Abstract
This article aims to trace the history of hiv/aids in Central America, with particular attention to El Salvador. Its first section presents a periodization that details the evolution of the response and understanding of the region in the social context. The second section focuses on a detailed periodization of how faith communities reacted to the presence of hiv/aids, especially highlighting their responses to the affected people. The third section of the article provides a biblical, theological, and pastoral perspective from the early days to the current response of faith communities to hiv/aids.
Introduction
The emergence of contextual theologies takes place in a historical moment for the Christian tradition. On one hand, it is the result of several decades reflecting on divinity far from the traditional spaces for this purpose, convents, seminaries, bishop’s offices, and some synod or council, predominantly carried out by men of hierarchy, usually in Europe. The theology that emerges from these spaces reiterates the central social and political precepts, maintaining the inequality that prevails because religion, in a general sense, was instrumentalized to maintain hegemonic systems.
According to the perspective of María Lugones (2008), the social system rooted in the West—under European influence—has engendered two fundamental categories for perpetuating social control: gender and race. These constructions proved extremely useful during the colonial era—which began in the sixteenth century in Latin America—and have left an indelible mark on contemporary societies, where inequality is a constant in all interactions. The relationship between men and women, in particular, reflects this dynamic, placing the latter in a subordinate position. At the same time, the fictitious notion of race also plays a fundamental role in class relations. In Latin America, race and class are intrinsically intertwined, further exacerbating social disparities and consolidating a complex web of inequalities that persists today.
From the point of view of Desmond Tutu (2012), who reflects on racial exclusion in South Africa, theologies that bend to colonial projects are questioned. Tutu points out that behind the great doctrines, traditions, liturgies, and theological discourses lies a project of exploitation, exclusion, and abuse. In this sense, he radically advocates that theology should start from the losers of history, those who have inherited the precariousness created by the masters of the system and sanctified by the Christian churches. According to Tutu, these disqualify the communities’ experiences and numb them. Instead, he proposes a theological perspective rooted in the experience of the oppressed, challenging the orthodoxy that perpetuates unequal power structures. By acknowledging and dignifying the narratives of the marginalized, Tutu seeks to unravel the webs of oppression in theology, thereby promoting a more inclusive and just vision.
Racial, social, and gender barriers have had a profound impact on the response of governments and global social and religious organizations to hiv.
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That complex web of discrimination has had significant consequences on scientific development and the implementation of humanitarian policies. Joseph A. Edelheit (2004) highlights how these barriers have influenced the perception and approach to hiv, underlining the need to overcome these limitations to achieve significant advances in prevention, treatment, and support for affected communities: HIV/AIDS continues to demand that we not become distracted by boundaries of any kind—racial, ideological, socioeconomic, or cultural. We have already faced several challenges in which our “global” perspective on medicine, treatment, and prevention has demanded that we look beyond local answers. (p. 502)
Identifying and understanding these barriers is critical to forging inclusive and effective responses to the spread of hiv. This is of particular interest since these barriers affect legal issues that put people’s lives at risk: In many countries, the law (either on the books or on the streets) dehumanizes many of those at highest risk for HIV: sex workers, transgender people, men who have sex with men (MSM), people who use drugs, prisoners and migrants. Rather than providing protection, the law renders these “key populations” all the more vulnerable to HIV. Contradictory to international human rights standards, 78 countries—particularly governments influenced by conservative interpretations of religion—make same-sex activity a criminal offense, with penalties ranging from whipping to execution. Similarly, laws prohibiting—or interpreted by police or courts as prohibiting—gender nonconformity, defined vaguely and broadly, are often cruelly enforced. (Global Commission on HIV and the Law, 2012: 8)
However, theological liberation, as a path toward equity, finds its roots in diverse communities: Indigenous peoples, those in human mobility, racialized populations, women, and LGBTIQ+ people, among others. This approach recognizes the intersectionality of inequalities and seeks to address the complex dimensions contributing to vulnerability to hiv. By understanding and addressing these barriers from a theological perspective, more holistic and social justice-focused strategies can be developed to address the impact of hiv on diverse communities. Specifically, communities representing gender and sexual diversity face resistance, even from progressive or liberationist theologians. Their space for theological reflection is centered on sexuality, an area subject to a mechanism of social control. Traditional constructions of sexuality, according to Marcella Althaus-Reid (2019), implant guilt, thus facilitating control over bodies. Thus, the author argues that theology should advocate for the liberation of impoverished peoples, communities, and politics and the emancipation of sexuality. The call implies challenging and overcoming the oppressive norms that have permeated traditional theological conceptions, making way for a liberating and respectful perspective of gender diversity.
The theological liberation of sexuality emerges as a substantial challenge, as communities often lack the mental and emotional resources necessary to address it with due rigor and academic, theological, and Christian health. In the complex dialogue between LGBTIQ+ communities and Christianity, a marked duality is evident. Some sectors insist on reaffirming conventional sexual moralities, while others adopt attitudes of mockery and resentment. The duality contributes to polarization and highlights the urgent need for a theological liberation of sexuality. Neither approach facilitates meaningful reflections or contributes to the constructive dialogue necessary for a deeper and more compassionate understanding. The need for a theological liberation of sexuality manifests itself as urgent, requiring an approach that promotes mutual understanding, empathy, and inclusion, overcoming the barriers that have hindered convergence between LGBTIQ+ communities and Christian teachings. This process involves both an intellectual and emotional commitment to fostering a space where gender diversity is addressed with respect and openness.
