Concept of the Russian Orthodox Church's Participation
in Overcoming the Spread of HIV/AIDS and Work with People
Living with HIV/AIDS
PART I. THEOLOGICAL AND ETHICAL ASPECTS OF THE DISEASE
PART II. TASKS IN ORGANIZING CHURCH WORK WITH PEOPLE
LIVING WITH HIV/AIDS
PART III. COOPERATION WITH STATE AND SOCIETY
At the end of the 20th century, people responsible for pastoral care in the Russian Orthodox Church, as was the case for many countries in the world, were confronted with the epidemic of the human immunodeficiency virus (HIV).
Today this epidemic, which has affected primarily the young and economically active populations and which requires increasing expenditures for treating the sick, presents one of the most serious threats to the CIS countries.
In our countries, the HIV epidemic finds favourable conditions in the widely-spread anti-social and amoral forms of behaviour, such as promiscuous sexual contacts and use of injected drugs. At the same time, cases are not uncommon where the infection occurs because of negligence on the part of medical staff, as well as through rape and adultery; there is also a growing number of children born from HIV-infected mothers. Originally prevalent among 'risk-groups', this disease is gradually afflicting an ever-wider range of social groups.
The Russian Orthodox Church in the persons of her clergy and laity participates in the efforts to overcome the epidemic of human immunodeficiency virus/ acquired immunodeficiency syndrome (AIDS) and its consequences.
Aware of her responsibility before God and the people, the Church believes it to be her primary duty to give a spiritual and moral appraisal of the HIV/AIDS epidemic. Social and medical factors and developments, which contribute to the formation of the so-called risk-groups, are only indirect and secondary causes of the HIV epidemic. The real first cause and source of the rapidly spreading epidemic is an unprecedented growth of sin and lawlessness, loss of fundamental spiritual values, moral traditions and guidelines in society. All these destructive processes point to the dangerous spiritual and moral illnesses which have affected society and which, if they continue, may lead to an even greater disaster.
The Church states clearly that illnesses and the suffering they involve, including alienation and disdain endured by the sick from those around them, are consequences of sin and neglect of God-commanded moral norms and interests of the neighbours. Condemning sin, the Church, following her Lord, performs the service of charity towards the sick. The Church works with drug-addicts who comprise the main HIV/AIDS risk-group. In recent times, HIV-infected people have been increasingly included in the pastoral care of parish priests.
The calling of the Church in the situation of the HIV epidemic is not any different from the God-entrusted service she has performed for centuries. At the same time, today's situation with regard to the HIV/AIDS epidemic is in many aspects new for the Church as its specificity concerns the nature of the disease, its moral roots and social consequences, as well as the global scale of the epidemic.
Part 1. Theological and ethical aspects of the disease
I.1. Human dignity and calling
The Christian affirmation of human dignity is based on the teaching of the creation of the world and the human being by God and of the teaching on the incarnation of the Son of God. According to the divine revelation expressed in Holy Scriptures, the human being was created in the image and likeness of God (Gen. 1:26). This raises the human being to the highest level of existence. Human dignity is also bound up with the incarnation of the Son of God, the Lord Jesus Christ. As consubstantial with God the Father in His divine nature, the Son of God became consubstantial to us in His human nature; He is like us in everything except sin.
The patristic tradition views this likeness, among other things, as the task to realize the image of God laid in human nature, that is, to seek to be like God in righteousness and holiness. Orthodox theology describes man's seeking the likeness of God as deification, that is, the attainment of the state in which human nature acquires by grace the properties of divine essence. It is in deification that, according to the church teaching, the highest calling of every human being lies.
I.2. Sin and its consequences
The fall is mankind's spiritual break from God. It has considerably weakened mankind's ability for perfection according to God's design for him. The condition of human nature has changed to affect the intellectual, sensual and physical parts of the human being. As a result of sin, man's physical existence is accompanied with illnesses from birth to death (Gen. 2:17; 3:16-19; Rom. 5:12; 6:16; 8:6; 1 Cor. 15:56; Heb. 2:14-15; James 1:15). It is in illnesses that the power of death over the human being is manifested (cf. Rom. 5:14; 1 Cor. 11:28-32).
