5
Religion and Religious Groups

Religion, manifested in personal belief and in organized denominations, is a large part of American life. The responses of major religious denominations and of religiously identified individuals to AIDS have been an important feature of the epidemic. Many religious groups have interpreted the AIDS epidemic in the light of their beliefs and teachings. Those interpretations have often led to public pronouncements on AIDS education, prevention, and care, as well as to the shaping of public attitudes toward those afflicted by or at risk of HIV infection. In addition, individuals who identify themselves with particular religious denominations or express particular religious viewpoints have taken positions about AIDS in light of their beliefs. Their positions have often been within the realm of private attitudes, but sometimes they have been manifested in public comments and actions. Given the broad influence of religion in the United States, the response of religious organizations and individuals is a factor in the effort to control the epidemic and to care for those affected by it.

In this chapter, religion is used as a general term to describe the positions and policies of major religious denominations in the United States and the views of individuals or groups that associate themselves with a professed religious belief. The chapter begins with a brief overview of religion and the ways in which the religious traditions that are influential in the United States have historically viewed epidemic disease and sexuality, which are key to understanding the reactions of religious groups to the AIDS epidemic. The chapter then turns to those reactions, first in the early years



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The Social Impact of Aids in the United States 5 Religion and Religious Groups Religion, manifested in personal belief and in organized denominations, is a large part of American life. The responses of major religious denominations and of religiously identified individuals to AIDS have been an important feature of the epidemic. Many religious groups have interpreted the AIDS epidemic in the light of their beliefs and teachings. Those interpretations have often led to public pronouncements on AIDS education, prevention, and care, as well as to the shaping of public attitudes toward those afflicted by or at risk of HIV infection. In addition, individuals who identify themselves with particular religious denominations or express particular religious viewpoints have taken positions about AIDS in light of their beliefs. Their positions have often been within the realm of private attitudes, but sometimes they have been manifested in public comments and actions. Given the broad influence of religion in the United States, the response of religious organizations and individuals is a factor in the effort to control the epidemic and to care for those affected by it. In this chapter, religion is used as a general term to describe the positions and policies of major religious denominations in the United States and the views of individuals or groups that associate themselves with a professed religious belief. The chapter begins with a brief overview of religion and the ways in which the religious traditions that are influential in the United States have historically viewed epidemic disease and sexuality, which are key to understanding the reactions of religious groups to the AIDS epidemic. The chapter then turns to those reactions, first in the early years

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The Social Impact of Aids in the United States of the epidemic and then in more recent years. The chapter relates the responses of some of the larger denominations to the epidemic and reports what can be reliably ascertained about the responses of individuals and groups that express their views in religious terms. The chapter is about responses to the epidemic by religious institutions and individuals. Those responses have not taken the form of changes in doctrines, beliefs, or adherents. However, the responses of religious institutions affect their activities, which in turn influence health policy, public education, care of the sick, and attitudes toward HIV-infected people. In this way, religious institutions are an important factor in the social response to the HIV/AIDS epidemic in the United States. The influence of religions and religious belief on the HIV/AIDS epidemic in the United States is difficult to fully discern. Official statements, media reports, and other published accounts provide one source of information. Another source, perhaps a more important one, is beyond the easy reach of researchers: the history of personal attitudes and actions of individuals who are informed and motivated by religious beliefs. Certainly, such individuals have expressed both compassion and discrimination, reception and rejection, involvement and indifference. Many stories have been told of such reactions, but the stories are ephemeral. Similarly, collective reactions of communities of religious people at the level of parishes, synagogues, and other local organizations have also spanned the range of responses. This form of religious response, embodied in the private attitudes and actions of individuals and in isolated activities of small communities, is often hidden from or lost to scientific inquiry. This loss is distressing. The institutions of organized religion can take positions, issue statements, and influence the consciences of their adherent. But it is through individuals, with and without public disclosure, that religion finds expression and evolves in response to changing conditions. It is also difficult to sort out a "religious" response from the myriad of other attitudes and motivations that surround any human reaction. Even official pronouncements of religious bodies, written in the idiom of religion and invoking its traditions and beliefs, may be influenced by secular and political concerns. The words and actions of individuals who present themselves as religiously affiliated or as representatives of religion may also reflect other interests. None but the most naive observer will accept every word and action by religious organizations and individuals as a pure reflection only of creeds and canons; none but the most skeptical will scorn all religious affirmations as disguised self-serving. The chapter does not attempt to capture the entire response of American religious denominations to the HIV/AIDS epidemic. It is limited to selected Jewish and Christian groups because of their size or perceived influence within American culture. Buddhism and Islam in the United States

