Pastoral care of people living with HIV in Zambia By Rev. Kennedy Chola Mulenga
PASTORAL CARE OF PEOPLE LIVING WITH HIV IN ZAMBIA BY REV. KENNEDY CHOLA MULENGA
Van Dyk in her book, HIVAids Care & Counseling: A Multidisciplinary Approach, sagaciously asserts, “HIVAids (sic) has forced us to think of caring rather than curing….Because we have no cure for HIVAids (sic), we must focus on caring for the psychological and mental welfare of people living with HIVAids (sic)” (2005:174 emphasis hers). It is my humble intention, therefore, to look at the care of people living with HIV and AIDS in Zambia from an evangelical standpoint. Evangelical Christians in Zambian have ample endowments (e.g. human resource, presence, a message of hope, etc.) to give meaningful pastoral care to people living with HIV without the blight of stigma as they have been known to do in past times. This paper will describe pastoral care, posit an interdisciplinary perspective to pastoral care, highlight the role of psychology in pastoral care, locate the place of spirituality as a unique contribution of pastoral care, and recommend a feasible evangelical pastoral approach to HIV and AIDS care. In short, this paper will posit an approach to pastoral care of people living with HIV that will both be evangelical and germane to a Zambian worldview.
2.0 An Interdisciplinary Perspective to Pastoral Care
As a point of departure I will discuss the concept of pastoral care from an interdisciplinary standpoint. What precisely is pastoral care with specific reference to people living with HIV?
2.1 The Scope of Pastoral Care
Maldonado (1990:17) makes a pithy distinction between the ideas of pastoral care and pastoral counselling with HIV and AIDS affected persons. He notes that pastoral care is like a larger “umbrella that encompasses all the actions that the church is called to undertake in relation to the physical, spiritual, economic, social and even political needs of those who are affected by the virus.” He clarifies that pastoral counselling is a component of the same umbrella, which is a sort of focused type of action. He views counselling in this sense as a temporary helping relationship between a pastoral counsellor and counsellee(s) seeking help.
Pastoral care, according to Gerkin, is the “caring task of the pastor in relation to individuals and communities” (1997:11). “Communities” in this usage allude to families living together, especially communities of faith, who have a common fellowship and want to be faithful disciples of Jesus Christ in the world. Gerkin (1997:19) further asserts that pastoral care has “application to the broadest range of pastoral and communal practices in the life of the church and the world.” Gerkin’s view of pastoral care is not limited to person to person encounters only, but is also applicable to caring for the church family and its community, the ‘environment’ of the community of faith. Pastoral care to the ‘environment’ of the community of faith entails the fulfilment of the church’s evangelistic task to the world at large (Gerkin 1997). Thus the terms “pastoral care” and “pastoral counselling” are often used interchangeably, although a distinction can be made, as shown in figure 1. So it can be said that in talking about pastoral care, pastoral counselling is implied or assumed. In this sense then a person cannot be a pastoral caregiver without being a pastoral counsellor. It is my view that these activities constitute what in theological terms is called the cura animarum or ‘cure of souls’.
Pastoral care is therefore a unique activity of caring for human life because it is created by God and belongs to Him (cf. Louw 1997).
Figure 1 Pastoral Care of PLWHA (Source: Maldonado 1990:6)
Figure 1 above diagrammatically represents Maldonado’s idea of pastoral care of PLWHA within which pastoral counselling falls (cf. Marshall 1995).
White (1998:99-103), on the other hand, elaborates pastoral care as having five critical tasks, namely, spiritual nourishment, herding (i.e. to collect and keep together), protecting, healing, and leading God’s people to their eternal destiny. The pastoral responsibility of spiritual nourishment relates to teaching, preaching, and explicating Scripture in the context of life experiences and challenges. The pastoral task of herding alludes to the preservation of the family and community of believers. Protecting the flock is closely implied in the spiritual nourishment motif, but vitally points to checking destruction which flawed teachings bring in the lives of the faithful. The healing task of “pastoral care is that it follows up distress with practical mercy and kindness” (White 1998:102). It is this healing task of pastoral care that takes centre stage in the care of people living with HIV and AIDS.
Magezi (2005) includes two additional vital functions of pastoral care. He identifies seven functions of pastoral care—namely, healing, sustaining, guiding, reconciling, nurturing, liberating, and empowering (Magezi 2005:137). The first five functions are the same as White’s, while the last two (liberating and empowering) are his inclusion. The latter two purposes of pastoral care will be the focus of this work in as far as care for people living with HIV is concerned. People living with HIV need freedom from such limitations as stigma and enablement to develop successful life outlook. Table 4.1 is a summary of Magezi’s seven functions/tasks of pastoral care from a historical perspective.
Table 1—Summary of Pastoral Care Functions & Expressions (Source: Magezi 2005:137)
Pastoral Care Function
Contemporary caring and counselling expressions
Anointing, exorcism, saints and relics, characteristic healers
Pastoral psychotherapy, spiritual healing, marriage counselling and therapy
Preserving, consoling, consolidating
Supportive caring and counselling, crisis counselling, bereavement caring and counselling
Advice-giving, devil-craft, listening
Educative counselling, short-term decision-making, confrontational counselling, spiritual direction.
Confession, forgiveness, disciplining
Marriage counselling, existential counselling (reconciliation with God).
Training new members in the Christian life, religious education
Educative counselling, growth groups, marriage and family enrichment, growth-enabling care through development crises
Raising awareness about sources of oppression and domination in society.