Being the cause of a break between man and God, sin also violates relations between members of the human community, leading them to growing mutual alienation, rivalry and enmity (Gen. 3:12, 4; 11:1-9).
I.3. Christ is the Redeemer of man from sin, illness and death
'God did not make death' (Wis. 1:13). He did not create man so that he may die (Ezek. 18:32), but so that he may live (Wis. 1:13 ff.; 2:23). While man is not created immortal by nature, God has called him to eternal life which is possible only in man's communion with Him.
According to the teaching of the Church, God Himself comes to man's help when he is caught in sinful passions and therefore death. The Son of God becomes the Son of Man. Christ conquers sin and delivers humanity from it (Mt. 9:13; Lk. 5:8). Having become 'sin' for our sake (2 Cor. 5:21) and 'curse' inflicted by sin, Christ 'has redeemed us from the curse of the law' (Gal. 3:13).
Healing from illnesses, purification from sin, deliverance from suffering and death are the fruits of Christ's victory over 'the prince of this world' who 'had the power of death' (John 12:31; Heb. 2:14; Rev. 7:13 ff.). And though illness does not vanish from the face of the earth with the coming of the Saviour, divine power, which will ultimately overcome it, is already working on earth. The wonders of healing anticipate the condition of perfection that will be attained by humanity in the kingdom of God. The death and resurrection of the Lord Jesus Christ have opened to every human being the way towards victory over sin and attainment of eternal salvation from death.
I.4. Christian attitude to illness and healing
'At all times the Church has been concerned for human health, both spiritual and physical', the 'Bases of the Social Concept of the Russian Orthodox Church' states. At the same time, the Church always remembers the biblical words that 'healing comes from the Most High' (Sir. 38:2).
Illness and suffering have not only a negative meaning, but can become an antidote for sin. Suffering impels a Christian to rethink his life spiritually. Illness may teach a person to share in the suffering of others, inspire him for the feeling of solidarity and common destiny of the human race and make him turn to God as the Heavenly Father. Illness reminds human beings of their mortality, but for a Christian, death is not only the last enemy, as it induces hope for his union with God after death -the hope based on the paschal faith in the risen Christ, the Conqueror of Death.
The Orthodox Tradition does not view illness and suffering as 'retribution' for our sins. Suffering is a consequence of human sinfulness and is allowed by God, but it is not imperative for salvation, for sin is overcome by repentance and observance of God's commandments.
The Church Fathers do not believe it possible to establish an unequivocal link between illness and a particular personal sin. Thus, St. Mark the Ascetic says, 'Do not think that every grief comes upon people for their sins'. St. John Chrysostom also warns against hasty conclusions about the causes of illnesses, saying, 'There are many irrational people who usually draw from the misfortunes of others wrong conclusions about their lives. Such was their attitude to Job as well. Knowing nothing bad about him, they would say to him: you have got yet little punishment for your sins (Job 33:27)'. St. Philaret of Moscow shares this attitude: 'Who can measure the depth and explore the ways of God's fates? Who will dare declare an ill person condemned and every illness a sign of guiltiness?'
I.5. The sick and the Church
People suffering from various illnesses including serious and lethal ones are of special concern for the Church. The Church lifts up each day communal prayers for their health and salvation.
The Gospel calls everyone not just for compassion for the other, but for the effective manifestation of love, expressed in works of charity, in spiritual and material support for those who need it.
In its attitude to the suffering and the alienation of man, the love of Christ, from the earliest time, has revealed itself as the highest spiritual power that does not work according to temporal rules but can conquer the world and bring salvation to the doomed. When meeting with those who suffer, who are desperate, who are on the brink of death, righteous people and saints of the Church have showed not just charity and compassion, but love in abundance. This love is also poured on those suffering people who find themselves to be despised and alienated social outcasts whom social morality believes to be unworthy of compassion. The attitude of compassion and love for lepers, punished criminals, people from whom others turned away in disdain or horror, has been at all times a Christian and evangelical virtue. For Christ the Saviour 'came to call not the righteous, but sinners to repentance' (Mt. 9:13).