The impact of hiv on the LGBTIQ+ community has been substantial, raising questions about the role of theology in eliminating stigma, blame, and discrimination toward those living with hiv. Such a context presents itself as a strategic terrain for dignifying sexuality itself. It is essential to address the suffering experienced by people affected by hiv and their affective and social environment. In this sense, we propose an interpretation of the book of Job that serves as a mirror for our community, reflecting on how we face the fight against hiv and achieve significant progress. Job’s narrative, with its exploration of suffering, resilience, and search for meaning, can offer valuable insights to address the challenges posed by hiv in the context of the LGBTIQ+ community.
Therefore, this article aims to trace the history of hiv/aids in Central America, with a particular focus on El Salvador. Its first part provides a periodization that illustrates the evolution of the response and understanding of the region in the social context. The second part focuses on a detailed periodization of how faith communities reacted to the presence of hiv/aids, especially highlighting their responses to those affected. The third part of the article offers a biblical, theological, and pastoral perspective from the early days to the current response of faith communities to hiv/aids.
Archeology of the presence of hiv/aids in Central America and El Salvador
One factor that has greatly affected the development of a non-traditional understanding of sexuality from the LGBTIQ+ communities is the hiv epidemic. The arrival of hiv on the global stage occurred 40 years ago, mainly affecting gay men, trans women, and female sex workers.
In the early years of the pandemic, arguments were even made about the possibility that the virus had been a human creation aimed at depleting specific populations (Cantwell, 1993). Although this was never scientifically proven, what was perceived from the beginning is how, through fear, stigma, and discrimination, hiv was used as a tool of hegemonic systems to impose necropolitics. The notion of “necropolitics” was proposed theoretically by the historian and political theorist Achille Mbembe (2011). Based on his contribution, we observe how this necropolitical perspective was reproduced in scenarios of health conditions. Thus, initially, hiv was called “the 5H disease” because the scientific community associated the infection with five populations: Men, 2 Homosexuals, Hemophiliacs, Heroin-dependent, and Haitians, with a highly stigmatizing burden.
Eventually, hiv was categorized as “gay cancer,” and this sector of the population began a heroic struggle because the epidemic added a new discriminatory charge. Conservative sectors quickly claimed the virus was “God’s punishment” toward gays. Even this burden of guilt invades gay communities, which internally coined moralizing speeches and, worse, attitudes of contempt and rejection toward those living with hiv. The conservative discourse of sexuality as “dirty,” “indecent,” and “sinful” has been revalidated.
Returning to this past does not mean doing it simplistically. Still, we do it with a conviction to recover memories and to do it not only conscious of the pain that this past has but also as a way to reconcile ourselves with it, as Christopher Castiglia and Christopher Reed (2012) state, Faced with the too-frequently disheartening history of AIDS and its cultural aftershocks, we have drawn from these critics a confirmation of memory’s power to exhilarate and empower. We want, however, to acknowledge that although memory can help us create better presents, it cannot be expected to eliminate the sorrows and losses of the past, which must remain part of our memories. Memory is neither clean nor comforting, but is messy business, and never more so than when our efforts to “feel backward,” as Heather Love persuasively demonstrates, produce ambivalence, uncertainty, and impatience alongside admiration, clarity, and joy. We must reckon with the past as well as reconcile and commune with it. (p. 25)
However, we still owe much to Latin American historiography that rescues the memory of the suffering and spiritual testimony of people in Latin America who went through the first decades since the appearance of hiv, such as the case of the Brazilian Methodist pastor Ernesto Barros Cardoso (Sentiido, 2020), among others. Regarding this issue, Kyle D. Desrosiers (2020) states, Though it is true that many HIV-positive people and activists argue that the status quo of religious doctrines inspired governmental inaction in AIDS research and treatment, HIV also represents a personal spiritual crisis for those who live with the virus. These folks have navigated questions about what it means to be stigmatized as a sexual “other,” to be queer (LGBTQ+) or marginalized as a sex worker or drug user, and how to exist in a society that does not support their full human dignity. These questions of life, value, and meaning are inextricably linked to religion and worldview. Living with HIV also frequently necessitates the examination of questions of health, mortality, and living a meaningful life. Indeed, the treatment of HIV-positive people—politically, socially, and by religious doctrines and religious leaders—represents a continued injustice all compassionate citizens must reckon with. Those living with HIV or acquired immunodeficiency syndrome (AIDS) continue to experience legal and social disparities, physical health issues, and identity-related collective trauma. It is in this context, that the experiences, beliefs, and opinions of those living with HIV/AIDS should be understood. (pp. 2–3)
Along the same lines, the theological upholding of sexuality obliges the dignification of people living with hiv and the appropriation of the integral response to the epidemic with total seriousness and academic rigor. The current realities of hiv are a thousand times more favorable than 40 years ago. The positive diagnosis is no longer a death sentence because the drugs are highly developed, and with few or no adverse effects, it is possible to keep people with undetectable viral load, which means that it cannot be transmitted, their defenses are not decimated, and survival is among the highest. Nowadays, there are also prevention mechanisms, such as condoms and the development of pre-exposure prophylaxis—usually known as PREP—which practically immunizes you against the virus.