Encouraging one to develop one’s own/alternative base
Pastoral care is thus a composite process of caring for individuals and communities with the goal of meeting a need which has emanated such as the need for healing, sustaining, guiding, reconciling, nurturing, liberating, or empowering. Pastoral care implies pastoral counselling with a view of enabling the counselee to tackle his or her challenges more effectively. It must be noted further that counselling is the salient manifestation of pastoral care especially as it relates to the care of people living with HIV (Maldonado 1990; Louw 1997; van Dyk 2005). Therefore it is imperative that every pastoral carer be equipped as a pastoral counsellor. I think that this is what Gennrich means by “being there” when she writes that care involves much more than counselling:
Care involves really understanding a person’s many social, personal, physical, cultural, spiritual needs and understandings, and responding to them in an integrated way. But above all, it simply means being there. Others call it accompanying a person, or walking life’s journey (or part of it) with them….This is akin to the African traditional value of ubuntu – doing whatever is necessary to care for the sick person because their sickness affects everyone in the community and in the family, and working hard to ensure that life flows on as normal” (2004:47 emphases added).
Gennrich captures the essence of pastoral care in an African setting, particularly, the community orientation of pastoral care. Effective pastoral care in an African setting is certainly not individually oriented, but is more of a community oriented activity (Couture & Hunter 1995, Louw 1997).
Now, if it is true that African pastoral care is not person-centred as is western care and counselling, what is it that makes pastoral care African? Louw (1997:393) aptly asserts that “Pastoral care becomes African when it reflects the philosophy or life view of the African culture.” Louw (1997:401), Citing Mtetwa, describes the defining trait of African pastoral care as follows:
One of the most remarkable and tangible dimensions of African Spirituality relates to the unique notion of communality and collective solidarity that the African society exhibits in all spheres of life. There is a profound sense of interdependence, from the extended family to the entire community. In a real sense, everybody is interrelated, including relations between the living and those who have departed.
I think that the evangelical church in Zambia should harness this characteristically African life-view of community in fellowship and ‘integrate’ it with the metaphor of the church as a family of God’s people where authentic fellowship translates into care for those affected and afflicted by HIV and AIDS. This approach does not mean that pastors in Africa must do away with the insights of other disciplines such as psychology, medicine, etc. These disciplines have a vital relationship to pastoral care which when neglected will do a disservice to the care of people living with HIV. The question may be posed as to where and how pastoral carers would maintain a sound relationship between the Bible (Christianity) and the scientific discipline of psychology, for instance. Are the two disciplines antithetical and irreconcilable? What benefits can be drawn from the “tension” between them? Put simply, what is the value of psychology in pastoral care?
2.2 The Role of Psychology in Pastoral Care
It was found in the foregoing section that for Africans counselling is a community and extended family issue, but now it is necessary to know whether psychology is germane to pastoral care in an African context. To help answer this matter it may be vital to ask another question: ‘Why is the question of the connection between psychology and Christianity (the Bible) relevant to pastoral care?’ First, psychological counselling/care seems to dominate the relationship. For instance, most Non Governmental Organisations (NGOs) who provide HIV and AIDS care and counselling in the sub-region prefer to employ staff with psychological training to pastorally trained persons. Furthermore van Dyk (2005) presupposes a psychological approach to care and counselling of HIV and AIDS affected people as the most effective when she says that:-
1. Counselling must always be based on the needs of the client.
2. Counselling has a dual purpose (Egan 1998):
· to help clients manage their problems more effectively and develop unused or underused opportunities to cope more fully; and
· to help and empower clients to become more effective self-helpers for the future (van Dyk 2005: 175).
Van Dyk’s goal of counselling—“to help clients manage their problems…and become more effective self-helpers…” seems to be only partially accurate. That goal of counselling becomes trite when the person living with HIV is at the brink of death and needs more reassurance and comfort than anything else. I posit that something much more than the two facets posited by van Dyk must be targeted in pastoral care of people living with HIV. A specific “pastoral or hope therapy” (Louw 2006) should be given at this point in the life-journey of people living with HIV. It is my opinion that pastoral care (and counselling) is more holistic than any other approach as it not only aims at facilitating the clients ability “to explore and discover ways of living more fully, satisfyingly, and resourcefully” (van Dyk 2005:175), but also seeks to impart hope (Louw 2006) beyond HIV infection. Basing his argument on the fact of Christ’s resurrection as the source of hope beyond suffering for people living with HIV (cf. 1 Cor. 15:10ff), Louw aptly asserts that “…one can view the resurrection of Christ as the final critique of God on death, suffering and stigmatizing. Resurrection hope is about the death of death, about the fact that every form of rejection, stigmatization and isolation has been finally deleted by God. People suffering from HIV should therefore be empowered to start to live despite the reality of the virus” (2006:104). This is a more holistic approach to the care of people living with HIV as it not only points to positive living here and now, but also addresses the issue of hope in the afterlife (cf. Yancey 1990) when all pain will be no more (cf. Rev 21:4-5; Rom 8:18-25).
White (1998:97) sums it up this way: “The fact is, only the Christian carer is engaging with the whole of a person: a body-soul-in-community, with an eternal destiny. This is our confidence: he may expect to reach areas which no other carer can touch.” It is precisely at this point (hope impartation) at which pastoral care of people living with HIV differs from other approaches to care. This observation, however, does not mean that psychology has not made any meaningful contribution to pastoral care and counselling. There are two ways one can look at psychological and biblical approaches to counselling. There are two schools of thought on this matter: Psychology against the Bible and psychology ‘integrated’ with the Bible.