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The Social Impact of Aids in the United States and the religions of Native Americans are not discussed. Although powerful forces in the personal lives of their adherents, these religions are not ordinarily given to public statements from official representatives about their beliefs. The primary objective of this chapter is to describe how organized religion has responded to the epidemic and to note the ways in which that response has affected the broader public response and the formation of public and health policy. Many Americans have strong feelings about religion and its place in public life. It is difficult to write about religion without making, or suggesting, value judgments, and even strenuous efforts to avoid such judgments will sometimes be interpreted by some readers as condemnatory or complimentary. In this chapter, the panel has made such efforts to avoid judgments on various religious responses to the epidemic and also to avoid any prescriptions of how religion should respond or what religious should teach. Rather, the intention is to elucidate the role that religious organizations have played in the epidemic and, in so doing, stress the importance of taking that response into account in efforts to understand the impact of AIDS in American society. The response of religion to the epidemic has been multifaceted. Not only are there many religious communities with their distinct traditions, but within the traditions themselves various themes intertwine with varying emphases. This complexity makes generalization difficult and simplification perilous. As discussed in this chapter, certain themes from certain traditions were more noticeable in the early years of the epidemic, which led to the impression that religion in general was unsympathetic toward those touched by the epidemic and hostile toward preventive efforts. Unquestionably, many people in the gay community strongly believe this is so, as evidenced by two events sponsored by the AIDS Coalition to Unleash Power (ACT-UP): a disruption of Sunday Mass at St. Patrick's Cathedral in New York, where demonstrators desecrated the communion wafers and chained themselves to pews while 4,500 protested outside, and a demonstration outside Boston's Holy Cross Cathedral during an ordination ceremony, where ACT-UP members, some of them "in drag," tossed condoms at newly ordained priests as they left the building. A broader view of the religious response shows these negative reactions, to be sure, but also a more complex picture of religion and AIDS in the United States. The important role that religious organizations can play in the HIV/AIDS epidemic has been recognized by the lead federal agency in the effort to contain the epidemic, the Centers for Disease Control (CDC). Realizing that its resources are limited and that the widest possible cooperation with other social institutions is needed, the CDC, through the National Partnership Program of its National AIDS Information and Education Program, began in 1989 the development of programmatic relationships with the business

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The Social Impact of Aids in the United States and religious sectors of society. Relationships with 30 religious organizations that represent a spectrum of denominations and interests were established. The CDC provides the organizations with technical assistance, referrals, conference support, and information on use of the national AIDS information clearinghouse database. The participant organizations are expected to enhance the CDC's educational outreach by using this information in their own educational and media endeavors. According to the Centers for Disease Control (1990:10) the organizations are considered particularly appropriate: [they] have broad access to significant populations; have influence and control significant resources; are widely respected and have great credibility with very large segments of the population; and have communications and other networks in place to focus on HIV issues and needs. One consequence of the partnership with religious organizations has been an expanded and positive coverage of HIV issues in the religious press (Centers for Disease Control, 1990). Also, some religious groups are collaborating with public health agencies to provide HIV prevention education to their members. Thus, CDC has recognized the importance of religious organizations as sources of communication and cooperation in the difficult task of devising and implementing educational programs. If the collaboration of religion is to be fostered in the fight against the epidemic, the nature and dynamics of the religious response to the epidemic must be understood. RELIGIOUS DOCTRINES AND TRADITIONS The Nature of Religion The words religion and religious are extremely difficult to define. One distinguished scholar of religion wrote of "the striking lack of unanimity among modern students of religion regarding the nature of the concept under analysis" (Bertholet, 1934: xiii, 237; see also Spiro, 1968). Every attempt to define these terms will miss some important feature or will misrepresent one or another of the many forms religion takes. For the purposes of this chapter, religion and religious refer to those organized communities of people who express adherence to an explicit canon and creed about the ultimate nature of human life and its transcendent source. In a general way, religion in Western societies has taken the form of communities of people identified by some title, such as Roman Catholic, Reform Jew, Southern Baptist, Mormon, and so on. Those communities are structured in quite different ways, some with an authoritative hierarchy, others as consensual gatherings. The communities usually espouse a canon, that is, a set of ideas, often committed to writing, that express the origins

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The Social Impact of Aids in the United States and the most salient images, concepts, and histories with which the communities identify. For Christians of all denominations, the Old and New Testaments make up this canon; for Jews, the Torah and the Talmud. Finally, almost all religious communities have statements of principal beliefs, sometimes called creeds, that express the ideas and commitments that define the community from others. The diverse religious communities with which American society is familiar give varying authority to their canonical scriptures and their creeds: some permit and even encourage broad interpretation; others insist on strict and even literal readings and application to belief and practice. Consequently, within the broad groupings of Christianity and Judaism are many communities that fall along a spectrum from literal and strict interpretation to liberal and figurative interpretation of their basic canons and creeds. These differences are frequently referred to with rough and often inaccurate terms. Despite the difficulty of describing these different positions in a completely accurate way, the differences are real, and they have significant influence on the way in which American denominations have responded to the AIDS epidemic. Religion, as presented here, differs from most other social and cultural institutions in two significant ways. First, the canons and creeds almost always refer to a transcendent, supernatural power, God or Yahweh, whose relationship to the world and to humans is described in the canons and creeds with some specificity. Second, the canons and creeds explicitly contain certain directions about moral behavior on which religious communities have built moral codes and interpretations of conduct for the faithful. The forms of conduct that are prescribed are, for all faiths, vitally related to the meaning, ends, and purposes of human existence in relation to God. Serious adherence to a faith implies dedicated acceptance of its canons, creeds, and codes, even though believers will admit that they may sometimes, perhaps often, fail to live up to their professed beliefs. Although distinct faiths require adherence to their creeds, canons, and codes with greater or less literalness, religion, almost by definition (the word comes from the Latin for "bound" or "tied to"), requires adherence and fidelity to those features. At the same time, religion displays remarkable adaptability. The survival of many religious communities through very diverse, and often adverse, cultural situations is proof of that adaptability. Thus, when organized religions encounter new situations and experiences, their adherents will often interpret them in light of their beliefs. Conversely, when beliefs are challenged as outmoded or inadequate to new circumstances, religions will seek to preserve them or will modify them to the extent that modification does not violate the basic beliefs. It is rare to find a religious denomination deliberately abandoning or radically changing its beliefs: if change comes, it usually comes slowly and in less than obvious forms.