The image of God in man is indestructible even in the situation of sin and alienation from God. A sin of the other cannot be a ground for either praise or disdain. The Church teaches that we should hate sin itself and oppose it rather than shift the feeling of hatred and alienation on to the sinner. According to the patristic principle, 'You should hate sin but love the sinner'.
In the situation of the HIV/ AIDS epidemic, the clergy and laity should do everything that is possible to ensure that the attempts of people living with HIV/AIDS to come to the Church should not be met with indifference, or worse, disdain and condemnation. A person living with HIV/AIDS is called to find in the Church the house of the Father, a haven of salvation and a caring family.
In today's society in which cruelty and hatred towards others are often cultivated and the struggle with other people for a higher social status and acquisition of maximum wealth is encouraged, the Church should proclaim in word and show in deed her faith and conviction that compassion, charity and selfless love for others are a universal and absolute ethical value.
Part II. Tasks in organizing church work
with people living with HIV/AIDS
II.1. Parish level
The role and tasks of a pastor
a) Building up God's sacraments
Priestly service consists first of all in building up the sacraments of Christ, that is, continuous work to build and consolidate the Church through the God-instituted sacraments and other sacramental actions. The Church herself is a sacrament in the most profound and comprehensive sense of the word and her sacramental life is centered on the Holy Eucharist. The service of the word and pastoral care of parishioners have as their task to ensure the appropriate participation of the faithful in the Eucharist through which they enter into communion with God, 'being one body in Christ' (Rom. 12:5).
Those who have come to believe in Christ and have been purified through the sacrament of Confession cannot be forbidden the entry to the kingdom, just as an HIV-infected person cannot be denied the participation in the sacrament of the Eucharist.
The same concerns other sacraments as well. People living with HIV/ AIDS, who open their hearts to the faith in Christ during their illness and, if they are not baptized, sincerely wish to embrace the sacrament of Baptism, should be received in the church community with love. The same reception should be given to those baptized who did not live a church life before but wish now, after repenting before God, to unite with the Church.
It is an important task of a pastor to help involve people living with HIV/ AIDS in parish life. This involvement should begin with their joining the devotional and liturgical rhythm of the parish. In solving the problem of safety for other members of the community when people living with HIV/ AIDS share in church sacraments, a pastor should be guided by the following:
From the medical point of view, there are no obstacles for administering the sacrament of Baptism to an HIV-infected person in the parish baptistery if he or she has no open bleeding wounds. There are no obstacles either for administering to such people the sacraments of Anointing and Extreme Unction. The same is true for giving communion to HIV-infected people, as well as their kissing icons and other sacred objects.
Treating medical recommendations with respect, the faithful do remember that Baptism is not 'taking a common bath', but a church sacrament, and the water for it is blessed. The same is true for the faithful touching sacred objects and, above all, taking the highest ordinance, which is the Body and Blood of Christ. According to the deepest conviction of many generations of the faithful, no infection can be transmitted through a spoon immersed in the true Blood of Christ.
Among forms of spiritual support for parish members living with HIV/AIDS are special prayer services for their health and the inclusion of special petitions in the Augmented Litany. For a few years now some parishes of the Russian Orthodox Church observed a tradition of conducting special monthly prayer services for the health of people living with HIV/AIDS.
In the ordination a pastor is given the gift of bearing witness on behalf of the entire Church tradition. A priest is called to preach always the Word of God and to interpret the Gospel as applied to the life of the community and every Christian. The church sermon should address the needs and problems of the modern world and man, which are to be resolved in the light of the divine revelation and the teaching of the Church.
The HIV/AIDS epidemic, the causes of its spread and society's attitude to those with HIV/ AIDS should compel the clergy to address this subject in their sermons more frequently. At the same time, condemning sin and lack of spirituality, which are the authentic source of the spreading epidemic, a pastor should insist on the patristic principle that one 'should hate sin but love the sinner' while condemning pharisaic attitudes and the sinful habit of condemning others.
The sermon of a priest should necessarily include Christ's call to the faithful to show effective love of their neighbours, especially the sick, the needy, prisoners and the marginalized.
c) Pastoral care of people living with HIV/AIDS
A pastor's compassionate and sacrificial love of his flock is an essential foundation and principle of pastoral care. Among the favourite patristic images of pastorship is the work of a doctor (see St. Gregory of Nyssa, Homily III). The healing of a soul should be undertaken with consideration for the individual features of those who need such healing.
