Modern Western medicine, like other scientific disciplines, has been slowly experiencing a paradigm shift for sometime now. Perception of health and healing, centred on the individual, is gradually giving way to a communitarian and holistic perspective. The result of this change of model and perspective affects not only the practice of medicine, but our very understanding of the relationship between fundamental matters such as life and death, sickness and healing, individual and community, part and whole and so on.

A similar phenomenon is occurring in areas like theology, economics and in various social and life sciences. For instance, much of Western theology which laboured for the last 450 years or so, under the banner of individual’s faith and individual’s salvation, is now critically reviewing its conceptual models. All contextual and liberation theologies that emerged in the last decades of the 20th century have discovered a clear community-dimension as their starting point. Individual’s suffering and need for liberation, whether in Feminist theology or Dalit theology, are woven into the most intimate experience of a community that has been the victim of patriarchal or caste oppression for thousands of years. It is impossible to liberate (save) one individual in such a community without touching the profound pillars of that community’s cumulative experience over the centuries.

Ecological awareness and insights have brought to light the vital connections that exist between all forms of life and between environment and life. The web of life is a known reality that permeates all the micro and macro dimensions of life on earth. In the post Newtonian physics, particles have no individual existence or meaning apart from the ever-dynamic energy states of the whole.

It is in this context of the vital network in creation that we need to look at the HIV/AIDS epidemic. Virus and bacteria are living organisms, whether harmful to human beings or not. They exist in the life’s total network, whether known, not yet known or unknown to us. When we speak about Human Immunodeficiency Virus (HIV) we think of the virus as harmful to human life. But it is created by God and may have a beneficial function in some other part of God’s creation like other innumerable benign bacteria. Hence the question, why does God create such a virus, may be irrelevant even in the context of suffering’ caused by HIV/AIDS. We need to raise a host of legitimate scientific, medical, ethical and pastoral questions such as: how does the virus get into the human biological system and damage human immunity? What can we do to prevent the virus? What is to be done once the virus succeeds in creating immunodeficiency and produces the syndrome? How do we treat the sick and how do we prepare the community for such eventualities? and so on. Like in every human tragedy there is an important attitudinal question that has to be tackled from several perspectives.

In the foreword to the booklet HIV and AIDS Curriculum fOI Theological Institutions in Africa (2001) what Musa Wen kosi Dube writes, summarizes the multiple dimensions of the phenomenon.

The theological aspects outlined in this curriculum includes elements such as sacredness of life, interdependency and goodness of creation, men and women created in God’s image and blessed, freedom, risk and responsibility in Creation, sin in Creation, concepts of life and death (in African world-views), and individual and community healing (in African cultures). Some of the related ethical issues include:

• Oppression, social justice and disease.

• Poverty, racial and sexual discrimination.

• Liberation, social justice, life and healing.

• Gender, children’s rights, HIV/AIDS and healing.

• Healing the world: international and human rights.

• Feminist perspectives on women, sin, disease, healing, wholeness,
care and HIV/AIDS and women (in African societies)

HIV/AIDS cannot be considered as an epidemic in the classical sense, Le., a disease that appears, affects people in a community or region and then disappears. It has become an endemic and a pandemic, a fatal malady that has come to stay within human communities and that acquires global proportions in terms of its reach and consequences. In dealing with this disease we are dealing with the very survival of human race in the long run. In the near future we are to deal with the frightening possibility of whole populations being wiped out in regions like Africa.

We may look at some of the following theological considerations as having some relevance for the Church’s approach to HIV/AIDS.

Every time we affirm that God is the Creator, and sustainer of the world, we simultaneously affirm that God’s creation is good. The Genesis account of creation reiterates that God saw that whatever God created was good. Christian biblical faith equally affirms that evil is not the creation of God. So in the original creation there was only good.

Evil appears later in human history when human beings exercised their freedom in the wrong way. So the polarity between good and evil, though an historical, existential experience of humanity, is not found at the primordial instance of God’s creation. Later theological tradition, especially the Eastern Church’s teaching, understood this as significant for Christian anthropology and theology of creation. Eastern Christian tradition developed a very positive and optimistic understanding of creation on the ground that the whole created reality came to being as the outcome of God’s love and will, and therefore, it is essentially good. All creatures, both human and non-human, share in this essential goodness of creation which is a "philanthropic" manifestation of God’s own goodness, the very quality of God’s Triune Being.

Evil, on the contrary, is understood as non-being. As Gregory of Nazianzus puts it, "Evil has no substance of kingdom." It is simply the absence of good. It is equated to darkness, because darkness is simply the absence of light. There is no substance or particle that we can call darkness. It is an experiential, existential reality (very similar to the Indian vyavaharika reality), but ultimately darkness is the absence of light. It disappears when light appears.

