AIDS- Ethical and Spiritual perspectives

Dr. Khomdon Singh Lisam *

1. Introduction:
The topic of ethics, spirituality and AIDS assumes immense relevance in the context of Manipur today. It may not be an exaggeration to say that today; we are living in a society full of crimes, extortion, and kidnapping, murder leading to anxiety, tension, and stress. Our society is facing problems like ethnic conflicts, terrorism, corruption, communal hatred, violence etc. It appears to me that the human life and human values has no meaning in Manipur. We are living in a perpetual tension and stress. Therefore, it is pertinent to find ways and means to find a stress-free, violence-free society in Manipur? How can we restore the human values of love, compassion, friendliness, cooperation, and a sense of belonging to each other in Manipur? We need a soul searching to find meaning of life, meaning of love, mutual trust, compassion and tolerance.

I feel that Manipur is facing a spiritual crisis or spiritual emergency. To me, it is the lack of spirituality among the Manipuris that is the root cause of all these problems. . Therefore, the need of the hour is to find how ethics and spirituality take the center stage in Manipuri society.

2. Spiritualism as I knew it:
Spiritualism is one word which puts a human being on the highest pedestal of life. Spiritualism is probably the world's most tolerant religion. Because it does not depend on religious dogmas. Religion and Spirituality are inter-related and intertwined but they are not the same. Every religion has two aspects - theological and spiritualism. Spirituality does not expect you to change your religion or your beliefs. One may continue to practice Christianity, Hinduism, Islam, Buddhism, etc, and still the doors of Spiritualism remain open to you. Spirituality is above religion. The Hindus believed that The Bhagavad-Gita is the storehouse of spiritual knowledge. If you ask me the meaning of Spirituality, I would say that Spirituality is the way you find meaning, hope, comfort and inner peace in your life. Many people find spirituality through religion. Some find it through music, art or a connection with nature. Others find it in their values and principles. To me, when you show qualities like love, joy, peace, patience, compassion, wisdom, and intelligence, you are also showing your spirituality. "A heart reconciled with God and with your neighbor is a spiritual heart"- so goes the saying. What God likes best in each religion is oneness-of heart.

3. Spirituality, Ethics and AIDS: You may ask how Spirituality and ethics are relevant to AIDS. AIDS is real, AIDS is here and AIDS is killing millions of people every year. AIDS has got no cure and no vaccine. Today, AIDS has become no-1 killer of young people in Manipur. Where does the mistake lie? Does it lie with the parents, or the teachers, or the political leaders? Is it the mistake of every one of us? And is it not the responsibility of every one of us to teach the young minds the importance of moral education, the importance of human values like love, compassion, truth, honesty, righteousness and empathy. Spirituality teaches us the core values of life, the real essence of us. Whenever you intend to do something, you ask your inner self -the god within yourself -is it good or bad. You do not need mobile phone or internet to talk to your inner self. The reply would be instantaneous and immediate" much faster than internet. Is gambling good? Is alcohol drinking good? Is drug use good? Is pre-marital sex good? Is extramarital sex good? You will get immediate reply “It is very bad - do not do it ". If you obey your inner self, you will always remain truthful, happy, healthy and wise. You will be free from HIV/AIDS. This is the teachings of spiritualism. Would I be wrong if I say that the older generation has never attempted to instill and inculcate the meaning of spirituality in the minds of our younger generation? Spirituality is not taught in the schools and that is why the young generation should be made to know the superiority of mind over matter. For this spiritualism is the only tonic.

I will share with you one life story of Mema (name changed) 41 years of age and suffering from AIDS for 8 years. Mema was desperate, looking for drugs to hasten her death. I did not know what to do about her. Before going to work, I would visit her and sometimes stayed there without saying a word, I could not even comfort her. After a week, crying she told me: "You know, I had my husband, I have three children, the relationship with my husband was the only relationship which meant something to me. We were living in a world full of meaning. Now he is no more, it is as if everything has lost its meaning. The family and relatives have rejected me. I lost my dignity, my reputation, my status in society - I just want to die, please help me to die now. I will not tell anyone." That was eight years ago. Those days, ART was not available for free. I said to her “You simply have to look up to someone having a sense of life, some counselor, some spiritual teacher and you also will live. I will arrange for one if you agree. “Now she is a counselor in one of the NGO fighting for AIDS in Manipur. Now she has found a new hope, a new lease of life and a new purpose in life. What she needed was a spiritual healing. This is where the role of spirituality and ethics comes in.

