AIDS and Religion in America

The Carter Presidential Center, Atlanta, Georgia

November 8-11, 1998

Duke University

1998 AIDS National Interfaith Network

Many sections of American society have accepted this intellectually. The days in which prominent public figures called for the exclusion of all HIV+ persons from the U.S.A. and the forcible detention of native-born American PLWAs in concentration camps are, we hope, over and gone. In many ways, especially with the new life-prolonging treatments, HIV/AIDS has become just another chronic disease, and as such, it is something that we think can be left to specialists in the medical profession and ignored by the public at large. But Buddhism would ask more of us. The teaching of interdependent arising (pratitya-samutpada) instructs us not only that isolation from others is impossible but that connection with others is a fundamental given. Ven. Thich Nhat- Hanh has translated pratitya-samutpada as "interbeing," emphasizing by this English word that, if everything occurs conditioned by and conditioning everything else, we owe our very existence to everything else that exists, not only everything that is good and pleasant but also everything that is unpleasant, evil, or neutral. In a celebrated poem about a young girl who is raped by a pirate, Thay tells us how he, a male, and a celibate, highly moral monk, is both the young girl and the pirate. When we take "interbeing" to heart, we do not merely tolerate persons who have a disease that we do not happen, at the moment, to have, we actively identify with them. Medically, we may be HIV-. In the context of interbeing, we are all HIV+.

The existential as well as intellectual realization of the interdependence of all living beings, and the existential as well as intellectual realization that whether or not we are PLWAs we are all "PLISs" (Persons Living... In Samsara), is the basis for Buddhist compassion and the principal motivation for the mutual caregiving between HIV+ and HIV- persons.

The best gift, it is said, is the gift of the Dharma (the Teaching). But in order to be receptive to the Dharma a person must be reasonably comfortable, must have an adequate supply of artha, physical goods, that which is necessary to maintain life functions. In Buddhism there is nothing transcendent but there is, metaphorically, an inside and an outside to the prison of samsara. Technically, the inside is called laukika (pertaining to loka or place, that is, locatable as being here or there) and the outside, or liberation, is called lokuttara (outside of loka, not locatable as being here or there, unconditioned). Dharma is extra-samsaric, it cures the root disease of birth, and is therefore the ultimate focus of Buddhism. Dharma is based, however, on artha, intra-samsaric good, which is never discounted as unimportant. Artha is generally taught in terms of the Four Requisites: food, clothing, shelter, and medicine. The interrelation of artha and Dharma is illustrated by the symbiosis of the monastic order (Sangha) and the lay people in traditional Buddhist cultures. Lay people provide the Four Requisites to the monks and nuns, ensuring that they have adequate means to support themselves in this lifetime, and the monks and nuns respond by sharing Dharma (in the form of counseling as well as sermons) to the lay people, thus giving them the means to obtain a better rebirth in their next life and, eventually, liberation from samsara.

It is notable that medicine is one of the Requisites. It is never suggested in Buddhism that the true practitioner will never get sick. The Buddha, and many of his disciples, fell ill, and indeed the Buddha died of a gastrointestinal infection. Therefore, it can never be a Buddhist position to ignore medicine, or to suggest that if one meditates more the illness will go away without the benefit of medical attention.

Meditation, however, is not neglected in Buddhist approaches to health. Tibetan medicine, which combines Buddhist principles with medical experience derived from Indian, Chinese, and native Tibetan traditions, typically diagnoses and treats a patient in the context of their lifestyle. Physical diagnosis (chiefly the examination of the urine and a variety of pulses) and physical treatment (usually herbal) is combined with questions about diet, moral practice, and meditation. Generally, the patient will receive a prescription for pills along with recommendations for moral and meditative practice. That is, artha and Dharma are combined.

Since HIV is not a single disease with a specific etiology, it does not respond well to the highly specialized, technocentric approach of orthodox western medicine. Holistic forms of medicine, which resemble traditional Buddhist approaches, are more effective. Buddhist teachers, therapists, and medical practitioners, especially persons trained as Tibetan physicians, can and should work alongside western health care providers, particularly those specializing in Mind-Body medicine, hospice work, and long-term residential care, to bring the PLWA the best possible treatment for body, mind, and spirit.