The goals set by the authorities in terms of health and comprehensive response to hiv are to achieve that 90% of people living with hiv know their diagnosis, that 90% of these are adherent to treatment, and that 90 perfect of adherents have an undetectable viral load. Those current points represent health relief for millions of people, but it has not been easy to get there, and it is still challenging to fight stigma and discrimination as well as guilt and shame in people.
The hiv/aids epidemic has left a deep mark in Central America, with El Salvador being one of the most affected countries. Since the first cases were identified in the 1980s, the region has faced significant challenges in understanding and managing the disease. Over the decades, there has been a complex evolution in the strategies implemented to address this public health crisis.
In response to the spread of hiv, various strategies have been implemented, evolving into a more comprehensive approach. These strategies not only focus on hiv/aids prevention and treatment but also include psychosocial support measures and educational programs. Awareness and education play a crucial role in the fight against the spread of the virus, seeking to reduce the stigma associated with hiv/aids and to encourage safe practices.
Despite these efforts, challenges remain, such as equitable access to health services and eliminating cultural barriers. However, continued commitment to comprehensive approaches and collaboration between governments, organizations, and communities is critical to addressing this complex reality and moving toward a future with a lower incidence of hiv/aids in Central America, especially in El Salvador.
The periodization of the emergence and expansion of hiv/aids in Central America, with particular attention to El Salvador, reveals a complex evolution. Since 1984, the first cases generated stigma and lack of understanding, especially in El Salvador, where the limited health infrastructure aggravated the situation (Aguilar and Alas, 2018). During the following years, comprehensive strategies focused on prevention, treatment, and awareness were implemented, but persistent challenges, such as unequal access to care, continued to mark the period. Collaboration and education became crucial elements in the last stage, outlining a path toward a more effective management of the epidemic in the region.
1980–1990: The first cases and the emerging consciousness
In the 1980s, the first cases of hiv/aids in Central America generated deep concern in El Salvador. The lack of understanding of the disease and its transmission contributed to the stigmatization of infected persons, creating significant barriers to prevention and support for those affected. In this context, Salvadoran society faced additional challenges, such as limited health infrastructure and inadequate educational resources.
Stigmatization exacerbated the spread of the virus by discouraging those at risk from seeking information and medical care. In addition, the absence of adequate public education programs contributed to a lack of awareness of safe practices. These factors converged to create an adverse environment in the initial management of the epidemic in El Salvador, marking a crucial decade in the understanding of and response to the threat of hiv/aids in the region.
1990–2000: The expansion of the epidemic and public awareness
In the 1990s, the spread of hiv/aids in Central America prompted an active response focused on public awareness. Governments and non-governmental organizations intensified efforts to educate the population about the disease and its prevention. Educational programs were implemented in schools and communities, addressing the critical need to inform about safe practices and dismantle the stigma associated with hiv.
Awareness-raising became an essential pillar in the fight against the epidemic. Awareness campaigns were promoted in the media, emphasizing the importance of prevention and support for those affected. The 1990s saw a significant change in public perception of hiv/aids, with a concerted effort to demystify the disease and promote empathy.
However, despite these advances, challenges, such as overcoming cultural barriers and improving access to health services, remained. The 1990s marked a crucial period in which public awareness emerged as a vital tool in the fight against hiv/aids, laying the groundwork for more comprehensive approaches in the following decades.
However, stigmatization was uneven across the region. While in some countries, there was more awareness, in others there was less. One factor that confirms this disparity is observed in the migratory phenomena, where the pathologization of migrants brought additional injustices to those already existing in their places of origin. The pathologizing connection between migration and queer people—especially men—was subjectively constructed by considering migrants as social agents particularly prone to the risk of hiv/aids and other sexually transmitted infections as well as their propagation (Kendall and Langer, 2005; Rangel et al., 2008). In this dynamic, fear of risk and vulnerability became control mechanisms, perpetuating stigmatization, and discrimination instead of comprehensively addressing the diversity of gender expressions and sexual orientations. Several countries in the region implemented bans on the entry of immigrants with hiv, even requiring laboratory tests, as was the case in the United States (Fernandez, 1992). Although in some places, this situation has undergone positive changes, in others, the stigma and discrimination associated with people with hiv are still far from being wholly eradicated (Luibhéid, 2008).
2000–2010: Advances in treatment and comprehensive care
The first decade of the twenty-first century, from 2000 to 2010, saw fundamental advances in response to hiv/aids in Central America, marked by remarkable progress in treatment and comprehensive care. The introduction of antiretroviral therapies (ART) marked a paradigm shift, allowing people living with the virus to lead healthier and more productive lives. This innovation not only transformed the quality of life of those affected but also contributed to reducing hiv transmission.
In this decade, treatment programs expanded significantly throughout the region, facilitating free or low-cost access to the necessary therapies. This approach addressed individual health and played a crucial role in prevention by reducing the viral load and, thus, the likelihood of transmission.
In addition, a comprehensive approach was implemented to address the epidemic. Care services were diversified to include hiv testing, counseling, medical care, and psychological support. The importance of addressing the specific needs of high-risk groups, such as people who inject drugs, was recognized. Harm reduction programs were established not only as a public health measure but also as a means to promote inclusion and personalized care.
Throughout this decade, the pivotal collaboration among governments, non-governmental organizations, and communities played a vital role. Despite persisting challenges like enhancing access in rural areas and eradicating stigma, progress in treatment and comprehensive care established a solid foundation for the more efficient management of hiv/aids in Central America. That, in turn, has contributed significantly to enhancing the quality of life for those affected.