But there are thousands of “Memas” today in Manipur in all the districts requiring your love, compassion and understanding. They do not expect miracles to happen. They do not expect you to give cure drugs. But they expect you to treat them just like any other human being with human dignity, human compassion, empathy and understanding - free from stigmatization and discrimination. I may also share with you that frequently, the scenes of Uganda haunted me in my dreams. The scenes of a complete devastation of villages due to AIDS. Now the same situation is approaching in Kamjong and in some parts of the valley districts. Feeling the sense of hopelessness and despair, once I thought of leaving everything and running away. That is how the question came to me: "Who are these people to me?" and "But who am I to them?” What is the meaning of life to me- full of anxiety, tension and hopelessness. I tried to rediscover the meaning of life, purpose of life, the vision and the dream - the dream of achieving a drug free and AIDS free Manipur .

4. Religion and AIDS:
Our religion has taught us for more than 2000 years that pre-marital sex is bad, sexual promiscuity is bad, prostitution is bad, and homosexuality is bad. The religious teachings insist on monogamy, mutual fidelity. We all know the story how Jesus Christ saved one woman from being stoned to death. AIDS is not a disease of the priests and bishops. However, nowadays , even the homosexuals are becoming religious leaders in some parts of the world . Many religious leaders in the communities all over the world are also dying of AIDS. Manipur is also no exception. Religion gives us peace, solace and compassion. Religious organizations are rooted in local community structures and are therefore in an excellent position to mobilize communities to respond to the HIV/AIDS crisis. The words coming from the mouth of religious leaders can incite the community into action. If the religious organizations do not participate in the HIV/AIDS prevention work, it can definitely contribute to stigma, fear, discrimination and misinformation. Buddhism taught us that human suffering arises out of attachment. Suffering ceases when attachment ceases. Freedom from suffering within a human being is possible by practicing the “The Noble Eight Fold Path "- right view, right thought , right speech, right action , right livelihood, right effort , right mindfulness , right concentration. There is no conflict or contradiction between religious teachings and AIDS prevention messages. By following religious teachings, you can protect yourself from HIV/AIDS. If you can not follow, then you have to take up risk reduction strategies to minimize the risk of HIV infection.

Pope Benedict said that HIV and AIDS should be controlled with abstinence only. But is it acceptable to the young people of today's modern world. I will tell you one incidence which happened when The Pope John Paul II visited Sao Paulo few years back. "The young people screamed and sang with the Pope. The Pope John Paul II talked about virginity and remaining chaste to protect themselves from HIV/AIDS. Despite this, the next day the streets were covered by a huge amount of used condoms scattered all over the place. Nowadays, the Catholic religion, who has always strictly forbidden condom use, has recently announced they are considering allowing them in very special circumstances say for example if one of the spouses is infected. One can ask a question here - is it mentioned in the bible - if not who has authorized this. I was just wondering how the word condom was brought up in the matter of religion. The first published use of the word 'condom' was in the year 1706. Condom was a doctor in the time of Charles II, who invented the device to help the king to prevent the birth of more illegitimate children.

Let us not forget that we are living in the 21st century. In olden days, the conscience of an individual was dictated by the king, emperor, or priest. Today the conscience is dictated by the person's individual decision, which is illuminated by principles that might be inspired by religion or by the medical science or by a United Nations document on human rights. That is why I said that there should be inter-marriage between science and religion to make it more acceptable to the masses. Otherwise, religion will try to draw us backward.

Do you believe that AIDS is a sin? If so, what sin the new born babies who are infected with HIV have committed? Therefore, there is a need to integrate the HIV/AIDS prevention messages with the religious messages as a part of the everyday, every week religious services to the community.

5. Challenges of AIDS to Ethics:
Ethics are series of guidelines/norms for a specific group in order to ensure good and correct behavior in respect of their professional /group - Medical Ethics, Nursing Ethics, Legal Ethics, and Social Ethics.

AIDS has posed a formidable challenge to our already tested norms of ethics and standard of our medical profession in particular.

We tend to forget that people with HIV AIDS have also human rights. . Let me emphatically tell you that a patient with HIV/AIDS has:

the right to be informed
the right to have his/her privacy respected
the right to autonomy(self-determination)
the right to give consent,
the right to confidentiality
the right to have access to medical care and nursing care
the right to be protected from unlawful discrimination
the right to die without pain and with dignity

It would be interesting for all of you, if I share with you some of the major International Code of Medical Ethics. For instances;

The international code of medical ethics said: "The health of my patients will be my first consideration" (Geneva - September, 1948.)

