Wednesday, December 01, 2010

Mikkeitz 5770: Joseph, Hanukkah and AIDS

Hanukkah, the festival of lights most often falls late in December, and close to the solstice. As part of the eight Days of Hanukkah, the new moon occurs, leaving us with a holiday with little to no Moon and the least amount of Sun. This year it is early, but begins on one of the darkest days in another way. December 1 is World AIDS Day, and I have a hard time separating starving cows from HIV. In this week's portion, Pharaoh starts by having a dream:

1 And it came to pass at the end of two full years, that Pharaoh dreamed: and, behold, he stood by the river. 2 And, behold, there came up out of the river seven cows, well-favored and fat-fleshed; and they fed in the reed-grass. 3 And, behold, seven other cows came up after them out of the river, ill favored and lean-fleshed; and stood by the other cows upon the brink of the river. 4 And the ill-favored and lean-fleshed cows did eat up the seven well-favored and fat cows So Pharaoh awoke. 5 And he slept and dreamed a second time: and, behold, seven ears of grain came up upon one stalk, rank and good. 6 And, behold, seven ears, thin and blasted with the east wind, sprung up after them. 7 And the thin ears swallowed up the seven rank and full ears. And Pharaoh awoke, and, behold, it was a dream. [Genesis 41]


After finding no one to interpret the dream, The chef cup bearer remembers Joseph in prison, and Joseph is called before Pharaoh. After telling Joseph the dream, Joseph delivers both the good news and the bad news:

29 Behold, there come seven years of great plenty throughout all the land of Egypt. 30 And there shall arise after them seven years of famine; and all the plenty shall be forgotten in the land of Egypt; and the famine shall consume the land; 31 and the plenty shall not be known in the land by reason of that famine which follows; for it shall be very grievous. [Genesis 41]
Joseph’s solution would have many a bible-thumping Tea Partier screaming "Socialism!" Levy heavy taxes on grain production during the time of plenty and store all that grain, then distribute it during the famine. Joseph in seeing the dream realizes something most people do not: this famine will affect everyone. If the grain isn’t stored it is not just the poor who will starve but so will the rich. Indeed, everyone in the region will starve.

Joseph is involved in setting the economic policy of one of the two superpowers of his time. Sitting in Synagogue last Erev Shabbat, listing to one of my friends give an excellent D'var Torah, I began to not think of economics, but public health. I had just read a rather startling report From Human Rights Watch about the American South. their report, Southern Exposure highlighted the overwhelmingly large numbers of AIDS and HIV cases in the American South. The epicenter of HIV infection in the United States is not New York or San Francisco, but Dixie. Inadequate healthcare and education are contributing to a dangerous situation.

Surprised by this, I did some checking in the U.S. Centers for Disease Control website, and found the recently released data for 2008 Notifiable diseases. Combing through that data the magnitude of the problem struck me. Almost Half the Reported AIDS cases were from the three southern regions of the united starts, the area from Maryland on the northeast to Texas on the southwest.

While the Southern Exposure report mentioned the lack of needle sharing programs in southern states as one contributing factor, I wondered if there was another issue besides the drug abuse issue. Indeed the report mentioned the lack of adequate sex education, particularly in the use of disease and pregnancy preventing measures. With more digging I compared it to the numbers for other sexually transmitted diseases. Compared to Syphilis for example, and adjusted for population, similar patterns appear. Comparing rates for Gonorrhea, the South Atlantic region has almost double the case rate as the Pacific or the Mid Atlantic regions.


Key to that is the poor state of sex education in this region according to the report:

The states in the South with the highest rates of HIV, sexually transmitted disease, and teen pregnancy are not ensuring that students receive comprehensive, evidence-based education in sexuality and HIV/AIDS. Alabama, Arkansas, Louisiana, and Mississippi do not require sex education at all; of these states, only Alabama requires HIV/AIDS education be taught in the schools. Florida, Georgia, North Carolina, and South Carolina do require sex education to be taught in the schools, and North Carolina recently replaced its abstinence-based education policy with the Healthy Youth Act, legislation that requires local schools to teach evidence-based information approved by experts in sexual and reproductive health. However, Alabama, Arkansas, Louisiana, Mississippi, Florida, and South Carolina all require that where schools teach do sex or HIV/AIDS education, abstinence before marriage shall be "stressed" or "strongly emphasized." … The discussion may include contraceptives but only if such discussion includes a discussion of the risks (failure rates, diseases not protected against). In no case shall there be a demonstration of how condoms or any other contraceptives are applied.[http://www.hrw.org/node/94476]


As alarmed as I am at this, I also remember an strangely humorous aggadic passage discussing the tension involved in Sex education.