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The Social Impact of Aids in the United States Religious institutions, then, perhaps more than any other institution, respond to unprecedented situations through defining features of their traditions. This sometimes means that a religious response will take the form of hard-line resistance to a new situation judged incompatible with its faith. Sometimes the religious response will consist of a reinterpretation of the tradition that enables it to coexist with a new situation. The doctrines and practices of religious institutions are not static, but even as they undergo change in response to new situations there is usually a strong urge to identify and preserve essential elements of the past. Thus, religion is almost always traditional and adaptive at the same time; its responses to new situations will be a mix of the dogmatic and doctrinal with the practical and pragmatic. These features of religion are important in understanding how religious groups in the United States have responded to the HIV/AIDS epidemic. Religion in the United States Religion was a powerful force in the origins and growth of the American republic. From colonial beginnings, Protestant and Catholic Christianity, and later Judaism, provided vital ideas, communal energy, and spiritual enthusiasm for the formulation of American institutions and public life (Clebsch, 1968; Reichley, 1985; Wuthnow, 1988; Butler, 1990). During much of the twentieth century, however, the place of religion in American culture was anomalous. The dominant cultural view was that religion has lost its influence among Americans and had moved to the margins of American life. The constitutional prohibition of establishment of religion erected a wall of separation between church and state higher than it had ever been, leading policy makers to steer clear of anything that might appear to breach that wall. Many aspects of public life, from education to entertainment, are carried on without reference to religion and, indeed, often seem antithetical to traditional religious teachings. In many respects, American life seems thoroughly secular (Clebsch, 1968). By the late 1980s it became clear that that view was no longer tenable (Marty, 1987). Religion simply cannot be ignored as a social force in U.S. society. The sheer number of people who associate themselves with religion and who participate in its activities are testimony to the presence of religion. The constitutional wall may effectively separate governmental and ecclesiastical structures, but it does not keep ideas and influences of the world of religion from filtering into the world of public affairs. In the realm of health alone, current debates over the legality of abortion, the permissibility of fetal research, toleration of assisted suicide, and the rights of parents of religious persuasion to withhold from their children certain therapeutic and preventive health measures are recent examples of the constant interplay between religion and public affairs.

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The Social Impact of Aids in the United States The vitality of religious life in the United States is remarkable. In 1989 there were more than 200 religious denominations in the United States. The 15 largest religious bodies encompassed 80 percent of the estimated 144 million total membership of congregations. The Roman Catholic church reports the largest membership (approximately 53.5 million), and the Southern Baptist Convention claims the largest Protestant Christian membership (approximately 14.75 million); the largest African American denomination is the National Baptist Convention, U.S.A. (an estimated 5.5 million); Reform Judaism is the fifteenth largest religious group (slightly fewer than 2 million) (Jacquet, 1989). Although reports of membership from denominations cannot be easily compared due to different definitions of membership, by self-report approximately 90 percent of Americans identify with a denomination (Goldman, 1991). Frequency of attendance at services provides another measure of religious commitment. The 1988 General Social Survey found that 27 percent of respondents attended services once or more per week, 17 percent attended more than once a month, and 20 percent attend from once a month to several times per year. By most measurable indices, the United States is a more religious country than all European nations except Ireland and Poland (Gallup Organization, 1985; Reichley, 1985). Claims of religious affiliations and reports of church attendance are not, of course, measures of religious dedication or fervor, and there are several indications of an increase in deeply personal affirmations of religious belief. Among Christians, the number of persons expressing ''commitment to Jesus Christ" indicates the importance of religious faith to many individuals. The Gallup Organization recently reported that 74 percent of adult U.S. citizens claimed such a commitment, compared with 66 percent in a 1988 survey and 60 percent in a 1978 survey (Christian Century, 1990). Even though many of America's 6 million Jews are not religiously observant or are only occasionally so, scholars note the emergence of a "committed minority … whose conscious choice of religious involvement has infused all branches of American Judaism with new energy and passion … that has virtually transformed American Judaism within the last two decades" (Wertheimer, 1989). Religious affiliation and personal commitment to religious belief also find expression in patterns of charitable giving. Individual donors, who accounted for 84 percent of all giving in 1988, favored religious charities over all others. Of all households making contributions, 53 percent gave to religious organizations; human services and health were distant runners-up at 24 percent each. Religious organizations also ranked first in terms of average contribution per household: $375 to religious, $50 to human services, $44 to education, and $31 to health organizations (Independent Sector, 1990). The place of religion in social life is indicated further by the ubiquitous

