Overcoming structural church barriers: towards a systems assessment model for effective HIV and AIDS ministry
By Vhumani Magezi [email protected] ABSTRACT
The HIV and AIDS epidemic is decimating society. It has been established that FBOs, particularly churches, are playing a key role in responding to the epidemic in many poor grassroots communities in South Africa. However, the work is not documented in some instances, while in other cases churches are still not involved. To ascertain churches’ initiatives, an assessment framework should be developed. The understanding of church as a family system with interrelated concepts of the identified patient, homeostasis (balance), differentiation of self, extended family field, and emotional triangles provides an understanding of the dynamics and barriers in HIV and AIDS church ministries. These family concepts, together with a relational systemic therapy model shed light on the position of churches regarding people living with HIV and AIDS (PLHA) and also provide practical guidelines for people to shift from stigmatising and discriminating positions to caring and loving.
1. Introduction and premise: HIV/AIDS challenge, multifaceted responses and assessment gap South Africa’s epidemic is defined as a hyper-epidemic by UNAIDS as a result of the country having more than 15% of the population aged 15–49 living with HIV.1 However, the recent Human Sciences Research Council (HSRC) study revealed that there has been significant progress leading to HIV and AIDS prevalence stabilizing at 11%.2 But the HSRC report adds that overall the situation remains dire with 5.2 million people living with HIV and AIDS.3 Various sectors of South African society such as government, civil society organizations and community people concede that HIV and AIDS is a huge challenge. Hence, the magnitude of the problem calls for a concerted effort if intervention is to be effective. Encouragingly enough for South Africa, the strategic responses to the epidemic are clearly outlined in the country’s HIV and AIDS and STI National Strategic Plan (NSP) 2007-20114.
1Vhumani Magezi is Post- Doctoral Research Fellow, North-West University, Faculty of Theology, School of Ecclesiastical Sciences, Potchefstroom Campus
UNAIDS 2008 report on the global aids epidemic
1 The NSP clearly states that addressing the epidemic is far from being the responsibility of a single player (i.e. government); rather, it is the responsibility of all sectors5. Interventions should be multifaceted, collaborative and multi-sectoral. Hence, one of the six guiding principles for the NSP is to develop partnerships between government departments and civil society for effective responses6. And central to the implementation of the NSP are civil society organisations, which are responsible for leading in implementing an average of over 75% intervention objectives, while in other priority areas such as prevention and treatment, care and support, the leadership role is over 90%.7
8 The NGO leadership role above indicates recognition by government that indeed civil society organisations are leaders in grassroots interventions. Brown and Korten rightly maintain that NGOs have comparative advantage in promoting micro development due to their ability to touch base with community grassroots9. One subcategory of NGOs is Faith-Based Organisations (FBOs), particularly churches. In some developing countries, particularly in certain parts of South Africa located in the environments referred to as the second economy of the country, there are few functional health care systems, if any10. The institutions that are present in these communities are in most cases a church and a school. But generally, churches are more readily present in such communities.11 Indeed, as Sue Parry notes, FBOs are an integral part of life and society in Africa:
5 NSP 2007-2011, 56. 6 NSP 2007-2011, 59. 7 Magezi, V, Implementing the NSP-NGOs’ role: Government, NGOs and CBOs collaboration in HIV and AIDS: AFSA’s experience,
2 They have the widest network coverage on the continent, the largest constituency of people, and an enviable infrastructure, extending from the international community, to the most marginalized.12
However, while there is such an “opportunity and possibility” 13 for effective HIV and AIDS interventions, worryingly, churches have been in many ways participating in and perpetuating the stigmatisation and discrimination of people living with HIV and AIDS. To emphasise the negative role that many churches play, Christo Greyling drew parallels between HIV and AIDS and apartheid. He laments that HIV and AIDS is: [r]epeating what apartheid did – marginalising a section of the population and tearing families apart. People who are infected and directly affected by HIV and AIDS are stigmatised and discriminated against – even by their very own family members. As was the case during apartheid, women and children bear the brunt. Their vulnerability and powerlessness in the face of the onslaught of HIV and AIDS is made worse by poverty, patriarchy and violence.14 Christo Greyling adds that the churches’ responses have been slow and generally led by the passionate few. Concurring with Greyling, Harvey argues that resolutions such as the 1992 United Methodist Church’s Resolution on AIDS and the Healing Ministry of the Church are commendable, yet at grassroots/congregational levels, not much is happening15.
