Ethics and HIV/AIDS Care - A Buddhist Approach
Asst. Prof. Athachinda Dipdung

What is Life?

An understanding of Buddhist teachings on life and the origins of disease is necessary when applying the Buddhist approach to caring for people with HIV/AIDS.

The Tantabidhaka Sutta explains life as being the Pancakhandha, the Five Aggregates, or the five causally conditioned elements of existence forming a being or entity. These are:

1. Rupa-khandha: corporeality
2. Vedana-khandha: feeling; sensation
3. Sanna-khandha: perception
4. Sankhara-khandha: mental formations; volitional activities
5. Vinnana-khandha: consciousness

The Pancakhandha can be described as the body and the mind. Theravada Buddhism stresses the importance of the mind as the seat of wisdom and the inducement for actions.

As the Buddha has said, "It is the mind that heads the Dhamma. For the Dhamma, the mind is of utmost importance. Success is achieved through the mind. A person whose mind is impure will speak impure words and perform impure acts. For that person, suffering will surely follow just as a cartwheel follows the footprints of an ox."

Though Buddhism places emphasis on the mind, it does not ignore the importance of the body. This can be seen in a discourse recorded in the Digha Nikaya where the Buddha says, "Those who would know the truth should not say that the body and the mind are separate, just as they should not declare the body and the mind to be one. It can be compared to two beams that are supported by each other. If one were to be removed, the other would fall away."

The Abhidhamma states that illness is partly physical, being related to the four elements, namely earth, water, air and fire, and partly mental. Phra Dhebavedhi has noted that disease has four characteristics:

1. The conditions for illness are present, but they are weak. As the body and mind are strong, the person will not be affected.
2. The conditions exist in a mild form, but because the body and mind are strong, disease will not arise.
3. The conditions are present. The body is strong, but the mind is weak. The body will not be affected, but the mind will.
4. The conditions are present and are strong. Even though the body and mind are strong, they will not be able to ward off the disease.

Buddhistic Care for People with HIV/AIDS

Commentaries on the Tripitaka, such as the Visuddhi Magga and the Mahawong, state that during the Buddha's time herbal medicines were used to balance the four elements (earth, water, fire, air) of ailing monks. In addition to the physical care, emphasis was also placed on the importance of Dhamma-based care (Dhamma Osoth), particularly to reduce stress and anxiety.

In his treatise "Buddhadhamma", Phra Dhebavedhi states that physical illness can give rise to stress, anxiety, restlessness, etc. which, in turn, can cause loss of mental calm and peace. Mental care is, then, an essential part of treatment. Knowledge of the Bojjhangas (enlightenment factors) is necessary when caring for people with HIV/AIDS as they can be used to reduce stress and anxiety. The Buddha himself recommended meditation on the Bojjhangas as a way to overcoming stress and anxiety arising from physical discomfort.

The Seven Bojjhangas are:

1. Sati: mindfulness
2. Dhammavicaya: truth-investigation
3. Viriya: effort; energy
4. Piti: zest
5. Passaddhi: tranquility, calmness
6. Samadhi: concentration
7. Upekkha: equanimity

An example of the importance of meditation on the Bojjhangas is seen in the case of the ailing Phra Maha Kassapa who was visited by the Buddha. The Buddha inquired as to his health, asked if there had been any improvement and if he were able to endure the condition. Phra Maha Kassapa replied that his condition had not improved and that it was difficult to endure. The Buddha then instructed him on the Bojjhangas and advised him to meditate. Later, Phra Maha Kassapa regained his health and praised the benefit of meditation on the Bojjhangas as taught by the Buddha.

On another occasion, the Buddha was approached by an elderly householder who spoke of how his body had become tormented will illness over the passing years. The Buddha told him that nobody could escape illness or the decay of the body. He reminded him that it was the body that was ill, not the mind, and that the mind should be calm and controlled.

Phra Dhammabidhaka stresses the importance of the relationship between the body and the mind. When a person becomes physically ill, the mind will be weakened. Meditation on calmness can help to overcome physical suffering. A person with a strong morale will have a strong immunity. Meditation can help to cure or reduce the effects of illness. Phra Dhammabidhaka has explained the three states of the relationship between the body and the mind. In the first state, the body is ill at ease and the mind is also ill at ease. In the second state, the mind can determine the effect the illness is having on the mental well being or the morale; and in the third state, the mind can prevent the illness from affecting the mental well being as well as establishing physical comfort.

From the above, we can see the importance of mental care when looking after people with HIV/AIDS.

Even the Buddha himself combined mental care with physical care when he was ill. At one time, he asked Phra Maha Chunta to recite the Bojjhangas for him when he was ailing. After hearing the recital and contemplating on it, he recovered from his illness.

Meditation on the Bojjhangas is focussing the mind on one spot or one emotion and keeping it so focussed. When the mind is relaxed, stress and anxiety will be replaced with feelings of peace and calm. This has a good effect on the body and can help strengthen the immune system so that it is able to fight against disease. (Praves Wase)

Bojjhanga meditation can help people living with HIV/AIDS overcome any feelings of depression they may have due to their condition. Mindfulness of breathing, observing each in and out breath, is mentally calming, costs nothing and brings many benefits such as reducing stress, anxiety and fear.

