As we approach yet another World AIDS day, it is worth stopping to reflect where we have got to this year.
First the good news – new HIV infections are down, deaths are down, and the number of people on antiretroviral treatment is up. The UN High Level Meeting on AIDS in New York last June committed the world to getting 15 million onto antiretrovirals by 2015, and to zero new infections, zero deaths and zero AIDS related stigma by 2020. Hilary Clinton at a recent speech committed the US to work towards an AIDS free generation, with the recent research findings that antiretrovirals are a key element in reducing new infections forming one of the planks in that commitment.
In October a UK Consortium meeting at Lambeth Palace reiterated the important role of faith based responses to HIV. In short, it has been a year where the science, the statistics and even the political will seem to have been blowing the right way for once.
However, that is not the complete story. For on the downside, funding is rapidly disappearing, making the likelihood that these high level targets will be met less and less likely (especially around access to treatment). There are also worrying signs that faith is not always good news in the fight against AIDS.
These two stories should come as no surprise – the economic downturn has hit the whole aid industry hard, and is going to make sustaining major drives to increase access to treatment, care and prevention politically more and more difficult.
And that faith is not always good news is not news for many who feel that religious people and institutions have been discriminating against people with HIV for years, perpetuating stigma. This situation has changed a lot, and continues to change, but we know that many people of faith still find it hard to deal positively with HIV. But it is a more specific issue that is of current concern.
Recent news stories have highlighted the role of religious healers (particularly from African Pentecostal and Charismatic Christian traditions) who have been encouraging people with HIV to stop treatment because they claim that God had healed them of HIV. Many of these people had subsequently grown very ill, and some have died. That this happens in many developing countries has been documented for some time. But there is now growing evidence that it is a problem here in the UK as well, where the fastest growing churches are African led and Pentecostal in flavour.
Whether because they are charlatans out for money or (as I suspect in the majority of cases) well meaning but misguided, pastors and religious leaders in many traditions are claiming that God has healed a person, and then getting them to ritually dispose of their medication as a sign of their belief in their healing. The consequences are a serious threat to the well being and even the life of the individual, and a potential threat to public health.
Stopping ARVs can lead to a rapid rebound in viral load, threatening a collapse in the immune system, but also rendering the individual much more infectious to sexual partners as well as to their unborn and newborn children. Furthermore sudden cessation of treatment can lead to viral drug resistance, limiting future treatment options for the individual and anyone they may subsequently infect.
There is plenty of evidence that faith has a part in the healing process. We know that a sugar pill can have similar efficacy in stopping pain as an analgesic, if the patient believes it is a real pain killer. The trust and faith that a patient places in a doctor, nurse or care team can have a big impact on their subsequent recovery. And it is true that people often cope better with debilitating conditions when they have been prayed for, or had other interventions that appear to have no basis in science, but in which the individual has faith.
If, like me, your world view accepts a God who intervenes in the physical world to effect cures, the fact that prayer can affect health comes as no surprise. But even if you only accept this as a pscyho-neuroimmunological response, it is still not to be discounted. There is a mounting body of research on the impact that religious belief and practice (especially within a wider faith community) can have in have in preventing illness and promoting recovery, whether or not you accept the existence of miracles.
But to take the leap of taking someone off of medication with no medical verification is highly suspect. Such an approach works on an assumption that God does not work through medical interventions and that only miraculous healings are valid. This is, needless to say a position that is not taken by Christians, Muslims, Jews or other major faith groups, who have for centuries held that medicine is not only valid in treating illness, but that the skills and learning that facilitate it are a gift from God.
In short, this practice is based on a misunderstanding of both science and orthodox theology. Not all Pentecostal and African led churches follow this practice – the majority would always encourage people to take prescribed medication and only come off it on the advice of their doctor. However, there are undoubtedly some churches that do encourage people to stop treatment in an unplanned and inappropriate manner. This is not unique to this particular Christian tradition either – there are anecdotal reports of Muslim faith leaders and traditional religious healers who are also encouraging treatment cessation, although the evidence of the scale of this in any religious community in the UK or elsewhere is still very sketchy.
These practices are not something that can be challenged by just presenting the science behind ARVs and the evidence of their efficacy. The world view of these faith leaders does not give primacy to scientific evidence per se. Instead we need to start with challenging these religious leaders to rethink their theology from within their own faith and using their own scriptures, and this can only be done by other leaders from within their tradition. If they can be encouraged by their peers to see that science and medicine are also God given, only then can we hope to persuade them that the science is worth looking at and to be trusted.
At the same time, we need to help the health professions to understand the world view, belief systems and values of patients coming from a variety of faith backgrounds. Assuming that your patient shares with you the same understanding and values about health, illness, aetiology, medicine, drugs, compliance, etc. is dangerous. We need to help train health professionals to bridge this gap in understanding, and to get allies within the faith traditions to work alongside them to communicate with patients.
But above all, we must challenge these healers. Some of them could be allies in our response to HIV, but at the moment are working against us. But just condemning them will drive them further underground – instead we (faith leaders, faith based organisations, secular NGOs, governments) all need to work together to tackle this head on.