Some Difficulties of Care for PLWHA at Parishes PDF Печать
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St George parish, headed by the author of the article, has rehabilitated drug addicts since 1998. First HIV positive young men joined the group of rehabilitants in 2002; they constitute nearly half of the total number lately. The parish clergy have accumulated some experience in work with PLWHA, and it has become clear what difficulties they may encounter in the course of ecclesiastical guidance to them, life in one community with them and communication.


The Concept of the Russian Orthodox Church’s Participation in Overcoming the Spread of HIV/AIDS and Work with People Living with HIV/AIDS is currently the main document that expresses the Church’s attitude to this disease and the diseased. I think that the Concept is well thought and balanced and does not provoke objections. However the document outlines only a number of main church views on the disease approved by the hierarchs, and it was not meant initially as a comprehensive work on the theme. The Concept does not exclude – on the contrary, it implies – additions to those issues that are described there only in brief; naturally, there are some important aspects of the problem that were not considered in the Concept at all.
Church people, including those that serve at St George parish, have shared many ideas, written a number of articles and published brochures on HIV/AIDS since the Concept was adopted. Nevertheless, there are still windows of opportunity to continue discussing the issue without repeating ourselves and others. Here I would like to share some of my ideas on the following issues:

·         Stigmatization of the HIV positive in the Orthodox Christian community;

·         Marriage for Orthodox Christian PLWHA;

·         Possibility of taking the monastic vows by an HIV positive;

·         Possibility of becoming priest by an HIV positive;

·         Why HIV/AIDS attracts so much attention.

Stigmatization
The PLWHA should not be outcasts in the Orthodox Christian community, and should not feel themselves ‘lepers’ among the healthy. HIV is not the seal of God’s rejection. HIV is a challenge, but not a curse. Unfortunately, the Orthodox flock’s attitude to the HIV positive does not differ much from that of non-church people: stigma exists on both sides of the church fence.

The negative attitude to the infected is justified by a rather unfair proposition that only awful sinners contract HIV (‘they got what they deserved’). So what? Does the Gospel teach us to despise sinners? There is no evangelic justification to disdain for somebody. More than that, the very fact of viewing the neighbour as a sinner is a wrong thing in itself. Let us have a brief digression to the basics of the Orthodox Christian ascetics to avoid sinning against the diseased fellows. Joseph Vrienos, scholar, said (although maybe rather audaciously), “There are four deadly sins, and if man indulges in one of them, he will not be able to repent; more than that, God will not be able to hear his prayer. These vices are pride, inability to love, treatment of others as sinners, and the desire to injure others”.

The Christian has the right to say, “I’m a sinner” or “We are sinners”, but the statement “You are a sinner” contains a serious error.

Let us look into what is meant by the words “I”, “ you” and “we”. Linguists have taught us that “we” is the plural of “I”. However it is a false statement beyond grammar. There is no “plural form” of “I”; “I” is the singular, everywhere and forever, now and in the future. There has never been and there will never be any other “I” except for myself. My consciousness and perception of myself (self- consciousness) can become equal under no circumstances to the perception of somebody like me; it will remain unique and irreplaceable. Man will never renounce his own “I”: depersonalization is an unachievable dream of certain Eastern religions. Even if “I” reach to the ultimate level of union with my neighbour (which is to happen, according to God’s plan, in the Kingdom – “That they all may be one; as thou, Father, art in me, and I in thee, that they also may be one in us” John 17:21), our self-consciousnesses will never dissolve in each other, for, as it was revealed, there are three Consciousnesses even in God at the single content of consciousness, and the unity of will, life and essence. God is one, but the Father is not the Son or the Holy Spirit, like the Son is not the Father or the Holy Spirit, and the Holy Spirit is not The Father or the Son.

“I” is always co-related with “thee” (you), in love or, alas, in hatred. The perception of any “thee” for man is always not only external, but also internal, especially when “Thee” means God. It always differs qualitatively from the perception of oneself, no matter how deep the unity was in fellowship. The unity of “I” and “thee” actualizes through fellowship: the existence of a new reality – “we” – reveals in this mutual revelation of personalities. “We” is not the plural of “I”, “we” is always ”thee” and “I” as a certain direct and indecomposable unity. “I” is not thinkable other than the member of “we”, as “we” is not thinkable other than the unity of “I” and “thee”.

