Spirituality & Stigmatization: Ministering to people living

with HIV

jim.mcmanus@bdpct.nhs.uk

Jim McManus, CPsychol,MFPH,MEPS,DipPsych

Assistant Director, Health Improvement

Methodology

• See –the situation• Judge – salient issues• Act – principles for pastoral response• Theological reflection using case study and

Lectio if time

25 Years of HIV

London is historically the epicentre of the UK Epidemic

Some Key Issues• The unique clinical features as well as the stigma and discrimination that

surrounded the early HIV epidemic led to the establishment of stand alone services where patients were managed by specialists.

• However, the escalation in the number of individuals seen for HIV care, together with increases in complex patient management, has put pressure on existing HIV services. These pressures have been felt not

• Between 2004 and 2005,the increase in individuals seen for care outside London was almost double that of the capital (17% versus 9%).

A simplified psychosocial model for stigma

Protective and vulnerability factors

Self Value and Identity

Challenges from illness

Challenges from perception of illness, death, life as compromised

Guilt

Challenges from Society

Loved ones

Challenges from Faith

Stress assessment

FriendsServices

WorkplaceChurch

Positive StressEustressDistress

Acting on These• Protective Factors• Key things which will help people

develop and retain positive sense of self

• Help people make positive assessment of stressors

• Key examples: managing a working life while on HART (managing the stressors well can improve life quality and health)

• Vulnerability Factors• Factors which predispose us to be

vulnerable to stigma or illness• Act on these to reduce or

neutralise them• Help person see and work

through them• Key examples: disfigurement or

smoking behaviour and progression of HIV infection

A Theological Analysis to Stigma - Summary

• The ministry of Christ – to reach out and include

• The role of the Church – sacramental community

• Societal Level• Parish Level• Individual Level• Teaching of Benedict

XVI

Motifs in Pastoral Care responding to Stigma

• Unite to the Cross – a good pedigree but this might reinforce the worries and fears during disease progression so need a context in which it is appropriate

• Call to Life and wholeness• Jesus in the Synoptic Gospels• Individual pastoral care without any social action is not

authentically Catholic• Reformed Theology in recent years• UNAIDS Theological Commission

– Piece of Lectio

Two key questions

1. Is HIV theologically special in and of itself, or is it what we make of it that makes it so?1. Stigma2. Structural and social sin – inequalities3. Not listening to the Gospel or Tradition

2. Given our Catholic heritage of teaching, why are we listening to Reformed theology when we haven’t yet bottomed out what our own tradition may have to say?

A Catholic Theology of HIV 1

• The person in the perspective of an economy of grace• HIV and AIDs as illnesses in the perspective of the • From Scripture through Tradition• Take the person with HIV seriously – moral and doctrinal

theology• Taking the person with HIV seriously means we have

some tasks in Catechesis, Sanctification and Pastoral Care

• Taking the person seriously means taking the person in their “economy of Life”

• Taking the person seriously means engaging with Social Theology and with society and its institutions

A Catholic Theology of HIV 2

• The nature and dignity of the human person• The redeeming work of Christ

– The healing ministry of the Church

• Illness as Challenge and as opportunity– Human life as lived in eschatological perspective– Joy and Justice– The Sacraments– The Church as Sacrament - Schmaus

• The Doctrine of Human Ecology – John Paul II• Touch, Incorporate, Uphold – Benedict XVI

– Jesus in the Synoptic Gospels – uses then goes beyond the traditional socially sanctioned models of prophetic and healing ministry

Some Theological Conclusions• A Christology of HIV• Unite to the Cross is a sign of Hope, not just a sign of

passive suffering• The ministry of Jesus – dealing with the individual and

the social context• A Pneumatology of HIV• A truly Catholic response to HIV builds upon a

sacramental economy of grace to create a pastoral response which helps people LIVE with HIV, even in the face of death

• This provides a place for a theology of the Cross which Reformed Theology around HIV does not seem to do

Pastoral Response• What – Sanctification• How – Build resilience and discipleship• Psychological dimension of sanctification -

can be seen as a means of building protective factors and reducing vulnerability factors

– Example of Jesus in the Gospels– Sacraments– Five Functions of Pastoral Care– Creating an understanding of acceptance– Creating a welcoming parish community– Knowing the limits of your own competence– Picking the main issues you can impact on– Use of the Optio Fundamentalis

• Self awareness and self care on the part of the Pastor

Biological

Psychological

Social

Spiritual

Secular and Christian Agenda

Some Starting Points for Parish and Area Level

• …with respect to the fundamental rights of the person, every type of discrimination, whether social or cultural, whether based on sex, race, colour, social condition, language or religion, is to be overcome and eradicated as contrary to God’s intent

• Gaudium et Spes• It is essential for every human being to have a sense of

participating, of being a part of the decisions and endeavours that shape the destiny of the world.

• World Day of Peace Message 1985• It is a strict duty of justice and truth not to allow

fundamental human needs to remain unsatisfied, and not allow those burdened by such needs to perish. It is also necessary to help these people to acquire expertise, to enter the circle of exchange, and to develop their skills in order to make the best use of their capacities and resources

• Centesimus Annus http://www.ncan.org