I was speaking to a Chinese doctor who trains Three Self Church members to minister to those affected by AIDS in their villages. He works in central China where unscrupulous and unsanitary blood collection practices in the 1990s left thousands infected with the virus; whole villages now are informally called "AIDS villages." "In the beginning people wouldn't even buy cabbages from these AIDS villages," the doctor explained. "There was so much fear and stigma." The Christians were no different from anyone else, but now that is all changed. It is the believers who care for the dying, show compassion and give good information, he explained. The village people trust them implicitly.
My own experience with Christian AIDS programs has been in Africa, so I was keen to find out how long it had taken for attitudes to change. "Two years," he said, "and now so many are coming to Christ."
In Africa, I have personally watched the Lord mobilize believers for HIV/AIDS ministries of compassion and prevention. I have seen many who have begun to hope again in this life and have received the promise of redemption. This Chinese doctor was also describing the Lord's powerful work, reviving and motivating His people for holistic ministry.
I began to dream of the potential of a vast array of Chinese believers—believers from various backgrounds, classes and cultures, sent by the Lord of the harvest to bring His grace to those suffering from this disease and to those who are yet-to-be infected. It was not long after that we were introduced by the doctor to a man in his fifties who had already lost his wife and child from HIV infection and is himself infected. Now he has turned to Christ and works full time training others for this ministry. He said, "I only wish I had trusted Christ earlier in my life."
Where we are today and why it is not too early
HIV/AIDS is a plague of biblical proportions, and we have just begun to experience its fury in Asia. Of 39 million people infected with HIV in the world, China officially has an estimated one million people with the virus; this amounts to only one-tenth percent of the population of China. However, Asian countries, including China, are now home to some of the fastest growing AIDS epidemics in the world. UNAIDS projects that China may have ten million people infected by 2010 (or one percent of the population). Dr. Eberstadt of Harvard University's Center for Population Studies predicts that five percent of China's people will be infected in 20 years. In the coming decades, we will likely be measuring worldwide AIDS deaths not in the tens of millions but the hundreds of millions with a shift from Africa to Asia.
HIV/AIDS is a disease of broken relationships. The pathway of its entrance into China tells a tale about these relationships. Intravenous drug abuse, especially in Yunnan and Xinjiang provinces, was an early "infection pump." In its wake, many drug users—up to fifty percent or more—are infected with HIV.
Sex for money is big business in Asia, and China is no exception. Many women are infected with the virus, both commercial sex workers as well as wives who stay back home. The HIV which started from China's western borders and minorities has now made its way to the central parts of China. It is now breaking out from the high risk groups to become a more "generalized" epidemic, fueled by multiple heterosexual (and perhaps occasional homosexual) relationships. Since 1979 for instance, sexually transmitted diseases in China have increased by fifteen to twenty percent per year! Seventy percent of young people in Shanghai in 1999 approved of premarital sex. Broken relationships are deadly, both in the physical and spiritual realms. Nevertheless, our good God restores broken relationships. That is why HIV/AIDS work is ministry.
Now is the time to begin to think about what God may be doing in allowing this scourge of AIDS in China. We must not wait until five percent of China is infected. We can act now to diminish the impact of the epidemic and see believers mobilized to go out into the cultures of China with God's healing power and grace. It is not too late, and it certainly is not too early.
What is being done in China?
Since World AIDS Day in 2003, China's government has shifted its official stance about AIDS. Perhaps based in part on experience with SARS, we now can find AIDS posters and school campaigns more visible. Now much central government financing goes to AIDS prevention and treatment efforts. The blood supply has been cleaned up significantly. AIDS patients, at least in some areas, are getting antiretroviral drugs.
In July 2004, China's prime minister announced the official figure of one million people infected and called for international help. One Chinese health information specialist I met told me that this official "turnaround" in attitude towards HIV has reached the provincial level but has hardly touched the stigma and shame found at many county and local levels.
Not long ago, a man infected with HIV was admitted with AIDS to an infectious disease hospital in China. When other patients eventually discovered the cause of the man's problems, most of them fled the hospital. There is so much fear, even among the professionals. The solution? It will be people who have the courage to confront the fear and stigma and show compassion to the infected while speaking truth about sex, relationships and forgiveness. What a calling for God's people!