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The Social Impact of Aids in the United States presence of places of worship and religion-related educational, health, and social service organizations. Indeed, many social and cultural institutions, and even many commonly accepted "secular" beliefs, have migrated from the world of religion into the secular world and remain there, invisible but indelible (Douglass and Brunner, 1935; Clebsch, 1968; Wuthnow, 1988). Like other huge organizations, national religious organizations can be slow to act or change. Local congregations, less burdened with bureaucracy, and individual members can be sentinels to identify emerging issues and be more immediately responsive. Yet when the national bodies speak and act, the whole nation becomes the audience and, at least theoretically, every neighborhood with a local congregation exists is affected. And political boundaries generally are not barriers to religious bodies and their institutions of education, health care, and social service. Religion and Epidemic Disease Christianity and Judaism retain within their traditions memories of epidemic disease. Those memories have become powerful images in the religious imagination and have influenced theological interpretations of the way God deals with humanity. The Hebrew scriptures (Old Testament), also revered by Christian faiths, contain many references to plague and pestilential disease, often in the context of divine wrath and punishment (Gen. 12:17; Lev. 26:6, 26:21, 26:25; Num. 8:19, 11:33, 15:37, 25:8, 31:16; Deut. 7:15, 28:22; II Sam. 4:8, 5:6; II Sam. 25; Jer. 21:6, 33:36). In the Book of Exodus, for example, God speaks the terrible words, "For now I will stretch out my hand, that I may smite thee and thy people with pestilence" (9:14). At the same time, God protects from the ravages of pestilential disease (Ps. 106:29). The Lord of the Hebrews and Christians is described as intimately involved in the lives of humans and brings both disease and deliverance as signs of anger and love. Undoubtedly, this idea of a God who has power over good and of evil is a difficult one: How can God be omnipotent and good and yet evil exist? The attempt to understand and answer this question, the so-called problem of theodicy, is a perennial endeavor for believers and nonbelievers alike. Still, the belief of a God who is involved in human life remains deeply embedded in the major religious traditions of American culture (Berger, 1967). The belief that pestilence came from God was given "scientific confirmation" by contemporaneous medical explanations of the causation of disease. Greek medicine explained epidemics as the result of the conjunction of astral, meteorological, and terrestrial influences that, under certain circumstances, created a "climate" for disease. They named this the ''epidemic constitution," a theory that prevailed in various forms until the nineteenth century. Since theological and philosophical views alike held that

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The Social Impact of Aids in the United States physical forces were, in some sense, under the guidance of Divine Providence, it was logical to see pestilential diseases as caused by God. The sixteenth-century surgeon, Ambrose Pare, for example, described the plague as "the coming of the wrath of God, furious, sudden, swift, monstrous, dreadful," and he devoted an entire chapter of his book to supporting this view with many scriptural quotations. He went on, however, to explain at length "the human and natural causes … the infection and corruption of the air and the visitation of the humours of the body that dispose them to take the plague from the air" (quoted in Winslow, 1943:177). Thus, both religious and scientific beliefs coincided to support the common contention that pestilential disease was an act of God. How that act of God was to be interpreted has always been a matter of debate. In the Christian Middle Ages, the most common interpretation asserted that plague was punishment for the sins of humans. Religious authorities prescribed prayer and penance; at the same time, they insisted that measures be taken to prevent and stop the ravages of disease and that the sick be cared for. The sins being punished by God were usually viewed less as the particular sins of individuals than as the collective and pervasive sinfulness of all human beings. Even the most fervent preachers could not help but notice that the virtuous and the vicious, the religious and the irreligious, and the innocent child and the old villain were all stricken together. Indeed, it seemed to some observers who noted the deterioration of morals and social life consequent on great epidemics that the good were taken while the bad were spared. One early Christian historian (Gasquet, 1893:260) wrote of the plague in the reign of Emperor Justinian (A.D. 527-565): "whether by chance or providential design, it spared the most wicked." Thus, it is rare to find a link between sin and sickness, so common a theme, focused on one or another kind of sin—although an imaginative preacher could certainly seize on plague as punishment for his favorite vice (Numbers and Amundsen, 1986; Slack, 1988). Epidemic disease regularly evoked this moral response of condemnation of sin and the call for repentance. The "great mortality" (bubonic plague) that devastated London in 1665 was commonly seen as a "visitation of God's hand," wrathful against sin in bringing the plague and merciful in removing it (Shrewsbury, 1970). Preachers and physicians alike warned the populace that plague was a judgment of God against such transgressions as "Lust, Pride and whoredom, wantonness and prophaneness" and advised them to avoid such worldliness as "profit, pleasure, usury, feasts and plays, censure, blasphemy and hypocrisy" (Leasor, 1961:68). Yellow fever, which attacked the U.S. eastern seaboard from the late eighteenth century through the first quarter of the nineteenth, inspired not only the first efforts at organized public health in the United States, but also repeated calls from clergy and public officials for prayer and repentance. In the particularly

