AIDS: fear and compassion

Reducing irrational fears. Opening our hearts. Understanding how AIDS is and is not communicated.

Harvey A. Elder, M.D., is professor of medicine, Loma Linda University School of Medicine, Loma Linda, California.

"I'd like to be her friend, but I think she has AIDS in her family."

"No, I'm not going to a church that accepts people with AIDS. What kind of people do you think we are?"

"He has AIDS. He should not hold a church office."

"I don't want to wash his feet. I could get AIDS."

"I don't want to baptize her. I'm afraid of catching AIDS from her."

AIDS. Even the word brings fear to the hearts of brave people. We avoid it. But AIDS is! It is more than just four letters. It is a powerful word. AIDS powerfully affects people. Many of us transfer our fear of AIDS to people who may have, or who we suspect may have, AIDS. In doing this we create the problem: "How, as compassionate people, do we deal with our fears, without abandoning people with AIDS and without abandoning people with high-risk behaviors who may yet get AIDS?"

Information dispels fear. Factual information allows us to separate valid concerns from irrational fears. Let's examine the facts about AIDS, its cause, and methods of transmission. Then we can know when we are at risk and when we are not. With well-gathered information we can respond intelligently to valid concerns while quieting our irrational fears. Acting on factual information makes us able to minister to those affected by HIV without being limited by irrational fears of contracting AIDS ourselves.

How HIV/AIDS functions in the human body

HIV (human immunodeficiency virus) causes AIDS (acquired immune deficiency syndrome). The documentation for this fact is stronger, better established, and more persuasive than the support for any other theory or belief regarding the cause for this disease. A virus "lives" only in a living cell. Outside the cell it is just a collection of inert molecules. A virus acquires "life" only as its molecules bind to a living cell allowing the virus to enter and capture the cell. Once it enters, the virus forces the cell to do its bidding. Most viruses are very "particular," binding only to certain cells. Virus binding depends upon a certain match.

The binding molecules of a virus fit only certain molecular arrangements, similar to a key and lock. The virus "key" molecule fits only certain molecular "locks." Only a critical molecular arrangement on the cell surface matches the virus. A virus must contact the molecular "lock" that fits its molecular "key" so the virus can bind, enter, and grow. This becomes clearer when we look at HIV.

HIV remains lifeless unless it enters one of the cells with a matching molecular lock. When exposed to air, HIV and its surrounding fluid dries and gradually loses its ability to bind to a living cell. 1 It dies!

HIV, being the human variety of immunodeficiency virus, must find a human cell. It cannot live and multiply in cells of other animals or insects. Only humans can acquire and transmit HIV. Animals and insects play no role. HIV does not bind to just any human cell; it binds to cells that have the CD4 marker2 as their molecular lock. If we identify which human cells have CD4 markers and how HIV gets to these cells, we can develop a prevention plan.

Scientists found CD4 markers on only a few human cells.3

1. Certain lymphocytes called "Thelper cells" have CD4 binding sites. These cells inhabit lymph nodes and wander through the blood vessels to tissue and, via lymphatic vessels, meander back to lymph nodes. They are also present in a few body fluids such as pus, semen, vaginal secretions, spinal fluid, and human milk.

2. We have a group of "garbage collector" cells called "macrophages." These large cells wander through the body "eating" and destroying tissue debris, cancer cells, and many kinds of infectious organisms. These cells are also present in blood, pus, and injured tissue.

HIV multiplies rapidly in a Thelper lymphocyte. In this way, in less than 48 hours, thousands of new HIV can be released!4 These released HIV attach to CD4 binding sites of new T-helper lymphocytes and repeat the cycle. With this kind of com-pounded multiplication, within a few weeks of first meeting HIV, the infected human will be producing more than one billion new HIV every day!

The body fluids in which HIV lives and moves (such as the blood and bloody fluids, pus, semen, vaginal secretions, human milk, and cerebral spinal fluid mentioned above) often contain the HIV in T-helper lymphocytes. If these are fluids from recently infected people, they contain large numbers of HIV. Within a few months of infection the person's immune system acquires the ability to partially control the multiplication of HIV. Then HIV multiplication slows, and these fluids come to contain fewer HIV. However, as persistent HIV infection progressively destroys the immune system, patients become symptomatic, and the blood level of HIV rises again. With advanced AIDS, HIV multiplies faster.