Dr. Ted Green, a Harvard consultant, has written persuasively about the grass-roots efforts by ordinary people which turned around the HIV epidemic in Uganda in the 1990s. The success factors he identifies in his research include government commitment and a multisectorial response which incorporates emphasis on "primary behavior change," that is, abstinence and faithfulness. In Uganda, everyone got involved, including the church. Experts estimate that the effect of this primary behavior change in Uganda was the equivalent of a "social vaccine" which was eighty percent effective!
Thus, while recent China government efforts on AIDS have been commendable, these efforts by themselves will fall short if "grass-roots" Chinese people are not mobilized to live out healthy lifestyles and give themselves in sacrificial service to others. This is where I believe the Lord is calling His church to be.
Susan Hunter in her book AIDS in Asia says that the HIV/AIDS epidemic has broken the illusion of medicine's control over epidemics. Condoms and antiretroviral medication have their place, but we will not catch the wave in China without preventing new cases. This means we need to do what we can to help mobilize Chinese believers, volunteers, Christian and not-for-profit ministriesand even businesses to become leaders in Christian HIV/AIDS ministries.
One Christian group has taught its Chinese staff to train others in HIV/AIDS prevention. They use participatory methods to change not just "head information" but attitudes. They are getting various invitations from their province and beyond to train both in English and Chinese.
Another Chinese not-for-profit agency has developed its ability to train registered church members in HIV prevention and care. They are now also caring for drug addicts. They have seen the need to balance care and prevention. The words (prevention messages) become more believable when they are fleshed out in practice (care). According to James 1:27, "True religion is to visit orphans and widows."
An international Christian agency has partnered with the official church to produce home-based care manuals for teaching believers the basics about caring physically, emotionally and spirituallyfor those dying with AIDS.
Bible Societies are developing some resource materials for those with HIV/AIDS, including youth-friendly Scripture which addresses the underlying issues of relationships, sex, dating and marriage. Another group is planning to add HIV/AIDS issues to their youth-friendly Chinese website. Still others are in the thinking stages of how to create contextualized local programs in China which deal with the same issuesnot just as lectures but as dramatic presentations and stories.
Some materials such as the "True Love Waits" program have been translated into Mandarin and are available in China. However, over the long term, my experience in Africa would say that the most effective programs will be created by Chinese. This means we must work to disciple, mentor and develop leaders.
While this vision has barely been caught by believers in China, changes in law this year have made it possible for officially registered groups of Christians to serve in the social sector. This is a time of opportunity if the vision can be fanned into flame. China will need counselors to deal with broken family relationships; Bible teachers who develop materials that address marriage, families, youth and children; writers, Christian dramatists and more.
Where to begin
What advice might we gather from lessons believers in Africa are learning? Start with God, not HIV/AIDS. Seek His understanding and make HIV/AIDS a prayer priority. The problems underneath HIV corruption, sexual sin, oppression, injustice and stigmaare "ready-made" for the gospel. Only God is big enough for HIV/AIDS.
Become informed and keep others within your agency informed. Pray for champions for AIDS ministries. Help the leadership of your organization to understand what God is saying to you. The Christian expatriate doctors in China have been talking together about AIDS; a similar network among readers of this publication is also beginning.
Look for ways of building on the strengths of your organization, developing an HIV focus with your current activities rather than starting something entirely new. The solutions are relationship-rich, not technical (as in money, condoms and even medicine). They involve ministry, passion, volunteerism and the hands and feet of Jesus.
Medical people have an important role to play in this disease in China, but eventually you need a multi-disciplinary team. Use creative people like artists and gifted communicators, as well as social workers, counselors, leadership trainers, teachers and theologians. We have found that people with skills in project planning, management and evaluation are invaluable. All of these will encourage Chinese believers to bring a holistic approach to this ministry.
Christians in Africa would say to us, "Don't wait!" Let us make it our prayer that we will be able to hear the voice of the Lord as He strengthens His church, exalts the gospel of grace and reaches out to the suffering and marginalized peoples of China through HIV/AIDS ministries.
Image credit: aids 02 by Shoko Muraguchi via Flickr.
Paul Hudson, M.D., M.P.H. is a physician consultant for HIV/AIDS for China. Based in Thailand, he and his wife have served in medicine and public health in Ethiopia and Nepal. He has helped to develop partnerships for Christian HIV/AIDS ministries in a number of countries in Africa. View Full Bio