, neighbour. And HIV, like dementia, cancer and mental health, is slap bang in that mix.

1. One of the key roles of that relationship, expressed in the community of the Church is sanctification - a Catholic word for bringing people to full humanity in relationship with God and each other.

For that to happen, inclusion must be full -  the sacramental, prayer and community life of the Church must be as accessible, inclusive and life-sustaining for all of us affected by HIV as it is for anyone else. The Churches have been patchy at that.

    In living this inclusion, we discern Christ’s body is living with HIV, and that has much to teach us about who we are and what we are, and our dependency on God. The great swiss german theologian Karl Barth once translated one of the beatitudes as “how blessed are those who know their need of God.”  Time for us all to lay that one to heart.

    Finally, the nature of HIV has much to teach us about health. People with HIV, like those with cancer or many conditions, play a hugely important role for the Church. It is a Johanine, prophetic role of giving the Church a model of health and healing which calls us to the very centre of our mission – participation in healing and caring for Christ’s people as a participation in Christ’s mission.

       Many of you have heard me complain that we live with a definition of health as perfect wellbeing which none of us have ever really achieved and whose sole good point is that it’s aspirational, if not eschatological.  Which will come first, the WHO Definition of  health or the Parousia, can only have one – very obvious answer – The Parousia will come, the WHO vision maybe later.  Living with HIV is about adjustment to a changing reality of health experience and expectation, and says much about what we can be despite a condition which remains life-threatening, as well being manageable. Now, isn’t that a rich model to reshape our Christian understanding of health in this life with?

I want to leave you with this thought:
When this project launches it won't be long till the start of Advent. I sat a couple of years back in the still dim, dry coldness of the chapel behind the High Altar in St Peter’s in Rome, at seven o’clock on a late November morning, for Mass before the Vatican’s annual International Health Conference. Cardinal Turckson, the celebrant, preached powerfully of the “long period of waiting” on the Lord which Advent reminds us of. Hopeful, watchful, expectant.  After Advent we hope for the Lord to be with His people.

People with HIV in the Churches which confess Christ’s name and in the services which support and care for them are people in Advent - a people waiting, expectant, of inclusion but also of the opportunity to witness and serve too. One witness of people with HIV is that health and healing can come sometimes despite, but often as one adjusts and responds to HIV. That paradox embodies the Christian nuance of health and healing.

This Video expresses both the joys and rejoicing, the coping, crying to the Lord, the wilderness as well as places of inclusion, and the expectation of God’s people with and affected by HIV.  The task for the institutions of all our Churches now is to proclaim God is with them, with us, and in doing so, include, love and learn from each other.

It’s in that Advent spirit I commend expectantly to you this resource as prevention tool, pastoral care tool, and opportunity to live the Gospel.

Date: 30/8/2017
Not another video about HIV? Yes, and here’s why

Jim McManus

Professor Jim McManus is Director of Public Health for Hertfordshire, HIV Lead for the UK Association of Directors of Public Health, a Member of the Sexual Health Interest Group of the Faculty of Public Health and Vice Chair of the Health and Social Care Advisory Group of the Catholic Bishops Conference in England and Wales.

In a few weeks, a new resource will be launched which tells the story of people living with and affected by HIV. Funded by Public Health England, through their HIV Prevention Innovation Fund, this new resource will feature people prepared to talk despite the stigma. Prepared to share how they cope and how HIV, their health and the deepest issues of their lives come together, and the problems and the positives of that.

And I have been privileged to be the sponsor of that project, at PHE’s request.

We are in a time when virological suppression is a major success story (People I work with, people I love who ten years ago would have died are still alive and well and every day I cherish that and them.)  We are in a time when we could achieve the end of new HIV transmissions, and tools like PrEP are further resources in the long travail which has been the journey since the first people I knew and loved with HIV died.

