Mission & Evangelism
HIV/AIDS resources

Hopeful Compassion
Spiritual Care for the Person Living with HIV/AIDS
ANDRÉ E. DE LA PORTE

OVERVIEW OF EMOTIONAL AND SPIRITUAL ASPECTS
Being tested HIV-positive can have a major impact on someone’s life. Many people are able to continue with a normal life after the diagnosis. They are more aware of their physical and health status and are concerned with minor illnesses and blood-test results. With the onset of AIDS symptoms the person enters a whole new phase, both on a physical and emotional level. Physically, the disease progresses in four phases.1 There is a parallel emotional progression, which is accompanied by distinctive human needs.

It is important to note that many of these feelings appear at different stages of the disease. Each of the human needs, therapeutic interventions and spiritual needs can therefore also appear in other phases.

TEACHING METHOD
In this article the focus will be on a teaching method and its practical application. The content of the teaching can be supplied by the person using this method, in keeping with his/her faith tradition. In preparing people to care for persons living with AIDS (PLWHA), experiential learning2 is preferential. This is a collaborative approach where teachers and learners are seen as equals.

In this method, training is circular and not linear. Linear training advances in steps, focuses on content and some skills, and often causes dependence. Circular training takes one principle and applies it to different situations. For example, in circular training, empathy as a concept is taught and then applied to an HIV-positive person, a person living with AIDS, a family of a PLWHA, the dying patient, the bereaved family; it focuses on processes, skills and some content and it explores, discovers and empowers.

The spiritual experience and framework of the carer and the person living with AIDS are taken as a starting point. The processes are: understanding the existing resources; mobilizing and strengthening these resources; and developing new resources.

Participatory methods are used: drawing, story-telling, demonstration, group facilitation, songs, music, poems, rhymes, active listening, mime, discussion, role-play, brainstorming, case studies, field visits, cartoons, creative visualization, observation and games.

Another guiding principle is the fact that we give meaning to our lives with the stories we tell.3 Morgan4 gives the following definition of a “story”: “Events, linked in sequence, over time and according to a plot.” I want to help people to:
– tell their story;
– discover the plot of the story;
– identify unique outcomes in their story;
– develop this into a new story.
This training will empower participants to:
– understand and tell their own life story better;
– help others to tell their stories;
– decide on new outcomes for their own stories;
– help others to change the devastating effect of AIDS in their life story into a growth-directed outcome.

OBJECTIVES OF A PROGRAMME TO TEACH SPIRITUAL CARE
On completion of such training participants must be able to:
– have a better understanding of persons living with AIDS, their situation and the effects on their families;
– relate to and communicate with persons living with AIDS with empathy and compassion;
– understand the emotional, social and spiritual needs of persons living with AIDS and their families;
– come to grips with their own mortality so that they can relate to the terminally ill with hope and compassion;
– assist persons living with AIDS to live positively with their condition;
– help persons living with AIDS to use their spiritual resources to impart hope and meaning in their life;
– assist families to cope with the stress of caring for a terminally ill person;
– provide support to the bereaved;
– know when it is time to get help and make appropriate referrals in terms of person, time and place.
Towards understanding people living with AIDS and their families

DEEPENING EMPATHY AND COMPASSION FOR THE PERSON LIVING WITH AIDS
A prerequisite for caring is insight into and understanding of the plight of the person who has been diagnosed as HIV-positive. This understanding should lead to a greater degree of empathy for that person. The methods of story-telling and group discussion are far more powerful than simply providing information.

Two stories in cartoon format5 about two different people who tested HIV-positive and later died from AIDS are distributed to participants, who have to write stories to accompany the drawings. Participants are divided into groups of 3-5.

Exercise: Empathy and compassion
Look at the cartoons on pages 126-27, and tell the story of each of these people using the guidelines below.