R. Kahana once went in and hid under Rab's bed. He heard him chatting [with his wife] and joking and doing what he required. He said to himself: One would think that Abba's mouth had never sipped the dish before! He said to him: Kahana, are you here? Go out, because it is rude. He replied: It is a matter of Torah, and I am required to learn.[Berachot 62a]


Both Rab and Kanaha are right. It is rude to be a voyeur, but Kahana wanted to know how to be holy in the act of sex, only to find it needs a lot of passion and joy. In context with the Gemara passages before this one, it becomes clear, that everything from toilet habits to sex are a matter of Torah, and we are required to learn from our teachers. Rab does not give lessons in the academy about sex, and students have to observe his personal habits to find out. Yet there are some Talmudic passages that do give instructions. There is even a few sex manuals written by Medieval Rabbis such as the Ramban. While their choices and directives were not as liberal as those today, knowing how to make love properly was not only important but a holy act.

Yet the majority culture has this tendency to portray sex as dirty and sinful, and only abstinence is sacred, reflected strongly in government policies in the South. More than a thousand years ago, Jews realized abstinence doesn’t work, yet the majority religion still can’t figure that out. Neither are they willing to protect their flocks from disease – The knowledge of prophylactics is forbidden knowledge, even for adults. In doing so they shield young and old from knowing what choices they have which will spare their lives from life threatening disease. Many religious institutions, heedful of “be fruitful and multiply” doom their believers to a slow painful death. While the CDC numbers do place a large amount of the current cases in the South in poor African Americans, like the famine of Pharaoh and Joseph, this can easily spreads to the privileged people as well. They too are ignorant of precautions, and while they might not be infected with HIV, herpes or gonorrhea might be in their futures.

There is a way to stem the tide of infection, a variant of Joseph’s storehouses. It is a active and strong public health and public education effort. We know it works. Regions that were the epicenter of the HIV infection are now much smaller infection sources than the south. Good education in at-risk communities have slowly reversed the infection rates.

Joseph and Pharaoh were not slouches. They both understood there was times when Government needs to take care of the needs of the public. Economic policy is just one way of course that we can help people. A comprehensive way of healing the sick, and preventing them from becoming sick is also critical. Yet it is sorely lacking.

Torah is the tree of life, and in doing so addresses all aspects of life, even good sex. It does not hide from it, but puts it in a perspective that makes sense. For Rab, sex was a fun joyous thing to do with his wife, as though it was his first time every time -- it was far from dirty or sinful to have sex and enjoy it. But there were responsibilities involved, and Rab and Kahana took those seriously as well, as their halakic rulings show well. The majority culture’s insistence on avoiding sex or making it sinful tragically hides those responsibilities, and bans talking about it in places where the most good can be done: our public schools, the media and clinics.

The dark and cold of December 1 is both world AIDS day and it is the beginning of Hanukkah. The darkness of the day is not just the Darkness of AIDS and the numbers of people it kills or debilitates yearly it is the darkness of public health, who I expect will be far dimmer after the recent elections. It is the darkness of those so stigmatized by a disease they will not get tested or treated. It is the darkness of the GBLT young people who cannot get constructive information about who they are, and thus make some very bad decisions, or have bad decisions made for them. It is the darkness of "sex is bad, don't do it" while still heeding a genetic programming in our bodies we cannot fully control.

I fear the darkness not just for sexually transmitted diseases, but for those that are more easily transmitted by food, water and air. The system to control AIDS is not that much different than those for other diseases and their public control. Education, surveillance, and the ability to mitigate the spread of disease is the same for almost any disease. Like Joseph feared, I believe we are setting ourselves up for the seven lean cows, who will eat the seven healthy ones. This will not just be a one demographic, geographical ethnic or otherwise: No one will be safe from disease.

Yet this is also Hanukkah, the festival of lights and the miracle of the light that did not go out even in the time of darkness. While many will merely think of it as a Jewish Christmas, at its core it is an anti-assimilation holiday, celebrating we are different and want to live differently. It celebrates where a people did not want to follow the majority religion but live their lives according to Torah. It reminds me there is always a light cutting the darkness. It reminds me that we as the inheritors of the Talmud and Torah need to be there helping the sick and preventing illness through good education and good example. We need to support a strong governmental system of education and disease prevention. In that way can we be a light unto the nations in a time of darkness.

Decades after AIDS and HIV entered the scene, we are on December 1 around the world both Pharaoh and an imprisoned Joseph, deciding if a dream and warning signs are enough to act. May we all have the wisdom of that Pharaoh and choose wisely. May we have the discernment of Joseph to act wisely for us and for the future generations.

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