HIV does not "take over" all body fluids. Most body fluids other than blood, pus, semen, vaginal secretions, human milk, and cerebral spinal fluid have no HIV or very low levels. Certain body fluids, such as saliva, actually kill HIV.5 We know which fluids contain HIV and which do not.

How HIV is spread

How does HIV spread? To answer this question we need to look at activities that transmit HIV.

1. Certain sexual activities transmit HIV. Sexual intercourse, whether heterosexual or homosexual, transmits microbes from partner to partner. These microorganisms may persist in their host for years. Thus the genitalia of sexually active people can carry the genital microbes of all their sexual partners during the previous five years. These microbes can be HIV, or agents for other sexually transmitted diseases.

The sexual activity that stretches the anus tears the lining mucosa and exposes cells with CD4 markers. This makes anal sex the most efficient way of transmitting HIV. However, all forms of intercourse, regardless of the body orifice used, can transmit HIV.

2. Blood transmits HIV. Blood and blood products from the United States, northern Europe, Australia, and New Zealand are very (but not absolutely) safe.6 Reused needles and syringes for drug use carry blood from previous users; hence, these frequently transmit HIV.

3. About one fourth of the babies of HIV-infected mothers in the United States develop HIV infections. The fetus can be exposed to HIV while developing in the uterus or during delivery. The newborn may also acquire HIV through its mother's milk.

4. HIV crosses diseased or cut skin, and causes infection by attaching to cells in the deepest skin layer. HIV has not been shown to cross normal skin.

Conditions that do not transmit HIV/AIDS 

By 1984 epidemiologists had identified the first three of the above four routes for the spread of HIV/AIDS. During the subsequent 12 years, despite intense research, no additional routes have been discovered. Only rarely has HIV crossed skin broken by disease or trauma and initiated HIV infection.7 Still other methods of transmission may exist, but if they do, they occur very rarely.

These logical arguments have been empirically documented by laboratory and epidemiological studies. For example, people who live with "people with AIDS" (PWA) do not acquire HIV infection unless they are sex partners or share needles and syringes. Family members sharing kitchen, bathrooms, the same dishes and dishwater, even without special disinfection do not get HIV infection. Eating food prepared by PWA does not transmit the virus. The same question goes for washing family laundry with laundry from a PWA. Even sharing the same toothbrush and razor, though this is not recommended regardless of HIV status, has not transmitted HIV. Though kissing on the cheek or lips does not spread HIV, deep kissing can. Mosquitoes and other biting insects do not transmit HIV. 8 (Some authorities believe HIV can be transmitted through insect bites.)

Ministering without fear

Let us return to our first question: "How, as compassionate people, do we deal with our fears? How do we deal with fear without abandoning people with AIDS?

The following facts can dispel most of our fears.

1. Sex with an HIV-infected partner transmits 75 percent of AIDS in the United States and 80 percent of AIDS globally. Sex in the sanctity of marriage between two who are HIV-free and who have been and are committed to lifelong monogamy is absolutely safe.

2. Intervenous injection drug use transmits 23 percent of AIDS in the U.S. and 6 percent of AIDS world wide. We minister best to those with drug habits by encouraging them to enter treatment programs. "Tough love" is the most compassionate ministry for a person still using drugs. Until they are "clean and sober" for more than a month, verbal ministries and acts of compassion only encourage addiction.

3. Blood transmits about 1 percent of AIDS in the U.S. and 6 percent of AIDS globally. While receiving blood has some risk, it is absolutely safe to donate blood in most countries. We who have no risk behaviors may minister in lifesaving ways when we systematically donate blood as often as every two months.

4. Maternal-fetal transmission accounts for 1 percent of U.S. AIDS cases and 8 percent of global AIDS cases. Today this transmission can be decreased by expensive drug therapy for the mother and the newborn.9

Showing care and compassion

How can we show care and com passion to those who are HIV/AIDS positive? By doing the things loving people do. We can bring them to church, sit with them, and invite them to our potluck dinners. And we can eat some of the food they bring! They can serve and be served during the ordinance of humility. Pastors can safely enter the baptismal font with them.10 We need to have people who are affected and those who are infected by HIV as integral parts of our parishes.

