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God and the Fight Against AIDS

1.

In 2003, President George W. Bush asked Congress for $15 billion to fight AIDS in developing countries. During the 1990s, HIV spread rapidly, especially in Africa, where some 250 people were dying from AIDS every hour. The US had been accused of not doing enough to fight the epidemic, and when the bill passed, many conscience-stricken Americans, moved by images in the press of dying women and children, praised the administration. But some were not sure. Much of the money will go to church-affiliated charities or faith-based organizations, including some evangelical Christian groups that have very little experience with AIDS.

While Catholic and Protestant churches have been running AIDS programs since the 1980s, few evangelical Christian groups have done so. Indeed, as the deadly virus spread around the world, many evangelical Christians were silent or worse. Jerry Falwell called AIDS God’s judgment on promiscuity, and former Senator Jesse Helms, a longtime congressional ally of the evangelicals, told The New York Times in 1995 that AIDS funding should be reduced because homosexuals contract the disease through their “deliberate, disgusting, revolting conduct.” When lawmakers moved to amend the Americans with Disabilities Act to protect people with HIV from discrimination, some evangelical Christians lobbied against them. In a 2001 poll, only 7 percent of American evangelicals said they would contribute to a Christian organization that helped AIDS orphans.1

Shortly after the 2000 election, some evangelical Christians began to change their tune. “We cannot turn away,” Helms wrote of the global AIDS crisis that had by then killed 20 million people over two decades. “It is true,” wrote Ken Isaacs of Samaritan’s Purse, an evangelical charity run by Billy Graham’s son Franklin, “that when we choose to act outside of God’s mandate for sexual purity, we should be prepared to deal with the consequences.” “However,” he went on, “God calls Christians to tell others of the redeeming love of Christ and the eternal life they can have through him.” Also, with so many people on the verge of death, “AIDS has created an evangelism opportunity for the body of Christ unlike any in history.”2

It is worth noting that during the 2000 campaign, Bush, a born-again Christian, promised to provide more federal funding to faith-based groups working on various social problems. Thus it may be no coincidence that some of the same people who once treated the issue of AIDS with indifference suddenly seemed so concerned about it. Do evangelical Christian groups have a role to play in fighting the AIDS epidemic? Maybe they do, but at the moment they are engaged in an unseemly battle with secular AIDS organizations over US government contracts that could derail what little progress there has been in combating the epidemic.

Most of the $15 billion in the AIDS plan is to be spent on treatment and care for people with AIDS, but $1 billion is earmarked for HIV prevention through abstinence-only-until-marriage education. Since 1996, the US government has spent hundreds of millions of dollars on similar programs in American schools. These programs teach children that heterosexual intercourse within marriage is the only safe and acceptable form of sexual behavior. Teachers in those programs are barred from mentioning condoms and birth control—except their failure rates.

Human Rights Watch and other activists point out that every abstinence-only program that has ever been evaluated has failed to reduce rates of teen pregnancy or sexually transmitted diseases, and they fear that the $1 billion abstinence earmark will have similarly dismal results in other countries. Human Rights Watch has now accused the US government of violating the right of young people to information about sexuality, condoms, and other methods of contraception that could save their lives.3

The US administration used the success of Uganda’s HIV prevention program to justify the $1 billion earmarked for abstinence-only programs. During the 1990s HIV infection rates in Uganda fell, from around 15 percent to around 6 percent, a success that is unique on the continent. In 2000, researchers at USAID began to question why HIV infection rates had fallen only in Uganda and not in other African countries such as Zimbabwe and Malawi, where the epidemic had been raging for almost as long. The difference, they concluded, was that most countries relied too heavily on condom promotion alone, whereas Uganda had a range of programs that encouraged abstinence and faithfulness as well as condoms—a strategy that came to be known as ABC—for Abstain, Be Faithful, or Use Condoms.

In 2002, during the congressional debates over the President’s $15 billion AIDS bill, the virtues of ABC were hotly debated, and unfortunately distorted. Republicans argued in favor of earmarking funds for abstinence-only-until-marriage programs, while Democrats tried to defend funding for condom programs. In the midst of the pro- ceedings, Uganda’s First Lady, Janet Museveni, flew to Washington and presented a formal letter to Republican lawmakers stating that abstinence was key to Uganda’s success. Her involvement helped secure the $1 billion abstinence earmark that appears in the final bill.

Mrs. Museveni’s claim that abstinence had triumphed over AIDS in Uganda is incorrect. Between 1988 and 2001, the average age at which young Ugandan women started sexual activity rose by less than a year, even though the national HIV rate fell by some 70 percent.4 Most Ugandan girls begin having sex at around age seventeen, a year or so younger than in Zimbabwe, where HIV rates are about five times higher. More than half of all Ugandan women have been pregnant by age nineteen. HIV rates in pregnant teenage Ugandan girls fell rapidly during the first half of the 1990s, but during this time, the rate and ages at which these girls became pregnant—a marker of their sexual activity—barely changed at all.5 Moreover, a study carried out in a rural area of Uganda found that young women who abstain from sex until they are twenty are just as likely to become infected with HIV by age twenty-four as young women who first had sex in their teens.

Nevertheless, about four years ago, Uganda’s leaders began lecturing the nation about virginity and “moral” conduct. President Yoweri Museveni has claimed that abstinence until marriage is a traditional African value. Before colonial times, if an unmarried girl became pregnant, “the punishment then for the boy and girl was death,” he told an audience of AIDS researchers in 2001. “The girl would be tied in dry banana leaves, set on fire, and rolled down a cliff, and the boy speared.” But these traditions broke down when the Europeans took over, he said. Society became permissive and eventually HIV began to spread.6 Last year, the First Lady led a march for virginity through the streets of Kampala, and the king of the Baganda, Uganda’s largest tribe, has pledged that all female virgins will receive a free washing machine on their wedding day. Not to be outdone, leaders of the Karimojong tribe have called for a ban on miniskirts, though Karimojong people traditionally wear no clothes at all.