Part 1
• Who was the person? Give him/her a name, identity, background and occupation.
• How did he/she get AIDS?
• What is the doctor saying?
• What impact did the diagnosis have on him/her and the family?
• How did it affect their relationships (e.g. work, friends, church and community)?
• How did the disease progress?
• How did he/she and his/her family feel at each stage of the illness?
• How did the community react?
• How did he/she die?
• What happened at the funeral?
• What happened after the funeral?
Each group gets a chance to tell their story (identify one person in the group to tell the story).

Part 2
Discuss the stories in the small groups according to the following guidelines:
• Who would you rather be in these stories?
• What could be done to assist these people in each situation?
• Would it matter how he/she got AIDS?
• What did the doctor do differently?
• Why did one person’s family desert him?
• How would you feel if this happened to you?
• How can the family be helped?
• How can the community be helped to get involved?
• What can communities do to assist the person living with AIDS?

The facilitator shares the following definition of empathy: empathy is looking at the other person’s feelings and situation through their frame of reference (way of seeing life) and communicating this understanding to them.

UNDERSTANDING THE EFFECTS OF OPPRESSION
The following exercise introduces the concept of oppression within the context of HIV/AIDS. After this exercise participants will understand:
– the oppressing effects of HIV and AIDS;
– the role of culture and preconceived ideas in keeping people trapped;
– the importance of having and knowing about options;
– the effect of gentle confrontation;
– the effect of behaviour change.

Exercise
The facilitator explains the following:
• I am going to read you a story about a person affected by
AIDS.
• The story will have three parts. In the first part we will see the effects of AIDS. In the second part someone will challenge the person. In the third part we will see the effects of liberation.
• A blanket will symbolize each oppressive idea. As I read the idea anyone from the group can take a blanket and put it over the person in any way they want to.
• Then someone will challenge the person.
• As the story changes and new ideas are formed, someone in the group removes each blanket.

The facilitator appoints someone beforehand to be the “challenger”. This person gets up without announcement and reads the middle section of the story.

Story
Martha is a woman living in Mamelodi. She is married to Herbert, who works as a teacher and earns a reasonable salary. Herbert cares well for her and the children, but he is very authoritarian and traditional in his views about marriage. They have three children. Martha does not have a job and looks after the children.
• Martha was feeling very anxious because she knew that Herbert was not faithful to the marriage and she was scared that he had contracted AIDS.
• She was considering talking to him but was afraid that he would leave her and the children if she confronted him.
• She decided to talk to his mother, but she said that it is not the place of the woman to confront her husband.
• Martha was becoming more and more depressed, because she was constantly worrying that she would get AIDS. What would then happen to her children?
• Eventually Martha decided to talk to her pastor. He said that Herbert was a respected member of the congregation, and she should not shame him by suggesting that he had AIDS.
• Martha then resigned herself to her situation. There was nothing she could do, and if she had to die, so be it.
• Martha became more and more sad and withdrawn. She felt hopeless and depressed. She started to neglect the children and did not want to do anything.

Martha, why have you given in to the fears and prejudices of others? You are a strong woman. You have given birth and raised three children. You have always been a loving and faithful wife. Is it true that you do not have the right to know your husband’s status? You have a responsibility towards your children and the community. Is it true that it is wrong to confront your husband, even if it relates to life and death? Is it really true that you do not have any choices?

• Martha decided to take the children and visit her parents in Hammanskraal for a few days during the school holidays and discuss the issue with them, as they were people of wisdom.
• Martha and her parents talked at length about all the issues regarding submission to her husband and her responsibility.
• Gradually Martha saw that she had to submit to her husband in what was right and proper, but not necessarily in all things.
• Martha realized that she had a responsibility towards herself, Herbert and her children. She decided to leave the children at her mother’s and go home on her own to talk to Herbert about the AIDS issue.
• Martha decided that she had to get herself tested before she could talk to Herbert. It took her days to decide, but eventually she went. She was still negative.
• So she went home and talked to Herbert. He was very angry, and she was very scared. But she just said: “If you do not get yourself tested, I am going back to my mother and staying there with the children.” Herbert hit her and stormed out of the house.
• The next day Martha wrote Herbert a letter to say that she was going back to her mother. He could let himself be tested and come and see her there. She would stay with him, even if he was HIV-positive. They could decide together how to deal with the situation. She would not come back before he had the test results.