2010 to the present: Reducing transmission and improving quality of life
In the last decade, from 2010 to the present, Central America, including El Salvador, has experienced a notable decrease in hiv/aids transmission rates, resulting from a comprehensive strategy encompassing prevention, treatment, and continuing education. One of the most successful initiatives has been implementing specific measures to prevent mother-to-child transmission, which has contributed significantly to reducing new infections and strengthening the health of mothers and newborns.
Efforts have intensified to reach key populations, such as sex workers and people who inject drugs, with prevention and treatment services tailored to their specific needs. Based on understanding the unique transmission dynamics within these high-risk groups, this approach has been crucial in addressing the epidemic’s roots and improving the effectiveness of interventions.
Comprehensive care for people living with hiv/aids has become a central priority in response to the epidemic. Programs focus on medical treatment and critical aspects such as psychosocial support, improving quality of life, and reducing stigma and discrimination. Including services that address affected individuals’ emotional and social well-being is essential to address the holistic challenges associated with the disease.
Despite these advances, challenges remain, including addressing socioeconomic barriers and ensuring equitable access to health services in all communities. The positive trend reflects a continued commitment to comprehensive approaches and effective collaboration between governments, organizations, and communities, laying the foundation for a healthier and more resilient future in the face of hiv/aids in Central America and, specifically, in El Salvador (Aguilar and Alas, 2018).
Continuing challenges and the future
Despite notable progress in the fight against hiv/aids in Central America, including El Salvador, significant challenges that require continued attention remain. Lack of access to health services, especially in rural areas, remains a considerable obstacle. Disparities in resource distribution and limited infrastructure make accessing needed testing, treatment, and support services complex for some communities.
In addition, discrimination and stigma continue to be significant barriers. Although programs have been implemented to reduce these problems, the persistence of negative attitudes toward people affected by hiv/aids makes it difficult for them to seek early testing and treatment. This involves individual health and contributes to the spread of the virus by discouraging disclosure and adherence to prevention and treatment programs.
The future of the response to hiv/aids in Central America depends on a continuous and coordinated approach involving governments, non-governmental organizations, and society as a whole. Public education will continue to be essential to increase awareness of safe practices and the importance of regular testing. Equitable access to health services, especially in remote areas, must be a priority to ensure that all people, regardless of their geographic location, have access to needed care.
Reducing stigma and discrimination will continue to be a crucial task. That involves awareness campaigns and cultural and educational changes to foster understanding and empathy for those affected by hiv/aids. Building a caring and compassionate society is essential to creating an environment where people feel safe to seek help and treatment.
In conclusion, despite persistent challenges, the combination of comprehensive approaches, continuing education, and coordinated efforts offer hope for a future in which the incidence of hiv/aids will further decrease, improving the quality of life of those affected in Central America and specifically in El Salvador.
A positive theology is possible and necessary
The theological and pastoral response to hiv/aids in Latin America has been a complex process that has evolved over the decades. From the early days of the epidemic to the present, religious communities, along with theological and pastoral leadership, have faced the challenge of addressing ethical, moral, and social issues related to hiv/aids. Two decades ago, Paula Clifford (2004) stated, It was probably this sea-change in many churches that greatly increased the demand for a theological approach that could help them make sense of the complexity of HIV/AIDS. In many countries, for over a decade the church has been at the forefront of home-care provision and health services for people affected by HIV. In addition, there is the emotional and spiritual support offered by many Christian congregations. People involved in such activities, as well as the individuals and families who are infected or affected by HIV, need some kind of theological framework within which to do their work and live their lives. (p. 3)
However, this response in Latin America emerged very gradually. Initially, the lack of understanding about the disease and its transmission routes contributed to the stigmatization of those affected, raising ethical questions in religious communities about how to approach and support those living with hiv. As the epidemic progressed, theological debates about sexuality, morality, and compassion in the context of hiv/aids emerged.
Over time, many religious communities have adopted more sympathetic and compassionate approaches, recognizing the importance of prevention, education, and support for those affected (Paterson, 2005). Some theological leaders have advocated a message of inclusion and solidarity, seeking to eliminate the stigma associated with hiv/aids. This process of theological evolution highlights the need to adapt to changing scientific and social understanding, demonstrating the capacity of religious communities to be positive agents in the global response to hiv/aids.
Periodizing the theological–pastoral response
The following is an overview of the evolution of the theological and pastoral approach to hiv in Latin America. From the epidemic’s early days until today, religious communities have faced ethical and moral questions, evolving toward more compassionate and sympathetic approaches. The theological response has moved from initial stigmatization to inclusion and support, reflecting an adaptation to the changing scientific and social understanding of hiv/aids.
1980–1990: Ignorance and stigma
In the early decades of the hiv epidemic, spanning the 1980s and 1990s, a lack of knowledge about the disease led to severe stigmatization of people living with hiv/aids. In the context of many religious communities in Latin America, hiv/aids were perceived in terms of sin and divine punishment, generating an atmosphere of fear and discrimination.