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The Social Impact of Aids in the United States bad year of 1799, for example, the New York Common Council decreed a Day of Thanksgiving, Humiliation and Prayer. "The Hand of the Lord had lain heavily on New York, and whether its citizens had been guilty of sins of commission or omission, it was hoped that through prayer they could search their hearts and come to see the error of their ways" (Duffy, 1968:109). The social response to the cholera epidemics in the United States in 1832, 1849, and 1866 reveals the first break in this long tradition of theological interpretation of epidemic disease. In the first two epidemics, the tradition prevailed intact. As Rosenberg (1962:40-42) notes, medical and theological opinions were in agreement that "the intemperate, the imprudent, and the filthy were particularly vulnerable." Sin, if not the primary cause of disease, was at least the "predisposing cause." Even when a respectable person died of cholera, suspicion was aroused that "this ordinarily praiseworthy man either had some secret vice or had indulged in some unwonted excess." Most Americans had no doubt that cholera was a divine punishment on sinful makind and a divine exhortation to repentance. The governor of New York, in an official proclamation, declared that "an infinitely wise and just God has seen fit to employ pestilence as one means of scourging the human race for their sins, and it seems to be an appropriate one for the sins of uncleanliness and intemperance." Sins, it might be noted, were thought to fester among ''the huddled urban masses." By the time of the last serious cholera invasion in 1866, however, the religious interpretation and its attendant rhetoric had considerably softened. In the intervening years, the previously disdained theory of contagion had been given dramatic support by Dr. John Snow's identification of particular urban water sources as the sources of contagion. By 1866, "there were few intelligent physicians who doubted that cholera was portable and transmissible" (Rosenberg, 1962:195). In addition, the epidemiology of the disease was better understood. The ravages among the poor were better explained by the unsanitary conditions in which they were condemned to live than by their addiction to "the seven deadly sins." Rational measures of control could be put in place; theological explanations, though still relevant to the presence of any evil in the world, were relegated to the background. It appears that as scientific advance provided better explanation of the nature of communicable disease and better means of prevention, the tendency to resort to theological explanations dissipated. Only in one sort of disease, that communicated by sexual contact, did the theological reference continue to prevail—not as a substitute for the scientific causality, but as a reminder that the scientific cause, a microbe, was transmitted by human behavior that could be blamed as sinful (Brandt, 1987). In later epidemics, such as the influenza epidemic of 1919 and the polio epidemic of the 1940s, the traditional theological commentary was hardly heard in public discourse. Christianity and Judaism, then, have long and deep traditions that interpret

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The Social Impact of Aids in the United States disease within the scope of Divine Providence. At the same time, these religious traditions contain powerful imperatives to care for the sick. The Talmud "gave permission to the physician to heal; moreover, this is a religious precept and it is included in the category of saving life," one of the most stringent of religious obligations (Shulhan Arukh, cited by Jakobovits, 1978:793). Similarly, Jewish ethics ranks "as the noblest form of charity—'loving kindness of truth' in the language of the rabbis—services rendered to those who can no longer fend for themselves, including the utmost consideration for the dignity of the dying" (Jakobovits, 1978:797). In the New Testament, Jesus tells the story of the Samaritan who "had compassion'' on a wounded Jew and cared for him at his own expense (Luke 10:29-37). This image became paradigmatic for Christians; early Christian literature is filled with admonitions to care for the sick. Records of epidemic disease in the third century tell of Christians who devoted themselves to caring for Christians and non-Christians alike, even at risk of their lives: they were named "the reckless ones" (Numbers and Amundsen, 1986:48). Even when they were theologically convinced that plague was punishment for human depravity, ecclesiastical leaders organized medical care and enforced preventive efforts: quarantine and penitential processions were endorsed as protection from plague. Desertion of the sick by physicians and clergy alike was branded as shameful. Thus, historically, Christianity and Judaism strongly urged their adherents to care for the victims of epidemic disease. This profound tradition has also influenced the response of religious organizations to the HIV/AIDS epidemic. SEXUALITY The AIDS epidemic is marked by one feature that has made it particularly problematic for religion, namely, the group initially hardest hit and still numerically the group with the largest number of cases is men who have sex with men. This fact has posed a problem to those religions that explicitly condemn homosexual activity as sinful. Christianity and Judaism have historically been critical of homosexuality. Several texts of the Hebrew scriptures (Gen. 19; Lev. 18:22, 20:13) and several in the New Testament writings of St. Paul (I Cor. 6:9; I Tim. 1:10; Rom. 1:26-7) are interpreted by many to condemn homosexual activities. Early Christian writers, however, rarely alluded to them, and modern scholars debate their interpretation (Boswell, 1980; Lemay, 1980; Weeks, 1980; Adams, 1981). Still, from its beginnings, Christianity has generally considered sinful all forms of sexual expression other than procreative intercourse, although it appears that sexual acts between persons of the same gender were not singled out as more sinful than adultery or fornication. In the thirteenth century, however, church leaders began to see homosexual behavior as particularly heinous

