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Doctor treads a difficult path as priest and AIDS expert

By David J. Craig

During his residency at San Francisco General Hospital, in 1983, Jon Fuller learned exactly how he wanted not to treat people as a doctor and as a priest.

There, he saw physicians erect emotional walls between themselves and their AIDS patients, most of whom were gay men or drug addicts. Catholic chaplains called to give Communion to these patients often arrived wearing protective gowns, mask, and gloves, and with a compulsion to preach the rewards of renouncing homosexuality.

Fuller, now an associate professor of medicine at the BU School of Medicine, director of the Adult Clinical AIDS Program at Boston Medical Center, and a Jesuit priest, had planned to become a general practitioner because he felt that would be the most flexible way to serve as a Jesuit. But what he saw at San Francisco General convinced him that his calling was to care for those suffering from the mysterious new disease.

"Some chaplains who came to the hospital went so far as to demand that patients turn their backs on their partners, or they couldn’t get sacraments," says Fuller, "as opposed to letting them know that God loved them for who they were as people and helping to ease their transition toward death. That’s what clinched it for me. Bad pastoral care is terribly destructive for people with HIV."

Today Fuller, who was ordained in 1990, nearly two decades after joining the Jesuit order, and has been a member of the BU faculty since 1987, is helping battle AIDS on two fronts. As assistant director of BMC’s AIDS program, he helps coordinate medical, counseling, and advocacy services for about 700 adults infected with HIV in the Boston area and steers the program’s educational efforts.

Embattled Jesuit

In addition, Fuller has used his credentials as a priest and an expert on HIV to influence the Catholic Church’s policies on related social issues, such as condom use and needle exchange, in several papers and in a book he helped edit, Catholic Ethicists in HIV/AIDS Prevention (Continuum, 2000).

A typical day at the AIDS program is hectic and predictably unpredictable. Fuller’s patients are mostly poor and mostly addicts, and during many 40-minute office visits, his time is divided between sorting through the latest
housing crisis or drug abuse issue and discussing medication or dietary needs. Depression and anxiety burden many patients, and relapses into drug use and breaks in a rigorous medication regimen – which can allow the HIV virus quickly to build resistance – are common.

Fuller doesn’t want his patients to read into his advice any "moral overtones or judgments," so he doesn’t tell them that he is a priest, but his spiritual training manifests itself in subtle ways, such as in the optimism and sense of humility with which he goes about his work.

"My pastoral background has taught me, I think, that there really are very few times in life when things are futile," he says. "I’ve had people who for 14 years have gone a total of maybe a week or two when they were sober and not in jail or on the street. But each time things seem to take a step backwards, I have to be able to look at it as a new beginning and help the patient think about where he wants to go from here. And even when it seems that there’s nothing you can do to change things, you can always try to make people more comfortable."

The rewards that come with such an outlook, Fuller says, are manifold. Because many of his patients have complicated lives and may be facing an early death, seemingly small victories, such as helping someone return to work or find a stable living situation, are extremely satisfying.

"I know what people in the program here are threatened by," he says, "so if I can help them take responsibility for their addiction and for putting their life together, or just do well for a little while, that feels wonderful."

Problematic program approaches

People suffering with AIDS now live longer and have a better quality of life than those Fuller met in the epidemic’s early days. But the Catholic Church’s official stance on condom distribution and needle exchange programs has not changed.

In the introduction to Catholic Ethicists in HIV/AIDS Prevention, Fuller argues staunchly in favor of condom distribution and needle exchange programs to prevent the spread of AIDS. BMC’s AIDS program distributes condoms and refers patients to local organizations that run needle exchanges.

"When you’re talking about a prostitute in Thailand, where commercial sex is a large part of the economy, or a marital relationship where one person is infected and the other isn’t, a condom is going to be used not for contraception, but to decrease the risk of transmitting a lethal infection," says Fuller. "That’s been the understanding of many bishops and pastoral workers around the world for many years, but it’s a source of great tension because the Vatican has never espoused that understanding.

"In terms of needle exchange, there really is not a doctrinal reason why people shouldn’t embrace it," he continues. "The data show that these programs don’t increase drug use, they don’t increase frequency of drug use among those who are already injecting drugs, and they don’t recruit new people to drug use. They do save lives."

4 December 2000
Boston University
Office of University Relations