The World Medical Association, in its meeting held in Vienna in 1988 resolved that: -

"AIDS patients are entitled to competent medical care with compassion and respect for human dignity. A Physician may not ethically refuse to treat a patient whose condition is within the physician's realm of competence solely because the patient is HIV seropositive."

The declaration of the World Medical Association in Heksinki in 1990 stated that the interest of the society should never count far more than the well being of the subject". The American Medical Association (AMA) and the British Medical Association (BMA)(1986) resolved that:-

“There are no circumstances where treatment and care to an HIV infection person may be refused". Good medical ethics is also good medical practice. Measures protecting individual also protects society. 6. Human Rights and AIDS:
On 10th December, 1948, the Universal Declaration of Human Rights (UDHR) was adopted and proclaimed by the UN General Assembly as a global bill of rights -"a common standard of achievement for all peoples and all nations. These Rights are generally inviolable; inseparable and indivisible.

Now let me come to the International interest in protection of human rights of people with HIV/AIDS:

6.1 International interest in protection of human rights of people with HIV/AIDS:
London Declaration - 28th January, 1988
World Health Assembly Resolution WHA 41.24 of 13th May, 1988
United Nations Commission on Human Rights - 2nd March, 1989
UN International Consultation on "AIDS & Human Rights", - July, 1989
Paris Declaration of 1st December, 1994
51st Session of the Commission on Human Rights Resolution on the Protection of Human Rights in the context of HIV/AIDS - 28th February, 1995.

Several International Organisations have observed that the following measures are”

6.1.1 Consistent with the International Human Rights Standards":-
voluntary HIV testing with strict safeguard for confidentiality/anonymity.
pre/post - voluntary HIV testing counselling
voluntary treatment
voluntary modification of behaviour

6.1.2 The following measures are considered to be "In-consistent with International Human Rights Standards":
compulsory HIV testing
compulsory isolation, quarantine or removal to colonies,
enforced admission to hospitals/hospices,
mandatory collection, storage, process of identifiable personal information,
disclosure of HIV test to third persons without patient's consent
interference with freedom of movement
making entry into country of returning nationals conditional to their taking tests.

6.1.3 The International Labour Organisation (ILO) (WHO/GPA/INF/90. 1st June, 1988) has observed that:-
employment should be protected from discrimination
no pre-employment or employment testing / screening is required
no obligation for an employee to inform employer about his/her HIV/AIDS status
HIV infection is not a reason for termination or dismissal from service.

6.1.4 The International Bar Association has declared on 2nd October, 1989 that:-
effective legal measures should be brought forward to ensure equal access to employment for persons with HIV discrimination against HIV positive persons in housing, employment, public accommodation, granting of credit, delivery of services should be prohibited.

HIV testing as a condition of employment should be prohibited.

The legal environment should ensure appropriate ethical and juridical principles such as autonomy, respect for confidentiality, privacy, individual human rights, and right to health, non-discrimination, and equality before law. In the final analysis, the judicial function remains: - of protecting the vulnerable and defending their human dignity. We have to instill hope, comfort and inner peace in the life of the people with HIV/AIDS. We have to provide compassionate care, overcome discrimination and stigmatization, respect privacy, human dignity and confidentiality of people with HIV/AIDS. In other words, we have to consider the ethical and spiritual aspects of AIDS for better implementation of the AIDS Control programme.

If we join our hands together irrespective of caste or creed and move forward in a war footing like a people's mass movement, we are confident that we will be able to achieve a drug free and AIDS free society in Manipur in the near future. But the time for action is today. As tomorrow may be too late.

For this let me code the words of Mother Teresa. She said:
LIFE IS AN OPPORTUNITY; BENEFIT FROM IT
LIFE IS BEAUTY; ADMIRE IT
LIFE IS BLISS; TASTE IT
LIFE IS A DREAM; REALISE IT
LIFE IS A DUTY; COMPLETE IT
LIFE IS COSTLY; CARE FOR IT
LIFE IS WEALTH; KEEP IT
LIFE IS LOVE; ENJOY IT
LIFE IS A MYSTERY; KNOW IT
LIFE IS A PROMISE; FULFILL IT
LIFE IS SORROW; OVERCOME IT
LIFE IS A SONG; SING IT
LIFE IS A STRUGGLE; ACCEPT IT
LIFE IS A TRAGEDY; CONFRONT IT
LIFE IS AN ADVENTURE; DARE IT
LIFE IS LUCK; MAKE IT
LIFE IS TOO PRECIOUS; DO NOT DESTROY IT
LIFE IS LIFE FIGHT FOR IT