On the pastoral care of people living with HIV/AIDS PDF Печать
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HIV/AIDS has posed some difficult questions for confessors. This article is an attempt to answer some of them.

The initial attitude to AIDS that gained a footing among the Orthodox soon after the first reliable information about this disease appeared was briefly this: ‘It is a very timely disease. It is transmitted almost only by drug-addicts, homosexuals, prostitutes and their clients. God has sent it to the world to slow down the pace with which sin is spreading among people. Some refrain from these sins through fear, while the sin-breeders themselves are punished by death selectively’. Though it is not customary to speak about it in public, I believe a considerable number of the Orthodox in our country still hold precisely this opinion about AIDS.

Certainly, this view of the disease is simplified and one-sided. It has been caused by a lack of information about the disease itself and about the situation with regard to AIDS outside Europe, especially in Africa and Asia. But it would be unfair to blame people who think so. It should not be forgotten that they have a view of the world and an understanding of good and evil different from those of nonreligious people. The Orthodox are pleased not by the death of some people, even if they are bearers of sinful infection, but rather by the fact that their removal from the body of humanity has made this body spiritually more healthy. Just as any normal man is glad that a cancerous growth has been removed surgically from the body of a relative or friend not because he has become an invalid with a shortened organ, but because he will live longer after the operation. The church flock mourns the death of the most reckless sinners beat out by AIDS no less than other people do, especially if the sinners died unrepented.

Speaking about AIDS as a God’s punishment, the Orthodox use the term ‘punishment’ only in the sense of edification and warning from above. They mourn for those edified not in the sense of God’s retribution. The idea of God punishing and recompensing for sins in His justice is absolutely alien to the Eastern Church. For us, God, even ‘in wrath’, is always the loving God the Father. We are not taught and cannot see Him in a different way. We are not taught either to think that anything can happen on earth without His will and knowledge. The emergence of HIV is no exception. Does it mean then that in combating AIDS we resist the will of God? The more so that AIDS appears to slow down to some degree the sinful decay of the world? Nor did evil come to this world without God’s knowledge, and ‘the whole world lies in evil’ (1Jn. 5:19). What are we then to think about evil? Shall we not avoid resisting it?

Not everything that happens on earth is pleasing to God, though all that displeases Him is allowed by Him. To explain this affirmation, let us give the floor to St. Dorotheus:

“All that happens by His will, or as stated in the Prophet, I the Lord do all these things (Is. 45:7), or Shall there be a city and the Lord has not done it (Am. 3:6). Evil here is all the distresses that happen to punish us for our viciousness, such as earthquake, drought, diseases, battles – all this happens not because it pleases God, but because God allows this to come over us for our benefit. But God does not want us to wish this or help this to happen. For instance, sometimes God allows the devastation of a city, but He does not want us ourselves to put it on fire. Just as God may allow somebody’s disease and wills that this somebody should be sad, but does not want us to sadden him or say: as it is God’s will for you to be ill, we will not pity you. God does not want us to do such will of His. God wants to see us so good as to wish not what He allows.

But what does He want? He wants us to wish to do His good will, that is, all that pleases Him, that is done according to His commandment that we love one another, be compassionate, do charity – this is God’s good will”.

With this exhaustive explanation from the saint we can easily make the important conclusion concerning AIDS: the Orthodox can in good faith join the struggle with this lethal disease and sincerely thank God for it just as for any other sad thing God has allowed. This conclusion will become ever clearer if we remember that HIV affects not only most reckless sinners but also people innocent of using drugs or indulging in lechery and even innocent babies. And many sinners may not stuck in sin forever, but would give it up and repent. If they were infected in their vicious period of their life, how can we not struggle to prolong their life if they have already embarked on the path of repentance? According to the teaching of the Church, we ought to grieve the death of even a most unrepentant sinner rather than rejoice in it.

In many cases a young man, who has been informed by doctors that he is infected with HIV, takes it as a death sentence. At present this diagnosis means also the civil death of an HIV-infected person, as the extremely negative attitude of our society to the sick of this kind is well known. A young creature with an unsettled worldview experiences a strong feeling which has to be endured somehow, on the one hand, and which is often objectively impossible to be shared with his or her family, on the other. At this very point a disturbed youth can initiate profound relations or very first talk with a confessor.

