jim.mcmanus@bhwp.nhs.uk

1. Theological and Pastoral Dimensions Ministering to people living with HIV Jim McManus, CPsychol, FFPH, AFBPsS, CSci Director of Public Health for Birmingham jim.mcmanus@bhwp.nhs.uk

2. Stigma • Sigma Research into stigma of living with HIV • Psychological consequences of stigma • Increases speed of progression of illness • Isolation • Self-Worth • Spiral of Difficulties

3. Stigma • Sigma Research into stigma of living with HIV • Psychological consequences of stigma • Increases speed of progression of illness • Isolation • Self-Worth • Spiral of Difficulties Strong link between stigma and progression of illness in many diseases, especially HIV. This has a pedigree of evidence for a biopsychosocial pathway

4. HART means people live longer on the whole and KS lesions may be slightly less common But disfigurement still comes with HIV (eg lypodystrophy, wastingsarcomas) Still major challenges and very debilitating Psychological reactions Succumbers – give up Survivors – “manage” Thrivers - “live to the full – John 10.10” with an eye on the last things Visibility of Stigma

5. Stigma • Has different forms in different parts of London • Will require differing responses • Group Discussion: • What forms might stigma take in different communities? • What issues might this raise pastorally?

6. A simplified psychosocial model for stigmaProtective and vulnerability factors Services Loved ones Friends Workplace Church Stress assessment Positive Stress Eustress Distress Self Value and Identity Challenges from illness Challenges from perception of illness, death, life as compromised Guilt Challenges from Society Challenges from Faith

7. Acting on These • Vulnerability Factors • Factors which predispose us to be vulnerable to stigma or illness • Act on these to reduce or neutralise them • Help person see and work through them • Key examples: disfigurement or smoking behaviour and progression of HIV infection • Protective Factors • Key things which will help people develop and retain positive sense of self • Help people make positive assessment of stressors • Key examples: managing a working life while on HART (managing the stressors well can improve life quality and health)

8. A Theological Analysis to Stigma - Summary • The ministry of Christ – to reach out and include • The role of the Church – sacramental community • Societal Level • Parish Level • Individual Level • Teaching of Benedict XVI

9. Motifs in Pastoral Care responding to Stigma • Unite to the Cross – a good pedigree but this might reinforce the worries and fears during disease progression so need a context in which it is appropriate • Call to Life and wholeness • Jesus in the Synoptic Gospels • Individual pastoral care without any social action is not authentically Catholic • Reformed Theology in recent years • UNAIDS Theological Commission • Piece of Lectio

10. The Gospels

11. Two key questions • Is HIV theologically special in and of itself, or is it what we make of it that makes it so? • Stigma • Structural and social sin – inequalities • Not listening to the Gospel or Tradition • Given our Catholic heritage of teaching, why are we listening to Reformed theology when we haven’t yet bottomed out what our own tradition may have to say?

12. A Catholic Theology of HIV 1 • The person in the perspective of an economy of grace • HIV and AIDs as illnesses in the perspective of the • From Scripture through Tradition • Take the person with HIV seriously – moral and doctrinal theology • Taking the person with HIV seriously means we have some tasks in Catechesis, Sanctification and Pastoral Care • Taking the person seriously means taking the person in their “economy of Life” • Taking the person seriously means engaging with Social Theology and with society and its institutions

13. A Catholic Theology of HIV 2 • The nature and dignity of the human person • The redeeming work of Christ • The healing ministry of the Church • Illness as Challenge and as opportunity • Human life as lived in eschatological perspective • Joy and Justice • The Sacraments • The Church as Sacrament - Schmaus • The Doctrine of Human Ecology – John Paul II • Touch, Incorporate, Uphold – Benedict XVI • Jesus in the Synoptic Gospels – uses then goes beyond the traditional socially sanctioned models of prophetic and healing ministry

15. Some Theological Directions • A Christology of HIV • Unite to the Cross is a sign of Hope, not just a sign of passive suffering • The ministry of Jesus – dealing with the individual and the social context • A Pneumatology of HIV • A truly Catholic response to HIV builds upon a sacramental economy of grace to create a pastoral response which helps people LIVE with HIV, even in the face of death • This provides a place for a theology of the Cross which Reformed Theology around HIV does not seem to do