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The Social Impact of Aids in the United States Thus, at this writing, Catholic teaching on AIDS takes official form in two documents: one permits education about condoms and the other affirms abstinence as the sole mode of prevention but does not explicitly condemn education about condoms. A long-standing tradition in Catholic moral theology allows individuals freedom of conscience in moral matters when solid theological and moral authority supports alternative positions. Thus, some Catholic educators accept the more liberal position of "Many Faces of AIDS"; others follow the more conservative position that is suggested, though not explicitly mentioned, in "Called to Compassion" (Reverend Michael Place, research theologian, Archdiocese of Chicago, personal communication, 1991). One priest, who is in a leadership position in AIDS education, stated (Reverend Rodney J. De Martini, director of AIDS education, Archdiocese of San Francisco, personal communication, 1990): "Both are operative documents, but in order to be honest educators and counsellors, we must mention not only the moral issues but the relevant scientific and medical facts. Among these is the relative efficacy of condoms." The Teacher's Manual for AIDS: A Catholic Educational Approach, issued by the National Catholic Educational Association (1988), provides a plan for wide-ranging and frank discussion of HIV/AIDS, in the course of which it states: "Basically, research is showing that, while condoms may provide some barrier to AIDS infection, they are often unreliable" (p. 130). AIDS: Ethical Guidelines for Healthcare Providers, issued by the Catholic Health Association of the United States in a second, revised edition of 1989, speaks of condom education in almost the exact phrases of ''Many Faces of AIDS," but in the spirit of "Called to Compassion," notes their unreliability (p. 12). Pronouncements of the U.S. Catholic Conference have moral authority but are not binding on individual bishops. Thus, dioceses headed by conservative bishops may enforce the more conservative position on AIDS education. This has happened, for instance, in the Archdiocese of New York, where Archbishop O'Connor has insisted that AIDS services within the church's jurisdiction refrain from distributing condoms and from education about safe-sex reproductive behavior in any way that violates the church's doctrines. In other dioceses, such as Cleveland, the bishop has authorized the more liberal approach taken in "Many Faces of AIDS." After emphasizing the church's doctrine on extramarital sexuality, the guidelines recommend that those who disagree with the church's position may be informed that public health advice includes condoms as prevention against AIDS (Spohn, 1988b:108).

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The Social Impact of Aids in the United States United Methodist Church The United Methodist Church is the second largest Protestant denomination in the United States with a membership of about 9 million. The denomination has a history of social activism. Its statement, "AIDS and the Healing Ministry of the Church," adopted in 1988, sets forth an extensive agenda for service, education, and support activity within the church and public advocacy for resources, protection of human and civil rights, education beginning at the elementary school level, and support for policies that permit people with AIDS to work to the greatest extent possible (reprinted in Melton, 1989:148-151). The church's Council of Bishops also spoke in 1988 to the church's members and beyond. The bishops stated that they "are certain that it [HIV] is not sent as a curse from God upon those whose life style is called into question." Furthermore, they cautioned against associating the epidemic with gay men (Council of Bishops, 1988): There is almost no category of the human family where the deadly virus does or has not appeared. Therefore, it is the better part of wisdom not to categorize the disease as only that of a certain element or group in the society. To do so will only delude us into believing that it is "their" problem not ours. Nothing could be further from the truth and nothing will more hamper responsible efforts to arrest and hopefully one day control this disease. It is our problem. All people are called to "engage in behavior that can prevent and/or minimize the spread of Acquired Immune Deficiency Syndrome." The church's teaching was restated by the bishops: heterosexual, monogamous sexual relations within marriage is the standard expected of United Methodists, and the practice of homosexuality is not condoned and is considered incompatible with Christian teaching. For people unable or unwilling to follow this standard, use of condoms is urged, as is avoiding intravenous drugs and needle sharing. The bishops' statement concluded by calling for the denomination at all levels and individuals to compassionate ministry, education, and public advocacy (Council of Bishops, 1988). The denomination has created an interagency task force on AIDS to provide a coordinated and conscientious approach to the epidemic and to develop AIDS-related resources. In addition, an AIDS Ministries Network has been created to list resources, provide information and examples of ministry, and give voice to people with HIV infection. The denomination has begun to incorporate the special human needs and educational challenges raised by the epidemic within its multifaceted mission. The pace and extent to which this occurs are affected, however, by the fact that the church's agencies are controlled by local boards whose thinking often reflects the local values and cultural mores, conservative or liberal. Although it is doubtful that the epidemic will effect a change in the church's teaching

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The Social Impact of Aids in the United States regarding risk behaviors, there appears to be some moderation of attitudes "when AIDS comes home" in the person of a family member or friend (Cathie Lyons, associate general secretary, Health and Welfare Ministries, General Board of Global Ministries, United Methodist Church, personal communication, 1990). Activities in Local Congregations As official statements were being formulated at the national level of various denominations, more members of religious congregations became willing to discuss how the epidemic was reaching into their homes and within the walls of their sanctuaries. As members disclosed how AIDS was affecting them and called on their congregations for care and support, the magnitude of the epidemic became more difficult to deny, and harsh judgments tended to wane when the person infected or the family affected was loved or respected. Congregations and their leaders, thus, had to decide how to respond to the needs generated by an individual AIDS diagnosis (Amos, 1988). Some congregations have elected to say and do nothing, effectively denying the epidemic and the people affected by it. Others have responded to AIDS as they would to any other life-threatening disease and taken care of their own. Still others have developed specialized ministries and programs, often in cooperation with secular service agencies and on an interfaith basis, directed to members and nonmembers alike. By January 3, 1989, the Washington Post could run an article headlined, "AIDS Epidemic Is Slowly Gaining Attention in Local Pulpits" (Stepp, 1989). The Second Presbyterian Church in Kansas City, Missouri, provides an example of local AIDS activities. The church organized an AIDS Ministry Group following a weekend seminar in the fall of 1989. Some members volunteer at secular AIDS agencies. Others make quilts for AIDS patients at a local hospice and collect materials for a quilt to be made by state prisoners to honor other prisoners who have died. The group educates the full congregation about the disease and how it should respond. It also helped a local nursing home establish an AIDS wing (William Tammeus, Elder, Second Presbyterian Church, Kansas City, Missouri, personal communication, 1990). In Seattle, volunteer Catholic religious and lay persons created the Catholic AIDS Spiritual Ministry, a team of people trained to give spiritual assistance to individuals with AIDS. The group occupies office space in a parish and is funded by Dignity. Although it receives no financial support from the archdiocese, it is, says its director, "supported in spirit" (Health Progress, 1986:61). Glide Memorial Church in San Francisco, led by a prominent African American pastor, has initiated AIDS projects to provide education, individual