Participants are divided into small groups to discuss the following questions:
• What ideas kept Martha trapped?
• What happened to help Martha change?
• What have you learned from this exercise?
• How can this help you in your care work?
Reporting back is done in the big group and noted on newsprint.

A CONVERSATION WITH MR AIDS6
In many cases people find it difficult to separate the problem from the person. In this case HIV/AIDS is the problem. Often the community and care workers see the person with AIDS as the problem. The exercise is based on the narrative technique of an externalizing conversation.7

On completion of this section participants will have:
– acquired the skill to distinguish the person from the problem;
– deepened their understanding of AIDS and its effect on the person;
– deepened their empathy with the plight of the person with AIDS;
– developed new strategies to deal with AIDS and its effects.

Participants are divided into groups of three. Three roles are allocated: Mr/Mrs AIDS, the journalists, and the infected/affected person. The journalist conducts an interview with each. His goal is to understand both and to write an article for his newspaper. Sample questions are provided. The journalist can ask any question which will help to understand Mr/Mrs AIDS and the infected person.

a) Questions to “AIDS”
• What are your effects on the person? How do you influence their emotions, thoughts and behaviour?
• How do you influence their work, family and relationships?
• What qualities do you have?
• What makes you powerful in the person’s life?
• What do you hope to achieve – what is your goal?
• How do you want to achieve this? What are your techniques and tricks?
• Are you alone?
• Who is supporting you? Who are your allies?
• What plans do you have if the person resists your influence?

b) Questions to the “subject”
• Which aspects of your life do you still have control over?
• In which areas are you winning (e.g. in marriage, work and relationships)?
• What counter-strategies have you developed to counter the strategies of “AIDS’”?
• What special qualities and skills do you have that “AIDS” cannot undermine?
• What is your purpose in life? To what are you committed?
• Who stands by you? Who supports you?
• How can you take advantage of “AIDS’” weaknesses?

c) Reflection by the subject
• How did you feel in both parts of the exercise?
• How do you feel about “AIDS”?

d) Reflection by the journalist
• What did you experience during both parts of the exercise?

After the role-play a group discussion is held, using the following questions:
• What have you learned from this exercise?
• How will you do your care work differently after this exercise?
• How can you use what you have learned in your work?
Spiritual care for persons living with AIDS and their families

The table at the beginning of this article emphasizes that emotional and spiritual care is interconnected. The spiritual needs of PLWHA can be summarized as follows:
– the need for security and God’s compassion;
– experiencing and communicating connection;
– experiencing and communicating forgiveness and reconciliation;
– experiencing and communicating dignity;
– experiencing peace and acceptance;
– comfort in grieving and loss.

Carers should be able to address these spiritual aspects in a practical manner.8 They must also identify and mobilize the spiritual resources available to the PLWHA and do appropriate referrals to spiritual leaders. Skills in the basics of mobilizing a spiritual community9 to get involved in care can be very valuable.

In the following exercises each of the above components will be explored. The goal is to understand and access the carer’s own spiritual experience and mobilize their resources for caring. This will empower them to provide compassionate and appropriate spiritual care.

The need for security and God’s compassion
On completion of this section participants will have:
– identified the role of security and God’s compassion in their own lives;
– understood the connection between a relationship built on trust and the experience of security;
– identified ways to communicate these aspects to persons living with AIDS.

The technique called “weaving of stories” will be used. Through this technique a few people tell their story and listen to each other’s stories around a central theme. The same exercise can be used with the other themes. The particular theme is replaced in the first sentence.

Exercise: weaving of stories (1)
• Participants are divided into small groups of five and seven.
• The facilitator asks them to remember and reconnect a personal experience of security and compassion.
• One person in the group is appointed as “questioner”.
• He asks the following questions,10 one by one.
• After he has asked a question, everyone in the group responds to that question only, going around in a circle.
• Participants may not comment on each other’s stories during the exercise.
• As each circular movement is completed, the “questioner” asks the next question.
The questions are:
• What was a time when you deeply experienced God’s compassion and/or a sense of security? Briefly relate the incident to this group.
• What was the meaning of this incident for you?
• What decisions did you make?
• What have been some of the effects of this incident and decision on your life?
• What possibilities do this incident and its meaning open up for you as you face the future?
• How can this incident and its meaning be used in your care work?