Thus, man’s life unfolds through the contact of three realities: “I”, “thee” and “we”. His possibilities with regard to each of these realities differ dramatically. There is a great deal of such things that are possible with regard to “I”, but impossible, and sometimes unthinkable, with regard to “thee”. One and the same action taken by man with regard to “I” and “thee” may be of an opposite moral value: good evidently turns into evil, and vice versa. One and the same proposition, one and the same commandment manifest itself differently when applied to oneself and to the neighbour, though objectively both of them are representatives of the human race. Here are some examples:

·         reproach: to reproach oneself is a great saving virtue; but it is a sin to reproach the neighbour;

·         rejection: God directly requires to reject oneself; but He strictly prohibits to reject the neighbour;

·         humbleness: it is necessary to continuously humble oneself, though there is no commandment to “humble” the neighbour; on the contrary, we are commanded to bear his infirmities (besides, it is impossible to “humble” somebody without his desire; humbleness is inseparably linked with the individual’s personal choice);

·         comprehensive commandment “all Lord’s ways are mercy and the truth”: a correct application of the commandment to oneself and to the neighbour will be as follows: it is advisable to require righteous behaviour of oneself, and show mercy (leniency) towards the neighbour;

·         forgiveness of offences: one can make oneself forgive the neighbour, but you cannot make the neighbour forgive you (more than that, it is impossible to make forgive, one can only ask for forgiveness);

·         love: man can dedicate himself to love the neighbour, and cannot (no matter how much he/she wishes) make the neighbour love him/her (even God cannot do this  though He is looking for love in return);

·         sin: the vision of oneself as a sinner is a true one; the vision of the neighbour as a sinner is fallacious (we simply do not have this kind of vision).

Let us comment on the last statement. The Holy Scriptures give rather many bitter evidences of the expulsion of man from Paradise. “God looked down from heaven upon the children of men, to see if there were any that did understand, that did seek God. Every one of them is gone back: they are altogether become filthy; there is none that doeth good, no, not one” (Ps. 53:2-3). “Every man is a lie” (Ps. 116:11). “He that is without sin among you, let him first cast a stone” (John 8:7). Are we wrong saying that each and every “born by a woman” is a sinner? No, if we believe what is said in God’s Revelation. However, do we see this ourselves? Yes we do, with respect to “I” and “we”. But the statement does not hold true with respect to “thee”: “For what man knoweth the things of a man, save the spirit of man which is in him?” (1 Cor. 2:11-14). We need know the inner motivation of our neighbour’s deeds to have the right to judge about his sin, but the motivation is concealed from us. We cannot see anybody the way his Creator sees the man for “the man looketh on the outward appearance, but the Lord looketh on the heart” (1 Samuel 16:7). We are simply not allowed to judge about our brother – “you are a sinner” – merely because of the commandment “ye shall not judge” (Matt. 7:1). God is right when saying this, while we are wrong when expressing similar statements, because He truly sees while we only pretend to be sighted.

Let us recall the Gospel about healing the man blind from his birth. The Apostles who knew man is not allowed to judge the neighbour’s sin asked their Teacher while passing a blind, “Master, who did sin, this man, or his parents, that he was born blind? Jesus answered, Neither hath this man sinned, nor his parents” (John 9:2-3). The Pharisees assert the opposite without a grain of doubt when addressing the man who had recovered his sight, and investigating the fact of healing, “Thou wast altogether born in sins, and dost thou teach us?” (John 9:34). They commit even a worse mistake when forcing an evidence against the righteous man out of the healed man, “Give God the praise: we know that this Man is a sinner” (John 9:24). Here, the Pharisees call the only sinless Saviour a sinner. The blind think themselves seers and fear not to make a mistake. This chapter of the Gospel closes with the following dialogue, “And some of the Pharisees which were with Him heard these words, and said unto Him, Are we blind also? Jesus said unto them, If ye were blind, ye should have no sin: but now ye say: We see; therefore your sin remaineth” (John 9:40-41). Here is a prompt, which we should use. Being blind for judging about the neighbour’s sins let us admit we are blind, and we shall not dare to pose as those who can see.

When somebody seeks our help, for instance a young HIV positive individual, let us not investigate how sinful he is. Let us better think what we can do for his salvation and wellbeing. However discretion prompts, in spite of everything said above, that we should take the current realia into account and advise that the individual should disclose the secret about his HIV status to the minimum number of parishioners, maybe only to the spiritual father, at first. The unpalatable truth is that even not every spiritual father is capable of a correct response to the trust placed in him by a young infected person. Nevertheless, thank God, the majority of spiritual fathers are people of discretion, and besides they must observe the confidentiality of a confession. The major part of priests have not met HIV positive people yet, because their number is relatively small against the population in general, and there are even fewer of them among the Orthodox Christian flock. When a wise priest hears such a confession he will realize that time has come for him to learn about this problem and to create the environment of a friendly attitude to HIV positive people in his parish. If it happens that there are two or three HIV positive individuals at the parish, it would be good for the priest to introduce them to each other, with their own consent, keeping their secret from the rest of the community. Thus a parish group of people living with HIV/AIDS may be started whose members help each other to bear the cross laid on them by the disease. The number of initiated into the secret may be extended as attitude to the HIV positive improves.