The ‘Psychology against the Bible’ school of thought holds that psychology has no relevance to the pastoral (spiritual) care. Jay Adam’s book Competent to Counsel (1976) categorically condemns the use of psychology in pastoral care and counselling and serves as an example of this school of thought. Adams holds that since the Bible is inerrant it is the only standard for faith and practice. He sees three elements in his nouthetic approach to counselling. Firstly, he contends that when something is wrong some sin or some problem needs to be acknowledged and resolved. Secondly, nouthetic contact is personal conference and discussion aimed at bringing change toward greater conformity to biblical principles and practices. Thirdly, nouthetic confrontation changes that which in life hurts counsellees head-on by verbal means. Adams infers that some of the causes of people’s sicknesses are that they are not living as God requires and are not doing what they should be doing. Therefore, Adams sees psychology as anti-Bible and to be avoided by Christians.
A second school of thought contends that biblical and psychological counselling can be integrated. Integration in this instance does not mean to merely blend the Bible with psychology “half-half”. From the onset it must be noted without hesitation that a danger exists in uncritically accepting any model of pastoral counselling. Integration in itself can easily become syncretism. Psychology has some value, however. Miller and Jackson (Magezi 2005:146) give clarity to the issue when they helpfully observe that “God also has given to humankind the gift of reason and through it the marvellous techniques of modern medicine and psychology.” They add, “We view such secular technology as a set of tools, to be employed within any system that does not exclude it.” In what way, then, can psychology be used in pastoral care?
By implication, psychological insights can be used in pastoral care and counselling as long as they are not opposed to any biblical teaching. It might also be asked, ‘How would Christians harmonize the inerrant, inspired Word of God and the science of psychology without being syncretistic?’ Christianity insists on the centrality of Christ as revealed in the Bible, but psychology holds to humanism—a teaching which ardently maintains that humans are the highest beings and at the centre of all things. It seems there is no meeting ground for the two. To resolve this apparent incongruity, Crabb (1979) proposes four options, which he terms the “Separate but equal”, “Tossed salad”, “the Nothing battery” and the “Spoiling the Egyptians”.
To start with, the “Separate but equal” view argues that the Bible is not a textbook of psychotherapy or medicine; therefore, if a person has a problem he should visit the right profession. Fields of legitimate concern, like medical, dental and psychological disorders are outside the area of Christian responsibility and professionals must handle them (Crabb 1979:34). This school of thought contends that the Bible is not a textbook of any other discipline except religion alone. Proponents of this view presuppose that emotional problems (for instance) do not have a bearing on spiritual issues. However, this inference seems to ignore the fact that certain psychological malfunctions are rooted in emotional problems such as guilt, anxiety, resentment, a poor self esteem, etc. The Bible is replete with instances when these emotional issues have had to be confronted or resolved by asking for God’s help. The Psalms, for instance, address these issues (see Ps 34; 51; etc). Thus such a simplistic separation between scripture and psychology (as the ‘separate but equal” proposes) is untenable and a misapprehension of the Bible.
Secondly, the “Tossed Salad” (Crabb 1979:35) approach seeks integration in the way a “tossed salad” is prepared by mixing a number of ingredients together in a single utensil to make a “tasty blend.” This model says that Christianity offers great truths that are vital to good living. Psychology too has truths that are beneficial to humanity. So when the cream of biblical and psychological insights is mixed, effective Christian psychotherapy will be the outcome. Opponents of tossed salad model do not depreciate psychology, but caution Christians against careless acceptance of secular notions which may compromise Scriptural teaching.
Thirdly, there is the “Nothing Battery” model (Crabb 1979:40). According to Crabb (1979) this model is a reaction against the above two models. The “separate but equal” model refuses to recognize the pertinence of Scripture to psychological problems. Whereas the “tossed salad” model compromisingly mixes Scripture with ‘secular’ psychology. The basic premise of the nothing battery model is “Nothing but grace, nothing but Christ, nothing but faith, nothing, but the Word.” Jay Adams’ nouthetic approach is an example of the “nothing battery” model. Adam’s nouthetic approach maintains that psychology is a foe of the Bible. Adam’s approach, however, must be noted for its high view of Scripture because no person can claim to be a Christian carer or counsellor if he/she does not obey biblical teaching. So Adam’s approach has immense value to pastoral care except it that seems to ignore that man is a psychological being whose complex emotional mechanics play each other in day to day life.
Fourthly, there is the “Spoiling the Egyptians” approach. The carefulness of the “separate but equal” towards psychology, the permissiveness of the “Tossed Salad”, and the overreaction of the “nothing battery” obliges a fourth school of thought to embrace the “Spoiling the Egyptians” standpoint. The expression “Spoiling the Egyptians” is derived from the occurrence in Exodus chapter 11, when God ordered the Children of Israel to take with them articles (as spoils) as they left the slavery of Egypt. This view critically evaluates psychology used in counselling, and picks up on some school of thought dissonant to the Bible. Crabb (1979:49-50) is quick to point out that the “Spoiling the Egyptians” approach has an inherent risk of taking with it a mixed multitude which can eventually cause problems as was the case with Israel in the desert. The rebellion in the desert is blamed at the mixed multitude from Egypt. This approach looks at psychology through the eyes of Scripture and not vice versa.
Crabb (19979:49-50) prefers the “Spoiling the Egyptians” standpoint and gives principles to govern a truly evangelical integration of Christianity and psychology. Firstly, for evangelicals psychology must come under the authority of Scripture. Where the two contradict each other, the Bible is accepted as the truth. Secondly, the Bible is God’s infallible, inspired, inerrant revelation in proposition. Thirdly, Scripture should have functional control over our thinking. Fourthly, functional control of the Bible can be achieved over psychology by spending much time studying the Bible systematically to understand overall content and to equip the Christian for a competent helping profession. Crabb’s thoughts are useful toward the understanding of the role of psychology in Christian counselling. But the “Tossed Salad” and the “Spoiling the Egyptian” approaches are hard to distinguish and one may easily confuse the one for the other. Therefore this approach is also inadequate.
