December 1, 2023
My participation in the 19th European AIDS Conference Oct. 18-21 gave me an opportunity to return to Warsaw, Poland, for the first time since the tumultuous year of 1989, when that country was emerging from the stranglehold of communism.
When I was sent to Warsaw 34 years ago to visit the struggling Polish United Methodist Church and seminary by the United Methodist Board of Higher Education and Ministry, communism was crumbling but authoritarianism still prevailed, and poverty was widespread. Stores were barren of products and in the March cold weather of 1989 all seemed dark, dirty and despairing.
Revisiting modern Poland in 2023 provided a dramatic contrast: The country appears prosperous, energetic and environmentally clean. Elections during my visit brought out 75% of the voters, as the country chose to move toward more progressive social and cultural politics, rejecting rigid anti-abortion policies and anti-LGBTQ+ perspectives.
This year’s conference theme, “It’s Time to Revisit,” prompted me to appreciate not only how Poland has changed but how United Methodism needs to revisit its social teachings on HIV and AIDS. The HIV and AIDS entries in the Book of Resolutions have not been updated since 2016, leaving the church silent on key HIV developments and needing to revisit its policies and programs.
What better time to do so than on World AIDS Day (Dec. 1) while plans are underway for the next General Conference in 2024?
Missing in United Methodist social justice literature is any reference to PrEP (pre-exposure prophylaxis), a major medical advance in HIV prevention since 2012 that greatly reduces the probability of getting HIV from sex or injection drug use. Initially, the primary focus of prevention was on stopping infections among gay and bisexual men, but now the medication is recognized as a major weapon in the fight against AIDS among all endangered populations. PrEP is also highly effective with sexually active serodiscordant couples (when one partner has HIV and the other does not).
Women, who represent 53% of the nearly 40 million people living with HIV in the world, need access to a prevention methods other than condoms, which typically are controlled more by men. In England, 30% of the people taking PrEP are women, but in most countries they are not offered treatment. While 23% of the 1.1 million people living with HIV in the U.S. are women, PrEP usage among males is three times higher than women. Women of color in the U.S. are less likely to use or know about PrEP. Pregnant HIV women taking PrEP are unlikely to have babies with HIV.
French scientists at the Warsaw conference noted that getting PrEP treatment for people proves challenging due to high costs, stigma, lack of public knowledge and people’s reluctance to take daily pills. UNAIDS seeks to make PrEP more acceptable and accessible, and the World Health Organization has endorsed an injectable form of PrEP that lasts for three months.
Currently, 230,000 people receive PrEP in Europe and Central Asia with a goal of 500,000 by 2025. How to provide such injections in rural Africa and elsewhere is problematic. In the U.S., the President’s Emergency Program for AIDS Relief is pioneering such efforts in South Africa and the war zone of Ukraine.
The General Conference in 2024 must speak out favorably about the advances and advantages of PrEP, if our Book of Resolutions intends to help mobilize our church to ensure that persons, regardless of race, gender identity and sexual orientation are aware of the value and availability of PrEP medication.
Also absent from United Methodism social teachings is any reference to contemporary goals set forth by UNAIDS. A 2014 goal called 90-90-90 hoped that by 2020 at least 90% would be aware of their HIV status, 90% would have access to antiretroviral therapy and 90% would have the HIV virus suppressed so that they could no longer transmit the virus. Despite considerable progress, by 2020 only 81% of those infected in the world were aware of their status, 67% were accessing medication and 59% were virally suppressed.
In 2021, UNAIDS reported that in places where there is a high incidence of HIV, only 41% have comprehensive prevention programs for adolescent girls and young women, despite this being a particularly vulnerable group. Though the aim was to reach 3 million people with PrEP, only 590,000 people were accessing it in 2020.
United Methodist literature should include UNAIDS’ new 95-95-95 fast-track focus if the church is to educate our global constituency. The goal projects 95% of people living with HIV know their HIV status; 95% of those who know their status receive treatment; and 95% of people on treatment have suppressed viral loads, meaning they can no longer transmit the virus to others. If faith communities lack knowledge or interest, achieving these noble goals will prove impossible.
Biometric goals alone, however, will not stop the global pandemic. As long as neither cure nor vaccine exist, then it will be imperative to focus on social justice, including zero discrimination. Therefore, UNAIDS has begun to emphasize 10-10-10, using societal enablers to fight AIDS.
Sanjay Bhagani, a professor of Infectious Diseases/HIV Medicine at the Royal Free London NHS Foundation Trust, emphasizes that “just setting medical targets is not enough. The elephant in the room is that people are persecuted based on their sexuality.”
Stigma and discrimination persist in 2023. Bhagani noted a United Kingdom survey showing that, due to stigma, 15% of HIV people won’t even get treated and 20% will not reveal their status to loved ones. “Until people recognize it is OK to hug, kiss, share meals, even have protected sex with HIV-positive persons, AIDS cannot end,” he said.
More difficult and controversial, 10-10-10 envisions that by 2025, less than 10% of countries should have punitive legal and policy environments that deny or limit access to services; less than 10% of people living with HIV and key populations will experience stigma and discrimination; and no more than 10% of women, girls, people living with HIV and key populations will experience gender inequality and violence. At this point, Christian persons could be especially valuable partners in the struggle to end AIDS, but their participation is problematic unless the church is mobilized away from apathy to action.
Unfortunately, achievement of these goals is unlikely to happen. Same-sex relationships are not criminalized in only 113 countries, so reaching 90% would mean 62 additional countries would need to change their policies in the next two years. Trends in Uganda and other African countries are toward more restrictions, not less.
Likewise, other 10-10-10 goals are even less likely to be met. Key populations with high rates of infection — such as commercial sex workers, injecting drug users, prisoners, transgender persons and undocumented migrants — continue to experience high levels of stigma and discrimination. For example, commercial sex workers are criminalized in all but six countries, transgender persons suffer high levels of violence, refugees often lack access to medical care, and preventative harm reduction programs remain rare. Both political and religious will to change those policies is nearly nonexistent in too many countries.
A 2023 UNAIDS survey of ecumenical faith-based groups highlights how Christians in African countries are in the forefront of helping prevent HIV and care for those infected. Noteworthy is how religious groups are reaching overlooked children and women. But a disturbing final note reported that faith groups demonstrate “almost complete neglect of key populations,” including failing to provide services to the children of “members of marginalized groups such as sex workers, transgender people, people who use drugs and men who have sex with men.” The report states that “this negative finding must be addressed with urgency by faith communities if the most marginalized children and adolescents living with HIV are to be able to access HIV services” in church facilities.
Yes, the time has come to revisit and rethink United Methodist policies about HIV and AIDS. In the words of the late Congressman and civil rights activist Rep. John E. Lewis, “If not us, then who? If not now, then when?”
Rev. Dr. Messer serves as executive director of the Center for Health and Hope in Centennial, Colorado, and as a member of the United Methodist Global AIDS Committee.