Whenever we are ill, or any kind of misfortune happens to us, we tend to ask "Why me?" We may feel we are being punished, perhaps by a vengeful God, perhaps by some impersonal cosmic force. We feel victimized, helpless, and out of control. We may say "It's my karma" meaning "It's my fate."

A true understanding of the Buddhist teaching on karma can give us back our dignity. The Sanskrit word karma literally means "action." In its early usage, in the Vedas and their ritual commentaries, it had no moral implications. By the time of the Buddha, it had begun to be used to refer to the outcome of an action as well as the action itself. To be precise, therefore, we should, in Buddhism, speak of an action as the karmic seed and the outcome of an action as the karmic fruit, and reserve the word karma itself for the law which connects the seeds and the fruits. It is also important to note that we use the words seed and fruit rather than cause and effect. The law of karma is organic, not mechanical. If I throw a ball into the air, its speed and trajectory are fixed, impersonally and implacably according to Newton's Laws of Motion. This is cause and effect. But if I plant an apple seed in the ground, the results--whether and when I get an apple tree, and how many apples I will get--depend on some previously existing conditions, like the soil and location, some future conditions, like the ensuing weather, and some actions of my own-1 can choose to nurture, neglect, or kill the seed. Also, if I decide I want apples, and all goes well, then I expect to get many apples from a single seed. This is a metaphor of the law of karma.

Suppose I break the second of the Five Basic Precepts, and steal something. Stealing produces a karmic: seed which can be expected to fruit as my experience, later in this life or in a future life, of being robbed. But exactly how things turn out depends on many factors. If I steal something which I do not need, merely out of greed, from someone who really needs the object; if I plan the action carefully and strongly will it to occur; if I rejoice at my success and gloat over the rightful owner's loss; if I grasp tightly onto the prized object; and if I do all this in the context of a life of crime and wrongdoing--then I have done my best to ensure that the karmic: seed will fruit, and fruit vigorously. Many times in the future I will, for no apparent reason, be robbed. If, on the other hand, I steal something out of necessity (such as food if I am starving) from someone who has an excess; if I steal almost automatically, without strongly willing it (just out of hunger, for example); if I then deeply regret my action, do not cling to the possession of the object, and do everything possible to pay the rightful owner back when I can; and if I do all this in the context of a life of moral rectitude and the practice of the Dharma--then I have done my best to ensure that the karmic seed will not fruit. In some cases, it is taught, the performance of an extraordinary good work, such as an extended pilgrimage to a holy site or a significant donation of time or money to a worthy cause, can kill the karmic seed so that it never fruits at all. Thus, while I am performing an action, and after I have performed it, I have some control over its outcome.

Even after the karmic seed is lost in the distant past--that is, if all I experience is the fruit of karma, such as being robbed for no apparent reason--I am still not entirely at the mercy of circumstances. First, I can recognize that the events are not random. Although I may not be aware of it, since it may be in a previous life, there is a reason for what is happening. Secondly, however, although there is a reason for the unfortunate event, there is no one to blame for it. The person who sowed the karmic seed, conventionally known as my former self, is dead. The robber is merely the instrument of the fruiting of karma. What, then, do I do about it? If I find I can run away and escape being robbed, I do so. But if the karmic nexus will not allow that, I submit to the robbery and try to generate compassion for the robber, who may be in a very difficult situation and is, in any case, sowing a seed of negative karma, cannot be excused of responsibility, is liable to be arrested and punished, and will in the future reap the karmic fruits of robbery. Then, I can try to use the robbery as a means of giving up attachment to my possessions. If I do all of this, I will turn the negative and frightening event into a positive good. If I do not, but react with fear and hate, I continue the karmic cycle by laying down new seeds of negative karma.

What this all comes down to is seeing the fruiting of karma as an opportunity to be grasped rather than a fate to be endured. In the case of finding that one is HIV+ we can use the Buddhist teaching on karma as a support for our practice. We recognize that it has happened for a reason, but we do not need to feel guilty or victimized, and we can exercise some control over how we deal with it, knowing that our actions will not be fruitless. A diagnosis of HIV cannot be good news, but it can be turned to good.