Fifth and finally, Magezi (2005:151-55) embraces the “Convergence Model” (following Louw  in A Pastoral Hermeneutics to Care and Encounter) as a balanced solution to the debate on the integration of the Bible and psychology. He handles the dilemma of integration between psychology and pastoral counselling as a tension. He says that the tension between the two is healthy (Magezi 2005:150).The convergence model views pastoral care and counselling from an eschatological standpoint. Eschatology points to the essence of the Christian’s ‘already but not yet’ existence by virtue of being a new being in Christ. Magezi (2005:151) asserts “Eschatology is not only a description of the end of history, but also reveals the essence of our new being. Eschatology defines the theological stance of pastoral care in terms of the cross and resurrection.” In the convergence model an inevitable implication of pastoral care is hope. Hence, the practice of pastoral care is “a sign of hope to the world. This hope is the fountain of peace and the motivation to live in this life, even with HIV/AIDS infection” (Magezi 2005:154). Eschatology entails that pastoral care is essentially linked to hope and confers the task of care on the community of faith. The convergence model recognizes that the tension exists between the “already” of our salvation and the “not yet” of the coming kingdom.
I prefer the convergence model as it scrutinizes psychological information on the basis of Scripture without depreciating the need for repentance as a prerequisite to salvation. The complementarism of the “Tossed Salad” should be avoided. The separation of the “Separate but equal” makes life unreal. It is my view that pastoral counselling should integrate the Bible and psychology on condition that the uniqueness of pastoral counselling is preserved every time. But the integration must be healthy, without compromising biblical Christianity.
3. Pastoral Counselling within an African Setting
Another fundamental question may be posed in this connection: ‘What is the nature of pastoral counselling that makes it uniquely suited to address the dilemma of people living with HIV in Africa?’ Whenever a person in an African context encounters a difficulty such as an illness or a calamity the why question is posed. Why me? Why am I suffering in this way? HIV infection elicits this question too. People living with HIV in an African setting invariably ask themselves—why should I be HIV positive when there are many others who could have been infected have not been infected? Who exhibit similar risky behaviour like me and do not get the HI virus? (Statement assumes promiscuity/HIV link) The African worldview seems to believe that HIV infection is something that occurs as a misfortune when a taboo is broken either by the individual or his close relative. Sometimes an HIV positive diagnosis is attributed to a punishment for an abomination committed or to witchcraft. So HIV and AIDS carries a lot of stigma partly due to this mindset. Magezi (2005:190) says that when an African asks the ‘why?’ question (cause and effect); he or she receives an answer from the diviner. So the diviner is the therapist in this setting. He describes African therapy as a process of finding causation of a crisis when he explains:
Your sickness, misfortune, or condition can be traced to either an inappropriate action by one member of the family or a conflict that existed among members of the family who may be dead. The purpose of the therapy is to say to the offender, you have done wrong or wrong was done by someone else; we have accepted responsibility, confessed the guilt/shame/damage by an appropriate ritual. If it was a past conflict, descendents of the parents who gave rise to the conflict do the confession on behalf of the dead (Magezi 2005:190 emphasis his).
This African frame of reference necessitates that a biblical (Christian) worldview or understanding be adhered to in Christian therapy. Therefore, Christian therapy addresses a fundamental transformation of worldviews through Bible teaching. Otherwise the age-old decry that Christianity in Africa is superficial and profoundly misunderstood will persist as we seek to have a germane pastoral care of people living with HIV.
What makes pastoral care and counselling unique and apt to give spiritual healing? Meier et al. (1991:134), identify the following principles which are distinguishing traits of Christian Counselling that make it apt to give spiritual healing in any perplexing life situation including an HIV/AIDS positive diagnosis:
· Christian counselling accepts the Bible as the final authority. Christians are not tossed back and forth and do not rely on their conscience, but they have the word of God that is valid and defines men’s telos and purpose.
· Christian counselling does not only depend on the human will to be responsible, but they have the Holy Spirit that assists them.
· Although human beings, by nature, are selfish and ignore or hate God, through faith they receive the Holy Spirit who gives them victory in overpowering their sinful nature.
· It deals effectively with the counselee’s past. Because people’s past guilt is forgiven (1 John 1:9), they can look to the future (Php 3:13-14).
· It is based on God’s love. God loves us and his love flows through us as we care for others (Ro 12:9-21). A Christian counsellor feels a spiritual relationship to others and helps them grow in Christ as they solve their problems.
· Christian counselling deals with the whole person. It recognizes that the physical, psychological, and spiritual aspects of humans are intricately related (Meier et al. 1991:134, see Minirth 2003).
Crabb (1979) focuses on the ultimate aim of pastoral counselling to demonstrate its uniqueness. He points out that when people have problems, they ordinarily emphasize finding happiness as of primary significance more than “becoming Christ-like in the middle of problems”. It should be noted, however, that the goal should not be happiness (as psychology may claim), but to live a life in obedience to Scripture by putting God first (Matt 6:33). In other words, it will be as we devote ourselves to becoming what Christ wants us to be that God fills us with unspeakable joy and peace, outside of what the world can give us. Crabb (1979:22) thus helpfully summarizes the ultimate aim of Christian counselling as “to free people to better worship and serve God by helping them become more like the Lord. In a word, the goal is maturity.” Pastoral counselling of people living with HIV should also should aim at helping them grow toward spiritual maturity.