Anyway, the theme of death will inevitably prevail in the talk of an overwhelmed youth infected with HIV. But is this memory of death that beneficial memory of death which Orthodox ascetics appreciate so much? To clear it up let us resort to the following quotation from To God as He Is by Starets Sofrony (Sakharov):

“Am I immortal as any other man or shall we all sink into the darkness of non-existence? This question asked earlier in calm contemplation now became like an amorphous mass of metal heated to a white heat. A strange feeling came to settle deep in my heart that all aspirations on earth are meaningless. All that was subject to corruption became worthless for me. When I looked at people I saw them, before any other thought occurred, in the power of death and my heart filled with compassion. I wanted neither glory from the ‘dead’ nor power over them; I did not expect them to love me. I despised wealth and did not think much of things intellectual as failing to give me an answer I sought. If I were offered ages of happy life I would not accept them. My spirit aspired after eternity, and eternity, as I was to understand later, was there before me, really regenerating me. The memory of death is a special state of our spirit, quite different from popular knowledge that we will die some day. It is a wonderful memory, taking our spirit out of earthly gravitation. As a power that comes from Above it puts us, too, above earthly passions, delivering us from the power of temporal affections and making us live like saints in a natural way. Though negative, it still presses us strongly to the Eternal”.

Every monk is familiar with the beneficial memory of death, for it is impossible to renounce the world fully without it. This renunciation has the three stages: physical withdrawal from the world, renunciation of previous ways and passions, diversion of the mind from the present and the visible to the contemplation of the future and the invisible. This beneficial memory of death cannot be said to belong to every Christian without exception. Is it granted to a young man who is aware of being HIV-positive? The easiest way to find an answer is to ask one of them:

“There are fathers who believe the HIV-infected have the memory of death which leads them to a spiritual life and asceticism. But my HIV-positive status leads to something different. It makes me think more about a sober life with God according to His commandments, because I had no such life before. I think about how to continue living, how to undergo a treatment because I am only 28. I cannot say I do not think about how I shall die. I do know though I will die a Christian peaceful death. But I have no strength and don’t think it necessary to think about it continuously, otherwise I fall into depression”.

An HIV-positive person does not receive together with the diagnosis the beneficial memory of death, but is shocked becoming clearly aware of the finiteness and fragility of his own life on earth. The value of all the elements of earthly life leaps up in his eyes to make him thirsty for life. In reality, the beneficial memory of death works against earthly values, depreciating all that will not cross the gates of death, while the power of the feeling makes a young heart revere every earthly blessing and satisfy its thirst for it. Thirst for life and thirst for eternity are opposite desires. A confessor should find out which of these two powers grips the one who comes to talk to him about life and death. Since the memory of death is rarer than the thirst for life, a confessor should help the youth to set up the hierarchy of the values of life, pointing to the need to remove sin from it and the ways of doing it. A confessor is able of supporting a youth who begin to appreciate his life in his desire to stop living fast as he did before. A confessor should not miss the chance to inform his life with a new, pure content, to reconcile him with God. But if a confessor begins preaching to a youth scared by his lethal diagnosis such things as eternal life, death as inevitable fate of all people, transience of all earthly blessings, judgment to come and the need to repent of his sinful life as a cause of his lethal infection – this preaching will not meet with any response from his heart. It may just finish him off. Such edification should be reserved for those who want to pursue monasticism.

Not all who learn about their HIV-positive diagnosis, however, take it so hard. But those who take it in a different way seldom come to a priest. Those who do come to an Orthodox priest for advice, along with the question of life and death, often ask whether they can be married and be given the church blessing upon the marriage.

What do confessors think about the marriage of HIV-infected people? Since the clergy have not been polled on this subject, I will cite the opinions of some of them, heard directly or from third persons. The answer to this question is quite foreseeable: there is no unanimous opinion among confessors concerning the marriage of HIV-infected people. Moreover, some of them tend to evade the question, while others do not even wish to think about it in a naïve belief it will never be asked of them personally. No wonder that in this situation HIV-infected people have to make a decision concerning marriage on their own and present their spiritual guides with a fait accompli.