It should be remembered that there are diverse ways of getting infected and diverse situations in which a person with HIV/AIDS who comes to a priest could become infected. An HIV-infected person may not prove to be a habitual sinner at all. A priest should treat an HIV-infected person like any other person suffering from a serious illness.
A person living with HIV experiences extreme psychological stress, which is especially difficult to bear at first when he or she is informed about his or her HIV-positive status. This psychological burden is aggravated by several other circumstances, such as rejection by society, loss of meaning in life, the feeling of fear. A pastor should give maximum possible attention to a person with HIV/ AIDS who comes to him for help. First of all, it is important to help such a person to overcome despair and find hope. The most important task for a pastor in dealing with an HIV-infected person is to give him or her an opportunity for finding the true meaning of life, to meet with Christ.
A priest should encourage a person living with HIV/AIDS to be responsible to himself or herself and to his or her family. With regard to himself or herself, the sick person should concern himself or herself with treatment and lead a healthy life, while with regard to his or her family, everything possible should be done to avoid their infection. A sick person can be of benefit to society, among other things, helping the HIV-infected people who need support to overcome the psychological stress and despair.
It is helpful for a priest taking pastoral care of people living with HIV/ AIDS to have knowledge about the progress of the illness, its peculiarities, the availability of treatment and methods of overcoming difficulties involved in social adaptation.
d) Pastoral care outside the parish
A priest should find time for visiting HIV-infected people at home, in hospitals and in hospices, especially those who are dying.
It is very important that a priest should have an experience of pastoral care of the dying, especially those who have been insufficiently inchurched. Due to peculiar ways in which HIV/AIDS is spreading in Russia, the terminal stage can be reached by young people, many of them with an experience of using drugs.
In case of the infection and death of both spouses, their children and those who were dependent on them may need the help of the parish.
Pastoral work with HIV-infected prisoners is important. In view of the fact that prevalence of drug-addiction and HIV-infection is very high among them, it is very important that a priest should be trained for work with such people.
e) Issues of family ethics in the pastoral care of people living with HIV/AIDS
The fact that HIV has been diagnosed in one or both spouses has proved to be a serious test for the family. Such cases require special pastoral consideration and tact.
Marriage between persons one of whom is HIV-infected and the other is informed about it and still wishes to contract the marriage presents a special case. Both of the future spouses, if they are determined to contract marriage, should clearly realize that there is a risk of infection faced by a spouse and future children. In this situation a pastor should do everything to ensure that this decision does not result from a temporary emotional response; for it should be well considered, responsible and spiritually and morally motivated.
At the same time, modern preventive and therapeutic methods diminish the risk of transmitting HIV infection from mother to child - the fact that opens up an opportunity for bearing healthy children in families in which one or both spouses are HIV-infected. In such cases, the spouses are to be recommended to consult a doctor for mandatory medical supervision.
Diaconal (church social) work with people living with HIV/AIDS
Where it is necessary and possible, parishes should set up services to provide spiritual and psychological support to people living with HIV/AIDS and their families. Only specially-trained lay people and clergy should work in these services. Parishes can set up hotlines for giving spiritual and psychological aid by specialists from among laity and clergy.
Parish home-nursing services taking care of the sick and elderly in hospitals and homes can also take care of HIV-infected people. Nurses and other specialists working in hospices can also help people living with HIV/AIDS. Lay people who participate in the service to prisoners can give psychological and spiritual support to HIV-infected inmates. Among important areas of work is the rehabilitation of HIV-infected drug-addicts. To this end, special rehabilitation programmes and centres can be established at parishes and monasteries.
All these forms of service to people living with HIV/AIDS and their families require special knowledge and training. It is important in parish diakonia that HIV-infected people should be involved in active social and other parish activities and included in the life of the parish.