A group discussion is held based on the following questions:
• How can you give PLWHA a deeper sense of security and of God’s compassion?
• What spiritual resources can you use to do this (e.g. Bible reading, prayer?)11

In our circumstances, we sometimes struggle to experience God’s abiding presence.12 Remember God is always with us. The following scriptures can be used in this regard:
– Jesus’ attitude towards the suffering (John 8:1-11 and Matt. 9:9-13);
– God is with us even in the deepest darkness (Ps. 23);
– God is with us when we feel trapped and helpless (Ps. 118:5-8; Heb. 13:5a-6);
– nothing can separate us from the love of God (Rom. 8:31-39);
– God sees that the vulnerable are cared for (Deut. 10:17-21);
– Jesus understands our suffering (Heb. 4:12-14);
– Jesus is the Good Shepherd (John 10);
– we are under God’s protection (Ps. 91).

EXPERIENCING AND COMMUNICATING CONNECTION
The importance of community and connection13 in the care of the PLWHA can hardly be overemphasized. Carers must understand how to create a sense of community and connection in their care work.

Exercise
Instructions on the process and for the facilitator
• Divide into groups of 8-10.
• Everyone sits on the ground.
• Hold one end of a ball of string. Roll it across the floor to someone sitting opposite you, calling out his or her name. Keep holding your end.
• Ask the recipient to hold the string so that it makes a taught line between the two of you. Let them roll the ball of string to someone else, saying their name.
• Continue in this manner till everyone is holding tightly to a piece of string.
• The ball should finally be rolled back to the first person, so that he/she holds the beginning and the end.
• Next ask everyone to look at the way the string connects all of you, like a spider’s web. You are all dependent on each other to keep the web firm and supportive. If anyone takes his or her hand away from the web, that part collapses. When that happens, the whole web collapses.
• While everyone continues holding the string, ask participants to suggest ways in which the web relates to our family, community or working life.
• Emphasize our mutual dependence on each other.
• After the discussion role up the string for future use.

Exercise
Case study: David14
David learns that his wife Jane is HIV-positive. He feels he cannot face this, so he thinks about sending her home to her family so that he can go on with his life. He is sure that he is not infected, but he has not had an HIV test. Both David and Jane had post-test counselling and are aware of the fear of rejection. Jane wants him to be tested also. He responds by saying that she is only accusing him falsely of being responsible for her infection and refuses. While David is thinking about what to do, they learn that Jane is pregnant with their first child. David now thinks about doing an abortion on Jane, since they have no money to go to a clinic. He is afraid that he might be infected also but cannot talk about his fear to Jane. If he is infected, then David knows that he, too, would die, and aborting Jane’s child would mean the family name would die out. He decides to send Jane home to her family without an abortion and find another wife who might also give him a child. Then he would have two chances to leave a son behind. Before he sends Jane away he talks with his friend, wanting his friend to agree that he is doing the right thing.

• If you were the friend, what questions would you ask?
• What do you think are the needs that David and Jane have?
• How could some of these needs be met?
• If Jane were a member of your church, what would you do when you learned that she had been sent home (suppose you did not know why she was sent home)?

A group discussion based on the following questions will be valuable:
• How can you give PLWHA a deeper sense of connection and community?
• What spiritual resources can you use to do this (e.g. Bible reading, prayer)?

The Bible consistently affirms that God cares for everyone, without regard for their physical and spiritual condition or their standing in society. Moreover, the Bible reveals the special love and concern God has for those whom society ignores and excludes. Jesus himself made this evident through what he taught, what he did and how he cared. We are connected to Jesus and he calls us his friends (John 15:1-17). In the church, as body of Christ, we are connected (1 Cor. 12). This is a comfort to the PLWHA and will help him or her to break through feelings of isolation and alienation.

