Pontifical Council for the Pastoral Care of Migrants and Itinerant People

People on the Move

N° 101, August 2006

Migrants

We have to make a distinction between the policy that has to be followed by migrants whether they are staying with their family or remaining alone. Thus a policy that groups men together staying in all male hostels, and returning home once a year to see their families, will create a special social cultural environment. When isolated from traditional socio-cultural norms and values of their home society, their behaviour is no longer regulated by social and moral constraints. This anonymous situation, particularly when there is easy access to different partners, multiplies the possibilities of infection. Returning home, they bring the disease along and spread over great distances. In South Africa for example, with its hundred of thousands of contract migrant labourers, miners are a clear example of such a policy and the spread of AIDS.

War crimes - systematic rape

The correlation between AIDS and war cannot be automatically made. However, the risk factor during war becomes higher, especially in cases where systematic rape is used as a weapon of war. This has happened, for example in Liberia, the Democratic Republic of Congo and Rwanda, resulting thousands of women being infected. One Rwandese widow stated: “After killing our husbands, they turned to us. They knew very well that they were infected with the virus and wanted us to experience the same agony”. She has now been living with HIV for nine years. Her skin is scared and eyes sunken by the disease. The genocide did not only kill; it left in its wake lasting psychological scars on thousands of survivors”⁵. 

Refugees and Internally Displaced Persons

Many times they are blamed for having introduced HIV/AIDS into a region. However, research indicates otherwise. The percentage of HIV/AIDS infected refugees is normally not higher than the one of the surrounding population. Often it is even lower. Evermore over the years, by attending awareness campaigns in camps, refugees are better prepared for prevention, which also leads to a reduction of HIV/AIDS infection rates. “Between 2001 and 2003, the UN High Commissioner for Refugees (UNHCR) and its partners measured HIV prevalence among pregnant women in more than 20 camps housing some 800,000 refugees in Kenya, Rwanda, Sudan and Tanzania. The results: refugee populations in three of the four countries had significantly lower HIV prevalence than the surrounding host communities. For example, in northwestern Kenya, 5% of refugees were HIV-positive, compared with a 18% HIV prevalence in the surrounding ... population. In the fourth country, Sudan, the refugee camps and host community had comparable infection rates”⁶. However a certain risk for spreading HIV/aids exists when refugees return. Then their percentage of infections may be higher than those of the remaining population in the country of origin, especially in isolated regions.

More research is still needed to get to know the situation of urban refugees, which is most probably worse than the situation of refugees in camps, since they have to struggle to survive. After all they do not receive material support and rely on government services that may discriminate against them when they are undocumented. This all may lead to a more risky behaviour. The same is most probably also true for Internally Displaced Persons who hardly can rely on the services of their government⁷.  

3. The Answer of the Catholic Church

The dignity of the individual plays a central role in the social doctrine of the Church. In fact that is the basis also of its vision for society: “...individual human beings are the foundation, the cause and the end of every social institution”⁸. This means “every man has the right to life, to bodily integrity, and to the means which are suitable for the proper development of life; these are primarily food, clothing, shelter, rest, medical care, and finally the necessary social services”⁹. In the same line “The joys and the hopes, the griefs and the anxieties of the men of this age, especially those who are poor or in any way afflicted, those too are the joys and hopes, the griefs and anxieties of the followers of Christ”¹⁰. This motivates the involvement of the Church, with those who suffer, regardless their ideology and religion. Thus when the Church speaks out about poverty or life, human rights or death penalty, this is done from the same point of view; each human person has an essential and priceless value, a dignity which should not be threatened. 

This is true also when new problems challenge the human being. Nowadays this includes the persons living with HIV/AIDS, so that this caring presence of the Church is incarnated into many different forms and covers a whole range of activities addressing the different aspects of the needs and the problems of the society.

3.1. In the hospitals

On various occasions, Pope John Paul II has affirmed that those suffering from HIV/AIDS must be provided with loving care and shown full respect, giving every possible medical and spiritual assistance, and indeed treated in a way worthy of Christ himself. So, as a consequence, the merciful love of God needs to be shown especially towards the orphans of parents who have died of AIDS¹¹. To be concrete the Catholic Church takes the care also for one in four patients who are HIV positive worldwide. “12% of care providers for HIV/AIDS patients are agencies of the Catholic Church and 13% of the global relief for those affected by the epidemic comes from Catholic non-governmental organizations. The Holy See, thanks to its institutions worldwide, provides 25% of the total care given to HIV/AIDS victims, placing itself among the leading advocates in the field, in particular among the most ubiquitous and best providers of care for the victims”¹². A breakdown of activities in 2005 shows that at present 45% of actions is undertaken by governments, 27% by the Catholic Church, 16% by other religious communities and 12% by Non Governmental Organisations¹³. 

