LUSAKA, ZAMBIA -- In a week's time, it is possible to hear the church both criticized and praised for its response to Zambia's HIV/AIDS pandemic.
The critics include gay rights and AIDS activists who acknowledge that the church -- the wider church, both Catholic and Protestant -- should be praised for its health work in many areas but is a major obstacle to what they argue is a needed nonjudgmental and realistic conversation about the extent of male-to-male sexual contact, which is still taboo in Zambia.
More needs to be done to determine how medical and clinical communities can reach out (but haven't yet) to those who may be engaging in risky sexual behavior, said Zambian gay rights activist Lundu Mazoka. He argues that is hard to do in a milieu in which churches continue "to preach hate from the pulpit."
Those praising the church include Zambia's health minister, Dr. Joseph Kasonde, who, in addressing the Africa Congress for Catholic Nurses the week of July 9, heralded the sheer reach of the church, particularly Catholic institutions.
By some estimates, nearly two-thirds of the nation's rural health care institutions are run by the church or have church ties. Both within and outside governmental bodies, there is a shaking of heads when people contemplate what life in Zambia would be like without the church and its work.
"If it weren't for the church, the rural folks would be forgotten," said Euphrasia Mapulanga, a staff person with the Churches Health Association of Zambia, known as CHAZ, a joint Catholic and Protestant network of health providers and community clinics that is the second-largest provider of health services in Zambia.
Sithara Batcha, a senior program officer with the Geneva-based Global Fund to Fight AIDS, Tuberculosis, and Malaria, the world's largest financer of AIDS programs, agrees that the lifeline the church is providing, particularly in rural areas, is crucial. "The Global Fund considers faith-based organizations to be critical providers of rural health care in many parts of the world, reaching the hard-to-reach and poorest population groups," Batcha told NCR. "Zambia has a good example in CHAZ."
Batcha noted that the Global Fund provides CHAZ funding for a number of anti-HIV initiatives, including programs to provide care to HIV-positive women who are pregnant in hopes that their children will not acquire the virus. Such work is sorely needed: The landlocked country of 13 million people has the sixth-highest rate of HIV infection in the world.
In a series of recent interviews with a group of visiting journalists, Dr. Clement Chela, the newly appointed director general of Zambia's National HIV/AIDS/STI/TB Council, also praised the church, saying, "The role of the church in fighting AIDS has been indispensable and very strategic in response to the HIV epidemic."
Chela placed that response in a greater context, noting that the long history of church mission work in Zambia, including the promotion of health and education, dates back more than a century. For much of that time relations between church and government have been cordial, with both being allies in providing health care to Zambia's rural poor.
But the AIDS epidemic that began in the 1980s introduced a new set of challenges for relations between the church and governmental and nongovernmental institutions. "In some sectors, the church was seen as very obstructive," Chela said of some governmental and nongovernmental views of the church, particularly on the issue of condom use and distribution, which the Catholic church, Zambia's single largest religious body, still refuses to support officially.
Chela, who is Protestant, said a "kind of truce" on the issue has emerged, and that the various parties have been able to work together, if at times uneasily, on HIV prevention and treatment during the last decade.
The issue of condom distribution to prevent HIV infection remains extremely sensitive, however. One senior governmental AIDS official said that it is no secret that condom distribution does occur at institutions affiliated with the Catholic church. This official added that the church would likely say it is merely working with those providing condoms "but would not directly say that 'we are distributing condoms.' "
For his part, Fr. Justin Matepa, national pastoral coordinator of the Zambia Episcopal Conference, would not go that far. Responding to several email queries by NCR, he said: "The answer is no; the Catholic church is not working with them (such institutions) in the context under discussion, as we run our own hospitals and institutions."
He said there "has been no statement from the Catholic church here particularly about condoms," and that the Zambian church upholds "the official teaching of the church on human sexuality and the goods of marriage." He added: "The church has continued to promote abstinence and faithfulness, given that sexual intercourse (presumed between heterosexuals) should be in the context of marriage for the unitive purpose and open to procreation."