EXPERIENCING AND COMMUNICATING FORGIVENESS AND RECONCILIATION
AIDS is more than an infected body; it usually has to do with infected relationships. Therefore an important area to be resolved for a person to die well is the healing and restoration of broken relationships. With AIDS there is considerable potential for broken relationships:
– a young person ignoring parental advice and being cut off;
– rejection by the church, community or family of the PLWHA;
– an unfaithful partner infecting their spouse.

The approach of death is an important time to seek resolution of these issues. Carers must be aware of the importance of forgiveness for peace and acceptance. They must also understand the importance of reconciliation for restoring relationships.15

Exercise: weaving of stories (2)
Refer back to weaving of stories (1) for guidelines.
• Use the same set of questions, and replace the first one with the following: What was a time when you deeply experienced forgiveness and/or reconciliation? This can be:
– when you forgave someone;
– when someone else forgave you and you did not expect it;
– when you were reconciled with someone.

Now briefly relate the incident to the group.

A group discussion on the following will be valuable. How can you help PLWHA:
– forgive someone who has wronged them (e.g. the person from whom they got HIV/AIDS);
– start a process of reconciliation;
– find spiritual resources to do this (e.g. Bible reading, prayer).

Sometimes you may feel that God has turned away from you, and no longer cares. But this is far from the truth. God is always eager to offer forgiveness and to accept us in love. God is faithful and his love is abundant (Ps. 103 and 130). Jesus came into the world to be a saviour, not a judge (John 16:18a, 12:44-50; 1 John 4:9-10). These truths will help persons living with AIDS with the process of forgiveness and reconciliation.

EXPERIENCING AND COMMUNICATING DIGNITY
Carers need to understand the importance of treating everyone with dignity and respect and to be committed to this.16 Understanding and respecting their own uniqueness and that of others is a prerequisite for this. Carers should be able to help persons living with AIDS to experience a sense of dignity and help them to discover their unique place in the world.

Exercise
Instructions on the process for the facilitator
• For this exercise you will need an apple or an orange for each participant (it can be another kind of fruit, provided each has the same fruit).
• Provide each participant with one fruit.
• Tell them to get to know their fruit very well. Look at its traits, colour, marks, etc. Give your fruit a name. Construct a history for it. Where did it come from? How did it get here?
• Now send around a basket or a box and collect all the fruits.
• Put them out on a table.
• Ask each participant to come and pick out his or her own fruit.
• When this is done, ask who is convinced that they have their original fruit.

In small groups discuss the following questions:
• What does this exercise tell us about human beings?
• What are some of your unique traits?
• How can you help people discover their own uniqueness?
• How would the world (your family, work-place, community) be different if you were not born?

Exercise
• Each participant should take a blank page and tear it into six separate pieces.
• They write one of their unique traits on each piece.

Now tell the following story: My dream trip

You have saved up a life-time for a trip. You have bought your ticket and packed your bags. You get on the aeroplane with a feeling of excitement. The plane takes off. The hostess brings you wonderful food.

Then after about three hours of flight the pilot announces that there is serious engine trouble and nowhere to land. But there is a parachute for everyone. All you have to do to get one is to give up one of your unique traits. Go around the group and collect the papers in a box. If someone does not want to give up a trait (paper) that is fine.

You land in the middle of a dangerous jungle and to get to a river safely you have to give up one of your traits (collect). When you get to the river you see that it is full of crocodiles. To get across you have to give up one of your traits (collect). On the other side there is a small town. You can find a map to get to a major town by giving up one of your traits (collect). Now you need transport to the town. Someone will take you in exchange for one of your traits (collect). When you get to the town you can get on a plane back to your home and family by giving up your last unique trait (collect).

Discuss the following questions:
• Which traits did you give up and why?
• What did you experience when you gave up your traits?
• Is there a similarity with the experience of a dying person who has to give up more and more of himself/herself?
• How can you assist PLWHA to keep a sense of uniqueness and dignity (refer back to the spiritual needs of the dying.)
• What spiritual resources can you use (e.g. Bible reading, prayer)?

