God of the Dying

Why the AIDS epidemic is a wake-up call for missionaries

In Africa, 5500 AIDS-related funerals happen every day. Whole communities are left with only the very young and the very old. We call it a medical crisis. But is it? Dr. Dan Fountain describes the AIDS pandemic in different terms. A globally known authority on whole-person care, Fountain served for 35 years as a medical missionary in the Congo, where he lost coworkers and friends to AIDS. Today, Dr. Fountain is the director of Global Health Care master’s degree program, the only program of its kind that teaches health care from a Christian perspective. In the following, he describes the critical role of the Gospel in addressing this epidemic.

When did you first encounter HIV/AIDS?
In 1982. My wife and I were serving as medical missionaries in the western part of the Congo at Vanga, an evangelical hospital. The first person with AIDS we cared for was Gus, one of our own staff members. He was the supervisor of several of our health clinics. He came to the hospital in September of 1982, suffering from some rather bizarre infections. We had no idea what he had. We treated him for almost a year until he died. And it was at that time--in the summer of 1983--that we found organisms in the secretions from his lungs. That was the confirmation that he had died from this new disease that had not even been named, but what we soon learned to be the Acquired Immune Deficiency Syndrome (AIDS). In retrospect, we realized we had probably cared for more people with AIDS in the preceding months. Since that time, we have seen well over 1,000 people and cared for them as best we could.

What would we, as Americans, be surprised to know about HIV/AIDS?
There are many things. One thing is that there is a strong misconception (which many Americans still have) that AIDS is a disease of those taking intravenous drugs or involved in the homosexual lifestyle. Now it is true that those two groups are especially at risk for getting the infection, but HIV can infect anybody. I have been exposed to HIV, because I’ve done thousands of surgeries on people in Africa, and I’m sure many of them had the virus. HIV can affect any of us.

The second thing is, although there is no cure of AIDS or any yet on the horizon, there is healing for the heart, mind, soul, and spirit for persons with AIDS. And, of course, the one who heals heart, mind, and spirit is the Lord Jesus Himself. By bringing the message of Christ to people with HIV in the Congo, we saw some remarkable things happen. Not only did they receive eternal life and hope and purpose for life, but often, because of their new-found hope in Christ, their immune systems would recover strength. They would go into remission, and many of them lived even for years without any special treatment for the disease.

The third thing is that there are many different strains of the HIV virus. Each of these strains is a bit different; therefore, this makes the production of a vaccine extremely difficult. New strains are developing all the time. This is because when a person gets re-infected with another strain, the original strain that he had, plus the new that he gets, can combine and produce a third strain, which may be even more powerful than the ones he already has. This is happening all over the world. So the situation is actually growing worse in terms of spread and in terms of developing treatments for HIV and a vaccine to prevent it.

Another thing that may surprise Americans is that the age group with the highest rate of infections in the United States is retirees. People in their 60s and 70s who, because of loneliness, are engaging in behaviors that are putting them at risk for the infection, and getting it.

How prevalent is HIV/AIDS in the world? Where is it most pervasive?
When we stop to think that 20 years ago the disease was unknown, and that now one percent of the world’s total population has been affected by the disease, that’s a very frightening picture. Of the 60 million affected, about 20 million have died; 40 million are still living, but the numbers are still going up even in the United States.

Prevalence varies from one part of the world to another. The highest percentages of those affected by HIV/AIDS are in sub-Saharan Africa, and particularly in the southern part of the African continent, where rates can be as high as 30 percent of adults being infected. What is a particular concern to Christians is that where there seems to be the greatest growth of the Christian church is also where AIDS has been spreading most remarkably. That raises some very difficult questions for Christians, in general, and for missionaries, in particular.

Prevalence is also increasing in India and China, but those countries seem to be 10 to 15 years behind Africa in terms of spread. Nobody really knows the exact situation there because data is insufficient, but many are fearful of major problems in those and other countries in Asia.

And are there any places where HIV/AIDS has been successfully contained?
I think the best example is the country of Uganda. We cannot say the spread has been contained in Uganda; however, infection rates have dropped remarkably. The main reason for that seems to be because Christians have been very active in disseminating the message of how God wants us to live. There are some recent studies that show that the average age at which young people in Uganda begin sexual activity has risen from 15 to age 17. Also, the number of sexual partners of people in Uganda has dropped remarkably. Initially people concluded that the decreasing rates of infection among Ugandans was due to the distribution of condoms. But the data does not confirm this, because distributing condoms will not cause the age of initial sexual activity to increase. If anything, it would cause it to decrease. Nor would disseminating condoms decrease the number of sexual partners. So it seems clear that the message that Christians have been sharing throughout Uganda is having an effect.

You are saying that in Uganda, the spread of HIV/AIDS is lessening because people are heeding the church’s teaching about how God wants us to live. And yet, at the same time, you also say that it is in “Christian” [or evangelized] countries of Africa that HIV/AIDS is spreading most quickly. How do you make sense of that? Have you drawn any conclusions?
Not only the AIDS epidemic, but violence and genocide have been occurring in countries that have been “Christianized.” The problem, as I see it, is that we have been very active in offering Christ and getting people to make an initial commitment to Him, but we have neglected making disciples. In other words, there have been mass conversions but not nearly so many real transformations. We have taught a superficial Gospel. We have not preached the Gospel in such a way that it reaches the deeper level of people’s thinking or behavior. We have preached forgiveness of sin, which, of course, is biblical, but we have failed to preach the law of God. In other words, we have led people to Calvary without having taken them by Mt. Sinai. So for many, the Christian faith becomes simply a veneer on top of their traditional beliefs and behavior patterns. That has left them vulnerable to the problems of HIV and many other things.
But in Uganda, many Christian leaders who had been transformed by the Gospel banded together and began doing something, and the message got out rather quickly that HIV/AIDS is a spiritual problem—a disease of relationships.

