A Covenant to Care: Recognizing and Responding to the Many Faces of HIV/AIDS in the USA

United Methodists have been in ministry since the beginning of the HIV/AIDS pandemic. They have followed the way of healing, ministry, hospitality, and service shown by Jesus Christ. According to the Gospel of Luke (4:16-21), Jesus identified himself and his task with that of the servant Lord, the one who was sent to bring good tidings to the afflicted, hope to the brokenhearted, liberty to the captives, and comfort to all who mourn, giving them the oil of gladness and the mantle of praise instead of a faint spirit (Isaiah 61:1-3). God’s Word calls us to a ministry of healing, a ministry that understands healing not only in physiological terms but also as wholeness of spiritual, mental, physical, and social being.

The Context of Caring Ministry in the United States

In recent years, AIDS in the United States has received less media attention, but that does not mean the disease has gone away. Though medical drugs can prolong the life of people who have been infected, there is no cure for AIDS. Not only must our commitment to ministry continue, but it must also expand, particularly in the area of prevention education.

HIV/AIDS affects and infects a broad cross-section of people in the United States and Puerto Rico: all ages, all races, both sexes, all sexual orientations. The cumulative number of AIDS cases reported to Centers for Disease Control (CDC) through December 2008 is 1,106,391. Adult and adolescent AIDS cases total 851,974 among males and 211,804 among females.[1]

In the early 1980s, most people with AIDS were gay white men. Overall incidences of new cases of AIDS increased rapidly through the 1980s, peaked in the early 1990s, and then declined. However, new cases of AIDS among African Americans increased. By 1996, more cases of AIDS were reported among African Americans than any other racial/ethnic population. The number of people diagnosed with AIDS has also increased, with American Indians and Alaska Natives in 2005 ranking 3rd after African Americans and Hispanics.2 In 2005, the rate of adult/adolescent AIDS cases per 100,000 population was 71.3 among African Americans, 27.8 among Hispanics, 10.4 among Native Americans/Alaska Natives, 8.8 among whites, and 7.4 among Asians/Pacific Islanders.[2] Though national surveillance data does not record the hearing status of people with HIV/AIDS, the Department of Health and Human Services believes that deaf and hard-of-hearing people have been disproportionately infected with HIV.[3]

As of December 2006, according to CDC estimates, more than one million people in the United States were infected with HIV. One-quarter of these were unaware of their status! Approximately 56,300 new HIV infections occur each year: about 75 percent men and 25 percent women. Of these newly infected people, almost half are African Americans, 30 percent are white, 17 percent are Hispanic. A small percentage of men and women are part of other racial/ethnic groups.[4] No longer is HIV a disease of white gay men or of the east and west coast; it has not been for more than a decade. In 2007, 40 percent of persons with AIDS were living in the South, 29 percent in the Northeast, 20 percent in the West, 11 percent in the Midwest, and 3 percent in the US territories.[5]

United Methodist churches, districts, and conferences can help to stop the spread of HIV/AIDS by providing sound, comprehensive, age-appropriate and culturally sensitive preventive education, including information that abstinence from both sex and injection drug use is the safest way to prevent HIV/AIDS. In addition, the church can provide grounding in Christian values, something that cannot be done in public schools or in governmental publications on HIV/AIDS.

Youth and Young Adults: AIDS is increasingly affecting and infecting our next generation of leaders, particularly among racial and ethnic minorities. In 2007, African American blacks and Latinos/Hispanics accounted for 87 percent of all new HIV infections among 13- to 19-year-olds and 79 percent of HIV infections among 20- to 24-year-olds in the United States, even though together they represent only about 32 percent of people in these ages.[6]

Racial and Ethnic Minorities: African Americans, Hispanics and Native Americans have been disproportionately infected with HIV/AIDS. Representing only an estimated 12 percent of the total US population, African Americans make up almost half, 45 percent, of all AIDS cases reported in the country. While there were fewer new HIV infections among black women than black men in 2006, CDC’s new analysis finds that black women are far more affected by HIV than women of other races.[7]

It is critical to prevent patterns of risky behaviors that may lead to HIV infection before they start. Clear communications between parents and their children about sex, drugs, and AIDS is an important step. Church, school, and community-based prevention education is another step. Youth and young adults must be actively involved in this process, including peer education.