What is the stumbling-block for confessors? There are two complicated points in making a decision on a marriage of HIV-infected people: first, the issue of bearing healthy children in such a marriage and the possibility for the sick parents to raise them without the risk of orphanhood; secondly, the issue of contraceptives. The first question becomes less acute after the couple acquires reliable information about the possibility for HIV-infected parents to give birth to children free from HIV-infection. The second question is much more complicated as there is no adequately defined theological conception on sexual relations in the Orthodox doctrine.

Let us look into the painful question of whether the use of contraceptives is admissible in a marriage of HIV-infected people. First of all, it should be clarified whether sexual relations in a marriage have a value of their own or should be subjected exclusively to procreation? It is well known what the Catholics think about it. Pope Paul VI in his 1968 Encyclical Humanae Vitae affirms: ‘The Church, in urging men to the observance of the precepts of the natural law, which it interprets by its constant doctrine, teaches that each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life’, in accordance with age-old tradition tracing back to St. Augustine’s teaching on marriage. Changes made to the Catholic teaching on marriage, initiated by Vatican II, have not affected this fundamental attitude. But if every marital act should be open to conception and sexual relations are believed to have no independent value, then contraception is inadmissible in any situation. HIV-infected Catholics therefore have to reconcile themselves to the following answer: ‘Since a sexual act without a possibility for conception loses every value and becomes a meaningless and sinful pleasure, you have to reject either contraceptives or sexual relations in your marriage’. But the sick cannot take this advice, while the Catholics including clergy who sympathize with the infected people are reluctant to follow this strict advice. This problem has caused a serious crisis in Catholicism.

The Orthodox teaching on marriage differs from the Catholic one. There is no need to make any essential changes to it as it meets the challenges of time, though needs to be clarified in still underdeveloped areas. The issue of sexual relations in marriage though is passed over in silence. Precisely because it has not been finalized, it allows of various theological opinions.

God’s blessing upon the first human beings to multiply was given when they were still in paradise. The way of procreation is hidden, but the Holy Fathers, whose opinions on this subject have survived, insisted unanimously that it was different from that known to us today. In the fallen world, however, human beings multiply in the same way as animals do. But sexual relations of persons cannot be equated with those of animals. The evidence is this:

·         The feeling of shame among humans

·         The presence of a hymen in human virgins and its absence in other female mammals

·         The presence of orgasm among women and its absence among female mammals

·         Face-to-face intercourse present only among humans.

The last two points suggest that sexual relations in marriage have a value of their own, not subjected wholly to the purpose of child-birth. Face-to-face intercourse opens to spouses some profound knowledge of each other. ‘Adam knew Eve his wife’ (Gen. 4:1). In the Gospel of John, ‘life eternal’ granted us by Christ is predicated by the term ‘to know’, which is also the Hebrew word describing marital relations. ‘And this is life eternal, that they might know thee the only true, and Jesus Christ, who thou hast sent’ (Jn. 17:3).

Having accepted the opinion that sexual relations have self-value, let us move back to the issue of contraceptives. The rythm method is the only admissible contraceptive measure. Father Ioann (Krestyankin), an authoritative confessor, has this to say about it: ‘This method is not to be even confessed, for it is a method of reasonable continence. It is commendable and not blameable’. But in case of HIV-infected people, the primary problem is not contraception but concern for the health of ‘the other half’. The rhythm method does not eliminate the problem. Even if both spouses are HIV-positive, they may have the virus of different kinds and different virus exposure. It is impossible for confessors to evade the question of contraceptives. Why is it so difficult for clergy to bring themselves to answer it? – Because, they have to remember about the Church’s ban on contraception, on one hand, and to consider the Orthodox married HIV-infected people who ‘outlawed’ themselves and who are not inclined to live in marriage ‘like brother and sister’, on the other. They have to find a clear answer acceptable for both sides.

In our search for a decision, let us look at the no less complicated problem and the clear answer to it accepted by the whole Church centuries ago to see if the decision algorithm can be applied to the use of contraceptives in an HIV-infected marriage.