In the Epiphany liturgy (Epiphany or the Feast of the Baptism of Christ and the manifestation of the Triune Mystery is also called Feast of Lights in the Eastern tradition) of the Syrian Orthodox tradition, it is said that "God began the act of creation by creating light in order that the whole creation may be filled with light." This is a profound theological statement. Light here stands symbolically for God’s Being of goodness, freedom, beauty and love. These are the qualities that are infused in the created reality. These are the qualities that are to be fully realized in the created reality in its eschatological status. In between, all life led by human life is called upon to grow in light, in the path of perfection, in growing conformity to Gods’ will and love and in the image of God. This is the process of deification (theosis), of ultimately participating in God’s very nature. Evil has no place in this ontological progress of created reality including humanity, the priest of creation, except as the existential phenomenon that constantly tests human freedom and the human aspiration to grow in the good and be divinized.

Integrity is the state of transparency, harmony and wholeness. It is preeminently True because it has no discord or contradiction, no defect or deficiency within it. Human sin is an existential reality that breaks up the integrity of creation. Sin brings in falsehood and darkness that cloud transparency in relationship. Contradiction and disintegration begin to operate when sin alienates from each other the elements in creation that are harmoniously interconnected.

The Gospel of Christ, therefore, is essentially about manifesting the integrity of creation under the sign of the Kingdom of God through the healing of humanity and the whole creation.

The New Testament does not directly relate sin to sickness. It never judges an individual’s sickness on the basis of his or her state of sinfulness. The prime example is Christ’s attitude to the young man born blind. Christ categorically affirmed in answer to the insinuating question of the Jewish religious leaders that neither the blind man nor his parents sinned. Christ totally disagreed with the usual moralistic and judgemental tendency of human beings everywhere to directly relate sin to sickness in the case of individuals. Yet in some other cases like in the healing of the paralytic, Christ says ‘your sins are forgiven’ as a prelude or pre-condition for healing.

The Christian tradition, while being careful not to associate an individual’s sin with his/her sickness, interpreted that in the total life of humanity, sickness of all kinds or in other words, all that weakens the integrity or holistic character of creation, has roots in the alienation that has happened between humanity and God (The word sin is often mis-understood in an individualistic, moral sense, while alienation can be understood in a broader ontological sense). To take an example, the often sexually transmitted and contagious HIV/ AIDS that has moralistic connotations in ordinary human communities, and cancer that is not contagious and has no usual moralistic undertones, are both conditions of sickness and disintegration, and as such they are both the consequence of the sinful alienation of humanity from its source of being. In this broader perspective, it does not matter that some cases of HIV/AIDS are caused by the sexual misconduct or drug use of certain individuals, some are caused by blood transfusion and some others through childbirth transmitting the disease from mothers to newborn babies. It does not matter, that forms of lung cancer are created by the excessive smoking of the patients and some others occur for no known reasons in individuals who leads a ‘sane’ style of life. No moral discrimination is made in such cases, based on the act of lifestyle of an individual. Yet the theological connection between sin and sickness at the level of the entire humanity - is maintained.

The modern world may find it unfashionable to link sin with sickness. This is primarily because the teaching of the Western Church on sin since Augustine has been forensic, that is, sin was considered as violation of law that produced guilt. The guilty is to be judged and duly punished. So sin, guilt, judgement and punishment were closely interconnected. Augustine’s notion of the original sin exacerbated this forensic notion of sin since he maintained that humanity as a whole is condemned and has lost even the ability to will good. Human will is so corrupted from the moment of conception that no human effort is of any value. The corruption of sin was intertwined with the sexual act of human procreation. The sin of Adam was passed on to later generations through concupiscence in the sexual union of man and woman.

So in this understanding of sin as interpreted by Western tradition, sexuality became the matrix of human smfulness. One of the major hurdles in facing HIV/AIDS is this theological-moral association of sexual sinfulness with HIV infection, deeply entrenched in the minds of believers. It is good to notice that the Eastern Christian tradition cannot agree with the Augustinian position on original sin, and the legalistic notion of human sinfulness, though the popular views in many Eastern churches since the time of Crusades and the later colonial movement have been influenced by the Western teaching like in many other spheres of life.

The Eastern Patristic tradition conceives sin as the primary form of disease. The ultimate consequence of this disease is death as taught by the Apostle Paul and others. Sin as disease entails death. Sickness too, if not healed, ultimately brings in death. In the therapeutic notion of sin as sickness, the process of diagnosis, treatment, healing and restoration to the condition of wholeness is predominant. The model of guilt, judgement and punishment does not match the therapeutic model of sickness, treatment, healing and reintegration.