This period was marked by widespread ignorance about the routes of hiv transmission and the erroneous perception that the disease was linked exclusively to behaviors considered immoral. In this context, people living with hiv/aids faced social and religious stigma, resulting in their marginalization and exclusion. Religious communities, in many cases, grappled with the duality of offering compassion and, at the same time, reinforcing negative attitudes associated with hiv. In this regard, Denise Ackermann (2005) stated, In the Aids pandemic, communities of faith, indeed all people of faith, are facing a kairos, a moment of truth and crisis, a time for change and decisive action. [. . .] The questions are so daunting that our natural human reaction is to recoil or become numb, and to resort to inaction since dealing with the challenges appears to be beyond our capacity. But inaction is no choice for people of faith. We are not required to perform the impossible. We are simply asked, metaphorically speaking, to be God’s hands of compassion in the midst of the present crisis in our country. We can start by countering the deplorable effects of stigma, because there is no place for stigma in fulfilling God’s reign on earth. (pp. 387–388)
This initial phase reflects the religious communities’ need for more education and understanding to overcome misperceptions and foster a more compassionate approach to those affected: The inclusive and caring witness of communities of faith in these times needs compassionate and wise women and men whose actions are marked by a repudiation of all forms of stigma, as well as by imagination, perseverance, a concern for justice, courage to put their bodies on the line and fidelity to the teachings of the One who showed us the way. (Ackermann, 2005: 395)
Although Ackermann initially focused on the hiv situation in Africa, it is essential to note that the evolution of the theological and pastoral approach to hiv in Latin America also gradually developed. That process was characterized by the progressive overcoming of ignorance and the reduced stigma associated with this disease in terms of “divine punishment” or “sin.” In the Central American region, there was a slow but steady transformation in the understanding of hiv, accompanied by significant efforts to raise awareness, promote education and reduce discrimination within faith communities. Even so, remnants of this stage can still be perceived in various conservative religious sectors even today.
1990–2000: Awareness and pastoral response
In the transition of the 1990s, as an understanding of the nature of hiv/aids advanced, faith-based organizations responded with a significant shift toward greater awareness and a more compassionate pastoral response. This period marked a move away from initial stigmatization, and many churches began to offer emotional and spiritual support to people living with hiv/aids and their families.
The pastoral response focused on providing comfort and understanding, recognizing that hiv/aids affects not only the body but also the spirit and interpersonal relationships. Churches became places of refuge, where people living with hiv/aids found emotional and community support, counteracting previous marginalization.
Simultaneously, educational campaigns were implemented to combat the ignorance and stigma associated with hiv/aids. These initiatives sought to demystify the disease, provide accurate information about its transmission, and prevent discriminatory attitudes. The more profound understanding of the disease in this period contributed to religious communities’ more informed and empathetic approach, laying the groundwork for a more comprehensive response in subsequent decades.
2000–2010: Active involvement and integral support
The first decade of the twenty-first century saw a remarkable shift in the role of religious communities in response to hiv/aids in Latin America. Many churches intensified their involvement, taking a more proactive approach to prevention, supporting people living with hiv/aids, and promoting access to care and treatment. Archbishop Njongonkulu Ndungane (2005) expressed himself in this regard as follows: We need academic theologians to help us sift through scripture and tradition, sensitive to culture and context, aware of the best in contemporary scholarship. We must tease out what will best guide our lives today, incorporate it in our training, and communicate it clearly in ways that help people live their lives. We must challenge society, governments and the world! (p. 384)
Thus, rather than merely offering spiritual and emotional support, churches became active agents in the fight against the epidemic. Educational programs were conducted within religious communities to demystify the disease and promote safe practices. In addition, collaborative partnerships were established between faith-based and health organizations to address the epidemic holistically, recognizing collaboration’s importance in providing prevention and treatment services.
This change in dynamics reflects a continuing evolution in the theological and pastoral response to hiv/aids, marking a period in which religious communities not only offered comfort and understanding but also became active partners in the search for practical and compassionate solutions to the complexity of the epidemic.
2010 to the present: Inclusion and holistic approach
The last decade has seen a significant shift toward a more holistic approach in the theological and pastoral response to hiv/aids in Latin America. Religious communities have taken the lead in promoting inclusion and non-discrimination of people affected by hiv/aids, marking an essential shift from initial stigmatization.
Support programs have been established that encompass medical services, counseling, education, and emotional and spiritual support, recognizing that the impact of hiv/aids is not limited to the medical realm but affects the whole human being. Churches have become centers that offer spiritual comfort and tangible resources to improve the quality of life of those involved.
In addition, there has been a growing recognition of the importance of addressing the underlying causes of hiv/aids. Religious communities have broadened their focus to combat poverty, promote education, and pursue gender equality. This shift toward a broader perspective reflects a deeper understanding of the complexities surrounding hiv/aids. It highlights the crucial role of religious communities in addressing both the symptoms and the roots of the problem (Rocha and Galarza, 2012).
Hiv/aids, suffering, and redemption
In this section, we explore the book of Job in the Hebrew Bible as a horizon of meaning concerning the theme of suffering, divine presence, and action. The book of Job, placed in the context of sapiential literature, presents the story of a righteous man facing a series of extreme sufferings. This story addresses the philosophical questions inherent in evil and suffering and raises questions about the nature of faith and divine justice. Job’s experience serves as a theological reflection on how people find meaning and comfort amid suffering, offering a unique perspective within the Judeo–Christian tradition.
