Catholic Ethicists on HIV/AIDS Prevention, edited by James F. Keenan

When I mentioned this book to HIV activists, public health officials and fellow Protestant clergy, all were quick to offer a smart remark, dismissing the likelihood that Roman Catholics could have anything of value to say about HIV prevention. But they were wrong. This book lays the necessary groundwork for an agenda of mutual self-interest for those serious about ending the spread of AIDS. This book makes a start at building a bridge between public health and theological reflection.

Keenan begins with the simple observation that how we define a problem also defines the solution. He argues that Catholic moral theology can be used either to build a prevention-oriented strategy or to undermine it. And he boldly states that "certain moral positions adopted by church personnel are at odds with some relatively effective HIV-prevention measures favored by Catholic health workers involved in the pandemic."

The 38 Roman Catholic authors of these essays remind us that HIV disease exists throughout the world. It disproportionately affects the poor, women, children and those who are socially marginalized. In the U.S. this population includes gay men, injection drug users and sex workers, and is disproportionately found in communities of color. Globally HIV primarily affects heterosexuals. This is increasingly true in the U.S. as well, though infection rates may be rising again in some gay communities.

The first part of Kennan's book explores practical approaches to preventing HIV infections in multicultural contexts. Reading about prevention programs in India and Brazil broadens our knowledge and our sympathies. It also gives us ideas to try here. Pastors considering the possibility of hosting a needle-exchange site at their churches will want to read "Come, Ye Disconsolate: American Black Catholics, Their Church, and HIV/AIDS," by Diana L. Hayes, and "Needle Exchange in San Juan, Puerto Rico: A Traditional Roman Catholic Casuistic Approach," by Jorge J. Ferrer, S.J.

The section devoted to counseling issues encourages counselors to define their personal values--a vital task for working effectively with people with HIV, their friends, families and sexual partners. "Australian Parents of Young Gays and Lesbians: Support and Protection," by Peter Black, C.Ss.R., describes the painful tension under which Catholic counselors are required to work in avoiding seeming to approve of homosexual behavior. In "An American Catholic Hospital Sponsors a Support Group of Gay Men," John Tuohey describes how a clinic tries to dodge the charge of "cooperating in the performance of sexual acts considered intrinsically disordered." Ethicists call this casuistry, and public health officials characterize it as equivocation, yet everybody engages in it.

The second half of the book, "Fundamental Moral Issues for HIV Prevention," is useful not only to Roman Catholics but to Protestants who are seeking to construct a moral theology consistent with Protestant principles. Protestants will find especially valuable Lisa Sowe Cahill's "AIDS, Justice and the Common Good." Cahill draws heavily on the values of liberation theology--values congruent with the Protestant social gospel tradition.

The book's international and multicultural perspective is a refreshing alternative to the U.S. bias of most Protestant theological reflections on HIV. But only José Antonio Trasferreti, in "Encountering a Brazilian Man Abandoned in His Illness," mentions the need for the church to provide spiritual solace to transgendered persons. To its credit, the book incorporates the stories and to a lesser extent the voices of people with HIV, but as a gay man with HIV I was disappointed that no self-identified gay or HIV-infected people appear to be included among the contributors. In articulating ethics, the social location of the affected person is powerfully important.

The book couldn't be timelier. June 5 marked the 20th anniversary of the first mention of AIDS in the Center for Disease Control's Morbidity and Mortality Weekly Report. This book identifies what must become the church's most urgent priority now: prevention, not just treatment. Public health officials warn us that if we do not provide resources for prevention as extensively as we provide resources for treatment, we will live with this tragic epidemic for many generations to come.

Our system of care, both in the health professions and in the church, is more equipped to treat infected people than to prevent ongoing infection. The days when HIV positive children were not welcome in Sunday schools are mercifully over. But rare is the church that makes condoms available during the coffee hour, or that is willing to risk the social and legal censure of supporting a needle-exchange project.

Lives are at stake, and the credibility of the church depends on its ability to talk about the issues of HIV prevention in ways that are consistent with its traditions. We must listen, as these authors do, to what people with HIV are telling us about poverty and access to health care, about sexism and racism. Only then can we help prevent a third generation of the world's people from being infected by HIV/AIDS.

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