For decades, corrupt African leaders—from Kenya’s Daniel Arap Moi to Malawi’s Hastings Banda to Zimbabwe’s Robert Mugabe—have been blaming Western decadence for Africa’s problems. Even Idi Amin took time out from murdering cabinet ministers and religious leaders to crack down on miniskirts and makeup. Therefore it is worrying that Museveni, whose undemocratic tendencies have been criticized, is drawing increasing attention to the personal morality of others. Nevertheless, the renewed emphasis on abstinence was puzzling. While virginity until marriage may have been valued in the old days, faithfulness in marriage never was. Uganda’s traditional chiefs and kings had hundreds and sometimes thousands of wives and concubines; polygamy, of both a formal and informal nature, remains extremely common in Uganda, and the sexual affairs of President Museveni himself are a frequent subject of gossip, as are those of other government officials including those who set the nation’s AIDS policy. Among members of parliament, sexual harassment by male colleagues is a fact of life for many female MPs, and prostitution, though officially illegal, flourishes in Kampala’s good hotels, including those owned by close political associates of the President and his wife. Porn magazines abound. Sexual matters such as breast implants and premature ejaculation are fervently discussed in mainstream newspapers and on the radio. According to po-lice reports, among the most fre-quent culprits in cases of defilement—or sex with a minor—are Christian pastors, along with teachers and policemen, and a local NGO recently urged pastors to use condoms because they were endangering their congregations.

The preaching about abstinence in Uganda thus seemed at odds with the culture. But Africa’s masks and secrets are often impenetrable to outsiders. Was this a charade to impress the right-wing bureaucrats in the Office of the US Global AIDS Coordinator who oversee the spending of the $1 billion earmarked for abstinence-only?

2.

I arrived in Uganda in September 2004 with this question in mind. As I usually do, I stayed at Makerere University in Kampala. It was the beginning of the school year and students were arriving from all over the country. The freshmen dressed in the formal way of 1940s American college men and women, in long skirts and slacks and buttoned-up white shirts with collars. Each year, upperclassmen at Lumumba Hall, a men’s dormitory, welcome the freshmen by displaying their dorm mascot on the grass in front of the building. The mascot is a life-sized sculpture of a man made from scrap metal, with a large drain pipe for a phallus. In order to educate their peers about HIV, the students dress the phallus in a new condom every day, and a fresh box of condoms—free for the taking—is placed at its feet. “He symbolizes the culture of our hall of residence,” one of the students explained to me. “He has girlfriends, but he always uses a condom.” One afternoon shortly after I arrived, a pastor from a nearby church marched up to the statue, removed its condom, set a match to the box of free condoms, and then prayed over the fire: “I burn these condoms in the name of Jesus!” he boomed, and then promised each student a free Bible.

Uganda is in the throes of a born-again Christian revival. With the arrival of the first missionaries in the nineteenth century, nearly all Ugandans became either Catholic or Protestant, but during the past ten years, thousands—perhaps millions—of them have been swept out of their dusty, austere churches into bright new amphitheaters that even on weekdays are filled with music and prayer and swaying worshipers speaking in tongues. Born-again Christianity is catching on throughout sub-Saharan Africa, from the slums of South Africa to the windswept plains of Maasailand, but Uganda’s Christian traditions, and its position bordering heavily Muslim Sudan, Kenya, and Tanzania, have made it a magnet for American evangelical missionaries, who have poured huge sums into the country during the past ten years. In the major towns, “crusades”—massive religious gatherings—are held nearly every week, often attended by thousands of people.

  1. 1

    The Hope Factor: Engaging the Church in the HIV/AIDS Crisis, edited by T. Yamamori et al. (Authentic Media, 2003) p. 250.

  2. 2

    The Hope Factor, p. 194.

  3. 3

    See Health and Development Networks, “Condom U-Turn Puts Many Young Ugandans at Risk,” May 26, 2004; Human Rights Watch, “The Less They Know, the Better: Abstinence Only HIV/AIDS Programs in Uganda,” March 2005; Center for Health and Gender Equity, “Where Is the ‘C’ in ABC: Implications of US Global AIDS Policy and Funding for HIV Prevention in PEPFAR Focus Countries,” March 2005; Thomas J. Coates, “Science vs. Assumption in Public Health Policy: Abstinence Alone Not the Answer,” San Francisco Chronicle, May 25, 2004; and Esther Kaplan, With God on Their Side (New Press, 2004).

  4. 4

    Ruth Bessinger, Priscilla Akwara, and Daniel T. Halperin, Sexual Behavior, HIV, and Fertility Trends: A Comparative Analysis of Six Countries; Phase I of the ABC Study (Measure Evaluation, 2003), at www.cpc.unc.edu/measure /publications/special/abc.pdf (accessed June 22, 2004).

  5. 5

    Even by year. Virtually the same number of fifteen-, sixteen-, seventeen-, eighteen- and nineteen-year-olds became pregnant in 1988 as in 1995, a period when HIV rates in the same group of pregnant girls fell by nearly half. Teenage pregnancy rates did fall significantly between 1995 and 2001, but the use of modern contraceptives, including condoms, nearly tripled during this time, so it is difficult to attribute this to abstinence alone.

    Table: HIV prevalence among 15-19 year old pregnant women

    Table: Teenage pregnancy in Uganda

  6. 6

    Speech given at “AIDS Care in Africa: The Way Forward,” meeting sponsored by the Rockefeller Foundation, Kampala, Uganda, April 19–21, 2001.

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