Sometimes it feels as if our lives have no meaning. We feel it would be better if we were dead. God knows each one by the name and God has a plan for each one of us. We are special and unique for God. Therefore God will never forget us (Isa. 49:15-16). You can know that in Christ you are a new creation (2 Cor. 5:17).

EXPERIENCING PEACE AND ACCEPTANCE
One of the difficult tasks of a carer is to guide persons living with AIDS towards accepting and preparing for death. The knowledge that he/she is leaving a legacy can help a person die peacefully. The construction of a memory box17 and/or a memory book is a valuable tool in this regard.

Exercise
Instructions on the process for the facilitator
• Ask participants to bring along a small box (about the size of a shoebox).
• They must also have material (e.g. paper, paint, crayons) to decorate the box.
• Explain that a memory box is a box in which you keep special things for people you love. These things can remind the family and children of the person when he/she is no longer alive. This will help the person to accept his or her death. Things to put in are photographs, baby clothes, and traditional gifts for their child. You can also write a memory book. This is a book in which the person writes letters or messages to friends, family or children. This can be read after the person is dead.
• Allow time for people to decorate their boxes.
• Let participants then make a list of what they would like to include in their own memory box.

A group discussion on what a person needs to be able to die peacefully will be valuable. The following should be included:
– physical comfort;
– listening;
– respect;
– respect of their wishes;
– as much independence as possible;
– the possibility to grieve (because of loss of independence, physical abilities);
– presence and belonging: let the person be part of the community as long as possible (e.g. sitting outside and watching, telling stories);
– being part of final decisions (e.g. about the future of children).
What did you experience while making the memory box? How can you assist PLWHA to die peacefully and with dignity (refer back to the spiritual needs of the dying)? What spiritual resources can you use to do this (e.g. Bible reading, prayer).

HIV/AIDS makes us sharply aware of our own mortality and ultimate death. But the scriptures proclaim the even greater reality of life beyond death. Some good examples are:
– a tent on earth and a house in heaven (2 Cor. 4:16-5:8);
– Jesus is the way, the truth and the life (John 14:1-14);
– the Lord is with us, even in the darkness of death (Ps. 23);
– God gives us peace (Rom. 5:1-11);
– our future is assured in Jesus Christ (John 1:11-12, 10:28-29);
– what really matters (Phil. 3:8b-11).

COMFORT IN GRIEVING AND LOSS
When dealing with grieving and loss it is important that we are aware of our own experience of and reaction to loss. It is from this perspective that carers can understand how to support PLWHA in grief, and families after death.

Exercise: Putting everything together
Try to use as much of the knowledge and skills you have gained in the following case study.

Timothy18
Timothy is a 33-year-old doctor. He first suffered from a sexually transmitted disease in his third year of university. He graduated with honours and became well known because of his love for Jesus and great care for people. The day before his wedding he found out that he was HIV-positive. He was in shock, and greatly embarrassed. His fiancée decided to marry him even though he was HIV-positive in order to show her true love. Timothy worked for some time until he became weak. Because of his access to good medical care and the loving care his wife gave him, his health improved somewhat. He began working at a hospital near his home and transformed it into a large and beautiful health centre. He continued to get sick from time to time but did his best not to show his sickness. Many Christians supported the family in prayer and encouragement, and Timothy continued to work tirelessly. His strength became less and less and he finally became very sick. Timothy’s older brother had also become very sick with AIDS, and Timothy witnessed to him and asked people to pray for his salvation. Three days after Timothy was buried, his older brother died and within a year the first-born brother had also died of AIDS. In one year, all the sons of the family had died of AIDS. Timothy’s wife is praising God for how He has helped her deal with all the struggles. She is HIV-negative.