The Episcopal Conferences of Africa and Madagascar (SECAM) fully support this task and “commit themselves to making available our Church’s resources be they our educational and healthcare institutions or social services” and “to identify focal points in parishes, dioceses, and national Episcopal Conferences in order to assist with gathering information and development of programme strategies”¹⁴. 

Further developments have led to the establishment of the “Good Samaritan Foundation”, created by Pope John Paul II, on 12th September 2004, for the purpose of showing the concern of the whole Church for the poorest and most deprived among the sick, the people affected by AIDS, and the focus of the Foundation is Africa¹⁵.

3.2. Access to medicines

Access to life-saving antidrugs (ARVs) is difficult in many countries, with the result that millions of people cannot use them because these medicines are not sufficiently available, or their cost is too expensive for a large part of the population. Partly, this is a consequence of the intellectual property rights or the patents on the medicines. In this regard it is appropriate to recall what the Second Vatican Council emphasized regarding the common destination of the world's goods¹⁶ and what is taught by the Encyclical Centesimus Annus, that is: "Of its nature private property also has a social function which is based on the law of the common purpose of goods”¹⁷. This has immediate consequences in dealing with hunger, poverty and disease. As far as sicknesses are concerned, it means that the right of every individual to health care should be promoted and that property rights are subordinated to the common good¹⁸. The Holy See has promoted this and proposed it in UN meetings, asking “the rich countries to respond to the needs of HIV/AIDS patients in poorer countries with all available means, so that those men and women afflicted in body and soul will be able to have access to the medicines they need to treat themselves”¹⁹. The same approach could be taken by local Churches in relation to their respective governments to obtain the necessary resources for the treatment of HIV/AIDS patients.

Therefore the Church supports the view of UNHCR²⁰ that refugees should be treated in the same way as citizens of the country concerning aids and access to medicines, whereby mandatory testing of asylum-seekers should be forbidden, since it does not prevent the spread of the virus and is not in accordance with human rights standards.

3.3. Against discrimination and stigmatisation

Persons suffering from HIV/AIDS are also vulnerable, because many times they face discrimination or are stigmatised by their immediate surroundings or by the society at large. In fact, the relation between the sick and the healthy, a relation between human beings, is threathened by intolerance and one should not blame people suffering from AIDS. In this context Pope John Paul II spoke several times against the discriminatory treatment of people suffering from it. As stated already in 1989 with these patients: “God loves you all without distinction, without limit. He loves those of you who are sick, those suffering from AIDS. He loves the friends and relatives of the sick and those who care for them. He loves all with unconditional and everlasting love”²¹. The Bishops of Southern Africa put it in this way: “AIDS must never be considered as a punishment from God. He wants us to be healthy and not to die from AIDS. It is for us a sign of the times challenging all people to inner transformation and to the following of Christ in his ministry of healing, mercy and love”²². These convictions are embedded in the vision that “all men possess a rational soul and are created in God's likeness, since they have the same nature and origin, have been redeemed by Christ and enjoy the same divine calling and destiny, the basic equality of all must receive increasingly greater recognition. .... with respect to the fundamental rights of the person, every type of discrimination, whether social or cultural, whether based on sex, race, color, social condition, language or religion, is to be overcome and eradicated as contrary to God's intent”²³. This is a common teaching of the Church, and every Christian Community is asked to join in and promote a relation of trust, acceptance and caring, and so become a place of healing where all are welcome and feel at home.

3.4. The question of “reproductive health” in refugee situations

Some years ago several UN Agencies published a field manual concerning “reproductive health” in refugee situations²⁴. It promotes “reproductive health” as a right, taking its lead from the Cairo Conference²⁵. After various discussions with the UNHCR, an answer²⁶, indicating the concerns for the Holy See, was developed by three dicasteries of the Roman Curia. 

Differences concerning the concept of “reproductive health”, as is evident in the positions of the Holy See and the UN, result in taking sometimes opposite actions. In fact “Regarding the terms ‘sexual health’ and ‘sexual rights’, and ‘reproductive health’ and ‘reproductive rights’, the Holy See considers these terms as applying to a holistic concept of health, which embrace, each in their own way, the person in the entirety of his or her personality, mind and body, and which foster the achievement of personal maturity in sexuality and in the mutual love and decision-making that characterize the conjugal relationship in accordance with moral norms”²⁷ Furthermore the Church holds that human life starts at the moment of fertilisation. 

So we must say thath the Field Manual proposes an utilitarian and narrow approach of sexuality. This results in the use of condoms on a massive scale and the morning-after pill, when forced sexual relations have been realized (and this pill is considered by it as an emergency contraceptive), with sterilisation also regarded as a simple “contraceptive”. 