16. Priesthood and HIV Pastoral Care – A natural place for Ministry • Priesthood of Christ • The Role of the Priest • Eucharistic Ministry • Sacramental Ministry • Pastoral and Teaching Ministry • United to Christ, Crucified and Risen • Focus of Unity in the Parish • Visible sign of the Body of Christ • Eschatological Context • Ecclesiological Context – a Community • Suffering Service

17. PresbyteriumOrdinis • The office of priests...also, in its own degree, shares the authority by which Christ builds up, sanctifies and rules his Body...Priests, by the anointing of the Holy Spirit, are signed with a special character and are conformed to Christ the Priest in such a way that they can act in the person of Christ the Head.

18. In the measure in which they participate in the office of the apostles, God gives priests a special grace to be ministers of Christ among the people. They perform the sacred duty of preaching the Gospel...Through the apostolic proclamation of the Gospel, the People of God are called together and assembled. All belonging to this people, since they have been sanctified by the Holy Spirit, can offer themselves as "a sacrifice, living, holy, pleasing to God" (Rom 12:1). • Through the ministry of the priests, the spiritual sacrifice of the faithful is made perfect in union with the sacrifice of Christ.

19. Their ministry, which begins with the evangelical proclamation, derives its power and force from the sacrifice of Christ. Its aim is that "the entire commonwealth of the redeemed and the society of the saints be offered to God through the High Priest who offered himself also for us in his passion that we might be the body of so great a Head."(13) • The purpose, therefore, which priests pursue in their ministry and by their life is to procure the glory of God the Father in Christ. That glory consists in this-that men working freely and with a grateful spirit receive the work of God made perfect in Christ and then manifest it in their whole lives.

20. Although they have obligations toward all men, priests have a special obligation to the poor and weak entrusted to them, for our Lord himself showed that he was united to them,(28) and their evangelization is mentioned as a sign of messianic activity.(29) • ...Finally, and above all, priests must be solicitous for the sick and the dying, visiting them and strengthening them in the Lord.(30)

21. Priesthood and HIV Pastoral Care • Priesthood of Christ • The Role of the Priest • Eucharistic Ministry • Sacramental Ministry • Pastoral and Teaching Ministry • United to Christ, Crucified and Risen • Focus of Unity in the Parish • Visible sign of the Body of Christ • Eschatological Context • Ecclesiological Context – a Community • Suffering Service

22. Pastoral Response Secular and Christian Agenda • What – Sanctification • How – Build resilience and discipleship • Psychological dimension of sanctification - can be seen as a means of building protective factors and reducing vulnerability factors • Example of Jesus in the Gospels • Sacraments • Five Functions of Pastoral Care • Creating an understanding of acceptance • Creating a welcoming parish community • Knowing the limits of your own competence • Picking the main issues you can impact on • Use of the Optio Fundamentalis • Self awareness and self care on the part of the Pastor Biological Social Spiritual Psychological

23. Some Starting Points for Parish and Area Level • …with respect to the fundamental rights of the person, every type of discrimination, whether social or cultural, whether based on sex, race, colour, social condition, language or religion, is to be overcome and eradicated as contrary to God’s intent • Gaudium et Spes • It is essential for every human being to have a sense of participating, of being a part of the decisions and endeavours that shape the destiny of the world. • World Day of Peace Message 1985 • It is a strict duty of justice and truth not to allow fundamental human needs to remain unsatisfied, and not allow those burdened by such needs to perish. It is also necessary to help these people to acquire expertise, to enter the circle of exchange, and to develop their skills in order to make the best use of their capacities and resources • Centesimus Annus http://www.ncan.org

24. Self Care • Study and Learning • Prayer • Spirituality • Community • Rest, Recreation • Boundaries of Time • Boundaries of Person • Rule of Life • Source of Help • Intimacy • Spiritual Director Know when to Act Know when to Seek help