Questions for discussion
• If you had been the pastor about to marry Timothy, what would you have advised him to do when he told you he was HIV-positive?
• Now that you know the end of the story, what does it tell you about how God often works in people’s lives?
• What kind of healing took place?
• What scripture would you use to help Timothy know God’s will for his life?
• If you were Timothy’s friend and met him in the hospital while he was sick, what scripture might you have offered him?
• What would you have prayed for?
• How would you have assisted his wife?

In groups discuss the following questions:
• What are the needs of a grieving person and how can you best assist them?
• How can you assist PLWHA and their families to work through the grief process?
• What spiritual resources can you use to do this (e.g. Bible reading, prayer)?

In grief we can be sure that God understands our suffering. Jesus knows the pain of dying and the agony of grief. Jesus had a friend who died (John 11:1-44). God offers us rest in Jesus Christ (Matt. 11:20-30). We can go to God with every need (Phil. 4:6-14). We can comfort one another (1 Thess. 4:13-18).

LIVING POSITIVELY WITH AIDS
As the epidemic progresses, the emphasis on positive living with HIV/AIDS will become more important. In this regard stories of people who are living with the disease are very important. A fictional19 or a true story20 can be used. After reading the stories, participants can discuss the following questions:
• What were the spiritual needs of the people in these stories?
• What is hope? How would you explain it to someone else?
• What gives meaning and purpose to life?
• What kind of things can persons living with AIDS do to increase their sense of usefulness?
• What examples do you know of people whose lives have held great meaning even with AIDS?
• What spiritual resources can be used to give a person hope?
Be sure to include the following in the feedback:
• Hope will help us look after ourselves and live a healthy life.
• Meaning and purpose is greatest when we do something that will last.
• Creating and maintaining good relationships gives hope.
• We should maintain a positive attitude towards ourselves and others.
• Accept and give both physical and emotional affection.
• Socialize with friends and family.
• Seek counselling to maintain a positive attitude and talk about your feelings, whether angry, sad, accusatory or hopeful.
• Do not blame others.
• Deal with guilt and shame.
• Purpose and meaning will come as we focus on changing ourselves and giving to others.
• Purpose comes when I understand: who I am (in my physical and spiritual family), to whom I belong as God’s child, what my accomplishments are, and how I will be remembered.

“Positive living with AIDS” is the slogan of TASO (The AIDS Support Organization) in Uganda.21 This includes the following:
• Maintain a positive attitude towards yourself and others.
• Do not blame others.
• Deal with guilt and shame.
• Follow medical advice.
• Seek medical attention quickly when infections such as bronchitis, thrush or skin sores appear. Every time a person with AIDS gets an infection, the body’s resistance to AIDS is further lowered.
• Get enough sleep and do not get overtired.
• Do not smoke or drink alcohol. This reduces the body’s resistance to disease.
• Take enough non-strenuous exercise to keep you fit.
• Continue to work if possible.
• Occupy yourself with non-stressful activities like crafts.
• Accept and give both physical and emotional affection.
• Socialize with friends and family.
• Seek counselling to maintain a positive attitude and talk about your feelings, whether angry, sad, accusatory or hopeful.
• Always use a condom during sex, even if both partners know that they are HIV-positive. This prevents pregnancy and catching other sexually transmitted diseases, which would further lower immunity to disease.

In the Bible hope is an expression of certainty based on God’s promises rather than our wishful thinking. Also, when we place our hope in God it means we are assured that God will finally conquer evil and give us a share in victory.22 The following scriptures can be useful:
• God is our shelter and strength (Ps. 46).
• God is with us in our crisis (Isa. 34:1-5).
• One day we shall see clearly (1 Cor. 13:8-13).
• Death is defeated (1 Cor. 15:51-58).
• No more pain and no more death (Rev. 21:1-4).