Crabb (1979:24ff) further explains that maturity is both spiritual and psychological. For a person to become psychologically sound and spiritually mature, he/she must grasp the fact that his acceptability before God is not based on his behaviour, but rather on Jesus Christ’s behaviour (cf. Tit. 3:5). He says, “The foundation of the entire Christian life then is a proper understanding of justification.” Christian counselling, according to Crabb, is thus about whether the individual is responding biblically in whatever situation he/she experiences. “A counsellor must help the client to move OVER to the pathway of obedience” writes (Crabb 1979: 26). “Moving over” involves getting rid of barriers in the way, such as “I can’t” or “I won’t”. This change of position (“moving over”) is about behaviour change. Christians, however, should experience much more than change. He points out:
Attitude must change, desires should slowly conform more to God’s design, and there must be a new style of living…. The change must not be only external obedience, but also an inward newness, a renewed way of thinking and perceiving, a changed set of goals, and a transformed personality. I call this second, broader objective the up goal. People need to move not only OVER but also UP (Crabb 1979:27 emphasis his).
Psychological counselling does not consider as essential this reality of moving OVER to biblical conformity and rising UP toward an attitude of Christ-like submission to God’s will. Pastoral counselling on the contrary pays scrupulous attention to this issue which underscores its characteristic contribution to the helping ‘profession’. In HIV and AIDS care where death might be imminent and the individual experiences anger, guilt, and despair, a carer should stress God’s acceptance and unconditional love of the person. This means that people caring for people living with HIV whose condition has deteriorated (and counsellors) are therefore to be sensitive to spiritual needs which are only met in sharing and accepting the message of grace in the gospel. People living with HIV will stand a better chance of being healed spiritually when they see themselves as acceptable before God, and entrust themselves to His care. At this point people living with HIV would have ‘moved over’ (i.e. started to think biblically) and begun ‘moving up’. The ‘moving up’ (spiritual maturity or faith development) will not happen in isolation but in an environment of authentic fellowship, mutual support, and encouragement).
Meier et al (1991) point out that the environment of pastoral counselling is the community of faith. God’s love flows through the believers as they mutually take care of each other (cf. Heb 10:24-25). A Christian counsellor has a spiritual relationship to others and helps them to grow in Christ as they solve their problems (Meier 1991). Pastoral counselling therefore implies that believers who experience God’s love and grace share it with others. People living with HIV are also accepted and become part of the church family. Thus individuals involved in HIV and AIDS counselling should, in the course of their work, have the desire to allow people living with HIV to experience salvation since works of mercy are not an end in themselves but a means of God’s saving mission. The experience of conversion by a person living with HIV is a facet of pastoral care which Crabb (1979) terms as “moving over”. I think that it is important for a pastoral carer of people living with HIV, at some point in the relationship, to share the message of salvation and encourage them toward growth as disciples of Christ.
Crabb astutely points out that because pastoral counselling is the responsibility of every Christian, Christian leaders have a dual function—“to equip the body and offer back-up resources” (1979:16). He sees pastoral care and counselling in three senses. Firstly, there is the counselling by every Christian through encouraging, empowering and loving one another. Secondly, pastors, elders and church leaders teach biblical principles of loving one another to the community of faith. And thirdly, specially trained people deal with counselling and exploring deeper and complicated issues, as the role of Christian professional counsellors. Crabb’s model of congregational care is practical and germane to African HIV and AIDS pastoral care. The wider community of faith would be involved in home care, as their ability permits, but pastors, elders or specialists from outside should equip those who commit themselves to the ministry of home-based care.
Therefore, pastoral care and counselling is characteristically different from psychological counselling in the following four points—its context, means, goal, content, and target group (counselees) (Crabb 1979, Meier et al 1991, Louw 1997; Magezi 2005). The context of pastoral care is the community of faith; it is accomplished through Christians’ mutual care; its ultimate aim is spiritual maturity (and faith development) motivated by unconditional love (agape) enabled by the Holy Spirit; its content is God’s promises in the Bible, and the target group (counselees) are church members and all in need of help (e.g. people living with HIV both Christians and non-Christians). Since pastoral care/counselling of people living with HIV is the focus of this paper, it is imperative to point out critical issues in HIV and AIDS care and counselling in Zambia, beginning with HIV and AIDS counselling.
4. HIV and AIDS Counselling in Zambia
Pre- and Post-HIV Test Counselling
There are two basic phases of HIV and AIDS counselling, i.e., pre-and post-HIV test counselling, normally done through Voluntary Counselling and Testing (VCT). The purpose of pre-HIV test counselling is to find out why counsellees want to be tested, assess the nature and extent of their current and past high-risk behaviour, and advise on prevention of HIV transmission (van Dyk 2005:202-213). Pre-HIV test counselling is critically vital as it provides an excellent opportunity to educate people about HIV and AIDS and safer sex because some counselees may choose not to return to collect their results. VCT is an entry point to prevention and care for HIV and AIDS. Figure 1.2 summarizes the various opportunities VCT presents to counsellees. Furthermore it is recommended in HIV and AIDS counselling that the same person who gives pre-test counselling should give the post-test counselling because the latter is a continuation of the former (Haworth et al 1991, van Dyk 2005, Magezi 2005, etc).