It has become a cliche that a sentence of death marvelously concentrates one's mind. In Buddhism, our minds are supposed to be concentrated anyhow, for we are all supposed to be aware of the inevitability of death, but we tend to forget, especially if we are young and healthy. A diagnosis that we have turned seropositive can remind us of the Buddhist teaching that (i) death is certain; (ii) the time of death is uncertain; and (iii) the causes of death are many. We can also be stimulated to reflect on our human rebirth: (i) it is rare to be born as a human; (ii) it is rare to be born at a time when the Dharma is known; (iii) it is rare to meet the Dharma; (iv) it is rare to have the leisure to practice the Dharma. All these considerations, the so-called Bases of Mindfulness, are quite traditional reflections intended to stimulate our practice, and all are peculiarly applicable to a PLWA. By employing them, we can transform the negative and frightening event of the physician's bad news into a Dharmic good. And if we are not ourselves diagnosed as HIV+, we can use the diagnosis of someone we know as a stimulus to our own practice.

Revulsion at samsara, it is taught, is the foundation of the Bodhisattva Path. When we are quite certain that suffering is so completely pervasive in samsara that there is nowhere to rest and hide, that wherever we go we are still in the prison, we make the decision definitely to leave samsara. Perceiving that other beings are in the same predicament as ourselves, we desire to help them gain the same release that we are seeking. Since we can only be really helpful to beings if we ourselves are fully liberated we determine, with the motivation of assisting all living beings to be free from all suffering for ever, to attain complete and full enlightenment as swiftly as possible. Thus the mind devoted to enlightenment, the bodhichitta, arises in us.

Revulsion at samsara is not easily attained. We are addicted to birth-and-death and we think that, if only we had or did such-and-such, the suffering which we experience now would vanish. Periodic sharp pain, the suffering of suffering, is obvious. But perhaps, we think, when it passes, pain will disappear for ever. This, it is said, is like a person sitting in the shade who thinks "I would be happier sitting in the sun" but after sitting in the sun for a while thinks "I would be happier sitting in the shade." We have mistaken the suffering of change for the absence of suffering. When we investigate the suffering of change we realize that, just after the change, another form of suffering arises, but it is so subtle we hardly notice it. After a time, it grows, and we desire another change. Realizing that, however we shift, we are still uncomfortable, we waken up to the suffering of conditioned existence and the universal pervasiveness of suffering within samsara. Thus arises the revulsion at samsara and the desire definitely to leave it.

Does a virus have the Buddha Nature? It is a living being, or rather it has a mode of existence when it is a living being, and it appears to seek pleasure, or continued existence, and to avoid pain, or death. So, in its active mode, a virus appears to satisfy the conditions for a sentient. being (sattva) locked into the cycle of samsara until it attains liberation or Buddhahood. In its passive, or crystalline, form, a virus does not appear to be sentient, but then it may be imagined as being in stasis while its karmic seeds mature, after which it changes to its active, organic, state. Such modes of existence are not unknown to traditional Buddhism: there are the top few realms of the cosmos, from the realm of the Fourth Dhyana up to the realm of Neither Notions nor Not'.' Notions, at the Pinnacle of Being, rebirth into which is due to "immobilizing karma" (aninjya-karma) rather than, as with lower realms of existence, merit or demerit, and in which, it is said, there is no motion but the fruiting of karma. subtly continues; and there is, somewhere, the mysterious realm populated by the Unconscious Deities who, dying from that realm and being reborn as humans, teach that we arise from nothing because when they think back to their former life it is all a blank.

Therefore, however bizarre it might seem at first, it is appropriate for a Buddhist infected with HIV to have compassion towards the being that is surviving by destroying its host. However, this does not mean that a PLWA should invite death by refusing therapy and allowing the virus to multiply unchecked. Only from the human rebirth is the attainment of Buddhahood possible. Only humans can effectively engage in all three practices of the Triple Training (ethical conduct, meditation, and Dharma study). For these reasons, it is taught, the human rebirth is more fortunate than other rebirths. A virus rebirth, we may imagine, is one of the three unfortunate rebirths (the realms of animals, hungry ghosts, and hell-beings) and a virus is unlikely to be able to practice Dharma. It can only live out its karma, part of which is to be attacked and killed by the cells of the host's immune system or by a medicine. In these circumstances, we can speculate that killing the virus is not a failing of compassion. But, the killing should be done with regret.