The large and growing Hispanic population in the United States is also heavily affected by HIV/AIDS. Although Hispanics accounted for 14.4 percent of the United States population in 2005, they accounted for 18.9 percent of persons who received an AIDS diagnosis.[8]

Women: AIDS among women has been mostly “an invisible epidemic” even though women have been affected and infected since the beginning. Women of color are especially impacted by the dis- ease. The majority of female adults and adolescents living with an HIV diagnosis in 2008 were infected with the virus through heterosexual contact (73 percent). An estimated 15 percent of diagnosed HIV infections in 2009 among females were attributed to injection drug use.[9] Of the total number of new HIV infections in US women in 2009, 57 percent occurred in blacks, 21 percent were in whites, and 16 percent were in Hispanic/Latinas.[10] Reducing the toll of the epidemic among women will require efforts to combat substance abuse and reduce HIV risk behaviors.[10]

People who are Deaf, Late-Deafened, and Hard of Hearing: In the United States, studies on the deaf or hard of hearing are limited and it is unclear how many people in this sub-population are living with HIV/AIDS. Estimates fall into a wide range of 8,000 to 40,000 people.[11] The National Center for Health Statistics reports that adults with hearing loss have poorer health and increased risk of engaging in health risk behaviors than adults with good hearing. The rate of substance use disorder among deaf or hard of hearing is higher than among the general population. Substance use, in turn, is linked to higher risk for HIV infections.11 Undergraduate deaf college students scored significantly lower on the HIV/AIDS Knowledge Index than hearing undergraduate students. This lack of knowledge about HIV disease contributes to the fact that the deaf are often not diagnosed with HIV until symptomatic and die sooner than hearing individuals.11 Many people erroneously assume that American Sign Language (ASL) users have high English proficiency, but the truth is that ASL has its own grammar and syntax and communicates in concepts. As a result, HIV prevention and treatment materials are often culturally inappropriate and linguistically incomprehensible for the deaf and hard of hearing.11 Developing communication methods appropriate for the deaf or hard of hearing may help reduce health risk behaviors in this population and ensure equal access to health services. These methods may include peer to peer communication, as research suggests that the deaf are more likely to learn from each other rather than from formal information sources.11

Older Adults: The number of persons 50 years and older living with HIV/AIDS has been increasing in recent years.12 In 2005, persons aged 50 and older accounted for 24 percent of persons living with HIV/AIDs (increased from 17 percent in 2001). Some older persons may be less knowledgeable about HIV/AIDS and there- fore less likely to protect themselves.[12] Reaching this group of people with HIV prevention messages means exploring avenues such as church, widows’ support groups at senior centers, and Golden Age Clubs at community centers and churches.

Drug-Associated HIV Transmission: Since the epidemic began, injection drug use (IDU) has directly and indirectly accounted for more than one-third (36 percent) of AIDS cases in the US. Racial and ethnic minorities in the US are most heavily affected by IDU-associated AIDS. In 2000, IDU-associated AIDS accounted for 26 percent of all cases among African Americans and 31 per- cent among Hispanic adults and adolescents, compared with 19 percent of all cases among white adults/adolescents. Noninjec- tion drugs such as cocaine also contribute to the spread of the epidemic when users trade sex for drugs or money, or when they engage in risky sexual behavior that they might not engage in when sober.[13]

HIV prevention and treatment, substance abuse prevention, and sexually transmitted disease treatment and prevention services must be better integrated to take advantage of the multiple opportunities for intervention-first, to help uninfected people stay that way; second, to help infected people stay healthy; and third, to help infected individuals initiate and sustain behaviors that will keep themselves safe and prevent transmission to others.13 Efforts such as needle exchange programs need to be implemented and/ or expanded in order for the spread of HIV to be reduced.

The Challenge for Ministry

Across the United States, in churches large and small, pastors and laity have asked, “What can my church do?” Churches can build on areas which are already doing well; they can covenant to care. Churches and other United Methodist organizations need to continue or begin compassionate ministry with persons living with HIV/AIDS and their loved ones. In terms of prevention education, United Methodists have an opportunity to teach not only the facts about HIV transmission and how to prevent infection but to relate these facts to Christian values. Congregations can do HIV/AIDS prevention education in broader contexts, such as human sexuality and holistic health, as well as addressing societal problems, such as racism, sexism, addiction, and poverty. We call on United Methodists to respond:

1. Churches should be places of openness and caring for persons with AIDS and their loved ones. We ask congregations to work to overcome attitudinal and behavioral barriers in church and community that create stigma and discrimination of persons with AIDS and their loved ones. Congregations can offer Christian hospitality and become arks of refuge to all. We must remember that:
   • the face that AIDS wears is always the face of a person created and loved by God;
   • the face that AIDS wears is always the face of a person who is someone’s mother or father, husband or wife, son or daughter, brother or sister, loved one or best friend;
   • the face that AIDS wears is always the face of a person who is the most important person in someone else’s life.
2. Each congregation and annual conference, through their church and society committees, should mobilize persons for legislative advocacy at the local, state, and national levels to support for HIV/AIDS initiatives in the United States. These advocacy efforts will be strengthened through partnerships with organizations/coalitions who are currently involved in this issue.
3. Educational efforts about AIDS should use reliable medical and scientific information about the disease, transmission, and prevention. Spiritual resources must also be included to enable people to address issues related to discipleship, ministry, human sexuality, health and wholeness, and death and dying. Education helps to prepare congregations to respond appropriately when they learn that a member has been infected by the HIV virus or diagnosed with AIDS. It can lead to the development of sound policies, educational materials and procedures related to the church school, nurseries, and other issues of institutional participation. Prevention education can save lives.
4. Each congregation should discern the appropriate response for its context. Ministries should be developed, whenever possible, in consultation and collaboration with local departments of public health and with other United Methodist, ecumenical, interfaith, and community-based groups concerned about the HIV/AIDS pandemic. Congregations can organize to provide spiritual, emotional, physical and/or financial support to those in their community who are caring at home or elsewhere for a person who has AIDS. Projects might include observing events such as World AIDS Day (December 1) and the Black Church Week of Prayer for the Healing of AIDS (first week in March), sponsoring support groups for people with AIDS and their loved ones, developing strong general church programs for children and youth that also include AIDS education, pastoral counseling, recruiting volunteers, and offering meeting space for community-based organizations, including groups trying to overcome substance abuse and sexual addiction.
5. The United Methodist Church has a congregational HIV/ AIDS ministry called the Covenant to Care Program, whose basic principle is “If you have HIV/AIDS or are the loved one of a person who has HIV/AIDS, you are welcome here.” We commend those who have been in ministry through this program and recommend “Covenant to Care” to all United Methodist organizations. More information is available on the General Board of Global Minis-tries’ website at http://gbgm-umc.org/health/aids/.[14]

[1.] Centers for Disease Control and Prevention (CDC). HIV/AIDS Surveillance Report 2008. http://www.cdc.gov/hiv/surveillance/resources/reports/2008 report/
[2.] National Institute of Allergy and Infectious Diseases (NIAID), Fact Sheet: HIV Statistics (December 2005). (31 January 2006)
[3.] Department of Health and Human Services (HRSA) “Programs: The Deaf and Hard of Hearing and HIV/AIDS.” http://hab.hrsa.gov/programs/fact sheets/deaffact.htm (4 March 2003)
[4.] National Institute of Allergy and Infectious Diseases (NIAID), Fact Sheet: HIV Statistics (December 2002). (31 January 2003)
[5.] Centers for Disease Control and Prevention, “US HIV and AIDS Cases Re- ported through December 2007 Year-end Report.”
[6.] Advocates for Youth.
[7.] Centers for Disease Control and Prevention, “HIV/AIDS among African Americans.” 2006. http://www.cdc.gov/hiv/topics/aa/
[8.] Centers for Disease Control and Prevention, “HIV/AIDS among Hispanics in the United States.” 2006.
[9.] Avert (Averting HIV and AIDS).
[10.] Centers for Disease Control and Prevention, “HIV/AIDS among US Women.” 2009. http://www.cdc.gov/women/pubs/std.htm
[11.] US Department of Health and Human Services, HIV/AIDs Bureau 2008 http://hab.hrsa.gov/abouthabpopulations/deafhardofhearingfacts.pdf
[12.] Centers for Disease Control and Prevention, CDC HIV/Surveillance Report, 2005 http://cdc.gov/hiv/topics/over50/resources/factsheets/over50.htm
[13.] Centers for Disease Control and Prevention, “Drug-Associated HIV Trans- mission Continues in the United States,” 2002.
[14.] For more information about the Covenant to Care Program or the Church and HIV/AIDS Ministries, contact UMCOR, General Board of Global Ministries, Room 1500, 475 Riverside Dr., New York, NY 10115; Voice Phone: 212 870 3871; Fax: 212 870 3624; TDD: 212 870 3709. http://www.gbgm-umc.org/health/aids/.

ADOPTED 2004
READOPTED 2008 AMENDED AND READOPTED 2012
RESOLUTION #3241, 2008, 2012 BOOK OF RESOLUTIONS
RESOLUTION #152, 2004 BOOK OF RESOLUTIONS
RESOLUTION #141, 2000 BOOK OF RESOLUTIONS

See Social Principles, ¶ 162U.

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