In a second moment, we will connect Job’s experience and those living with hiv/aids. Both contexts involve facing adversity and questioning one’s relationship with the divine amid affliction. Job’s narrative provides a framework for reflecting on resilience, faith, and the search for meaning in situations of suffering, bridging ancient and contemporary experiences in the context of the hiv/aids epidemic.
The Sitz im Leben of the book of Job
The Book of Job is an ancient biblical text whose authorship and exact date of writing are debated among scholars, but it is generally placed between 600–300 BCE (MacKenzie, 1971). The book is poetry and tells the story of Job, a righteous man undergoing extreme suffering.
The context in which the Book of Job was written is relevant to understanding its meaning and purpose. The text is situated within the literary and theological context of the Hebrew Bible, specifically within the category of sapiential literature, which focuses on wisdom and reflection on life. The story of Job is a profound exploration of human suffering, divine justice and the nature of faith amid adversity. At the same time, biblical scholars note parallels between the themes of the book of Job and Egyptian and Babylonian wisdom literature and a marked dependence on the book of Jeremiah (MacKenzie, 1971).
Historically, the Book of Job reflects the philosophical concerns and questions that arose in the ancient Near East about the problem of evil and suffering. The story also falls within the Hebrew tradition, providing a unique perspective on the relationship between man and God, divine justice, and the human response to adversity. It is important to note that Job’s suffering is not presented anywhere in the book as “divine punishment.” In this regard, Roderick Andrew Francis MacKenzie (1971) states, The book is full of paradoxes, for it tries to approach the divine truth, unavailable to man, from various points of view. For the lesson to be taught, it is essential that Job genuinely love God, that he be a saint. Otherwise, his afflictions would have a certain proportion of just punishment. Moreover, only a man like him would be capable of enduring such a trial. (pp. 450–451)
The book of Job has been the subject of theological and philosophical interpretation over the centuries, influencing various currents of religious and philosophical thought. Its message of patience, faith, and understanding of the divine will has left a lasting mark on the Judeo–Christian tradition. However, some Christian interpretations may deviate from these axes and present suffering as divine punishment or a virtue. Neither interpretation is inherent in the message or Sitz im Leben of the Book of Job.
Finally, it is crucial to highlight that Job’s three friends, Eliphaz, Bildad, and Zophar, embody the “classical” theology of the time in contrast to Job’s perspective, representing a distinctive approach to suffering. Incorporating the contribution of Michel Foucault through the concept of “heterotopia,” Gerald O. West (2016) proposes a “heterotopic hermeneutic.” Through this approach, participants in his Bible study groups established a transtemporal connection to Job’s approach. In this context, West (2016) relates, [. . .] the biblical text offered participants images and metaphors that contributed toward a vocabulary through which to to talk about their trauma. Job’s trauma, so vividly articulated, also validated their incipient stories. They were not alone. Not only were they validated by others, they were validated by a sacred ancestor in the faith who refused to be silent, who asserted his agency, and who struggled to make sense of his traumatic loss. (p. 222)
This identification of actual people with a biblical character is because the book profoundly marks the difference between the “theoretical” approach of Job’s friends and Job’s “empathetic” approach. In this regard, Sarojini Nadar (2007) states, [. . .] Job and his friends are talking from a theoretical point of view. In other words, their words are exactly that—words! They are not grounded in any concrete experience. Job cannot afford the luxury of fancy words or ideas or theories. He has to find another way to speak about his suffering. He has to find a way of separating himself from the trap of theological language. The only way that he can do this is to insist on his own experience as a valid and legitimate source of God-talk. He cannot talk in theory when his suffering is a reality. When confronting the theological arguments of his friends he moves beyond his own suffering to the suffering of others as well. (p. 128)
Thus, the Book of Job aspires to be a source of knowledge that brings us closer to the reality of situations through experience rather than relying exclusively on theoretical discourse. The “wisdom” that emanates from the biblical message in Job becomes a “counter-site,” a heterotopic space that challenges, subverts, and offers alternatives to the hegemonic visions of hopelessness and necropolitics.
Incarnation in hiv-positive bodies
Due to the Sitz im Leben of the Book of Job, Carlos Osma (2019) revisits the biblical book of Job to unravel new narratives for LGBTIQ+ communities from it. Osma posits that, at the beginning of the book, Job is presented as an ideal character; even as a hegemonic male in every sense, he is the aspirational figure of patriarchal societies. In his process, he suffered the stripping of his benefits and tasted the bitterness many people without hegemonic aspirations live with. That is to say, for LGBTIQ+ communities, it is easier to understand themselves in this stage of the character, and precisely I add that with the arrival of hiv, this can find parallels.
As with Job, misfortune comes as a surprise, so in a time of much LGBTIQ+ activism, hiv appears to bring down the aspirations of generating positive changes in terms of inclusion and visibility. Hiv became our burden and our burden. In the biblical book, we see the development of a character who embraces hardship and stands firm in his faith and his affirmation that these misfortunes are not due to a fault committed. That is the interesting point: how did LGBTIQ+ people of various generations stand firm in affirming that our sexual orientations and gender identities are not a sin? This despite carrying hiv on our backs.