So the HIV/AIDS pandemic is really a wake-up call. As Christians and as missionaries, we need to know that when we proclaim the Gospel of Christ and people respond to it, we have only begun the work of training disciples.

What are the obstacles facing AIDS prevention and cure?
I think one of the biggest obstacles is that people believe HIV/AIDS is simply a medical crisis without realizing its deeper roots. As I said, AIDS is also a spiritual problem and a relationship problem.

When I say it’s a spiritual problem I mean that we have forgotten - or never knew - who we are as persons, that God created us and put His image in us. We have forgotten - or never knew - that we are responsible to God for how we live and for how we use our physical bodies, that what He has taught in His word is fundamental to healthy living as well as to eternal life.

And I say that AIDS a relationship problem, because we have forgotten what it means to love our neighbor, and that we are responsible to God for that. We have become involved in relationships that are superficial and that are primarily oriented toward our own pleasure.
So, the real obstacles are in the spiritual and social arenas. And if we can help people understand that, it will go a long way to create the kind of changes that are necessary - not only to address the AIDS problem - but for many other critical world issues as well.

Now, let me quickly remind us that AIDS/HIV is not a sin. AIDS is a disease. And it can affect anyone. Thirty percent of the women in Africa who become infected with AIDS have never had more than one partner.

You teach health professionals how to provide health care from a Christian perspective. Specifically, what are the differences in the way a Christian health care worker responds to someone dying with AIDS as compared to a health care worker who does not have those foundational beliefs in Christ?
Maybe the best way to answer your question is to tell about Nelly, one of my wife’s dearest friends in the Congo. Nelly was the wife of the principal of our high school. In 1982, this couple’s one-year-old baby became ill with numerous infections and died. The next year, their three-year-old began developing infections that did not respond to treatments, and the three-year-old died. That same year, Nelly’s husband began coming to the hospital with rather strange infections, and we treated him. Finally in 1985, for the first time, we were able to get the kits for testing for HIV. When we tested Nelly and her husband, they were both positive. Their three older children tested negative.

In the summer of 1985, Nelly’s husband died. Nelly herself became quite ill. On top of that, of course, she was carrying an enormous burden of grief and anger. She had lost her husband and two of her youngest children, and she no longer had any support for herself or her family. Her health declined very rapidly.

But many of the Christian young women at Vanga reached out to Nelly with food, pots and pans, clothes. As they brought her these things that she so needed and had lost, they shared the Good News of Jesus with Nelly. And she opened her heart to the Lord. It was quite remarkable to see how her health recovered. She became strong again and became good friends with Miriam, my wife.

She told Miriam, “I know what I have. I know what the prognosis is, but I want to live long enough to make sure that my living children finish their schooling and are well-grounded in the Christian faith. And I want to help spread the message to others in the high school who have AIDS that there is hope.”

This was at the end of 1985. Ten years later, in the spring of 1995, Nelly said, “Miriam, I’m tired and I’m ready to go home. My children know the Lord. They are firmly grounded in the faith, and they have finished their schooling.” And in May of 1995, she did go home to be with the Lord. Now, we had no antiretrovirals. Nelly lived an extra 10 years simply because of what the Lord had done in her heart and the strength He gave her on a daily basis. So you see, the most important remedy that we have for people with HIV/AIDS is hope. And there is always hope; there is hope through faith in Jesus Christ. And in many instances we have seen that hope translate into remission; people returned to health for months or even years.

So, we have immense resources through Jesus to bring to persons with HIV/AIDS which, when combined with the advances that medical science provides, can make an enormous difference.

As a Christian community, what should we be doing to address this crisis?
Again, we need to recognize that AIDS is not a sin. Nelly was a faithful woman, and she died of AIDS. We need to realize that people living with AIDS--however they have contracted it--are people for whom Christ died to redeem.

We also should realize that people living with AIDS are the largest unreached people group in the world. There are 40 million of them, and some of them are on our own doorstep. So we must rid ourselves of misconceptions, prejudices, and condemnation, and realize that Jesus loves those with HIV/AIDS as He loves us. Their only real hope lies in Jesus. And so we have immense responsibilities to take the message of Christ to these people. We all need to work together.

Dan Fountain, M.D., MPH served as a medical missionary for 35 years in the D.R. Congo as a surgeon, educator, and community health leader. Having pioneered an approach to whole-person care in the Congo, he served from 1996-2001 as a consultant to Southwestern Medical Clinic in Michigan, where he adapted the whole-person care model to a U.S. health care setting. He has served as an associate of MAP International and is presently an assistant professor at King College and director of the Global Health Care master’s degree program. He is known globally for his work in church-related health ministries and has authored numerous books in English and French on community health, primary health care, and care for the whole person.