There is consensus in literature that stigma plays a major role in reinforcing apathy and poor involvement among churches. The consequences of stigma, as Harriet points out, include reluctance of people diagnosed HIV+ to disclose their status, discouraging VCT uptake and poor adherence to medication among others16, which compounds the effects of HIV and AIDS. The challenge, however, is that stigma is the “society’s political economy”.17 It is aided by power relations and social structures. Richard Parker and Peter Aggleton rightly intimate that in some contexts, HIV and AIDS-related stigma and discrimination has been reinforced by religious leaders and organizations, which have used their power to maintain the status quo rather than to challenge negative attitudes toward marginalized groups and PLHA18.
12 Sue Parry, Responses of the Faith-Based Organisations to HIV/AIDS in Sub Saharan Africa, World Council of Churches Ecumenical HIV/AIDS Initiative in Africa (EHAIA), 2003,
3 Notwithstanding the reality of some churches being actively involved in various HIV and AIDS ministries, there are many others that are still inactive and indifferent. At the same time there is magnificent work being done by churches that has not yet surfaced and remains undocumented. Harvey, like Smart cited earlier, rightly observes that churches’ HIV and AIDS interventions constitute the major or only work in many communities, but neither the churches themselves nor global entities such as UNAIDS understand the work being done by churches19. On the other hand, there are churches that view themselves as doing too much and yet they are doing very little.
Therefore, the above scenario prompts the following questions: can there be a framework to assess church responses in order to determine, reveal and document the level of church involvement? And within a theological framework, what could be the theological basis or assumption that underlies such an assessment? In response to these questions, this article argues that: an understanding of a church as a family system with the interrelated concepts that distinguish the family model from the individual model of the identified patient, the concept of homeostasis (balance), differentiation of self, extended family field, and emotional triangles20 provides a framework to concretely assess the position of churches towards PLHA and shift such churches towards practical involvement. A church family systems model should be underpinned by a practical ecclesiology with clear functions for practical HIV and AIDS ministry.
2. Praxis and practice: a practical theological perspective of the church The word ‘church’ comes from the Greek noun, to kuriakon, used first of the house of the Lord, and then his people.21 But it is always used in the Bible to translate the Greek word ekklesia. However, it is important to underline that ekklesia does not refer to a building but to an assembly of people.22
Ekklesia (noun) is a word derived from the verb ekkaleo meaning to summon or to call out. The closest English equivalent of the word is convocation – a calling together, an assembly. It was the official term for the Athenian democracy. And it is in this secular sense that it used in Acts 19:32,39,41.23 However, the New Testament use of ekklesia is controlled by its employment in the Septuagint (LXX) to translate the Hebrew word
4 qahal, which has the same meaning of a convened assembly24 . In the strongest sense the qahal is the assembly of Israel convened by God (Deut. 23:2-9; 1 Chronicles 28:8; Numbers 16:3,20:4, etc). Thus in the New Testament ekklesia is used for a public assemblage summoned by a herald, and in the Old Testament (LXX) it refers to the assembly of the Israelites especially gathered before the Lord.25
Our concern, however, is the function of the church – how the community of believers function in our situation of HIV and AIDS. To gain an insight into the role and function of the church, one should consider it within the practical theological realm.
Smit in the article On learning to see? A reformed Perspective on the Church and the poor argues that the church should not be “docetic”. The church should “see and respond to suffering people in personal and creative ways”26. Smit’s concern and argument – as shared by Louw – is that Christianity should not be a sterile objectivism, a transcendent dimension that excludes the realities of being human.27 It should interpret and understand the Christian truth in terms of human experience in the world. Thus the challenge of the Church is to interpret God and salvation in terms of contextual life issues related to practical theology.