Education and catechism at parish level
A parish priest should give parishioners explanations on the HIV infection and people living with HIV/AIDS, giving parishioners objective and reliable information. This work should be carried out among both adult parishioners and children. Educational work with children with regard to HIV infection can be carried out in parish Sunday schools, special parish children and youth programmes and summer camps. The primary aim of this work is to educate them for Christian moral principles, which, once mastered, can help children control their behaviour in an independent and responsible way. In parish educational work, consideration should be given to the risks youth face today and the ways to confront them. From their early childhood, children should be educated for family values, fidelity and chastity, charity and compassion, rejection of drugs and other sinful temptations.
By virtue of their organization and internal order, monasteries present a good opportunity for the rehabilitation of people living with HIV/ AIDS. Therefore, it is desirable to establish rehabilitation centres for HIV-infected people at monasteries. These centres could admit people living with HIV/ AIDS.
II.3. Specialized church organizations
It is beneficial to establish special church organizations to give various kinds of aid to HIV-infected people and affected. These structures can assume the task to train parish diaconal workers for work with people living with HIV/ AIDS. The work with HIV-infected people can be carried out on the basis of already existing church organizations, such as care centers for the rehabilitation of drug-addicts already acting in some cities. These centres can run special units for the spiritual and psychological rehabilitation of HIV-infected people and palliative care.
II.4. Diocesan level
The social departments of the Russian Orthodox Church dioceses should include in their activity work with people living with HIV/AIDS, coordinating and supporting this work in parishes, sisterhoods, brotherhoods, monasteries and specialized church organizations.
It is necessary to carry out educational work about HIV among the clergy, explaining to them the need for supporting HIV-infected people and ways of giving this support, peculiarities of the liturgical practice and pastoral care.
Diocesan pastoral meetings
The pastoral care of HIV-infected people and the whole set of problems involved should be discussed and studied at diocesan pastoral meetings. This set of problems can range from the need for objective information about the HIV infection and ways of its transmission and prevention and psychological peculiarities of HIV-infected people to an analysis of the experience accumulated in solving the complex moral, pastoral and practical ecclesiastical problems involved.
Diocesan pastoral meetings can become an instrument for establishing cooperation between parishes in organizing joint diaconical initiatives to give aid to people living with HIV/AIDS and affected by it.
Courses for training pastors and lay people to work with people living with HIV/AIDS
The special training and re-training of both student priests and serving clergy is important in organizing the Church's participation in the efforts to cope with the spread of HIV/AIDS.
In this connection, it is necessary to introduce a special course in the curriculum of theological schools and to undertake other educational measures concerning various aspects of pastoral care of people living with HIV/AIDS. It is also advisable to conduct regular diocesan, inter-diocesan and church-wide pastoral courses for clergy to give them all the necessary information about the HIV/ AIDS disease and the principles and methods of pastoral care of HIV-infected people. It is also useful to organize diaconal training for laity to be instructed in charitable service and care of people living with HIV/AIDS.
Coordination and information
To make the work for giving aid to people living with HIV/AIDS effective, respective initiatives and exchange of methodological, legal and medical-psychological information between them should be coordinated both on diocesan and church-wide level.
II.5. Church-wide level
The social and educational work of the Church to help overcome the spread of the HIV/ AIDS epidemic and the pastoral and diaconal work with HIV-infected people carried out in dioceses and special church organizations should be coordinated on the church-wide level. This coordination will make it possible to adopt common approaches to the solution of complex canonical and pastoral problems, to promote the development of a common stand of the Church in her relations with secular organizations and to develop an informational and methodological basis for organizing particular forms of aid to HIV-infected people and for training clergy and laity.
Part III. Cooperation with state and society
III.1. Cooperation in moral education
The principal means of coping with the spreading epidemic of HIV/ AIDS is the reinforcement of spiritual and moral norms in society through religious education.
The Church and the education of the youth and children
The Russian Orthodox Church has traditionally played a key role in the education of youth and children for morality, patriotism, civic spirit and social responsibility, helping to assert in society the values of spiritual and moral order. And today, too, the Church is capable of speaking clearly and authoritatively to youth about complex problems of life, ethics, values and meaning, thus helping to strengthen the moral and physical health of the nation.