Identifying the body of Christ with the body carrying hiv/aids is profoundly symbolic and has a significant theological and pastoral charge. This connection bridges the gap between the Christian spiritual experience and the tangible and sometimes painful reality of those affected by hiv/aids or even dying from related conditions in places where medicine is not yet available to all people in the twenty-first century. Looking back to the beginning of this century, Ernst M. Conradie (2005) stated in this regard: In a context where millions are dying from AIDS-related disease it may offer comfort to the dying to hope that every life lived will remain before and with God forever. For God, nothing that has happened in history has been lost. Our lives, our pain, the injustices that we suffered, our moments of joy are kept, judged and healed in the presence of God. The challenge for Christian theology in a world where millions are dying is “to give an account of the hope that lives in us” (1 Peter 3: 15)—if indeed this hope may be found to be still alive. (p. 428)
In Christian theology, the “body of Christ” often refers to the Christian community as a whole, with each member playing a vital role in the functioning and well-being of the collective body. Extending this metaphor to the body bearing the burden of hiv/aids suggests a deep solidarity with those who take the effects of the virus. It is a powerful statement that invites empathy, compassion, and service to those who face the physical and emotional challenges of hiv/aids. However, even today, there are still faith communities that emphasize the “immorality” or “sinfulness” of people living with hiv/aids because of their inability to make “moral decisions” (Van Wyngaard, 2006: 33). At the beginning of this century, the World Council of Churches (2004) stated in this regard: [. . .] if sound moral decisions are required of people, an environment conducive to making such decisions is necessary, an environment in which openness to honest sharing of experiences and concerns is promoted and the integrity of people and their relationships is affirmed. Apart from such an environment, the vulnerability of marginalized groups to high-risk behaviour is greatly increased.
This situation shows a lack of empathy and identification with people who suffer. Denouncing this Christian “lack of hospitality” also highlights the importance of recognizing the presence of Christ in people who are marginalized and affected by illness. Rather than distancing ourselves from suffering, our theologies should advocate a direct connection with the Divine, recalling the Christian teaching that whatever is done for the least of the brethren is done for Christ himself (Mt 25: 40). Some studies even suggest that faith, spirituality, prayer, and meditation positively affect the health of people going through illness (Koenig, 2000; Ridge et al., 2008; Thoresen and Harris, 2002; Ventres and Dharamsi, 2013).
From a pastoral perspective, this identification leads to a call to action. The Christian community is challenged to not only offer emotional and spiritual support but also to advocate for justice, equal access to care, and the eradication of the stigma associated with hiv/aids. In short, by identifying the body of Christ with the body carrying hiv/aids, a theological and pastoral foundation is laid for solidarity, compassion, and transformative action in the fight against this disease.
Pastoral care
For 40 years, we have faced the presence of apologists from traditionalist denominations who—like Job’s antagonistic “friends”—attempt to place us in a position of antagonism to God. Even within our communities, we encounter statements such as “I don’t understand how you can be gay and attend a church,” a clear expression of the ancient idea of “curse God and die” (Job 2: 9). As a result of this theological malpractice that produces necro-theologies, there have been regrettable events such as the mass suicide of hundreds of Roman Catholic parishioners in Uganda driven by a “ministry” called Movement for the Restoration of the Ten Commandments of God in the year 2000. The justification for such an atrocious act of ritualistic death was the need “[. . .] within a neo-Platonic, dualistic philosophy and theology as a means of saving their souls from the supposed evil physical prison of the body within an evil world” (Twesigye et al., 2005: 457).
Despite these theological challenges and malpractice, we have remained steadfast in seeking paths of life and divine presence amid our doubts and uncertainties. We have shared our experiences, developed our theologies, and connected with those who—like us—work from a theological perspective that seeks liberation, celebration of diversities, and respect for human dignity in every part of our beings.
Just as our character glimpsed the light at the end of the battle—which failed to overcome him—we also appreciate God’s actual action on our behalf. Similar to the case of Job, we understand that misfortunes are not the work of God but represent the possibility of restitution and divine justice amid situations that threaten our existence. Therefore, we can affirm that the existence and spread of the virus were not God’s actions. Instead, we recognize divine intervention in the first-level treatments, prevention mechanisms, achievement of undetectability, and availability of prophylactic methods. These achievements are, in themselves, the hand of God at work. Despite the attempts of fundamentalist sectors, Christianity, and necropolitics to condemn us by delaying research and reducing investments, every advance has been conquered against all imaginable odds.
The presence of hiv/aids has triggered actions that strengthen community ties, consolidating friendships and family relationships in the fight against this scourge. In this context, what we can call an authentic “sense of community” has emerged, where we protect each other and seek policies and practices that do not increase vulnerability. By embracing those living with hiv, we are challenging the perceptions of an ultra-conservative society that stigmatizes us, placing us in a condition of sin and uncleanness. The real impurity and sin lie in the hate speech of this society, while our caring response demonstrates the value of compassion and unity in the fight against hiv/aids. This sense of community provides practical support and dismantles stigmas, promoting empathy and understanding rather than judgment and discrimination. For example, throughout my pastoral and activist experience, I have witnessed and collaborated in three ways in which this “sense of community” becomes a reality in people’s lives:
Education and awareness: Active commitments to hiv/aids education and awareness have been initiated in many faith communities. Some churches or ministries even hold regular educational sessions where health experts share up-to-date information and demystify misconceptions related to the disease. These talks provide a solid foundation for understanding and eliminating stigmas, promoting an environment of learning and empathy. At the same time, theological institutions have set out to develop educational programs or Bible studies to raise awareness among faith communities on the issue of hiv/aids. An example is the series of educational modules, “HIV and AIDS Curriculum,” produced by the World Council of Churches.