Therefore, our ecclesiological design should be sensitive to the context and intervene in concrete ways. Moltmann argues for the notion of the church as base communities that he calls “grass-roots” communities28. These grassroots communities, he argues, are a prophetic leaven for the renewal of the church and society. They live in a simple communion of the saints or fellowship of believers in a convincing way through open friendships among the people. Thus within the church we see the principle of koinonia, mutual care and service (diakonia). Koinonia refers to the fellowship, association, community, communion and joint participation of believers.29 These church principles of koinonia, mutual care and service (diakonia) should be the “being” of the church system. These two concepts are intertwined, assume the other and not mutually exclusive. They mark the being of the church i.e. what the church should be “mirror Christ”. Contrary to this assumption, however, reality indicates that many churches’ “being” is in contrast to diakonic functions expected within koinonia.30
24 Grudem, W., Systematic Theology: An Introduction to Biblical Doctrine,(England: Intervarsity Press, 1994). 25 Best, E., “Church”. In Harper’s Bible Dictionary, ed. Achtemier, P.J. et al. (San Francisco: Harper and Row, 1988) and Grudem, W., Systematic Theology: An Introduction to Biblical Doctrine, (England: Intervarsity Press, 1994). 26 Smit, D.J., “On Learning to See? A Reformed Perspective on the Church and the Poor”. In Poverty, Suffering and HIV-AIDS: International Practical Theological Perspectives, (ed) Couture, P.D. and Miller- McLemore, B., (Fairwater: Cardiff Academic Press, 2003), 66. 27 Louw, D.J., A pastoral hermeneutics of care and encounter, (Cape Town: Lux Verbi, 1998). 28 Moltmann, J., The Church in the Power of the Spirit: A Contribution to Messianic Ecclesiology, (Minneapolis: Fortress Press, 1993), 311. 29 Thayer, J. H., Greek- English Lexicon of the New Testament, (Michigan: Baker Book house, 1977). 30 Christo Greyling, HIV/AIDS and Poverty – A Challenge to the Church in the New Millenium, September, 2001, (EFSA: Institute for Theological and Interdisciplinary Research).
5 But what barriers cause many churches to not be involved in diakonic functions such as HIV and AIDS ministry? Can there be a model of church involvement assessment that can be adopted to determine the level of church HIV and AIDS interventions to overcome apathy, stigma and discrimination?
3. Towards an understanding of church system processes that are a barrier to effective HIV and AIDS ministry A system is a structure in process; that is, a pattern of elements undergoing patterned events. The human person is a set of elements undergoing multiple processes in cyclical patterns as a coherent system. Thus a system is a structure of elements related by various processes that are all interrelated and interdependent.31 A systems approach is composed of members who do not function independently of one another but as a unified whole. The parts are connected by a central sense of oneness. A person, within a system, is not viewed in isolation but within a network of relationships. Everything that exists is in an ongoing mutual relationship with everything else. Systems thinking therefore implies that the church system should not only take note of the individual, but the position he holds within a relationship. Each believer, by being part of a system (church) is in a web of interrelationship and interdependence with others, which poses a diakonic challenge. The church members (faith community or koinonia) are challenged to care for one another (mutual care). Believers identify with each other and share their burdens. Thus through members identification and oneness, systems thinking dispels the persistent challenges of discrimination and stigmatisation in HIV and AIDS.
However, to help us understand systems theory, Friedman identified the following important interrelated concepts that distinguish the family model from the individual model that are critical for church ministry assessment: the identified patient, the concept of homeostasis (balance), differentiation of self, extended family field, and emotional triangles32. Augsburger33 also identified the same concepts. These concepts will be considered and applied in the context of church involvement with PLHA and the ensuing ministries.
3.1 The identified patient The concept of the identified patient in a family system refers to the family member with the obvious symptoms as the sick one, but the member is just the one in whom stress or pathology surfaced34. In a child it can surface as excessive school failure or obesity among other things; in an aged member it could show up as senility, confusion, etcetera; and in a congregation (church) family it could surface as burnout, drinking, and other
31 Augsburger, D.W., Pastoral Counselling Across Cultures, (Philadelphia: Westminster Press, 1986). 32 Friedman, E.H., Generation to Generation: Family Process in Church and Synagogue, (New York: The Guilford, 1985), 19. 33 Augsburger, D.W., Pastoral Counselling Across Cultures, (Philadelphia: Westminster Press, 1986), 180- 186. 34 Friedman, E.H., Generation to Generation: Family Process in Church and Synagogue, (New York: The Guilford, 1985), 19.