The Church is open to cooperation with the state and society in the religious and moral education of children and youth, the development of educational work for preventing HIV and drug-addiction among children and teenagers and the initiation, together with public and state organizations, of educational and training programmes for preventing HIV/AIDS.
At the same time the Russian Orthodox Church believes it necessary to oppose simplistic patterns in which so-called sexual education is perceived as a panacea for all problems and the only means to educate youth for preventing AIDS. The Church does not believe it possible to maintain cooperation with public forces which, exploiting the theme of AIDS and HIV infection, advocate a way of life, norms of behaviour and ethical views unacceptable for Christian morality. This position of principle does not exclude the readiness of the Church for an open dialogue on all the complex axiological, medical and social problems arising in the context of the HIV/AIDS problems.
The Church and the mass media
Considering the special importance of the mass media in the task of forming public morality in an informational society, the Church believes it appropriate to take an active part in the work of the mass media on her own or in cooperation with public organizations and governmental structures (see, the Bases of the Social Concept of the Russian Orthodox Church, Chapter XV).
Today's tendencies in the development of a mass media policy do not help to promote public morality. Thus, today's television, through various films and programmes imbued with the cult of violence, all-permissiveness, immorality and laxity, bears not a small share of responsibility for the corruption of the moral foundations of society.
The mass media, and first of all, television could become an important means of struggle with the spreading of HIV/AIDS. At the same time, information campaigns for preventing HIV/ AIDS and drug-addiction cannot be effective without solid ethical foundations. A real alternative to drugs, vice and lack of spirituality should be offered. The state, society and the Church should combine their efforts in forming a public information policy aimed at propagating solid spiritual and moral guidelines and personal and social responsibility. A considerable benefit in moral education can be derived from such means of communication and information as the Internet, which has become for many people a permanent milieu for communication with others, obtaining knowledge and information.
III.2. Diakonia and social service
The most important areas of church work for preventing the spread of HIV/ AIDS and care of HIV-infected people in social areas where it is possible to maintain cooperation with public organizations and governmental structures are as follows:
- building a church anti-AIDS network to coordinate Orthodox initiatives in the area of preventing and overcoming AIDS;
- supporting church-public local projects for establishing counselling services and hotlines on HIV/AIDS problems;
- promoting the social rehabilitation and protection of rights of people living with HIV/AIDS;
- providing legal advice to HIV-infected people and the affected;
- psychological aid to people living with HIV/AIDS in medical institutions such as hospitals, maternity homes, in prisons etc., and to the affected;
- taking care of orphans born from HIV-infected mothers;
- nursing and care of HIV-infected orphans;
- home-visiting and nursing HIV-infected adults, including those in terminal stage;
- working with inmates of penitentiaries, including HIV-infected prisoners.
Effective church work is impossible without organizing a system of training and retraining clergy and church social workers engaged in the AIDS problems. Considering the medical and social specificity of the epidemic, it is also desirable that the Church should cooperate in this area with state and public organizations.
The primary directions of work in this area are as follows:
- medical and psychological training of clergy called to pastoral care of people living with HIV/ AIDS, including inmates of penitentiaries;
- training social workers, such as home-visiting nurses and counsellors on hotlines and at counselling centres for work with HIV-infected people and the affected;
- conducting seminars, round tables, training and other methodological and educational activities devoted to various problems of preventing and overcoming AIDS;
- publishing methodological aids for clergy and church social workers engaged in the work with HIV-infected people and the affected, nursing and home-nursing HIV/AIDS patients;
- advising on the methods of Orthodox social service used in preventing and overcoming AIDS.
III.3 Social partnership between the Church and the state
Social partnership between the Church, state and society is an essential condition for effective struggle with the spread of HIV/ AIDS epidemic.
With regard to church-state cooperation in this work, the Russian Orthodox Church recognizes as a priority cooperation with federal and regional ministries, departments and other bodies and their structural units in accordance with previously signed and newly concluded agreements. Developing social services for preventing and overcoming AIDS, the Russian Orthodox Church believes it necessary to participate in the work of inter-departmental and inter-sectional councils and committees in working out and implementing a state policy with regard to HIV/AIDS, including the work of the Russian Federation Consultative Council on HIV/AIDS.