ILLNESS
4.10 RELIGION, SPIRITUALITY AND CHRONIC ILLNESSES
128
oncology teams. Psycho-oncology addresses, among other things, psychological reactions to cancer among patients, their family members and their care givers.
129
Buckingham (2012) contend that spirituality is an important coping strategy among patients dealing with HIV and AIDS progression. They note that despite its function, spirituality has also been associated with negative HIV and AIDS outcomes such as stigma and social exclusion. According to Bussing and Koenig (2010), patients‘ struggle with chronic symptoms can bring feelings of guilt, loss, sadness, loss of self-esteem, loss of role function, questions about meaning of life and communication problems with family and friends. Moadel et al’s (1999) research in the USA found that 51 percent of cancer patients want help in overcoming fear, 42 percent in finding hope, 40 percent in finding meaning of life and 39 percent in finding spiritual resources.
Churches can provide People Living with HIV and AIDs with spiritual counselling, prayers for healing, hope for personal and spiritual salvation, social and material support, personalised care when they are sick and burial after they die (Dilget et al, 2007). Zou et al (2009), further alludes to the fact that the moral and sexual connotations associated with HIV transmission can also turn the church into a stigmatising atmosphere for PLWHA. This is mainly because HIV positive people are seen to have behaved immorally. Religious beliefs shape individuals‘ outlook on living with HIV (Zou, et al 2007; Ramamurthy, 2000). Faith practices and beliefs can provide a sense of hope and can help people prepare for and accept death. Zou et al (2007) argue that people often turn to religion to make sense of and come to terms with being HIV positive. Studies done in the USA by Cotton, Tsevat, Szaflarski, Kudel, Sherman, Feinberg, Leonard and Holmes (2006) have shown that PLWHA use religion to cope with their illness and that being diagnosed HIV positive strengthens people‘s faith. They also found that an increase in spirituality, after being diagnosed HIV positive, is
130
correlated with slower disease progression. A sick person may seek closeness with God or may curse God for his situation (Ramamurthy, 2000).
In a South African study by Barney and Buckingham (2012) among patients with advanced AIDS, many of their participants indicated that HIV and AIDS were indicative of God‘s judgment on sin. In a study by Barney and Buckingham (2012), some respondents also reported believing in ancestors as a significant method of coping with AIDS. Some believed that HIV is an indication that ancestors required veneration or wanted the victim to be a sangoma. According to UNICEF (2003), churches have strengths, they have credibility and they are grounded in communities. This offers them opportunities to make a real difference in combating HIV and AIDS. A number of PLWHA receive encouragement from their pastoral staff during HIV counselling as well as from the general congregants.
Bussing and Koenig (2010:21) proposed a spiritual needs model for people with chronic illnesses as follows:
Figure 3: Model of spiritual needs
Model of spiritual needs © Bussing and Koenig (2010:21).
131
In many African societies, a culture of silence surrounds HIV and AIDS. This is mainly caused by religious association between HIV and immorality. According to UNICEF (2003), in Uganda, imams are including information on HIV and AIDS in religious lectures and sermons.
According to Vance, Brennan, Enah, Smith and Kaur (2011), spirituality and religion can serve as a buffer to the stress of life by allowing people to interpret their life experiences in the context of their beliefs which provide purpose and meaning in life. Generally, chronic disease literature shows the benefits of spirituality and religion in buffering one from stressors of such diseases. In a study by Lorenz, Hays, Shapiro, Cleary, Asch and Wenger (2005) among HIV infected Americans, 80% and 65% reported that their religion and spirituality were important in their lives. Religious participation is also high among those infected persons who did not disclose their HIV status (Vance et al, 2011).
Vance et al (2011) also noted that although religion and spirituality have positive bio- psychosocial outcomes, they can be a source of stress among HIV positive people.
Often, the spirituality of people can increase after being diagnosed with HIV (Vance et al, 2011). Ignoring spiritual aspects in the management of HIV can contribute to poor health outcomes. Religious and spiritual issues usually emerge during counselling. This is commonly propelled by anger at religious institutions for their particular views on HIV (Vance et al, 2011). People with advanced AIDS usually focus on broader spiritual issues which may end of life concerns such as ―Will I go to heaven?‖ (Vance et al, 2011). Different groups of people may derive differential benefits from religion and spirituality. Bernard et al (2014) state that spirituality gives patients and their families
132
another opportunity to reconcile with one another, connect, or reconnect with God and seek spiritual, psychological or physical healing.
Siegel and Schrimshaw (2002:91) have identified perceived benefits of spirituality in the lives of PLWHA as follows:
it evokes comforting emotions and feelings
it offers strength, empowerment and control
it eases the emotional burden of the illness
it offers social support and a sense of belonging
it offers spiritual support through a personal relationship with God
it facilitates meaning and acceptance of illness
it helps preserve health
it relieves the fear and uncertainty of death
it facilitates self-acceptance and reduces self-blame.
The comfort of spirituality reduces the distress of life-threatening illnesses. According to Tuck, McCain and Elswick (2001), spirituality and religion are associated with better quality of life, greater social support, and more effective coping among PLWHA. In a study by Peterson, Johnson and Tenzek (2010) among HIV positive women in the USA, the respondents reported that they believed God had a purpose for their lives and that connecting spiritually to God as a higher power provided them with a way to make sense of and make changes to their lives.
In recent years, life expectancy after HIV infection has increased due to Highly Active Antiretroviral Therapy (HAART) but functioning continues to be compromised. This
133
usually results in reduced quality of life, increased dependency on others and increased mental health outcomes. According to Bernard et al (2014), spirituality helps many patients and their families in palliative and end of life care cope with stresses associated with illness and find meaning in the midst of pain and suffering. Bernard et al (2014) further argue that spirituality also helps patients with terminal illness, cope with pain suffering, and loss and accept that there is no cure.
4.11 INTERFACING SOCIAL WORK, RELIGION AND SPIRITUALITY IN CHRONIC