6 several ways. With respect to our discussion, it could be that the person who is diagnosed HIV positive leaves the church/congregation or keeps the HIV+ status private in fear of discrimination by other church members.
The purpose of using the phrase “identified patient” in family systems is to avoid isolating the problem family member from the overall relationship system of the family. The premise at the root of the family system, Friedman says, is that physicians do not assume that the part of the human organism that is in pain or failing to function properly is necessarily the cause of its own distress. The colour of a person’s skin can be related to a problem in the liver. Thus the problems in any organ can be related to the over- functioning, under-functioning, or dysfunctioning of another.
Systems theory therefore contends that, when a person is treated in isolation from his/her connections with others, as though the problem occurred on its own, fundamental change is not likely. The assumption is that the problem can recur, in the same or different form, in the same or different members. Thus trying to cure a person in isolation from his/her family is as misguided and ultimately ineffective as transplanting a healthy organ into a body whose unbalanced chemistry will destroy the new one as it did the old.
If a family problem is unresolved and one member is isolated as problematic, it allows other family members to deny the very issues that contributed to making one of its members symptomatic. In our example of the person who is diagnosed HIV+ and leaves the church or fails to disclose that status due to fear of stigmatisation and discrimination, congregation members can exonerate themselves, arguing that the individual left because he was immoral, does not belong to that church or some other excuse. Yet this overlooks the apathy, rejection, discrimination, and stigmatisation by the congregation members.
In fact, the family projection process of this congregation family would be scapegoating, saying the person got HIV and has now left to go where he/she belongs (immorality). A family projection process describes the primary way parents transmit their emotional problems to a child.35 Scapegoating, Friedman argues, suggests a far more conscious awareness than is usually present when this process occurs in families. The creation of an identified patient is often as mindless as the body’s rejection of one of its parts.
Another strand of family projection could be excessive care that is not sustainable. For instance, the moment a congregation member is diagnosed HIV positive the members start to over-assist the person, yet the individual still has many years to live and is quite capable of caring for themselves. Pathology, Friedman argues, can also surface as a super-positive symptom of a striking over-achiever. Such congregational family members are likely to be overly stressed, since their position in the system allows little to function differently. In the human body, severe over-functioning, as well as severe dysfunctioning, is itself evidence of a problem in a system and will, in turn, promote problems elsewhere.
35 Bowen Theory, Family Projection Process
7 The identified patient concept therefore means that, when a person who has been part of the church is diagnosed HIV positive or loses his job and leaves the church, he or she should not be viewed as having a problem. But this entails that one has to extend services to other members of the congregational family (koinonia) to give them support or additional insight into why the identified patient has left. Thus with a family systems model it is possible to work with non-symptomatic members of the family. There are times where the symptomatic member is so unmotivated that it is probably advisable to work without him/her. For instance, a wealthy church could be located next to a poor informal settlement where HIV and AIDS are rife, but none of these poor or HIV positive people belong to this church. Systems theory, especially the idea of identified patient, allows one to challenge such a church (i.e. it requires therapy).
In a nutshell, the identified patient in a family system implies that family therapy should not try to calm the family, but should treat crisis as an opportunity for bringing change to the entire system, with the result that everyone, and not just the identified patient, personally benefits and grows. By asking the following questions, a congregation may begin a critical reflection process: Who of our members left the church and why did they leave? Who are the very visible people in the community who are not represented in the church? To what extent is the church representative of the community? What are the topical issues in the community and to what extent does the church reflect on these issues?
3.2 Homeostasis (balance) Homeostasis is the tendency of any set of relationships to strive perpetually, in self- corrective ways, to preserve the organising principles of its existence.36. Individual models locate problems or illness in the character traits of individual members, while the family model conceptualises system problems in terms of an imbalance that must have occurred in the network of its various relationships, no matter what the nature of the individual personalities. Family systems theory assumes that if a system exists and has a name, it should have achieved some kind of balance in order to permit the continuity necessary for maintaining its identity. It is not concerned with the question: do these types of personalities fit, but what has happened to the fit that was there?