We can invite them to our homes. They can use our bathroom facilities. They can safely hold our children if the child does not have an infection. When our hands have no obvious cuts or eczema, we may touch them. We may touch them on the arm or shoulder, in areas where their skin has no obvious cuts or other lesions. We may hug them and kiss them on the cheek.

We and our churches are called by God to be incarnational centers of redemption. When we follow Jesus' charge to "go and make disciples," some of them will be infected with HIV, some with other loathsome diseases. There are no exceptions to our marching orders. The people Christ welcomes into His arms are those who feed the hungry, give drink to the thirsty, take in strangers, clothe the naked, care for the sick with acts of kindness, and visit those in prison. However, these people are precious to God. God's children have many maladies. Some have AIDS and are dying. We have the privilege of loving and caring for them.

God, us, and AIDS victims

We serve those with HIV infection and AIDS because we ourselves know something of brokenness. We know the hopelessness and despair of deserved lostness. We know that God, who showed us mercy, gives mercy to the undeserving. We, just as they, have never deserved God's grace. We must all come and fall before God in adoration and praise. He loved us! He wanted us! He found us! He saved us when we were rebels deserving death! God lavished us with His incomparable love. Dazzled by His incomprehensible mercy, we serve those with HIV infection and AIDS. They, as we were, are broken and suffer. Daily they suffer as we suffered. Gratitude demands that we serve those who are as we were; we can do no less. We are constrained to extravagantly lavish His grace on others without restraint.

In obedience we confront our fears. In obedience we experience God's greatness as He disarms our fears. Caring for those affected by HIV, we meet Christ ministering to their loss and grief. We see Him as the one who never leaves or abandons. Looking back, we realize that His compassion created our caring, His love formed our love. As we share, our gifts are anointed by His Spirit. Taking steps of service, we walk His path. In reaching out to touch, we find His hand guides our fingers. When speaking, His voice speaks tender words through our mouth. He takes our imperfect, conditional, broken love and uses it to heal the suffering of others. As we minister to others, He transforms us into ministers of His peace. In all this we live for the praise of His glory.

1. L. Resnick, K. Veren, Z. Salahuddin, et al. "Stability and Inactivation of HTLV-III/LAV Under Clinical and Laboratory Environments." Journal of American Medical Association 255:1887-1891.

2. J. N. Weber, R. A. Weiss, "HIV Infection: The Cellular Picture." Scientific American 259: 101-109.

3. R. A. Weiss, "How Does HIV Cause AIDS?" Science 260: 1273-1279.

4. J. Conn, "High Turnover of HIV in Blood Revealed by New Studies." Science 267: 179; T. Beardsley, "Fighting All the Time." Scientific American 111: 26. 27.

5. D. H. Coppenhaver, P. Sriyuktasuth-Woo, S. Baron, et al. "Correlation of Nonspecific Antiviral Activity With the Ability to Isolate Infectious HIV-1 From Saliva." New England Journal of'Medicine 330: 1314, 1315.

6. S. S. Roberts. "Blood Safety in the Age of AIDS," FASEB Journal 10: 390-402.

7. Centers for Disease Control and Prevention. "Update: Human Immunodeficiency Virus Infections in Health-Care Workers Exposed to Blood of Infected Patients," Morbidity and Mortality Weekly Reports 36: 285-289.

8. L. Mike, Do Insects Transmit AIDS? Office of Technology Assessment, Congress of the United States. Superintendent of Documents, Sept. 1987.

9. E. M. Connor, R. S. Sperling, R. Gelber, et al. "Reduction of Maternal-Infant Transmission of Human Immunodeficiency Virus Type 1 With Zidovudine Treatment," New England Journal of Medicine 331: 1173-1180.

10. B. C. Moyer, "The Caring Church and HIV; Special Issues of Concern to Pastors," in Compassion in a Time of AIDS: A Resource Manual (Lincoln, Nebr.: Church Resources Distribution Center, 1994), pp. 39-55.

Ministry reserves the right to approve, disapprove, and delete comments at our discretion and will not be able to respond to inquiries about these comments. Please ensure that your words are respectful, courteous, and relevant.

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Harvey A. Elder, M.D., is professor of medicine, Loma Linda University School of Medicine, Loma Linda, California.

July 1996

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