The therapeutic model is derived from the Church’s teaching about the incarnation of God is Christ. Christ came as a good physician, compassionate and assuming on his own shoulders the burden of the disease of human sin and guilt. Christ revealed God as a compassionate father (as in the case of the prodigal son) and as an all-caring, tender-hearted mother (as in the metaphor of the mother hen) Christ’s own activity in the world revealed him as a healer of all kinds of infirmity - physical mental and spiritual. He interpreted healing as a sign of the presence of the Kingdom of God. He sent the disciples on their mission to the world with the two-fold commission: heal the sick and announce the gospel of the Kingdom. Moral judgement and preventive methods are necessary and useful, but only at the stage before the disease affects a person or community. Once the person / community is sick the good physician cannot sit in judgement over the cause of the malady. Instead he/she initiates the healing process. Like in Buddha’s parable, when you see a person deeply wounded by an arrow, you do not spend all your time looking for the source and direction from which way the arrow came, but immediately begin to pull out the arrow and give emergency treatment to the wounded.

Salvation is etymologically related to health or wholeness in several languages. Incarnation of God in Christ was not a miracle of God to astound human beings but God’s therapeutic process to heal humanity of all forms of sickness that disintegrates creation, and lead human beings and all nature to the state of integrity, love and freedom.

All the sacraments of the Church contain a fundamental healing dimension in so far as they are community based and community oriented. It is a misconception, often deeply rooted in the minds of believers, that sacraments are devised for individual spiritual fulfillment and individual salvation. Take baptism, Eucharist, marriage, anointing of the sick or any other sacrament, the practical notion is that it is administered to an individual for his/her spiritual benefit. But in fact, there is no baptism without community. It is precisely the sacrament of sealing a person/child with the seal of the Holy Trinity, washing him/her in water and Spirit, that makes him/her a full participant in the Church community or the Body of Christ. The future spiritual growth and maturing of the baptized must take place in the community of the faithful. The same applies to other sacraments. Marriage that is often considered as a "contract" between two individuals is in reality the sacrament of the family community. Individuals are initiated to the sacred bond of the community for procreation, for fellowship with God and with all creation and the sharing of love in the matrix of a sustaining community. Even the very personal confession and absolution of an individual is aimed at restoring the alienated person to the koinonia of the Body of Christ. All these are healing processes in the sense of reinstating the individuals to the integrity of the Holiness of Christ. In the sacrament of anointing the sick, the longer version of the liturgy in the Orthodox tradition, includes not only the sick person, but all who are present on the occasion. All are anointed by the blessed oil of healing on the assumption that sin and sickness of an individual is rooted in the community’s sin-sickness condition and, therefore, all members of the community need healing.

With the new ecological awareness, the paradigm of healing is now being applied to the planet earth and the whole creation. The Body of Christ in fact ultimately stands for the organic interconnectedness of all physical reality. Any human-inflicted damage to the environment is a form of ecological sickness that leads to the death of all living beings. Human sickness has also environmental and planetary consequences. So healing of the earth and healing of the human sin and sickness are all closely intertwined. Christian sacramental theology assumes new meaning in the ecological context.

In biblical theology, the gift of God’s Image (Imago Del) is often interpreted on an individualistic basis. In highly patriarchical interpretations, this could be a male individual. In racist and colonial context this has been interpreted in favour of white, male individuals. The colonized and indigenous people have often been denied human soul or God’s Image as has happened during the Spanish conquest of American Indians. This kind of reductionist approach in understanding God’s image is clearly opposed to the authentic teaching of the Church. It is not simply the individual human person (man and woman, white and black), but humanity as a whole that has the Image of God. Humanity as one body is God’s Image as well as every individual person is Imago Dei. This is the teaching of ancient teachers like Gregory of Nyssa. The significance of this view is that an individual cannot appropriate for himself/herself in a reductionist manner, as we have seen, the most important gift of God to humanity. An individual’s quality of being in the image of God is fully realized only when the individual is rightly incorporated into the body of humanity.

Further, any damage to the individual’s Imago Dei through sin - affects the whole body and its corporate image. It is the same with all kinds of sickness. When one member suffers, the whole body suffers, as stated by the Apostle Paul in his elucidation of the Body of Christ concept.

Image of God is the theological symbol, among other things, of human dignity. The plague of AIDS has struck at the roots of human dignity and the wholeness of creation intended by the Creator. Every effort to heal humanity of this fatal infirmity is the effort to uphold the human dignity of God’s image in us as the greatest gift to humanity.

1. Musa Dube, "Foreword" to HIV/AIDS: Curriculum for Theological lnstitutions in Africa, Geneva, WCC, 2001, p. 4.

2. Sam Kobia, "Foreword" to Facing AIDS, wee, Geneva, 2001, p. viii.