He added: "As for further instructions and guide to pastoral care we are also able to refer to Chapter 11 of Pope Benedict's book/interview in Light of the World: The Pope, the Church, and the Signs of the Times."
In the book-length interview from 2010, the pope said that condom use could be justified in exceptional situations, such as when sexual relations risk the life of another.
NCR's John Allen noted that Benedict XVI's comments reflected a Catholic tradition of "counseling the lesser evil." Allen noted: "In so doing, the pope has also given a bit of reassurance to Catholic pastors, health care workers and anti-AIDS activists, who sometimes quietly tolerate condom use in morally flawed situations, and who have always been forced to look over their shoulder."
In a visit to a hospital run by a Catholic religious order in central Zambia that receives funding from CHAZ, clinicians said abstinence and faithfulness are the messages to, respectively, single persons and married couples. But discussions about, and distribution of, condoms does occur, particularly in the case of so-called "discordant couples" -- where one person is HIV-positive, the other negative.
The clinician emphasized that everything is done in holistic fashion, with the hospital encouraging routine HIV-testing, as well for males to consider undergoing circumcision -- the removal of foreskin from the penis. (Foreskin is highly susceptible to HIV infections, and male circumcision may be able to reduce by 60 percent the risk of female-to-male sexual transmission of HIV, according to the World Health Organization.
This clinician told NCR that "it is inevitable" that those affiliated with the church, at least at the level of hospitals and community clinics, have "bended" on the issue of condoms and HIV prevention, given health concerns and worries about the spread of the virus. "It's been realistic," the clinician said, though he realizes and understands why some believe the promotion of condom uses "promotes promiscuity."
"You can't control immorality," the clinician said. "In the end, it is an individual decision about what to do, and what to use." The majority of those who come to this hospital are Roman Catholic. "Regardless of their decision, people still need to be protected," said the clinician.
A CHAZ official said working ecumenically has meant that CHAZ has to respect the respective pace that each member church is willing to go on the issue of HIV prevention. (CHAZ does not run or manage hospitals but administers particular programs in member clinics and hospitals.)
Each church exercises its respective theological convictions in the institutions they run or manage, said the official, who is Catholic. The official added that some health workers are frustrated at times that elements within the Catholic church "still want to go slow." The alternative, this official said, is to "wait 50 years to change and do nothing or [instead] act now."
Nonetheless, asked about what is happening in some Catholic institutions in rural areas, the official said: "Condoms are being distributed by Catholic institutions, including the one we just visited." The official paused. "It's a local epidemic, and they [the clinicians] need to design these interventions."
"There is nothing happening in a dark corner. The dioceses know what the hospitals are doing. There are no covert operations," the official said. "Health facilities are distributing condoms. Yes, they are. Are they run by the church? Yes, they are."
While there is an understated, matter-of-fact realism about what is happening at the hospital, one Catholic affiliated with the hospital's work in the area of promoting HIV prevention used the phrase "obedient rebel" to describe how many view their work, particularly over the condom issue.
By that, health officials know that some within the church regard their work as not adhering to official church teaching. But, in fact, the official said, what is happening is being performed as an act of "higher obedience," or conscience, to help save lives.
"Personally I think one of the most important questions that the Vatican is failing to answer on HIV prevention is the fact that all couples who have one or both partners who are HIV-positive should use condoms to prevent infection, re-infection and transmitted resistance," the official said. "The church needs to offer a solution to the challenge of saving lives within the institution of holy matrimony. Failure to do so is an abrogation of its responsibility to save lives."
- Zambia pushes for continued education, medication for HIV/AIDS patients 
- HIV stigma, while declining, still a stark reality for some in Zambia 
- Church part of uneasy alliance combating HIV/AIDS in Zambia 
- Priest says condoms can only be part of larger strategy 
[Chris Herlinger, a New York-based freelance journalist and frequent contributor to NCR on humanitarian issues, writes often about Africa. He was a member of a journalists' delegation that visited Zambia July 9-13, sponsored by the Geneva-based Global Fund to Fight AIDS, Tuberculosis, and Malaria.]