The Note for the Bishops’ Conferences,in any case, states that pastors “have the duty to ensure respect for refugees as persons and for their rights. This involves knowing the refugees and the health care workers who are looking after them, winning their trust, listening to their appeals, and paying attention to everything said in confidence”. In any case by a presence that is not limited to Catholic charitable organisations, “pastors must be very vigilant to ensure that practices proposed by the Field Manual and considered to be immoral do not gain a foothold”²⁸.

3.5. Prevention

Marriage is a permanent, loving, faithful, mutual relationship between a man and a woman. It involves partnership and mutual respect and is committed to the bearing and rearing of children and the guidance of adolescents. It involves, rejecting artificial contraception²⁹, the use of natural methods for regulating birth means. In this perspective abstinence and chastity before and outside the marriage and faithfulness to each other within the marriage are virtues. Moreover, they are the best and most effective prevention against the sexual transmission of HIV/AIDS. This requires “training in the authentic values of life, love and sexuality. A proper appreciation of these values will inform today's men and women about how to attain full personal fulfilment through affective maturity and the proper use of sexuality, whereby couples remain faithful to each other and behave in a way that prevents them from becoming infected by HIV/AIDS. No one can deny that sexual licence increases the danger of contracting the disease. It is in this context that the values of matrimonial fidelity and of chastity and abstinence can be better understood. Prevention, and the education which fosters it, are realized in respecting human dignity and the person's transcendent destiny, and in excluding campaigns associated with models of behaviour which destroy life and promote the spread of the evil in question”³⁰.

“Every educational programme, whether Christian or secular, must therefore emphasize that true love is chaste love, and that chastity provides us with a founded hope for overcoming the forces threatening the institution of the family and at the same time for freeing humanity from the devastation wrought by scourges such as HIV/AIDS. The companionship, joy, happiness and peace which Christian marriage and fidelity provide, and the safeguard which chastity gives, must be continuously presented to the faithful, particularly the young (Ecclesia in Africa, 116). This task not only includes encouraging and educating young people but also requires the Church to be the leader in the sustained effort to promote programmes which foster authentic respect for the dignity and rights of women”³¹ and in this fields concrete work is done and associations are existing.

Nevertheless, in today’s ‘modern’ world such attitudes seem to be at odds with ongoing developments. Pope John Paul II addressed it in this way: “Do not be deceived by the empty words of those who ridicule chastity or your capacity for self-control. The strength of your future married love depends on the strength of your present commitment to learning true love, a chastity which includes refraining from all sexual relations outside of marriage. The sexual restraint of chastity is the only safe and virtuous way to put an end to the tragic plague of AIDS which has claimed so many young victims”³².   

3.6. HIV/AIDS infection among married couples

In this theme to be objective, I have here to say that a few cardinals³³, very recently, have discussed this matter. They seem to leave the option open for married couples to decide for themselves how to defend against the disease when one of them is already infected by AIDS. Also the Southern Africa Bishops’ Conference intervened in the discussion with these words: “There are couples where one of the parties is living with HIV/AIDS. In these cases there is the real danger that the healthy partner may contract this killer disease. The Church accepts that everyone has the right to defend one’s s life against mortal danger. This would include using the appropriate means and course of action. Similarly where one spouse is infected with HIV/AIDS they must listen to their consciences. They are the only ones who can choose the appropriate means, in order to defend themselves against the infection. Decisions of such an intimate nature should be made by both husband and wife as equal and loving partners”³⁴.

However, one has to recognize that there is a considerable difference of opinion among Catholic moralists on this topic. Moreover, even for those following this new point of view in the mentioned specific case, the moral law does not change as far as condoms and contraceptives are concerned as a matter of principle. In any case, I think there will be a clarification about this specific point of HIV/AIDS married couples from the part of the Holy See.

3.7. Education

Information, legitimate and moral prevention, counselling, respectful taking care for, considering the person as ... a person have to be integrated in Church structures also for education, i.e., formation programmes in the seminaries and religious houses, and at diocesan, deanery or parish level in accordance with the circumstances, and should include refugee communities. The necessary knowledge, combined with Christian and african wisdom, as far as life and human sexuality is concerned, taking here into consideration our african meeting. 

For the UN may I add that the battle regarding AIDS must go together with the one against malaria and tuberculosis, two diseases which kill the same number of people, together, that AIDS does. It will be a sign that in the battle against AIDS there are not “contraceptive” motivations, in the line of “reproductive health”, which finds the Catholic Church in a very convinced opposition.  

4. Conclusion

As Pope John Paul II wrote: “The battle against AIDS ought to be everyone's battle. Echoing the voice of the Synod Fathers, I too ask pastoral workers to bring to their brothers and sisters affected by AIDS all possible material, moral and spiritual comfort. I urgently ask the world's scientists and political leaders, moved by the love and respect due to every human person, to use every means available in order to put an end to this scourge”³⁵.