But, with the success of virological suppression come many challenges. Stigma, ongoing challenges of living, new health threats to people with HIV, and the need to renew our efforts to cherish those with and affected by HIV while reducing new infections. Cognitive decline, however subtle, diseases of ageing in an ageing cohort of people with HIV, negotiating social support, relationships and just coping with life alongside a lifelong health condition, remain psychological, social, practical and – dare I say it – spiritual and existential challenges for people.

This project will launch video resources on a website, with additional materials coming on over the next months, which address these issues head on. And I am so proud to be sponsor. In fact, when asked, I felt there was no way I could say no. This is needed.
But there is more. The people in this resource, and the resource itself, will address HIV through the context of Faith.  Specifically, Christian faith. I want to tell you why, and why health professionals should take notice. This brings me to a second set of reasons why I feel privileged to be the sponsor for this.

The project is being delivered by Catholics for AIDS Prevention and Support. A small charity which provides direct support and care. The resource features people from a range of Christian churches. I’ll speak about why later.

First, we know from ever greater scientific evidence that for people of faith, their understanding of health challenges, their coping, even their health behaviour, is profoundly influenced by and mediated through their faith. People of faith – even those who feel excluded by it – greatly understand their health experience, even down to their efforts to live with HIV or stay free from it, in a way linked to their faith.  We still lag behind in the UK with that understanding in many of our health services, despite it being a commonplace of Health Psychology for decades. We cannot do health without encountering faith in dialogue for people of faith. Ellen Idler’s 2016 book Religion as a social determinant of Public Health (Oxford University Press) is a lucid presentation of the evidence for this.

Second, health services sometimes still seem to remain squeamish, embarrassed or discomforted by the presence of faith. It’s the protected characteristic of the equality act many feel uncomfortable with. But over 40% of people in the UK still confess a religious faith of some kind. NICE guidance, NICE standards and more and more scientific evidence affirms that to personalise health care, we must recognise that we cannot treat faith as something totally private and separate from it. If a person of faith is in the clinical encounter, so is the issue of faith.

As a Catholic and a gay man, this is my experience too. I find it comparatively easy to be myself in the Church as a gay man trying to be faithful to that Church. (I could no more renounce my Catholic faith than I could fly unaided. And I don’t feel the need to justify why.) My faith is the reason I do my job, and it’s the way I cope with life and health. By contrast I am often belittled, or just met with puzzled looks, sometimes feel openly discriminated against, when I try to be an open Catholic in the field of health, especially sexual health and HIV.  Faith is not going away. It is not dying. Even if you think it’s a minority pursuit, it’s important to that minority. And this resource is an attempt to redress an inequity in health – that of faith and HIV.

We must do better on this as a health system. This new resource speaks actively into that. If churches are sometimes uncomfortable about HIV, health services still feel uncomfortable about faith. This resource seeks to bridge that gap. To that extent this is a series of interventions about reducing stigma to build health equity for a population which still faces many challenges.

Thirdly, this resource seeks to build inclusion of people with and affected by HIV in churches. To that extent, this clearly is a public health intervention. And this is why we haven’t produced a multi-faith resource. To understand HIV in the context of a particular faith, there needs to be dialogue in the language of that faith for people who have it. Yes, we need Islamic, Judaic, Hindu and more resources. And I hope people will use this approach as a template. But for a Christian black African woman to understand her HIV and her faith or for a gay male Christian to understand his faith and HIV prevention for himself or others, we need to relate that Christian faith specifically to health. This resource is not an exercise in Christian exclusivism. It’s an exercise in affirming the particularity of faith and producing a model others can use and follow.

How will this prevent HIV?  Well, by affirming and including people and pointing to them how much their health is something to be cherished and how much their faith acknowledges this. And we need to find a way to keep ourselves healthy and resilient to get the best from life.  And health doesn’t mean a blissful state of freedom from any problem. It means adjustment to the realities of our physical, psychological and social challenges and limitations.

This resource sits firmly in the tradition of public health interventions to strengthen individuals and change communities.