Another Buddhist teaching important to HIV/AIDS care is the teaching on the Brahma Vihara, the four Sublime States. These States, which should be developed and practiced towards all beings, comprise:

1. Metta: loving-kindness
2. Karuna: compassion
3. Mudita: sympathetic or altruistic joy
4. Upekkha: equanimity, neutrality.

These states already exist in all humans, but they should be nurtured and practiced towards others. Metta, or loving kindness, is especially important when caring for people living with HIV/AIDS. It will make the person feel cared for which in turn will help to reduce their fears and worries. This will help to overcome stress and anxiety, which will have a good effect on the physical well being.

The Sangahavatthu, the bases of sympathy; the acts of doing favors; are also beneficial to people living with HIV/AIDS and HIV/AIDS care-workers are encouraged to develop and practice them. They include:

1. Dana: giving, generosity, donation
2. Piavaca: kindly speech; convincing speech
3. Attacaiya: useful conduct; rendering services; doing good
4. Samanattata: even and equal treatment; equality consisting in impartiality; participation and behaving oneself properly in all circumstances

This Buddhist teaching supports integration and communal living and is important for people working with HIV/AIDS to apply it to their work. It helps to develop compassion and consideration towards people living with HIV/AIDS and arises spontaneously when people have developed the Brahma Vihara, or the Four Sublime States. When the Sangahavatthu have been developed, people will recognize that HIV/AIDS sufferers are also human beings who, just like themselves, crave physical and mental comfort.

Angels in White

It has long been the common view that a woman becomes a nun to escape a broken heart, to run away from personal problems, or because she has difficulty fitting in with the mainstream of life. And, once in the temple, her place is in the kitchen and her role is to look after the monks and novices.

This attitude is now changing, however, as a large number of nuns become actively involved in social and community work.
Nuns have set up centers in many provinces throughout Thailand to provide education and training for women and girls who are interested in spiritual development and studying Buddhist teachings. They also provide shelter and education for underprivileged and economically handicapped girls who would otherwise not have the same opportunities as others. These centers have saved many young girls from exploitation and being lured into the sex industry.

In addition to formal and non-formal education, the centers also provide handicraft and skills training so that the girls, after graduation, can find gainful employment and not only support themselves, but also their families.
The nuns who run and work in these centers are to be commended for their selfless devotion and the sacrifices they make.
In addition to the excellent work that they are already doing, nuns are now expanding their role to respond to the needs of women and children infected with or affected by HIV/AIDS.

To assist them, the Sangha Metta Project recently conducted a three-day seminar on The Role of Buddhist Nuns in HIV/AIDS Prevention and Care.

The seminar, conducted in collaboration with the Thai Association of Buddhist Nuns and supported by UNICEF, was attended by more than 50 nuns from central, northern and northeastern Thailand.

During the seminar, nuns were given up-to-date and accurate information on HIV/AIDS, as well as the socio-economic impacts. Experts from different organizations were invited to address the participants, and a group of women living with HIV talked about their personal situation, problems they had encountered as HIV+ women and how they had overcome those problems. Using the participatory approach, the nuns were given the opportunity to appraise the HIV/AIDS situation in Thailand and identify roles they can play in solving the problem. Working in groups, they developed strategies for carrying out those roles.

At the end of the seminar, the nuns concluded that they could help prevent the spread of AIDS by educating women and girls on HIV/AIDS. They could help women living with HIV/AIDS by providing care, counseling and meditation. To help alleviate the socio-economic impacts, they could provide vocational and skills training for HIV+ women and reduce the problem of orphans by caring for girls whose parents have died of AIDS.

The nuns who participated in the seminar have not forgotten their role. They have now become actively engaged, and are performing a variety of activities in their areas.

For example, nuns from Wat Nam Bo Luang in San Pa Tong District, Chiang Mai have made contact with the Nam Bo Luang Support Group for People Living with HIV/AIDS and can be seen at their regular monthly meetings providing counseling and advice. They also join monks in religious ceremonies and give donations whenever possible.

Nuns from Wat Ram Poeng (Wat Taphotharam), Muang District, Chiang Mai have been giving meditation instruction to members of the Clear Skies Group in Chiang Mai. They have also made contact with the Community Health Group, an HIV/AIDS support group in Mae Rim District, Chiang Mai, and plans are being made to give meditation and counseling to group members.

Northeastern nuns from the Thai Association of Thai Buddhist Nuns are setting up education programmes in northeastern provinces while nuns from the central region are organizing education programmes and skills training activities for people in their areas.

The work they are doing is extremely valuable at a time when more and more women are being identified as being HIV+. Most of these women have a husband who is ill with, or who has died of, AIDS. Their time is spent taking care of their husband, who is the main breadwinner, or their orphaned children, leaving them little time or resources to care for themselves.

The Sangha Metta Project recognizes and appreciates the contribution that nuns are making to HIV/AIDS prevention and care in Thailand. To help develop their role, the Sangha Metta Project plans to run more seminars and workshops and it is hoped that the network of this valuable resource can be expanded in the New Year.