Pastoral support programs: A key element in many faith communities has been implementing pastoral support programs specifically for those affected by hiv/aids and their families. These groups provide a safe and confidential space where members can share their experiences, receive spiritual support, and strengthen community ties. Including hiv/aids in sermons and reflections reinforces the importance of empathy, compassion, and non-discrimination in daily religious practice.
Inclusion in liturgical life: Some faith communities have taken concrete steps to ensure the inclusion of people affected by hiv/aids in their religious services. For example, on 1 December—established in 1988 as World AIDS Day—special events highlight acceptance and unconditional love, where everyone is welcomed without prejudice. In addition, meaningful rituals and liturgies have been introduced, such as specific blessings for people living with hiv/aids and their loved ones, reaffirming the community’s commitment to compassion and mutual support. These practices seek to create an environment where everyone feels valued and supported, regardless of their hiv/aids status.
These initiatives—among many others—promote a deeper awareness and comprehensive understanding within the faith community and contribute to forging an environment where people affected by hiv/aids feel genuinely supported, welcomed, and loved. In this context, the community’s commitment to compassion, empathy, and solidarity, which align with the Christian teaching to love one’s neighbor as oneself, is reinforced.
It is crucial to recognize that the faith community’s approach to those living with hiv/aids reflects a deep theological understanding. The affirmation that God has chosen the weak and suffering resonates with the teaching that, despite adversity, God is a being of love and compassion. It highlights the importance of understanding that God does not delight in suffering but represents the hope of justice and redemption for those facing challenges, including those related to hiv/aids.
The notion that God manifests himself through those living with hiv prompts a call to action in solidarity. The appeal to care for these individuals as divine carriers and to embrace the truth even in the face of fear for one’s health is an act of faith and trust in the community. For those who have not yet faced the reality of their health condition, the message is unconditional support and a promise to leave no one alone in their journey. In this regard, Guillermo Hansen (2013) explains, I would like to suggest the hypothesis that Christianity is precisely the encounter with the “monster,” an inhabiting of what is stigmatized that profoundly questions the ideologies and theologies that always try to cover up what is scandalous, render it ordinary and thus deactivate it. In the theology of the Apostle Paul and of Luther, this inhabiting occurs amid the dynamics of a God whose Word is received both as a demand (Law) and as a promise (Gospel), namely, an approach that deconstructs the stratagems that deny the dignity and integrity of people, and in the same movement opens up a new space to become creatures that are genuinely accepted and “given grace.” (p. 28)
In this perspective, as Christians, we are invited not only to eradicate misinformation and the propagation of myths by fostering an informed understanding of hiv/aids, but also to accept that reality as an encounter with all those who are esteemed. The faith community seeks to challenge ignorance through education and example, allowing God to manifest Himself through each person, not as an agent of pain but as a channel of love and genuine acceptance. Ultimately, this perspective reinforces the belief that God’s manifestation can be found in kindness, compassion, empathy, and respect for those facing the reality of hiv/aids.
Conclusion
The irruption of hiv/aids into the lives of people in Central America, especially in El Salvador, triggered a series of situations, often hostile. Ignorance, linked to a lack of information or training, generated unfortunate circumstances for many people. It has been a significant challenge to go back through that history until we reach this moment, where there are programs, treatments, and information that allow people living with hiv to lead a quality life.
Undoubtedly, theology has actively responded to hiv. Still, it has done so in a way that thanks to divine intervention, it does not imply death’s inevitability but becomes the bearer of hope and the possibility of renewed life. Although in the beginning, and persisting in some sectors of fundamentalist Christianity, there was condemnation and exclusion of people with hiv in some faith communities, many Christian churches have evolved to recognize in these people the image of Jesus.
This evolution has resulted in a pastoral response that tends more and more toward a holistic approach, not only accompanying those affected by hiv but also modifying biblical hermeneutics, liturgical and sacramental life, and spiritual conception. There has been a shift in theological understanding that now sees diversity and the fight against hiv as an authentic expression of the Christian faith. Inclusion and unconditional love are becoming central pillars of many faith communities that seek to reflect the compassion of Jesus.
Despite this progress, much remains to be done. The struggle against stigma and discrimination in some religious spheres persists, and the task of changing entrenched perceptions requires continued commitment. As it evolves, theology must continue challenging and transforming structures perpetuating rejection and exclusion. In addition, it is essential to advocate for continuing education in faith communities, fostering understanding and empathy.
The theological response to hiv/aids has undergone a remarkable transformation, but it is an evolving journey. Divine intervention is manifested not only in changing attitudes toward those affected by hiv but also in creating a space where hope flourishes and compassion and love guide the actions of faith communities.
The task ahead requires continuing to build bridges of understanding, break down barriers of discrimination, and work tirelessly to ensure that inclusion and respect form the foundation of an authentic and compassionate theological and pastoral response to hiv/aids. This approach must reflect Jesus’ compassion toward all people, as witnessed in the Gospels. By integrating these teachings, the reaction to the presence of hiv should address the medical and social dimensions and be guided by a deep commitment to understanding, empathy, and unconditional love, as God loves us unconditionally.
Footnotes
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
1.
Its use as an acronym has changed in the last decade, and it has been proposed to use it in lower case in order to have an impact on the reduction of stigma.
2.
In Spanish, “men” starts with “H” = “hombres.”