Thus the concept of homeostasis (balance) explains the resistance a congregation (church) family may have to change. There could be endless meetings and persuasion of church members to embrace new church practices or activities. An example of such resistance is Xapile’s story in The church in an HIV+ world37, who began an HIV and AIDS-friendly church in Gugulethu (South Africa), where some church members felt they had to leave the church because the homeostasis was disturbed, and they were uncomfortable with the change.
36 Friedman, E.H., Generation to Generation: Family Process in Church and Synagogue, (New York: The Guilford, 1985), 23. 37 The Church in an HIV+ World: A Practical Handbook, edited by Daniela Gennrich, (Pietermaritzburg: Cluster Publications, 2004), 49.
8 Friedman argues that if a husband with a wife who lectures and threatens children into conformity seeks counselling, but the counselling destabilises the balance in the home (i.e. what she is used to doing, though it is wrong), he would prefer to stop the counselling even though the change may be right. In the same manner, some churches/congregations may prefer more fellowship breakfasts where the church system is not disturbed rather than beginning HIV and AIDS or poverty relief initiatives in the neighbourhood in which resources are given out.
In maintaining the system’s balance (homeostasis), congregations would rather tolerate members who cause all sorts of problems, than disturb or tamper with the status quo. They would rather be satisfied with downright incompetence, whereas creative thinkers who disturb the balances of things are ignored. For instance, members who try to stir the congregation to be involved in HIV and AIDS and poverty initiatives may be resisted strongly, while those who do not contribute much in church are preferred. A starting point for a diagnostic process may be to ask the congregation the following basic questions: What kind of ministries are we involved in and why? What kind of Christian ministries are most uncomfortable for this church and why? What could potentially happen if one congregational member stands and says ‘I am HIV+’?
3.3 Differentiation of self A family system seeks to keep itself balanced, i.e. it is self-corrective. It resists change and tries to maintain the status quo (homeostasis). However, differentiation is concerned with the resources available within a family system for helping it to overcome its homeostatic resistance. Thus in our case we can ask the question: how can a few members in a church family that is apathetic and uninvolved in HIV and AIDS issues influence the congregation family’s position? How can these members act in a way that is contrary to the systemic balance? Systems differentiation shows us a way of thinking on such issues. The human components of a family system have the capacity for some differentiation, i.e. the capacity for some awareness of their own position in the relationship system, the way it is affected by balancing forces, and the way changes in each individual’s functioning can in turn influence that homeostasis.38
Differentiation is the capacity of a family member to define his or her own life’s goals and values apart from surrounding pressures to conform, to say “I” when others are demanding “you” and “we”. It is the capacity to maintain a non-anxious presence in the midst of anxious systems, to take responsibility for one’s own destiny and emotional being. Thus differentiation is the capacity to be an “I” while remaining connected. For instance, as mentioned earlier, in a church family where members are not concerned about PLHA, there are some people who remain committed to the church, but get involved with HIV and AIDS ministry on their own. They get involved despite other members’ indifference and resistance. Though these people are connected, they act on individual (personal) convictions.
38 Friedman, E.H., Generation to Generation: Family Process in Church and Synagogue, (New York: The Guilford, 1985).
9 Bowen, cited by Friedman,39 suggests that all members of the human family are on a continuum of differentiation. Where one falls on the scale is determined in large part by where our parents and their parents were on the scale, with various children in each generation being slightly more or less mature than their parents. This parental influence in our case could be taken to refer to church or denominational tradition, which therefore means that denominations or congregation families that have a tradition of not being involved in social issues are highly unlikely to break (differentiate) from this tradition, i.e. do things differently. This type of family, Friedman states, is far less equipped to deal with crisis and they would quickly seek to redress the balance if the homeostasis is disturbed. This in a way explains why certain evangelical churches find it difficult to change their tradition. They don’t know how to handle the changes (crisis), because they have been socialised to do things in a certain way.
It is the maintaining of self-differentiation while remaining a part of the family that optimises the opportunities for fundamental change. Thus the congregation family members who feel that they should be involved in issues that others are resisting – like HIV and AIDS ministry – should become involved (differentiate), while they remain attached to the congregation family. This may also apply at a denominational level, where certain local churches may feel they want to do things differently from the general denominational culture of apathy. These local churches should differentiate themselves while they remain part of the larger denomination (institution). In differentiation of self it should be noted that those family members who are least differentiated are the ones who usually sabotage the progress (change) that differentiated (creative members’ initiatives) bring. For instance, some church members may strongly argue for more Bible studies, which does not disturb the church culture (homeostasis) rather than to start a home-based care programme.