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The Social Impact of Aids in the United States counseling, support groups, and buddy programs, in addition to spiritual ministries (Mitchell, 1990:40). Throughout the country, other congregations have started support groups, joined with other congregations to field teams of volunteers to help people in their homes, financially supported people with AIDS and AIDS-related community-based organizations, and engaged in other special activities. In several cities, the African American religious community has formed alliances with the health department in order to educate a large number of people and to stimulate a compassionate response to people with AIDS from religious leaders (Jennings, 1989). In Philadelphia, the city gave Blacks Educating Blacks about Sexual Health Issues (BEBASHI)—an organization founded by Rashidah Hassan, a Muslim nurse—$100,000 for education on sexually transmitted diseases, including HIV. During 1985 BEBASHI distributed up to 20,000 condoms a month. African American clergy appear visibly in the fight against AIDS, according to Hassan, when they conduct the funeral of a person with AIDS and minister to the surviving family (Eisenstadt, 1988). It would be a mistake, however, to conclude that these sorts of responses at the congregational level are typical. Only a small fraction of congregations have chosen to make special commitments to serving people with AIDS, even though sanctioned to do so by their national organizations. But these social ministries, relatively few as they are, are significant because they generally involve lay people on an organized basis. Ministries of visitation, sacrament, prayer, and worship characteristically are offered to anyone suffering illness, but in many denominations, these ministries have traditionally belonged to ordained clergy and other professional church workers. Hospital chaplains, individual clergy, and others have provided these traditional services to people with HIV/AIDS from the beginning of the epidemic (Eisenstadt, 1988), and more clergy have been drawn to these ministries as the cumulative AIDS caseload has grown. Lay people, on the other hand, are not under the strict regimen of church authorities. They generally are free to select where and how to commit themselves in ministry. As such, the mobilization of lay people on an organized basis signals an important event: their appearance in direct compassionate ministries suggests that congregations on a broader scale have experienced the epidemic and begun to have a compassionate response to those who are affected by the epidemic. As Elizabeth Eisenstadt (1988:78) observed regarding the religious response in Philadelphia: Lay people have often been the spur for AIDS ministries; most couldn't be done without them. So often, clergy feel that they need to educate their flocks. More often than not, it's the sheep who turn around and push the shepherd back into the road.

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The Social Impact of Aids in the United States Given the size and the organizational strength of the Roman Catholic church, its participation in AIDS activities is important. Relatively little empirical research has been done, however, on the response of pastors and local congregations to the epidemic and the official pronouncements of the hierarchy. One study consists of a number of interviews with Catholic clergy and educators in the Los Angeles archdiocese, the largest in the United States. The author, after describing the various discussions and documents of the hierarchy, states (Horrigan, 1988:88): "While the Church is still debating what to say, its lower echelons have already plunged into action. According to Church officials, there are an estimated three million Catholics in the Archdiocese of Los Angeles—about fifty percent with Spanish surnames." The action consisted of a broad and programmed approach in three realms: spiritual support, practical care, and educational outreach. In 1986 Archbishop Mahoney established the Office of Pastoral Ministry to Persons with AIDS and commissioned 40 priests to this ministry. According to Horrigan, although spiritual support flourishes, educational efforts are limited in scope and in content, particularly with regard to condoms. However, priests and nuns engaged in educational works often express a willingness to collaborate with others not under direct church authority in providing the full scope of education about prevention. Despite these activities, the major segment of the Catholic population that is at risk, the Latino community, is largely unserved. Clergy and AIDS educators alike state that they would hope to see the significant organizational power of the church brought to bear in that community, but there is reluctance to do so, motivated by many reasons, including the desire not to stigmatize that population. Horrigan's study appears to be the only sociological inquiry into the actual response of Catholics at the level of social services and education. Despite the controversy concerning condoms, both U.S. Catholic Conference documents and several other pastoral statements stress the social responsibility of the Catholic church in caring for those afflicted with HIV/AIDS. In response, Catholic health care facilities and service organizations have expanded existing programs and created new services aimed at helping HIV/AIDS patients and their families. In AIDS: Ethical Guidelines for Healthcare Providers (Catholic Health Association of the United States, 1989:8), health care institutions are urged "to develop clear, coherent policies based on the principle of justice to guide them in their responsibilities to patients and employees, and toward preventing the spread of HIV." Thus, most policy efforts in Catholic health care institutions have been directed at promoting infection control and dealing with personnel who refuse to care for patients with AIDS and with employees who test positive for HIV or who have AIDS. According to Dennis P. Andrulis, president of the National Public Health and Hospital Institute, the experience of Catholic hospitals in caring for AIDS patients has paralleled that of other private hospitals

