HIV pastoral response seminar London 24th May McMa

Spirituality & Stigmatization: A Pastoral Response to people living with HIVHIV Pastoral Care Seminar, 24th May 2007: 

Spirituality & Stigmatization: A Pastoral Response to people living with HIV HIV Pastoral Care Seminar, 24th May 2007 jim.mcmanus@bdpct.nhs.uk Jim McManus, CPsychol,MFPH,MEPS,DipPsych Assistant Director, Health Improvement

Methodology: 

Methodology See –the situation Judge – salient issues Act – principles for pastoral response Theological reflection using case study and Lectio if time

The Reality of HIV in London: 

The Reality of HIV in London HIV infection has increased by 100% in the last five years Complex, chronic infection Significant complications from infection Unpredictability of course of infection Significant health challenges from medication especially antivirals Significant stigma experienced by communities Recent criminalisation of “reckless” or deliberate transmission including in married couples (and several convictions)

Slide4: 

25 Years of HIV London is historically the epicentre of the UK Epidemic

Policy Context : 

Policy Context In England, ‘The National Strategy for Sexual Health and HIV’, published in 2001, opened the discussion to further improve sexual health services and prevention. The English Public Health White Paper ‘Choosing Health’ (December 2004) highlighted sexual health as one of the six key areas for health service development. Previous policy initiatives 1990, 1994, 1998

Some Key Issues: 

Some Key Issues The unique clinical features as well as the stigma and discrimination that surrounded the early HIV epidemic led to the establishment of stand alone services where patients were managed by specialists. However, the escalation in the number of individuals seen for HIV care, together with increases in complex patient management, has put pressure on existing HIV services. These pressures have been felt not Between 2004 and 2005,the increase in individuals seen for care outside London was almost double that of the capital (17% versus 9%).

HIV and AIDS diagnoses and deaths, UK: 

HIV and AIDS diagnoses and deaths, UK Numbers will rise, for recent years, as further reports are received. Clinician reports of new HIV/AIDS diagnosis Large population of people living with HIV

HIV diagnoses by exposure category, UK: 

HIV diagnoses by exposure category, UK Numbers will rise, for recent years, as further reports are received. Clinician reports of new HIV/AIDS diagnosis

Late diagnosis of HIV infection: 

Late diagnosis of HIV infection Reports of HIV/AIDS diagnosis and CD4 Surveillance n=2356 n=156 n=2571 n=1478 n=7450

Number of individuals accessing HIV care, UK: 

Number of individuals accessing HIV care, UK Census of individuals accessing HIV-related care

Rates of adults accessing HIV care by residence: 

Rates of adults accessing HIV care by residence 1996 2005 Census of individuals accessing HIV-related care

Greatest Infection Rates: 

Greatest Infection Rates In 2005 there were 2356 new diagnoses in MSM and 19 863 accessing HIV related care; the greatest numbers recorded since the start of the epidemic. MSM remain the behavioural group at greatest risk of acquiring HIV within the UK. Among those attending sentinel GUM clinics in 2005, the annual HIV incidence was estimated to be 3.1% and the prevalence of previously undiagnosed HIV infections in those aged under 25, an indicator of relatively recent transmission, was 1.5% for London and 1.3% outside London.

HIV diagnoses and individuals accessing HIV care: 

HIV diagnoses and individuals accessing HIV care 1Numbers will rise for recent years, as further reports are received. Reports of new HIV/AIDS diagnoses and census of individuals accessing HIV-related care

HIV-infected individuals resident outside the SHA which provides their HIV care: 

HIV-infected individuals resident outside the SHA which provides their HIV care Census of individuals accessing HIV-related care

Ethnic group of individuals accessing HIV care by SHA: 2005: 

Ethnic group of individuals accessing HIV care by SHA: 2005 Census of individuals accessing HIV-related care

Exposure category of individuals accessing HIV care by SHA: 2005: 

Exposure category of individuals accessing HIV care by SHA: 2005 Census of individuals accessing HIV-related care

Prevalence of previously undiagnosed HIV infection – inside/outside London: 

Prevalence of previously undiagnosed HIV infection – inside/outside London Unlinked anonymous testing of GUM clinic attendees

Overview: 

Overview Most common cause of death in people with HIV worldwide HIV infection increases the likelihood that new infection with M. tuberculosis (due to immune suppression) will progress rapidly to TB disease HIV is the most potent factor known to increase risk of progression from M. tuberculosis infection to disease Co-infection is a major issue in London Treatment measured in months Tuberculosis: HIV-TB interaction and co-infection

Special Issues: 

Special Issues Women and Children African Communities Drug Using Populations Gay and Bisexual Men / MSM Co-infections Psychological and Neurological Morbidity Organic Damage and dementia Toxoplasma and other Opportunistic Infections “Silence” “syndrome” Psychological impact Disability Discrimination Act

Stigma: 

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

Stigma: 

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

Visibility of Stigma : 

Visibility of Stigma 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

Stigma: 

Stigma Has different forms in different parts of London Will require differing responses CASE STUDY Recently diagnosed person

A simplified psychosocial model for stigmaProtective and vulnerability factors: 

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

Acting on These: 

Acting on These 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) 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

HIV-positive London residents seeking treatment and care in 2005, by Sector and Primary Care Trust of residence per 10,000 adult population (Source: Survey of Prevalent HIV Infection Diagnosed): 

HIV-positive London residents seeking treatment and care in 2005, by Sector and Primary Care Trust of residence per 10,000 adult population (Source: Survey of Prevalent HIV Infection Diagnosed)

HIV new diagnoses by hospital of diagnosis by Sector, Primary Care Trust and diagnosing hospital: 2000 to 2005Source: HIV new diagnoses: 

HIV new diagnoses by hospital of diagnosis by Sector, Primary Care Trust and diagnosing hospital: 2000 to 2005 Source: HIV new diagnoses

A Theological Analysis to Stigma - Summary: 

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

Motifs in Pastoral Care responding to Stigma: 

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

Two key questions: 

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?

A Catholic Theology of HIV 1: 

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

A Catholic Theology of HIV 2: 

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

Some Theological Conclusions: 

Some Theological Conclusions 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

Pastoral Response: 

Pastoral Response 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 Psychological Social Spiritual Secular and Christian Agenda

Some Starting Points for Parish and Area Level: 

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