NOTES
1 A. Van Wyk, AIDS and Care and Counselling, Cape Town, Maskew Miller, 1999, pp.17-20.
2 “It seems that participatory methodology is one of the most successful counselling methods used to convey the AIDS message to traditional Africans. The counsellor becomes part of the group, sits with them on the ground, and brings the message with the help of visual material, while incorporating the help of group members.” Ibid., p.123.
3 See J. Müller, Comparisons on the Journey: The Art of Pastoral Narrative Conversation, Roodepoort, Logos, 1999; and J. Müller et al., Therapy as Fiction Writing, 2001, for the use of stories in counselling and research.
4 J. Morgan, What Is Narrative Therapy, Adelaide, Dulwich Centre Pubs, 2000, p.5.
5 The cartoons can be found in UNAIDS, Training of Trainers Manual: Home-Based Care for People Living with AIDS, Ghana, 1999; J. Müller, “Therapy as Fiction Writing”, in Ned. Gerf. Teol. Tydskrif, 42, nos 1-2, 2001; J. Müller et al., “Fiction Writing as Metaphor for Research: A Narrative Approach”, in Skrif en kerk, 2001.
6 Y. Sliep, “Little by Little We Make a Bundle: AIDS in Malawi”, in Dulwich Centre Newsletter, no. 3, 1996, pp.3-25, has shown how this technique can be used in community transformation.
7 See Morgan, What Is Narrative Therapy, pp.17-32, for a detailed discussion.
8 See A. Kellhear, “Spiritual and Palliative Care: A Model Needs”, in Palliative Medicine, 14, 2000, pp.149-55; and S. Bate, “Does Religious Healing Work?”, in Grace and Truth, 2, 1992, and 2000, pp.3-21.
9 See P.W. Robinson, Choosing Hope: Curriculum Modules for a Theological and Pastoral Response to the HIV/AIDS Epidemic, Module 3, MAP International, Nairobi, 1996; N. Kiiti et al., AIDS in Your Community, Nairobi, MAP International, 1994, and G. Williams and N. Tamale, The Caring Community: Coping With AIDS in the Urban Uganda, London, ACTIONAID, 1992, on community mobilization. See Facing AIDS: The Challenge, the Churches’ Response, WCC, 1997, pp.77-92, and R. and C Weatherford, Somebody Is Knocking at Your Door: AIDS and the African-American Church, New York, Harwort Pastoral Press, 1999, on mobilizing the church.
10 See J. Freedman and G. Combs, Narrative Therapy, London, Norton, 1996, pp.113-43, for a detailed discussion on the use of questions.
11 D. J. Louw, Illness as Crisis and Challenge: Guidelines for Pastoral Care, Orion, Halfway House, 1994, gives valuable guidelines on the use of scripture and prayer.
12 See Kiiti et al., AIDS, pp.36-39; K. Dortzbach and N. Kiiti, Helpers for a Healing Community, Nairobi, MAP International, 1996, p.23; V. Tampu, AIDS: Heresy or Prophesy? What the Virus Says, New Delhi, TRACI, 1993, and Facing AIDS, pp.27-29, for a discussion on the issues of AIDS as a curse and as God’s punishment.
13 See Facing AIDS, pp.23-25, for a theological discussion of human beings in relation; for acceptance in healing community, see pp.29-30; and for the role of the church as healing community, see pp.77-78. See W. Saayman and J. Kriel, AIDS, The Leprosy of Our Time?, Johannesburg, Orion, 1992, for a theological reflection on stigmatization.
14 Dortzbach and Kiiti, Helpers, p.44.
15 See Kiiti et al., AIDS, pp.84-85, for a discussion on dealing with guilt; and Facing Aids, pp.25-27, for a theological discussion on forgiveness.
16 See Facing AIDS, pp.52-54, for a discussion on the ethical principle of respect of persons.
17 See J. Morgan, “Boxes and Remembering in the Time of AIDS”, in AIDS Bulletin, 2, 2001.
18 Dortzbach and Kiiti, Helpers, p.36.
19 See World Health Organization, AIDS Home Care Handbook, 1993, for examples.
20 See Soul City Workbook 4, Caring for People with HIV and AIDS, 1998, for good examples.
21 J. Hampton, Living Positively with AIDS, TASO Uganda, London, ACTIONAID, 1990, p.2.
22 See Facing AIDS, pp.33-43, for a discussion on a theology of suffering and death, hope and resurrection.

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