Guest Blog: Close the gap

A reflection for Advent and World AIDS Day 2014.

“Advent is the recovery of how to live in a world of impatience as a patient people.” - Stanley Hauerwas

Richard Carson is the Chief Executive of ACET Ireland. ACET.  Here, he writes a guest blog post for VOX magazine to mark World AIDS Day (1 December).

Planning events for the last few World AIDS Days has generated an interesting dilemma for those of us working in the sector. The quandary is that, on the one hand, the brand of “World AIDS Day” remains popular with the general public. While, on the other hand, the good news emerging is that the annual day’s title is increasingly becoming an inaccurate description.

The number of those with access to antiretroviral treatment is increasing every year and now stands at 37% (doubling in the past 4 years). In Ireland a massive majority of those with access to treatment are free from the symptoms associated with AIDS. So ‘living with HIV’ is a much more accurate description, thus making our use of “World AIDS Day” questionable.

Indeed, the theme of World AIDS Day 2014 is “Close the Gap” with UNAIDS making the stunning statement that “ending the AIDS epidemic by 2030 is possible, but only by closing the gap between people who have access to HIV prevention, treatment, care and support services and people who are being left behind.”

“We have bent the trajectory of the epidemic,” said Michel Sidibé, Executive Director of UNAIDS. “Now we have five years to break it for good or risk the epidemic rebounding out of control. ”Those of us who can recall the days of perceived death sentences and little hope can easily get carried away with such optimistic statements.

Yet enormous challenges remain. Many countries and regions are struggling to break the back of the pandemic. Some countries have flatlined access to treatment and will need to redouble efforts to avoid a rebound. In Ireland we have one new HIV infection every day and the first six months of 2014 showed an increase in incidence of over 20%. About 20-30% of those living with HIV in Ireland have not yet tested and so are unaware of their status.

http://www.unaids.org/sites/default/files/documents/12_Populations_en_WAD.pdf

Take a look at the 12 populations in the UNAIDS infographic above. All experience the “gap” that must be closed if AIDS is to be ended. What is noticeable is that for many of these populations the gap is not just in terms of HIV. For some of these populations, they experience exclusion economically, socially, politically and in many other ways. For some of these populations, this exclusion extends to their experience of the church.

In many countries, silence concerning, or even endorsement of, the criminalisation of same-sex sexual conduct marks the response of churches. Closer to home many transgender women, gay and bisexual men, sex workers and injecting drug users have found that Irish local churches are places they associate with the deterioration of their mental health, even unto attempted suicide. Conversations on morality and repentance become impossible when structures of privilege and stigma remain intact.

The benchmark here is safety for those who are vulnerable. This is a basic standard yet it involves those on the side of privilege listening-to-understand rather than listening-to-reply. If this takes place then gaps begin to close. We have a long way to go. Let’s pray that a slippery slope lies before us to speed us on our way.

So how might we go about this? And more broadly, what values should an agency like ACET hold as we seek to be part of closing the gap on HIV & AIDS?

We operate in an incredibly results-driven world. Funding is often based on quantifiable impact whether demonstrated in terms of verifiable statistics or through testimonies in the church newsletter. Yet the patience required for closing the gap is enormous and the temptation to give up is huge. It is the temptation to grasp at results and perceived impact, to produce the next Big Idea that will save the world, to live out of anxiety. These all link to the Great Temptation of our age: to pretend to be impressive.

However in our work we have learnt that what counts can’t always be counted and what can be counted doesn’t always count. This is particularly true when working with those marginalised in society. HIV is unlike almost any other infection that has affected the world. Because of the routes of transmission and the history attached to it, the virus is almost unparalleled in that it touches into deep human experiences such as stigma, trust, shame, isolation and hope. To engage with this tiny little virus is to wrestle with these most complex areas of who we are - and that takes patience, lots of it. Results do not come quickly and never on our own terms.

As Jesus demonstrated in Emmaus, the most profound moments of revelation often come not in the sermon nor the in synagogue nor even in the sharing of Scripture but must wait for the intimacy of the table and the mundanity of breaking bread. To get to such a place requires the building of mutuality and equality in relationships, another concept that those locked into a results-driven paradigm will struggle with.

Yet, paradoxically, we believe that it is the only thing that gets results. One person we worked with described our staff in these terms: “They loved me without wanting to fix me. And that is what saved my life” or to paraphrase: “They loved me without expecting a testimony from me. And that is why I have a testimony.”

Don’t get me wrong, to be patient is not to lack in valuing quality, creativity, urgency, effort, thorough evaluations and impact measurement. One of our projects, in which we work with migrant-led and multiethnic churches in Ireland, is currently being run through a wonderful HIV prevention quality improvement tool that has been developed by leading EU-wide agencies in the field. Such resources are of vital importance.

However to be a people of patience is to live by a different rhythm to the world around us. Such people demonstrate a provocative and revolutionary way of life that shakes the foundations of the impatient. But in a toxically consumerist society this is no small task, its entry point is a narrow gate and only a few find it. As I sometimes remind our staff: “every ad you watch on TV is telling you that you are not doing your job.” This is why in ACET our work is centred on Jesus, not just his example but Him Himself. All we can claim is that seeking to work in the margins of society without His presence, strength and patience of us would be impossible. 

Inscribed in our office meeting room is this quote by the theologian Walter Brueggemann: “Those who sign on and depart the system of anxious scarcity become the historymakers in the neighbourhood.” It has been an enormous challenge for us to live out this reality, not least through a recent major funding crisis that miraculously turned around, with hours’ notice. The glorious paradox that Brueggemann illustrates is that when we rely on the idol of result-driven effectiveness we end up rooting ourselves in a paralysing anxiety. But when we measure our projects and proposals in patient faithfulness, transformation is the fruit.

So this World AIDS Day please join us in rejoicing at the extraordinary advances. We pray that the bend in the trajectory in the pandemic would turn into a steep downward fall, that we would all close the gap to those who have been excluded and that a revolution of patience would sweep our grasping and fear away.

Richard Carson is the Chief Executive of ACET Ireland. ACET (AIDS Care Education & Training) operates a range of projects that seek to improve the lives of those living with and affected by HIV in Ireland while also playing their part in reducing the number of new HIV infections. You can find out more about the work of ACET Ireland on their website: www.acet.ie or follow them on Facebook:www.facebook.com/ACETIreland