Berkley Center

Botswana is one of the countries hardest hit by the HIV/AIDS pandemic. About a quarter of Batswana (the term for the people of Botswana) between the ages of 15 and 49 are HIV positive. There are advertisements on television, radio, and plastered on billboards and minibuses promoting male circumcision (which significantly reduces the probability of infection), encouraging prevention of mother to child transmission of HIV, and reminding people that “Sexual Networking is Risky.”

Over the past decade Botswana has begun providing free antiretroviral therapy to citizens who need it, and the life expectancy is rising. Also, the incidence of HIV in infants has been greatly reduced. Despite the progress, fighting the epidemic remains a major challenge and expense for Botswana. It seems that no sector of society has been entirely spared from HIV’s effects. In numerous respects, religions play a role addressing the epidemic. In this letter I will focus on how the Roman Catholic Church has responded to HIV in Botswana.

First, it is important to note that Catholicism is just one of many forms of Christianity in Botswana. There are only about half a dozen Catholic parishes in the capital, Gaborone, a city of about 200,000 people. In short, it is not really accurate to say that Botswana is a Catholic country, especially when compared to African nations colonized by Catholic-majority European nations.

Nonetheless, the Catholic Church in Botswana has taken a number of actions to respond to the HIV epidemic, both with efforts to help those with AIDS and with efforts to reduce the further spread of HIV. The Church’s justification for devoting resources to the epidemic is straightforward: one Church official told me that the Catholic Church has always been at the forefront of working on behalf of vulnerable people in society, and that today in Botswana, HIV-positive people are among the vulnerable.

One of the Catholic Church’s most significant efforts is providing home-based care to AIDS patients. Volunteers are used to both directly provide care, but also to teach families how to care for a family member with AIDS. More than 500 AIDS patients were being served by this program in September.

One of the goals of this effort is to decrease the stigma associated with HIV/AIDS. Especially in earlier years of the epidemic (HIV was first identified in Botswana in the mid-1980s), many families feared that HIV could be spread through casual contact and thus AIDS patients were sometimes isolated by their own families, which not surprisingly adversely affected the care they received. Aside from care and education for families, the Church helps provide transportation, food rations, and even some medicines to patients in need.

Of course, preserving the dignity of all stages of human life is an important aspect of Catholic teachings, and so the Church here has recently opened a hospice where AIDS patients can die with peace and dignity. It is very important to know that especially in Sub-Saharan Africa, AIDS has not just affected HIV-positive people and their families, but rather whole communities.

Perhaps one of the most tragic aspects of the epidemic has been the orphans left behind. In Botswana, there are nearly 100,000 orphans due to AIDS. The Catholic Church runs a school and daycare center for some of these children.

But the Catholic Church is not just concerned with helping the sick. It is also working to reduce the spread of HIV. The Church has conducted a training program for youth known as Education for Life, which is meant to encourage young people to choose safe and healthy behaviors. This is an interesting example of interreligious cooperation because the Church did not just offer the training to its own members, but rather to members of any denomination in Botswana.

Also, the Church has encouraged youth to form and participate in groups known as Youth Alive, which bring youth together to support each other in making healthy choices. The HIV prevention efforts of the Catholic Church here illustrate that one of the strengths of the Catholic Church is its global reach. Southern African bishops did not have to create HIV prevention programs wholesale. Rather, they borrowed from the Church in Uganda, a country which experienced the effects of HIV somewhat before southern African states like Botswana.

Perhaps no discussion of the Catholic Church and HIV could be complete without considering the topic of condoms. The Catholic Church, like some other Christian denominations here, generally opposes condom use. Rather, the Church promotes abstinence before marriage and fidelity in marriage.

Along with other churches here, the Catholic Church disagreed with some of the early efforts of the Government of Botswana to respond to the epidemic, charging that the government was promoting condom use almost exclusively and neglecting behavior change. However, relations between the government and religions, including the Catholic Church, have improved a lot. While the government still promotes condom use, behavior change is a larger part of the discourse on HIV, and the government has worked to get actors throughout society, including churches, to support efforts to fight HIV.

Finally, it is important to note that the Church does not always discourage condom use. Specifically, serodiscordant married couples (those in which one partner is HIV-positive and the other is HIV-negative) are advised by the Church that they may make choices for themselves concerning condom use. In other words, my understanding is that while the Church does not exactly encourage condom use in this instance, it is not discouraged, either. As one Catholic told me, the theological underpinning of this position is that “it is not love to [leave behind] orphans,” which, of course, is more likely to happen if one partner infects the other.

While numerous Christian denominations in Botswana are interested in working to fight HIV, many churches here are rather small and appear to lack the institutional capacity of the Catholic Church. To the best of my knowledge the Catholic Church is something of an exception among churches in Botswana in that it has programs dedicated to responding to the epidemic (as opposed to other instances in which religions carry out work related to HIV, but do so through more general health and education efforts), and in that it spends its own resources trying to assist people in need, including non-Catholics. (This is not to imply that other Christian denominations do not care about people outside their own church. Rather, many churches are quite small and seem to have no real choice but to focus their limited HIV-related efforts on their own members.)

From what I have learned in Botswana about religion and the HIV epidemic, I am convinced that people in the United States would do well to not see the topic of religions and HIV as just another battleground of the culture wars, but rather try to understand the picture holistically and recognize the role of religions such as the Catholic Church supporting people affected by HIV, whether they are orphans, dying AIDS patients, or young people trying to reduce the incidence of HIV through the choices they make.