A congregation can reflect on the following questions as a starting point: what activities can we do or not do without consulting denominational leaders? Who are the people most resistant to new ministries and why? What is the church doing to encourage members’ functional autonomy? What are some of the most opposed initiatives by church members? What is the church doing to encourage members to act corporately and individually on issues?
3.4 Extended family field The extended family refers to the family of origin, our original nuclear family (parents and siblings) plus relatives (grandparents, aunts, uncles, cousins, etcetera). The extended family does not have much application to the church in general, but what should be underlined is that understanding the processes still at work regarding our family of origin, and modifying our responses to them, can aid in resolving immediate church family problems. Specific patterns of behaviour, perceptions, thinking, theology (i.e. for the church), can be influenced by our parents (family of origin). But when family members see beyond the horizons of their own nuclear family and observe the transmission of such issues from generation to generation, they can obtain distance from their immediate
39 Friedman, E.H., Generation to Generation: Family Process in Church and Synagogue, (New York: The Guilford, 1985), 27.
10 problems and, as a result, become freer to make changes. This may also apply to the congregational family; a local church (under denominationalism i.e. institutionalism) might experience pressure from the denominational family (extended churches) to conform to certain practices even though it wants to change. There could be resistance from the network of other congregations under one roof, if a church tries to implement an HIV and AIDS ministry, e.g. the resistance that Xapile encountered in the Presbyterian church in Gugulethu cited earlier. Thus, the extended family can dilute or nourish natural strengths; it can be a weight that slows our progress.
Furthermore, the intensity of the extended family’s influence on a nuclear family can also be understood by tracing its multigenerational transmission. A church that has, over the years, inherited a culture of apathy towards the needy is less likely to differentiate from the tradition. The nuclear family therefore, though still connected to the extended family, should be differentiated. A congregation that belongs to a denomination that is apathetic towards HIV and AIDS should make an effort to break (differentiate) from the extended family’s tradition. The following questions could be useful as a starting point: what are the demands put on us by the denomination’s leaders? What is the denomination’s defining tenets that one could not break from? What are the ideals of the denomination and to what extent do they promote or discourage ministry initiatives?
3.5 Emotional triangle Any three persons or issues can form an emotional triangle. Its basic law is that when two parts of a system become uncomfortable with one another, they will “triangle in” or focus upon a third person or issue, as a way of stabilising their own relationship with one another. A person may be said to be “triangled” if he or she gets caught in the middle as the focus of an unresolved issue. For instance, a husband and wife in conflict can triangle children. Conversely, when individuals try to change the relationship of two others (two people, or a person and his or her belief system), they “triangle” themselves into that relationship (and often stabilize the very situation they are trying to change).40 This may explain why zealous church members with initiatives who are trying to mobilise other members – say, for HIV and AIDS ministry – end up losing their zeal and become cold.
The concept of the emotional triangle focuses on processes rather than content. It provides a new way to hear people, as well as criteria for what information is important. For instance, what Charles says about John tells you more about Charles than it does about John. What Charles says to you about his relationship with John has to do with his relationship with you. Say, in a church/congregation family, one member (or elder) can go around telling people or the pastor that another elder is influencing other people to start soup kitchens rather than Bible studies. Applying the triangle process analysis, the pastor or that other person should realize that the elder who is reporting is trying to get support for his lack of involvement and apathy towards social issues, and he thinks the pastor or that other person could share the same position. Focusing on process in triangles illuminates and identifies problem members who gossip and negatively influence others in the church family.
40 Friedman, E.H., Generation to Generation: Family Process in Church and Synagogue, (New York: The Guilford, 1985).
11 With emotional triangles, the way to bring change to the relationship of two others is to try to maintain a well-defined relationship with each, and to avoid the responsibility for their relationship with another. For example, we can take the following triangle in a congregation: members willing to be involved in HIV and AIDS ministry, members unwilling to be involved in HIV and AIDS ministry, and the HIV and AIDS ministry issue. The members who are willing and motivated to do the ministry should proceed with the ministry, but still in close loving relationship with those who are unwilling. This means the willing members maintain their relationship with the other members, but are not pushing them into the ministry. Friedman argues that this approach may change the unwilling members to become involved more than trying to force them.