This is a programme of action which invites us to integrate the “AIDS ministry” into the normal life and work of the Church, respecting our own catholic ethical convictions, to strengthen it and to make sure that it reaches those in need. 

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L'HIV/SIDA ET SES EFFETS SUR LA SITUATION DES REFUGIES : UNE PERSPECTIVE CHRETIENNE

L'Afrique sub-saharienne est le sous-continent le plus lourdement affecté par l'HIV/SIDA, où les personnes, très souvent, n'ont pas les moyens d'assumer le coût des remèdes ARV. Les conséquences sociales et économiques de la maladie sont immenses pour la société. Le développement, la sécurité alimentaire et les politiques agricoles sont affectés de façon négative. L'espérance de vie diminue, les rôles-types changent de sorte que les personnes âges sont obligées de retourner travailler la terre et de prendre soin de leurs petits-enfants, tandis que les enfants ne vont plus à l'école.

L'infection HIV/SIDA s'est aussi diffusée à travers différentes formes de mobilité. Un des modes de propagation est la diffusion le long des routes, à travers les attitudes des camionneurs et des chauffeurs de taxi ; un autre, par l'intermédiaire de certains groupes de migrants résidant dans les auberges réservées aux hommes, et un troisième réside dans le viol systématique appliqué en tant qu'arme de guerre.

L'Eglise place la dignité de la personne humaine au centre de sa doctrine sociale. La conséquence immédiate réside dans les soins à donner aux patients atteints du HIV/SIDA et dans le respect à leur égard. Les Institutions catholiques assurent environ 25 % des soins au niveau mondial. En outre, l'Eglise encourage l'accès aux remèdes pour tous. Il est demandé à toutes les communautés chrétiennes de s'unir et de promouvoir un rapport de confiance, d'acceptation et d'assistance, et de devenir des lieux de soins où tous soient accueillis et se sentent comme chez eux.

La proximité et le respect se démontrent dans l'abstinence, la chasteté et l'emploi des méthodes naturelles des moyens de régulation des naissances. L'Eglise n'accepte pas certains éléments du concept de "santé reproductive" mis en avant par les agences des Nations Unies, éléments qu'elle considère comme immoraux. Il faut faire bien plus dans le domaine de l'éducation, en promouvant les programmes de formation au niveau des paroisses, des diaconats et des diocèses. Comme le Saint-Père Jean-Paul II l'a déclaré : "La bataille contre le SIDA doit devenir la bataille de chacun de nous".

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HIV/AIDS E I SUOI EFFETTI SULLE SITUAZIONI DEI rifugiati: UNA PROSPETTIVA CRISTIANA           

L’Africa sub-sahariana è il sub-continente più duramente interessato dall' HIV/AIDS e dove le persone, il più delle volte, non hanno i mezzi per sostenere il costo dei farmaci antiretro virali.

Le conseguenze economico sociali della malattia sono enormi per la società. Lo sviluppo, la sicurezza del cibo e le politiche agrarie ne sono influenzate negativamente. L’aspettativa di vita diminuisce, i ruoli stanno cambiando, cosicché le persone anziane sono costrette a tornare a lavorare la terra ed a prendersi cura dei nipotini, mentre i bambini lasciano la scuola.

L’infezione HIV/AIDS si è inoltre diffusa attraverso differenti forme di mobilità. Una ha luogo lungo le strade attraverso i comportamenti dei conducenti dei camion e dei taxi. Un’altra è legata ad alcuni gruppi di migranti che sostano negli ostelli maschili, ed infine una terza si ha laddove lo stupro sistematico è praticato come arma di guerra.

La Chiesa pone al centro della sua dottrina sociale la dignità della persona umana. E questo ha come immediata conseguenza il prendersi cura di pazienti affetti da HIV/AIDS e mostrare loro rispetto. Le Istituzioni cattoliche forniscono ormai il 25% delle complessive cure nel mondo. Oltre a ciò la Chiesa promuove l’accesso alle medicine per tutti. Ad ogni comunità cristiana si richiede di essere unita, e di incoraggiare un rapporto di fiducia, accoglienza e cura, diventando un luogo di guarigione, dove tutti siano i benvenuti e si sentano a casa.

La collaborazione ed il rispetto si dimostrano con l’astinenza, la castità e l’uso dei metodi naturali di regolazione delle nascite. La Chiesa non accetta determinati elementi del concetto di “salute riproduttiva” delle agenzie delle N.U., considerandole immorali. Di più deve essere fatto nel campo dell’educazione, favorendo programmi di formazione, a livello diocesano, di decanato e parrocchiale. Come Papa Giovanni Paolo II aveva già affermato “La battaglia contro l’AIDS dovrebbe essere la battaglia di ciascuno di noi”.