Let us remember what the Church thinks about the participation of the Orthodox in military actions. St. Basil’s Canon 13 reads: ‘Our fathers did not think that killing in war was murder; yet I think it advisable for such as have been guilty of it to forbear communion three years’. How shall we understand it? The Church blesses her faithful to go to war for the defence of their faith and land but cannot bless them to kill and does not justify their hatred of the enemy. War cannot be waged without killing the enemy at the battle-field. Even if one is forced to kill one has to repent. Only if soldiers draw the distinction between what should be praised and what is to be grieved they will themselves seek to bridle themselves, thus minimizing the tragic consequences of war.

Let us move back to our theme. The Church blesses the marriage of HIV-infected people and the fullness of their marital intercourse. Church pastors cannot insist that infected spouses should fully abstain from sexual relations since they do not deny the significance of these relations independent of the procreation purpose. The Church also charges spouses with care for each other’s health. Confessors understand that it is the concern for the health of ‘the other half’ that compels them to use contraceptives. Still, as they go beyond the limits of what is admissible, they ought to repent. Confessors cannot bless the use of contraceptives but they should be utterly tolerant to those infected and should not deny them the participation in church sacraments. The awareness that contraception in this case is only condescension, not permission, will prevent those infected from turning the possibility for sexual relations as part of marriage into the pretext for casting aside all the continence in nuptial bed. The time interval in which they can afford sexual intercourse should not exceed that which is available to healthy spouses observing the quite permissible rhythm method.

If this approach to contraception in case of HIV-infected spouses seems too complicated and contradictory, what then can be said about the Church’s attitude to war? But then, time will show whether the church awareness will make this approach its own.

An important remark in conclusion. There are reasons for keeping quiet about the self-value of sexual relations in marriage independent of the purpose of procreation. First, it is still a theological opinion not shared by all. Some hold the opinions adopted by the Catholic Church. Secondly, advocates of sexual pleasures can use it as an argument against the church practice. Indeed, if the churchmen themselves agree that the sexual intercourse in marriage has a value of its own, then why should the Church forbid contraception? The attack on the Church from this side should be repelled.

God’s commandments are not equally valid as there are major and minor commandments. If a situation falls under two commandments at the same time, the major repeals the minor, not vice a versa. Here are some examples. In the Old Testament, God commanded Sabbath and circumcision. The second commandment is more important than the first one, and Jesus Christ points out that if they coincide the second repeals the first: ‘On the Sabbath days the priests in the temple profane the Sabbath, but they are blameless’ (Mt. 12:5). In some cases, the commandment to love God repeals the commandment to love one’s parents: ‘If any man come to me, and hate not his father, and mother, and his own life also, he cannot be my disciple’ (Lk. 14:26). The reverse is always wrong.

The blessing to multiply and fill the earth was given in Eden and has remained valid in the fallen world. The blessing to maintain sexual relations independent of procreation is less valid, for it was given after the fall when human beings lost the heavenly way of life. It is not obvious and is challenged by many. Applying the above-mentioned principle to these blessing, we have to say that sexual relations between spouses, though important, should not repeal the possibility of conception where possible. As a result we come to the conclusion that coincides with the church attitude: contraception is fully forbidden and the rythm method is permissible. In this approach the rhythm method is not crafty. But if you believe that ‘every marital act should retain its intrinsic relationship to the procreation of human life’, while advising to adhere to the rhythm method, you are being crafty as marital acts in the periods when conception is not possible are closed to procreation.

HIV/AIDS is a challenge not only to medics but also society as a whole. It has posed a number of difficult religious and moral questions. Like drug-addiction, HIV/AIDS is not only a disease but also a social and spiritual phenomenon in its totality. The need for the Church to participate in solving the totality of problems raised by the disease is not challenged. This participation requires not only a theological reflection on the situation caused by HIV/AIDS, to some aspects of which this article has been devoted, but also an active practical work of the clergy together with medics, psychologists and social workers in combating HIV/AIDS. Combined efforts in this field should turn from possibility into reality.