Figure 2 Voluntary Counselling and Testing as an entry point for HIV prevention and care [Source: van Dyk 2005:104]
HIV and AIDS counselling is very important since people living with HIV usually experience psychological, spiritual and socio-economic needs. Fear, grief, denial, anger, anxiety, low self-esteem, depression, suicidal behaviour and thoughts, obsessive conditions, spiritual concerns and socio-economic issues are intensified after an HIV positive result. A further intricacy of an HIV positive result is that it adversely affects significant others, such as family members and friends. These people too should be helped to come to terms with the situation through counselling. The aim of counselling the significant others of a person infected with HIV is to empower them to become a care and support base for the person. Pastoral care is crucial to giving acceptance and sustained support of the infected person and his or her significant others (the affected). Post-test counselling creates a challenge and opportunity for the church to accept and care for the person in the context of fellowship (koinonia) where there is mutual and unconditional love (Vine 1996:233). We may, however, ask the questions: ‘How HIV and AIDS pastoral care should be done in a Zambian context?’ How does one talk to or counsel a person living with HIV? What is to be the attitude of the caring community toward people living with HIV? The following section responds to these questions.
5. HIV and AIDS Pastoral Counselling in Zambia
Van Dyk calls HIVAIDS pastoral care/counselling “spiritual counselling” (2005) and does not mind even if the counselling or care is non-Christian. She acknowledges the need for pastoral care of people living with HIV. She asserts, “Researchers often refer to the importance of dealing with the spiritual and emotional needs of HIV-positive clients and their loved ones, but this process remains one of the most neglected aspects of counselling, especially within the HIV/Aids (sic) context” (van Dyk 2005:249). Her observation is valid for the Zambian HIV and AIDS counselling situation where until very recently the training of ministers paid ‘little’ attention to HIV and AIDS counselling (Dube 2003a; Chirwa 2005). It was seen as a specialty of health professionals alone. Van Dyk advises HIV/Aids counsellors not to ignore the religious needs of people living with HIV, but cautions that counsellors must not “force” their religious convictions on their counselees.” She holds that in the HIV and AIDS situation any religion can help PLWHA come to terms with their predicament and find some peace. However, I am of the view that Christian counselling is the most appropriate form of care to people living with HIV and AIDS because it does not only impart positive living now, but also gives hope for eternal life in heaven. But one may ask the question: ‘why are many pastors in Zambia so uncomfortable counselling people living with HIV/?’
Van Dyk (2005: 249) rightly posits that “many clergy find it difficult to counsel HIV positive people properly because they are themselves ignorant about the disease and its ramifications….[and] many HIV-positive people avoid approaching their religious leaders for advice or consolation because they fear that they may well be condemned rather than supported.” Both these two points are valid obstacles to effective pastoral care of people living with HIV in Zambia. It is an aim of this paper to come up with means of overcoming these impediments to effective evangelical pastoral care of people living with HIV. But how can evangelical HIV/AIDS pastoral carers in Zambia achieve this much needed ministry?
Firstly, pastoral carers must be relationship builders. It has been shown above that counselling is a relationship (counsellor-client) which facilitates the client’s growth. In this instance, the relationship is between the pastoral caregiver (who can be the pastor or congregation member committed to the task) and the HIV and AIDS affected person or people. A good relationship with people living with HIV is necessary for them to open up. The counsellor will in this way facilitate the growth of the HIV-positive individual. Facilitation means to create a favourable environment toward positive growth in the person living with HIV and AIDS. Growth here means that the pastoral counsellor will aim at enabling the client to make changes toward living positively with the HIV status.
Secondly, the pastoral carer should not have a condemnatory attitude toward people living with HIV. Even if the person thinks that he or she has sinned (for all people do sin) emphasis should rather be placed on acceptance, forgiveness and reconciliation to God and His people. While pastor of an evangelical church in Lusaka I observed how individuals diagnosed with the HI virus were ‘feared’ and isolated by fellow believers. This was partly attributable to the lack of information on HIV and AIDS on the part of congregants and a shear ‘holier than you’ attitude towards people living with HIV. The pastoral carer therefore has a task to communicate grace and acceptance to people living with HIV. He/she should embody a gracious posture of compassion. The Bible is replete with examples of people who sinned and were subsequently forgiven by God. Some of them are heroes of faith such Abraham (Gen 20) and King David (2 Sam 11-12; Ps 51). The woman caught in adultery in John chapter 8 can also be used as an example of God’s desire to pardon those who come to Him in repentance rather than punish and condemn them (cf. 1 John 1:8-9).
Thirdly, the pastoral care giver should become a “companion on the journey” (see Müller 1999) of people living with HIV. It is not sufficient to show acceptance and compassion to people living with HIV. There will always be a need to console and practically help people living with HIV as they grapple with a lot of uncertainties and declining physical health as the disease progresses. The experience in Zambia is that when people are in their ‘terminal’ stages of the disease, they are shunted to their extended family for care. It is my hypothesis that evangelical churches in Zambia can walk alongside people living with HIV by giving consolation and practical home-based care.