In summary therefore, a family system such as a church is composed of members who do not function independently of one another but as a unified whole. The parts are connected by a central sense of oneness. This oneness, Augsburger noted, can be a healthy balancing of affectionate connectedness and respectful separateness; it can be an unhealthy “stuck togetherness” at one pole or an emotionally distant abandonment at the other extreme.41 And the concepts of the family system: the identified patient, homeostasis, differentiation of self, extended family field, and emotional triangles could be used to highlight the relationships of individual members in a church system. The relationship, however, provides opportunities and challenges to koinonia care for the poor and those living with HIV and AIDS.
Within a church system, effective service (diakonia) and meaningful fellowship (koinonia) are connected to members’ attitude. Attitude influences members’ behaviour. Warm, accepting and loving attitude closes space between PLHA with other church members while a judgemental and stigmatising attitude widens space hence hindering effective ministry. Therefore, it is important to consider church people’s attitude.
4. Challenging attitude within a hermeneutics of HIV and AIDS ministry: towards an assessment approach
In addition to the above attempt to understand the dynamics within church family systems, there is a need to target people’s attitudes, otherwise it may just end at a theoretical level. Members may continue in their path if not presented with a practical challenge and method to assess their position. Browning noted that there is a growing hunger to make theology in general more relevant to the guidance of action and to bridge the gap between theory and practice, thought and life42. Additionally, Bass, introducing the book Practicing Theology: Beliefs and Practices in Christian life, aptly poses the question: “But what does that have to do with real life?”43 This question aimed at theoretical formulations and dogma should haunt the church, particularly so within the
41 Augsburger, D.W., Pastoral Counselling Across Cultures, (Philadelphia: Westminster Press, 1986), 178. 42 Browning, D.S., “Pastoral Theology in a Pluralistic Age”. In Pastoral Theology: The Emerging Field in Theology, Church and World, (ed) Browning, D.S., (San Francisco: Harper and Row, 1983), 3. 43 Bass, D.C., “Introduction”. In Practicing Theology: Beliefs and Practices in Christian Life, edited by Volf, M. and Bass, D.C., (Michigan: William B. Eerdmans, 2002), 1.
12 African context of high HIV and AIDS prevalence. But how could this be possible? How could Christians be challenged to action?
The point made above is that through church family system thinking, mutual care of believers is encouraged. The PLHA who come to church and those we encounter in the community should experience care and love through us as conduits of God’s healing grace. Through compassion and identification with these infected and affected people the church would participate in a healing process. However, while we argue for a practical ecclesiology driven by church family systems principles, the reality is that change in people’s attitude is not automatic. Change is linked to the inner work of the Holy Spirit. It requires the Holy Spirit to change people’s attitudes. The Spirit illuminates the truth (hermeneutics), changes and renews the believers’ view and perspective of people’s suffering - existential issues (agogics), and actualises ecclesiastical services (diakonia). Therefore, we assume that under pneumatological influence and compulsion, Christians’ apathy could be combated. Christian caring becomes visible to people.
Louw in the article The Healing Dynamics of Space. Relational and Systemic Therapy in Pastoral Care to people Suffering from poverty, provides a useful framework to start a diagnosis process. He poses the following pertinent question: how is it possible for pastoral ministry to give back to people their human dignity in order to help them not just to survive, but to live a fully human life despite severe poverty? 44 The challenge to pastoral ministry is, inter alia, to help people survive and to discover dignity and identity. The article focuses on attitudes and the pastoral art of understanding, the healing dynamics of relationships and the link between pastoral hermeneutics and the social problem of poverty. Human dignity has much to do with value and the quality of human networks and social relationships. Thus, while one should admit the immense complexity of the issues of HIV and AIDS, and that there are probably no easy answers or remedy or cure, pastoral ministry – apart from developing effective projects of outreach – has the task to help people to live a meaningful life and discover human dignity despite their poverty and HIV and AIDS condition.