It may make sense to thing of starting an Orthodox Christian PLWHA group in big cities, which can be attended by HIV positive members of several parishes of the city. Such a group of PLWHA believers should be open for friends and young relatives of the HIV positive. Secular PLWHA communities are no good for the churching youth for they are of a different worldview, a different spirit.

Marriage for Orthodox Christian PLWHA
It is always difficult to find a spouse. It is twice as difficult for an Orthodox Christian to find a spouse who is also a believer. To find a spouse for an HIV positive member of the Church among the faithful is a much more difficult task. However the HIV positive want to create a family and have children not less than healthy people.

The Church blesses marriage between two HIV positive persons (a concordant marriage), according to its Concept, and deems possible a marriage between an HIV positive individual and a healthy person (a discordant marriage). Can we help such a marriage happen? And which of the two mentioned marriages is preferable?

From the point of observing a future child’s interests, it is better when one of the parents is not infected (the mother, preferably). However there are several temptations in such a discordant marriage, which are difficult to overcome. First, the positive individual, in case of a potential discordant marriage, will be challenged with a problem without a nice way out: when should he/she tell the other partner about his/her HIV positive status? Should that be at the very beginning? It is foolish and shameful. Or when a deep feeling has already taken root? It is dishonest and painful then. So they have to look for such a moment of revelation about themselves which will be somewhere between ‘foolish’ and ‘dishonest’, and ‘shameful’ and ‘painful’. But it is equally terrifying to tell the truth about oneself from the beginning to the very end, from the first manifestations of mutual attention till the birth of an all-consuming feeling. And this is only the first in line, and yet not the most difficult, challenge.

When I am asked about a marriage between a drug addict in long remission and a person not familiar with the effect of drugs (naturally, both persons are believers), my piece of advice is often, though not always, the following. I recommend (without insisting) that the drug addict and his representatives should do everything possible to make this marriage happen. I advise the other side – people unfamiliar with the world of drug addicts – to refrain from such a marriage. I proceed only from the interests of those people who approach me: I do not make or break engagements proceeding from the interests of one party alone. I am not for or against such a marriage in general, I am for or against it for a particular person.

If a similar situation happens regarding a marriage of an HIV positive individual and a healthy one (I have not had a single case yet), I intend to advise (again, without insisting) to both sides to refrain from such a marriage. A future baby is a third party interested in such a marriage, but it will not ask since it is nonexistent yet. If it turns out that it exists but is not visible to the world yet for it is still in its mother’s womb, then the very fact of its existence denies me the right to impede its parents’ marriage even with a piece of advice.

If we agree that a discordant marriage is less acceptable than a concordant one from the point of both secular and church communities, and generates a greater number of spiritual and psychological challenges, then it is advisable to have some space where HIV positive men and women would be able to meet each other and mix in an environment which is not aggressive towards them. Alas, there are nearly no such places yet for the Orthodox Christian youth in megapolises, and they are nonexistent for its HIV positive segment.

Possibility of Taking the Monastic Vows by an HIV Positive
Every person who expresses the wish to take the monastic vows, can be tonsured a monk after going through a due test period. There is no need in inventing some special rules for the HIV positive. However the monastery, which professed an HIV positive as a monk, is to be challenged with two temptations. The first (in time) may take place when this monk begins to take antiretroviral therapy. If the monastery is not near a big city where the diseased can get the medicines and visit doctors, but in the rural area or in a town, his disease most probably will stop being a secret quite soon for the local inhabitants. The existing stereotypes will immediately generate gossip that at least some of the bretheren are homosexuals. No monastery needs such an ill ‘fame’. The second temptation in time is the necessity to take care of the monk at the terminal stage of his disease: it is against the monastic tradition to send a monk from the monastery to a hospice and leave him in the charge of secular people when he is dying. However, if the monastery lives in the spirit of God commanded love, the second trial will not burden the bretheren, while the first one will be most painful for a monastic community in any case. As for convents, the first temptation will not occur there, for a clear reason.

Possibility of Becoming Priest by an HIV Positive
There is no complete prohibition against ordination of the HIV positive, except for the obstacles general for everyone. This means that if it is found out that the candidate to the priesthood is a lecher, or in a second marriage, or a thief, or an alcohol (drug) addict, his candidature must be turned down on general grounds. However if the man got infected as a baby from his mother, or through blood transfusion at a medical institution, then the disease on its own will not be a hindrance to ordination. Nevertheless there are two serious obstacles in the life of any HIV positive that are not insurmountable:

·         Physical obstacles; and

·         Social obstacles.