Fourthly, pastoral care, which is germane to the needs of people living with HIV, should not be ashamed of the belief in the afterlife. Evangelical belief in the afterlife is about hope. This hope has two implications. First, it is a belief in the “final hope” (Yancey 1990:213) that is, the hope of the resurrection. Yancey (1990:245) puts it this way: “For the person who suffers, Christianity offers one last contribution, the most important contribution of all….The resurrection and its victory over death brought a decisive new word to the vocabulary of pain and suffering: temporary.” He points to the afterlife when the pain and sufferings of people living with HIV will be no more. The Bible is unequivocal about such a day. Secondly, faith in the afterlife for a Christian, means that something good lies ahead. People living with HIV need constant encouragement to have hope for a better day. This is not the same as optimism or wishful thinking. It is about faith in God’s compassion towards all people in trouble/suffering (cf. Ps 46:1 and 2 Cor 1:3-11). Paul says that hope is an expression of faith in God’s faithfulness (cf. Rom 8:24-25). Christians believe that no matter how bleak things look at present something good does really lie ahead. Therefore, the pastoral carer should not be embarrassed to lead people living with HIV to a place where they too can own the assurance of a better day in the afterlife through faith in the Lord Jesus Christ. This hope is about a day when HIV and AIDS will be no more. Scripture’s statement on the matter of hope should be used to inspire people living with HIV to hope for God’s final day. Paul describes this hope in glorious terms when he writes: “…our citizenship is in heaven. And we eagerly await a Saviour from there, the Lord Jesus Christ, who, by the power that enables him to bring everything under his control, will transform our lowly bodies so that they will be like his glorious body” (Phil 3:20-21). Even a body with HIV (here on earth) will be transformed to be like that of the Lord Jesus Christ—There will be no HI viruses in the afterlife. People living with HIV can live positively in the light of this anticipation. This hope is an implication of the Lord Jesus’ resurrection from the dead (cf. 1 Cor 15:51-55).
This paper has argued for the position that pastoral care is the best approach which adequately and meaningfully deals with the predicament of people affected with HIV and AIDS. I have also posited that pastoral care of people living with HIV be performed by both clergy and laity. The paper has demonstrated that a crucial element of the ‘professional’ pastor’s care is to equip members of the community of faith to be carers of people living with or personally affected by HIV and AIDS. Issuing from the foregoing I will summarize, in conclusion, the key findings of this paper.
First, pastoral care and counselling (cura animarum, ‘cure of the soul’), is a classical expression for pastoral work, designating the special process of caring for human life because God created it and all people are His. People living with HIV belong to God and they too must receive pastoral care. Second, the pastoral care task has shifted from the ‘professional’ pastor to the mutual care of believers (koinonia). This mutuality of care in the church family will entail relationship building (counsellor-client) where the counsellor will facilitate the client’s faith development. The mutually beneficial relationship will not only aim at faith development in the counselee, but will also facilitate the improvement of the counselee’s “capacity and ability to cope with and manage … presenting problems in order to enable [him or her] live a more personally satisfying life” (Haworth et al. 2001:3) in spite of an HIV-positive status. Third, the shift of pastoral counselling from the professional counselling room to the faith community is very significant for African pastoral care of people living with HIV. It creates a vital link between koinonia care and the community and the extended family care. Christians are encouraged in Scripture to care for one another through fellowship (koinonia). It has been shown above that pastoral care in an African setting is arguably the only structure that can replace the extended family if it collapses or is strained since the two share similar traits. Fourth and finally, pastoral care is uniquely able to address the plight of people living with HIV in Zambia as the community of faith is a viable means for providing this much needed dimension of care to people living with HIV (Cf. Richardson 2006).
- Adams, JE 1976. Competent to Counsel. Presbyterian & Reformed Publishing: New Jersey.
- Chirwa, V 2005 ‘The Need for Counseling As A Major in the Pastor’s Scope of ministry and Theological Education in Malawi in Light of HIV/Aids’ in The South African Baptist Journal of Theology Vol. 14, pp 82-99.
- Couture, PD & Hunter, RJ (Eds.) 1995. Pastoral Care and Social Conflict, Abingdon Press: Nashville.
- Crabb, LJ 1979. Effective Biblical Counseling. Baker books: Grand Rapids, Michigan.
- Dube, MW (Ed) 2003a. HIV/AIDS and the Curriculum: Methods of Integrating HIV/AIDS in Theological Programmes. World Council of Churches Publications: Geneva.
- ——- (Ed) 2003b. Africa Praying: A Handbook on HIV/AIDS Sensitive Sermons Guidelines and Liturgy. World Council of Churches Publications: Geneva.
- Gennrich, D 2004. The Church in an HIV+ World: A Practical Handbook, Cluster Publication: Pietermaritzburg.
- Gerkin, C V 1997. An Introduction to Pastoral Care. Abingdon Press: Nashville.
- Haworth, A, Chiboola, H & Kwapa, P (Editors) 2001. HIV/AIDS Counselling: A Generic Training Manual, Zambian Ministry of Health: Lusaka.
- Hunter, RJ 1996. Dictionary of Pastoral Care & Counseling. Abingdon Press: Nashville.
- Louw, DJ November 2006. “The HIV Pandemic from the Perspective of a Theologia Resurrectionis: Resurrection Hope as a Pastoral Critique on the Punishment and Stigma Paradigm” in the Journal of Theology for Southern Africa, Number 126, pages 100-114.
- ———-November 1997. “Pastoral Care in an African Context: A Systematic Model and Contextual Approach” in Missionalia Volume 25 No. 3, pages 392-407.
- Magezi, V/Louw, D July 2006. ‘Congregational Home-Based Pastoral Care: Merging the African Family and Church Family Systems for Effective HIV Ministry.’ Journal of Theology for Southern Africa, Vol. 1 Issue # 125, pp 64-79 .
- Magezi, V Dec 2005. ‘Life beyond Infection: Home-based Pastoral care to people with HIV-positive status within a context of poverty.’ Unpublished Dth Dissertation, University of Stellenbosch.
- Maldonado, JE (Ed) 1990. Guide to HIV/AIDS Pastoral Counseling. World Council of Churches: Geneva.