Such an approach, of compassionately allowing our bodies to be purged, should be less stressful for the PLWA than the standard medical approach which frames the treatment in agonistic terms full of the imagery of war. And since stress and a weakened immune system have been shown to be connected in some cases, the reduction of stress might, perhaps, strengthen the PLWA's immune system.

HIV does not exhibit sexual preference when it chooses a host, yet in America AIDS has been characterized as the "gay disease" because it entered the United States through the gay male population. Since the ruling ideology in the U.S.A. is homophobic, and indeed is suspicious of all sexual activity at the same time that it exploits it in the media, there is an additional problem for many American PLWAs: not only do they have a life-threatening illness, they are made to feel that they have become sick due to morally disreputable behavior. Something, must therefore be said about Buddhist attitudes towards homosexuality.

The condemnation of homosexuality in American public life is often justified by an appeal to Natural Law. In many states, certain conduct which, while not restricted to male homosexuals, is assumed by some to be typical of male homosexual activity (e.g., anal and oral copulation) is legally characterized as an "act against nature." This characterization implies that the universe has been made a certain way by a Cosmic Mind or Creator, and that it includes moral as well as physical laws. A method of engaging in sexual activity is said to be part of this cosmic legal system and persons who violate this law are similar to persons who appear to have found a way to violate the law of gravity. "If God had intended us to fly" it used to be said "He'd have given us win-s." The doctrine of Natural Law is deeply embedded in western thought, going back to the ancient Greeks and being expanded and modified in various ways across the centuries by powerful elements in Christian theology. Today, it tends to be selectively applied to sex, but it has been employed more broadly. In the eleventh century the Vatican declared the fork, at that time a newfangled gadget of haute cuisine, to be unnatural.

The legal category "act against nature" would appear to be unconstitutional, since it seems to impose religious sanctions on the populace at large, and the so-called sodomy laws are being challenged in the courts on just these grounds. Whatever their fate in the courts, it is important to note that, from a Buddhist perspective, they are nonsensical. There is no Cosmic Mind or Creator God in Buddhism, and so there cannot be a Natural Law emanating from such an Entity.

The Buddhist concern is not so much with the proper or improper nature of certain sexual activities but with the potential, in any sexual activity, for addiction. Desire (trishna) and its consequential grasping (upadana) is recognized as the source of suffering. We desire something that we think will bring us unalloyed happiness. Sexually, we lust after a physical form that appears to us to be perfection embodied. We do not recognize that, due to the universality of change, the body we desire does not truly exist. If we do succeed in obtaining it, it changes, and so do we. Thus we are cheated of our prize and we go on to try another body, but with the same disappointing result.

Of course, not everyone who engages in sex becomes addicted to it. The Buddhist teaching emphasizes the addictive nature of sex in order to point up its dangers. It warns us to be aware that the force of sexual attraction can be so overwhelming that it intensifies the confusion (moha) which is the basis for unskillful action, creating the conditions for increased suffering for ourselves and others. The media is full of reports of crimes committed under the influence of sexual passion. But if we realize the truth of impermanence, we can marry or maintain a long-term relationship, cultivating compassion for our partner, without becoming trapped in the circle of unrealistic expectations. Compassion is the leading Buddhist virtue, and it applies to sexual relationships just as much as to other forms of conduct. If the relationship is non-harming and is to the partners' mutual benefit, it cannot be condemned merely because the partners are not of opposite sexes. On this basis, same-sex unions have been solemnized by prominent Buddhist teachers in America.

Traditional Buddhism, however, exhibits some ambiguously homophobic features. They have yet to be fully studied, but they appear to be based upon a combination of cultural and medical presuppositions which would seem to be irrelevant to modem America. In no sense can Buddhism as a whole be said to be opposed to any one form of sexual activity as long as there is compassion and mutual respect.

The thoughts expressed in this paper are my own, but my reflections, especially on the human immunodeficiency virus as a sentient being, have been influenced by "Buddhism and HIV/AIDS: A Theological Response" by Jose Ignacio Cabazon, a paper read at the Annual Meeting of the American Academy of Religion in San Francisco, California, November 22-25, 1997. Professor Cabazon's paper, a version of which is to be published in Heart Lessons from an Epidemic: Buddhist Practice and Living with HIV, edited by Steve Peskind (Berkeley CA: Parallax Press, forthcoming), should be consulted in order to compare his views with mine.