Louw proposes a pastoral therapy model, which he calls the hermeneutical model of space therapy represented diagrammatically below.
Space Therapy The philosophy behind this hermeneutical model for space therapy is that people’s experience of worth within relationships is determined by the affective polarities of distance and proximity (the human quest for intimacy), as well by the normative polarities of vocation and discipline. These polarities demarcate a space wherein different positions are possible: A = apathy; B = frustration; C = appreciation (care/acceptance); D = motivation (intentional actions). These four positions display
44 Louw, D.J., “The Healing Dynamics of Space. Relational and Systemic Therapy in Pastoral Care to People Suffering from Poverty”. In Poverty, Suffering and HIV/AIDS: International Practical Theological Perspectives, edited by Couture, P.D. and Miller-McLemore, B., (Fairwater: Cardiff Academic Press, 2003), 209.
13 attitude and create the quality of communication within the human encounter. The quality of the overall dynamics is determined by a theology of grace and intimacy, i.e. to be accepted unconditionally without fear of isolation and the anxiety of being rejected.
Vocation Direction Goals
Violence Apathy Intention Aggression A D Motivation
Action Distance Belongingness
Unique Proximity Identity Frustration B Acceptance C Appreciation Care Depression Discipline Theology of Norms/values intimacy The value of this hermeneutical model to, for example, the problem of poverty in pastoral ministry [HIV and AIDS included (italics my own emphasis)] is that it helps people to understand the dynamics of space. Within pastoral ministry space means the creation of an understanding, which challenges people to change their attitude. When one understands one’s position within the undergirding dynamics of space, it helps one to shift position, for example, from A (apathy) to C (acceptance); from B (frustration) to D (motivation/action). The movement for change is always into the opposite direction and quadrant; A is the shadow of D, and B is the shadow of C. Both C and D should be viewed as supplementary to one another45.
45 Louw, D.J., “The Healing Dynamics of Space. Relational and Systemic Therapy in Pastoral Care to People Suffering from Poverty”. In Poverty, Suffering and HIV/AIDS: International Practical Theological Perspectives, edited by Couture, P.D. and Miller-McLemore, B., (Fairwater: Cardiff Academic Press, 2003), 214-215.
14 This model, apart from being a practical therapy analytical model, is useful to determine the level of ecclesial (koinonia) involvement (i.e. diakonia) with PLHA to guide ecclesiological practices. For instance, in African contexts where many people are affected by HIV and AIDS, if a minister or a congregation is not involved with the affected in the community, it means it is at A or B in the model. Furthermore, the model could be used in mapping congregational involvement, where they could be placed in different quadrants and challenged to be involved.
This model therefore means that the social problem HIV and AIDS cannot be addressed meaningfully if people and society approach suffering people from a position and attitude of apathy and frustration. These positions also inflict apathy or frustration on the poor and PLHA. Positions of motivation and appreciation create a sense of dignity, which inspire people to respond in a more responsible way. At the same time people are encouraged to set new goals in life. They are challenged to start with appropriate actions, which lead to new creative opportunities of living.
The model helps church systems (koinonia) to understand how PLHA function, thereby leading to proper interventions. HIV and AIDS generate despair and hopelessness. And within that situation the model helps church systems to understand their positions in the quadrant and also the position of the HIV and AIDS infected and affected person, which would lead to quadrant shift. The caregiver would become involved in the issues of the HIV and AIDS affected people, while the affected people also change their perception and view of life. Thus, it unearths and challenges churches’ (faith community - koinonia) apathy and encourages empathy and sensitivity to the needy, which is making God’s love and care more concrete.
5. Conclusion It has been acknowledged that FBOs particularly churches are playing a key role in HIV and AIDS interventions in many poor grassroots communities in South Africa. However, the work is not documented and other churches are still not involved. To determine the level of churches’ HIV and AIDS interventions, an assessment framework should be developed. The understanding of church as a family system with interrelated concepts of the identified patient, homeostasis (balance), differentiation of self, extended family field, and emotional triangles provides an understanding of the dynamics and barriers in HIV and AIDS church ministry. These family concepts, together with a relational systemic therapy model shed light on the position of churches regarding PLHA and provide practical guidelines for people to shift from stigmatising and discriminating positions to caring for and loving others.
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