- Marshall, JL 1995. Pastoral Care with Congregations in Social Stress in Couture, PD & Hunter, RJ (Eds) 1995. Pastoral Care & Social Conflict. Abingdon Press: Nashville.
- Marshall, M & Taylor, N 2006. “Tackling HIV and AIDS with faith-based communities: Learning from attitudes on gender relations and sexual rights within local evangelical churches in Burkina Faso, Zimbabwe, and South Africa” in Gender & Development Vol. 14, No. 3, November 2006, Oxfam GB.
- Meier, PD, Minirth, FB, Wichern, FB & Ratcliff, DE 1991. Introduction to Psychology and Counseling: Christian Perspectives and Applications 2nd Edition. Baker Book House: Michigan.
- Minirth, F 2003. The Minirth Guide for Christian Counselors. Broadman & Holman: Nashville.
- Müller, JC 1999. Companions on the Journey: The Art of Narrative Counseling. Logos Books (www.logos-sa.com).
- ——–1997. Intercultural Exchange: A Discovery of Being Different. In Intercultural Pastoral Care and Counseling. No. 2, pages 4-8.
- Müller, JC & Stone, HW 1998. Intercultural Pastoral Care and Counseling: Resources from Narrative Therapy and Brief Pastoral Counseling. In Skrif en Kerk, Jaargang. 19(2), pages 325-341.
- Müller, JC & Van Deventer, W 1998. African Cosmology and Pastoral Family Therapy. In Missionalia August 1998 Volume 26 No. 2 pages 260-271.
- Richardson, Neville July 2006. ‘A Call for Care: HIV/AIDS Challenges the Church’ Journal of Theology for Southern Africa, Vol. 1 Issue # 125, pp 38-50.
- Van Dyk, Alta 2005. HIVAids Care & Counselling: A Multidisciplinary Approach 3rd Edition. Maskew Miller Longman: Cape Town.
- Vine WE 1996. Vine’s Complete Expository Dictionary of Old and New Testament Words. Thomas Nelson Inc.: Nashville.
- White, P1998. The Effective Pastor: Get the Tools to Upgrade Your Ministry. Christian Focus Publications: Ross-Shire.
- Yancey, P 1990. Where is God When It Hurts? A Comforting, Healing Guide for Copping With Hard Times. Zondervan, Grand Rapids, Michigan.
 This paper represents, with slight modification, a chapter of the writer’s recent book Empowering Church-Based Communities for Home-Based Care: A Pastoral Response to HIV/AIDS in Zambia (Saarbrücken, Germany: VDM Verlag Dr. Müller Aktiengesellschaft & Co. KG, 2009). The book is an outworking of an MA dissertation submitted to the University of Pretoria for the Degree of MA in Practical Theology.
 This approach is based on the premise that when pastoral care does not transform the counsellee’s worldview it will not be effective. The counselee will see it as an intrusion in his/her way of life and will resent and reject it as irrelevant.
 This does not mean to say that I am urging Christians in Zambia to have fellowship with their departed, Christian or non-Christian. Even in harnessing the strengths of an African concept described by Mtetwa care must be taken that African Christians do not revert to ancestral worship.
 Adams (1976) terms this method of counselling as nouthetic counselling (from the Greek word noutheteo, to admonish, warn, instruct). He out-rightly condemns psychological counselling as an enemy of the Bible.
 Syncretism is an admixture of paganism and Christianity resulting in inauthentic (anti-biblical) Christianity.
 This is not to say people living with HIV got infected because they are not born again, but rather to stress the biblical teaching that salvation is about having eternal life after death (cf. John 3:16; 5:24; 1 John 5: 11-12; etc) through faith in the propitiatory work of our Lord Jesus Christ, which is a central tenet of evangelicalism. This point also assumes that the pastoral carer is helping an HIV positive individual who at the beginning of the relationship is not a Christian.
 Chirwa’s (2005) findings of the lack of emphasis on HIV and AIDS counselling training in ministerial and theological colleges in Malawi agrees with the situation in Zambia where pastors-in-training have little or no training in HIV and AIDS. The researcher’s first formal theological training in Zambia had little emphasis on HIV and AIDS counselling. The researcher’s class was merely given a two-day HIV and AIDS awareness seminar and yet one of the pressing pastoral challenges in the researcher’s country and sub-region is tackling the HIV/AIDS epidemic. Parry (2005:61) in a mapping study on ‘the responses of Churches to HIV/AIDS in South Africa,’ found that much of the apathy among evangelical Christians in south Africa was due to lack of pastoral leadership. She pointed out;
“The major problem seems to lie with the Pastors, who lack a theological perspective on HIV and AIDS, as they concentrate their efforts on evangelism. Many still believe that HIV/AIDS is retribution for sins committed. It is acknowledged that Pastors can play a critical role in changing people’s perspectives, and need to be well engaged and positively interactive with PLWHA…Others receive only a one-day course on HIV/AIDS ….Affluent Churches tend to do more, not only because of the additional resources but because they have the supportive infrastructure. There are few support groups for PLWHA” (Parry 2005:61).
This apathetic posture from evangelical pastors in South Africa is not so different from their counterparts in Zambia. It is the opinion of the researcher that it wouldn’t be farfetched to claim that Parry’s (2005) observation is valid for all evangelicals in the Southern African sub-region. We need to change.
 Müller (1999:1) describes narrative counselling as a journey of equal companions—counsellor and counselee. He writes, “Life is a journey. If you are alive, you have departed and you are on a journey…. We journey both separately and collectively. We come from somewhere and we are on our way to somewhere. We have a past and a future and with our stories we try to link these two—our past and our future—with each other.”