Physical ObstaclesCorporal defects and infirmities are not an obstacle on their own to ordination. Only those infirmities are an obstacle that hinder the priest’s service. Antiretroviral therapy, naturally, hinders the performance of religious rites for a priest since the diseased should take medicines according to a schedule, including morning hours, with water or a mandatory meal.
Social Obstacles
The clergy are to be of good reputation, and not only among the faithful. Apostle Paul said, “Moreover he [a bishop] must have a good report of them which are without; lest he fall into reproach and the snare of the devil” (I Timothy 3:7). People with HIV/AIDS have a most poor name in our society. To seek salvation in a community is one thing, to head it is another. The priest can hardly conceal his HIV status after he starts antiretroviral therapy.

These two hindrances together form in essence an insurmountable obstacle for a HIV positive candidate to becoming a priest.

Why HIV/AIDS Attracts So Much
Attention?
Some people think that the main reason for such focused attention to HIV/AIDS is rooted in the activity of an influential international lobby interested in the buzz and excessive hysteria regarding the disease. Well, that may be the case, but still this is not the main fact contributing to so much attention to the disease. There is a spiritual component of interest to it, among others.

When man thinks about AIDS, about this strange disease, he develops a certain mystical feeling. It is not enough to say that AIDS is something that God lets happen for our sins. That would be a too trivial statement for this disease. There is a true feeling that God tries to warn us through it about something very important. What about?

The visible world symbolically reflects the invisible, spiritual one. Saint Maxim the Confessor said, “The whole ideal (spiritual) world is mystically represented by symbolic pictures in the perceptible world for those who have eyes to see. The whole perceptible world is embraced in the ideal one”. According to the Church Father, bodily illnesses in general symbolize spiritual infirmities. Some illnesses are particularly loaded symbolically and with meaning, for instance, cancer or leprosy (there are many Bible pages on the later one). AIDS should be no doubt added to this list. This disease undermines the individual’s immune system. The immune system keeps human beings alive when some infection clings to them. In the spiritual world, God’s grace keeps man spiritually alive helping him to refrain from a passionate inclination and avoid sin. The attack on the immune system, in essence, symbolizes the loss of God given protection.

Now let us see what the Scriptures say about the second coming, “Now we beseech you, bretheren, … That ye be not soon shaken in mind, or be troubled, neither by spirit, nor by word, nor by letter as from us, as that the day of Christ is at hand. Let no man deceive you by any means: for that day shall not come, except there come a falling away first, and that man of sin be revealed, the son of perdition; Who opposeth and exalteth himself above all that is called God, or that is worshipped; so that he as God sitteth in the temple of God, shewing himself that he is God. Remember ye no, that, when I was yet with you, I told you these things? And now ye know what withholdeth that he might be revealed in his time. For the mystery of iniquity doth already work: only he who now letteth will let, until he be taken out of the way (2 Thess. 2:1-11). The majority of Fathers believe that by “he who now letteth will let” the last events happen we should understand the actions of the Holy Spirit in the world, His intercession and protection. What does it mean then that the disease came in the world that symbolizes the loss of God given protection? Most probably it means that “he who now letteth will let” is being “taken out of the way”. It is not incidental that this disease has caused so much alarm and absurd fears, and triggered general concern. The world is coming closer and closer to the last events, which is supported, however, by a plethora of other important events and signs. AIDS is only one of them.

The last problem I would like to highlight in conclusion is that only a small share of Orthodox Christian parishes have encountered the problem of HIV/AIDS in practice. It is the parishes that:

·         Rehabilitate drug addicts;

·         Are located at hospitals and clinical centres;

·         Do missionary work with the youth;

·         Offer spiritual care for the imprisoned;

·         Are located in the regions that are highly affected by HIV.

The clergy of these parishes most probably are already competent in HIV related issues, including the Church’s opinion on the problem. However the majority of priests have not encountered the disease directly. Since our clergy are overburdened with many other tasks, it is merciless and not wise to upset them with the need to study issues irrelevant for them. It is important, nevertheless, that every clergyman that finds himself unexpectedly involved in the care for an HIV positive individual, should know where in the Church he can look for a qualified assistance and who will extend a helping hand to him. Church people working with HIV/AIDS should communicate information about their existence to the clergy of the Russian Orthodox Church, they should make the Church aware that they are ready to help and that they have accumulated sufficient experience in understanding this disease and ways of overcoming the associated problems.