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The Social Impact of Aids in the United States in the United States (Catholic Health Association of the United States, 1990:1, 5). Catholic hospitals in the Northeast have felt the greatest impact from the AIDS crisis because of the large number of AIDS patients in the region. A 1988 survey by the national office of Catholic Charities reported that many Catholic charities had converted existing programs to respond to the HIV/AIDS epidemic. Such programs and services include education and prevention programs, drug treatment programs, housing, legal services (advocacy for people with AIDS), financial assistance, information and referral services, hospice and home health care, psychological and emotional support for patients and family members, meals and groceries, and transportation (Lightbourne, 1989). An annual survey by Catholic Charities showed that AIDS health clinics and hospices were among the top three areas to receive attention from agencies in 1989; AIDS advocacy ranked second in social action activities. Several agencies reported the development of new programs in AIDS education and prevention during 1989. It seems fair to say that the Roman Catholic church's vast network of health care and social services agencies have made notable efforts to provide assistance to persons with HIV disease or AIDS. This has been done despite a deeply ingrained doctrinal, and sometimes personal, antipathy to homosexual behavior and life-style. One Catholic official commented (personal communication, Don Hardiman, public affairs officer, AIDS/ARC Services, Catholic Charities of San Francisco, 1990) that the biggest impact is that AIDS has caused the church to consider people who don't sit in the front pew or don't sit in the pews at all; those who even though they might be Catholics, have been ignored and often disdained, such as gay persons and drug users. CONCLUSIONS The response of American religion to the AIDS epidemic has been notable and nuanced. It has been notable because, on the whole, it has followed the religious imperative to provide compassionate care and has repudiated discrimination. It has been nuanced because, in following that imperative, many religious denominations have had to accommodate the tradition of an epidemic as divine visitation on sin, as well as traditional doctrinal teachings on sexuality. The response of U.S. religious organizations to AIDS must be seen as mixed, as is to be expected, given the diversity of religion in America. Two broad patterns can be discerned, however, and should be taken into account in the 1990s. In the first pattern, religious groups are a "restrained" ally in the fight against the epidemic; this is seen in those churches that have declared the imperative of compassion as the most suitable religious response.

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The Social Impact of Aids in the United States Taken seriously by the faithful, this response has mobilized considerable personal and institutional energies in the work of care. At the same time, many of these religious institutions have doctrinal commitments that, to a greater or lesser extent, restrain their involvement, particularly in education and prevention. These doctrinal commitments, primarily teachings about homosexuality, sexual relations outside marriage, and contraception, may mute the response of even those religious groups that are viewed as allies. The second broad pattern can be seen among those religious groups in which doctrinal commitments, usually about sexuality, are so strong as to prevent the faithful from engaging in an active program of compassionate care. These groups continue a stance of condemnation of the causes of infection and, in so doing, contribute to what they consider the most, and only morally, effective message about prevention, namely, sexual restraint and abstinence from addictive substances. It would be a mistake for policy makers to fail to enlist the support of religious groups of the first sort in the fight against the epidemic. Even with their constraints, many can contribute significant energies and resources. At the same time, any alliances that can be formed must be entered with a clear awareness of the limits imposed by traditional doctrinal positions and communal attitudes. It would also be a mistake for policy makers to assume that the second form of response represents the uniform and universal response of religious groups. The formulation of policies for HIV/AIDS care, research, education, and prevention should be sensitive to the diversity of the response to the epidemic by the U.S. religious community. REFERENCES Adams, J. du Q. (1981) John Boswell, Christianity, social tolerance, and homosexuality. Speculum 56:350-355. AIDS National Interfaith Network (1989) We Are Living with AIDS: An Interfaith Call to Hope and Action (The Atlanta Declaration). New York: AIDS National Interfaith Network. Amos, Jr., W.E. (1988) When AIDS Comes to Church. Philadelphia, Pa.: Westminster Press. Bazell, R. (1983) The history of an epidemic. New Republic August 1:14-18. Berger, P. (1967) The Sacred Canopy: Elements of a Sociological Theory of Religion. Garden City, N.Y.: Doubleday. Bertholet, A. (1934) Religion. In Encyclopedia of Social Sciences. New York: Macmillan. Bishops of California (1987) A pastoral letter on AIDS. Origins (NC Documentary Service) 16:786-789. Bohne, J. (1986) AIDS: ministry issues for chaplains. Pastoral Psychology 32:173-192. Boswell, J. (1980) Christianity, Social Tolerance and Homosexuality . Chicago: University of Chicago Press. Boys, D. (1987) AIDS: reason for responsible anger. The Evangelist December:44-55. Brandt, A. (1987) No Magic Bullet: A Social History of Venereal Diseases in the United States from 1880, expanded ed. New York: Oxford University Press.

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