African Churches and AIDS Prevention: Much Still to Be Learned
May 19, 2008
In October 2007, the Berkley Center at Georgetown University, Washington, D.C.’s famed Jesuit institution, released a report entitled Faith Communities Engage the HIV/AIDS Crisis. The authors, Lucy Keough and Katherine Marshall, reviewed the literature on religion and AIDS to conclude that the role of faith in relation to the pandemic is poorly understood and complex. To Keough and Marshall, faith-based organizations, which they interpreted widely to include church-based groups, religious NGOs, and traditional healers, can be like a “double-edged sword” in the confrontation with AIDS. They are inclined towards the view of Gideon Byamugisha, a Ugandan priest and AIDS activist, that the moral role of faith groups has too often entrenched the structural determinants of the epidemic – poverty, gender inequalities, and stigma. In this view, the church should find in the epidemic not a moral challenge, but a struggle to care for the sick and spread AIDS awareness.
In April 2008, Edward C. Green, the leading proponent of African churches as moral catalysts for sexual behavior change, published a harsh critique of the Berkley Report in First Things, a journal of conservative Christian thought. Green’s 2003 book, Rethinking HIV Prevention, argued that African moral intuitions often prove more effective and relevant to preventing HIV than western science – a view that became an intellectual cornerstone of the U.S. anti-AIDS program known as PEPFAR (President’s Emergency Plan for AIDS Relief). PEPFAR has devoted both effort and resources to promoting abstinence and fidelity through religious organizations in Africa and elsewhere. In his April essay, Green and his co-author, Allison Herling Ruark, expressed irritation with the “deep ambivalence” about churches reflected in the Berkley report, dismissing Keough and Marshall’s analysis as “drastically out of sync with the culture and values of (Africans).” Green and Ruark also dismissed Gideon Byamugisha’s discomfort with the moral impact of the church in Africa as inauthentic. To these authors, the structure of moral authority in African churches is a powerful, homegrown, and un-ambiguous asset in the struggle against AIDS. Keough and Marshall are found wanting because they see complexity, risk, and contradictions where there is instead one large “central fact” of HIV prevention: “what the churches are called to do by their theology turns out to be what works best in AIDS prevention.”
I have been absorbed by this debate because I spent the last year studying religion and development in South Africa and conducting fieldwork with faith-based HIV prevention projects. There are certainly aspects of Green’s analysis that I can agree with. He and Ruark seem to be on target when they criticize the Berkley Report for uncritically accepting the view that structural determinants, such as poverty and gender inequality, lie at the heart of the pandemic. Many observers are coming to accept that the determinants of transmission are more nuanced and geographically heterogeneous. I also share Green and Ruark’s intuition that the apparent success of some African church efforts in changing sexual behavior should force a secular reappraisal of the role of moral authority in community health.
But Green and Ruark’s “central fact” – that churches across the board are combating the spread of the HIV virus – is stated far too broadly. Here, Marshall and Keough are much more on target for stressing “the extraordinary…. diversity of religions and the complexity of their roles in their work on HIV/AIDS.” And I believe that many, or even most, African church people involved in the struggle against AIDS would share my ambivalence about the role of churches in fighting AIDS. Green and Ruark dismiss Byamugisha as marginal and out of touch with the African religious mainstream, but in my experience, he is not alone in recognizing that the African church is divided and diverse in its relation to sexuality and HIV.
In my research, I interviewed regional managers and youth workers with evangelical Christian organizations funded by PEPFAR for prevention efforts, including outreach to churches. When I asked these Christian AIDS workers about their work with churches , many expressed concerns about the unwillingness of African clergy to preach on sexuality and dangerous sexual behavior. Some church leaders, the AIDS workers thought, found no power in their theology to delay the sexual behavior of young people and tacitly accepted that men would have many lovers. Prevention programs funded by PEPFAR and others are pushing for fundamental changes in sexual behavior through the churches, but on the ground, Christian AIDS workers are finding that many churches stand for things the way they are.
AIDS workers stressed to me that the term “Christian,” covers a broad diversity of communities in South Africa. As part of my research, I attended township Anglican services, praise gatherings at a massive multiracial mega-church, worship at a small Pentecostal church in the deteriorating inner city, and services at South African “Zionist” churches with their strong indigenous roots. These communities, all in one city, were so distinct, theologically and culturally, that I no longer believe we can speak sensibly of “the church” in Africa. And this diversity extends to the response of African church communities the AIDS epidemic. Some speak easily and in theological terms about prevention, some effectively address treatment issues, some are silent.
Green and Ruark seek to ground their argument for religious promotion of behavior change in epidemiologic evidence, and point in particular to the decline in HIV prevalence in mid 1990s Uganda, coincident with major AIDS education efforts undertaken by mainline churches. But research by others picks up a diverse pattern of interaction between belief and the spread of HIV. In 1999, British demographer Simon Gregson and colleagues reported that when AIDS came to Manicaland in Zimbabwe, members of majority churches shared in the rise of AIDS-related mortality. However, members of the indigenous Holy Spirit Churches did not. These Holy Spirit Churches, Gregson observed, held strict sanctions against premarital sex and associated sickness with sin. A young person suspected of transgressing could lose permission to wear the robes of worship. Gregson speculated that this judgmental theology could be protective.
In 2000, development scholar Robert Garner published a survey of different kinds of churches in a South African township: mainline Protestant, Pentecostal, Zionist, and Apostolic. Garner found that only in the small Pentecostal community were young people less likely to have children out of marriage than people who attended no church. For other churches there was no difference. Like Gregson, he explains the impact by pointing to the strong stance of the Pentecostals against sexual sin, and their vision of themselves as a people apart from a sinful culture. More recently, in 2006, Sohail Agha of Tulane drew data from a national survey of Zambian youth to show that young members of the Jehovah’s Witness Church, a church strict in its exclusion of transgressing adherents, were the least likely to have had sex – but also the least likely to use a condom if they had.
Within this small body of preliminary and geographically piecemeal reports, there is little evidence that the bulk of African churches generally are impacting sexual behavior in a way that will reduce the spread of HIV. There is evidence, however, that churches differ from each other significantly in their teachings about sexuality. A small minority among African churches, those who preach on sin and, at times, exclude those deemed sinful, seem to hold power to change behavior and prevent the transmission of HIV. For liberal Christians, here is “a double edged sword” indeed. The goal of HIV prevention in generalized epidemics is to change behavior and decrease incidence at the population level. The power of these minority churches seems to depend on being small and set apart from the average. As Garner points out, “exclusion, by definition, cannot be widely applied.”
But an appreciation of these few reports shouldn’t obscure the fact that there is little rigorous research on the role of African churches in the AIDS epidemic. In a better and more equitable world, this would matter much less. If decisions about HIV prevention were being made in local African settings, where the strong differences between churches are a matter of common sense, then it would not be as necessary to establish them rigorously. But as long as wealth and accredited technical capacity are concentrated in the Global West, westerners will be making crucial strategic decisions about the allocation of resources in the struggle against AIDS – and depending on research to guide them. Green, Ruark and others have been right to insist that churches, and religion, should play an important role in the struggle against AIDS. But in plotting this role, a simple equation of the African church with effective behavior change ignores the complexity of the truth and the difficult interrelationships among morality, sexuality, and health. If the community of AIDS experts is serious about engaging with churches, it must deepen its understanding of churches in Africa in all their diversity. ________________________________________________________________________
Thomas Cannell is writing a dissertation at the University of KwaZulu-Natal on PEPFAR, evangelical Christianity, and HIV prevention in South Africa.
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