Preaching Prevention. Lydia Boyd

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СКАЧАТЬ the 2006 World AIDS Day rally in downtown Kampala’s Centenary Park the heightened tension between prevention strategies and advocacy groups was evident. Various HIV/AIDS treatment and prevention groups had gathered to celebrate their work in a leafy plaza off Jinja Road, a main downtown thoroughfare. Speakers took turns talking about the ongoing challenge of HIV/AIDS in Uganda. A group of students from UHC, one of the local churches active in promoting abstinence, were carrying banners and signs reading abstinence pride and abstinence is the only way of preventing aids that they had painted that morning at the church. During a presentation by another group, which mentioned its condom distribution program, members of the church group booed and shouted “Abstinence oye!” Throughout the rally any mention of the word condoms was met with a similar reception.

      The apparent faultiness of other prevention methods was a fact often brought home by Christian abstinence activists in the years I lived in Uganda. A PEPFAR-funded student newspaper managed by a church-affiliated group on the university campus once ran a story explaining the “nine meticulous steps” involved in putting on a condom correctly. One young woman asked me, “If you can’t be consistent with coursework, how can you expect to use condoms consistently?” Another pastor’s presentation on youth sexuality in 2006 included a slide with a magnified sperm next to much smaller sexually transmitted viruses, the (misleading) lesson being that these diseases are so small they can permeate the latex in condoms. And a commonly repeated myth circulating among born-again Christian youth during a visit to Kampala in 2010 was that condoms cause cancer. This backlash against condom use was generated by the belief espoused by many Ugandan born-again activists, that abstinence (and, later, marital faithfulness) was the only way to prevent HIV/AIDS. In the years following PEPFAR’s introduction the mobilization of religious actors and the increased funding for abstinence-only programs contributed to a growing environment of antagonism among HIV/AIDS groups in the country. Editorials in newspapers and speeches by politicians often offered support for one side of the abstinence argument or the other. The Church of Uganda, which had in earlier years demonstrated a relatively inclusive approach to prevention strategies (at times even counseling condom use), by this time had embraced a far more antagonistic stance regarding condoms. Church leaders adopted rhetoric condemning adultery and other “sexual sins” and promoted condom use only within marriage. Public rallies in central Kampala encouraged youth to consider abstinence the only way to prevent AIDS (see figure 1.1).

      One of the most prominent church leaders to emerge during this period was Pastor Thomas Walusimbi, the founder of UHC, a congregation I will describe in greater detail in subsequent chapters. Pastor Walusimbi positions himself in Ugandan AIDS circles as a moral reformer, encouraging “appropriate” behavior as a way of preventing HIV/AIDS. He expertly emphasizes how abstinence and faithfulness are Ugandan cultural values that have been undermined by foreign AIDS agendas that he views as biased against a faith-based approach to HIV/AIDS prevention. During a speech on AIDS leadership given on the university campus in 2007 he characterized his work as a struggle against a foreign AIDS prevention establishment that is populated by experts who are “liberal, faithless, and have no families.” His message appealed to conservative American Christians, who also saw themselves fighting a moral battle against a nonbelieving, liberal establishment, as well as to an African audience for whom calls for a reassertion of “traditional” African gender and family norms in response to the social disorder of HIV/AIDS had become common. For young Ugandans, however, Walusimbi’s narrative of resistance to the corrupt influence of seemingly amoral foreigners provided a message about their own self-empowerment and global influence that was deeply appealing. When I interviewed him, Pastor Walusimbi elaborated on this argument, noting, “Africans have been so relegated to the backseat of development and modernism for so long. And there is a sense in which we always receive, we never give, we never create. Our stories are told for us. It really makes me weep. Even when we have a successful story, like our HIV/AIDS story is a successful story. Even then someone has to come and say this is what you did, this is how you brought HIV/AIDS down.” Walusimbi claims that Uganda is not recognized for the success it had curbing HIV prevalence primarily because foreign HIV/AIDS policy makers resist talking about morality in the context of AIDS. Ugandans, he noted, are “religious, we’re family oriented.” Therefore, he argued, the people are responsive to a message of abstinence and faithfulness. As I have outlined above, the story of Uganda’s success is far more complicated than Walusimbi would have it be. But the rhetoric he uses to couch his criticisms is attractive, emphasizing Ugandans’ own moral authority and autonomy in the fight against AIDS—a fight that is now, undeniably, driven by a global economic and political agenda far removed from Ugandans’ home communities.

      FIGURE 1.1. “Safe sex is no sex!” rally in support of abstinence, Kampala, October 2006

      While Walusimbi frames his protest against the perceived intrusion of external funders and their “amoral” agenda, his message gained prominence because of the worldwide controversies surrounding American HIV/AIDS policy. He characterizes his message as one of Ugandan youth empowerment, but the message’s power is derived from a connection to international—and especially American—Christian discourses regarding morality and AIDS. The meaning Ugandans attribute to Walusimbi’s message about personal accountability and self-control is an issue I take up in later chapters. But the landscape of AIDS activism in the early years of the twenty-first century, an era deeply shaped by a compassionate response on the part of President Bush’s conservative religious base, can be followed in Walusimbi’s rhetoric.

       Conclusion

      In the late 1980s and into the 1990s Ugandans did in fact adapt their behavior, delaying sexual debut and reducing their concurrent partnerships—effectively abstaining and becoming more faithful, thus reducing HIV prevalence in the country. But the story of PEPFAR is a story of how behavior change was taken out of the broader structural and cultural matrix that had brought it force and shape and how it was given a new kind of agency through the ideals of “compassionate care” championed by the U.S. government. Starting in 2003, when behavior change was adopted as a buzzword by President Bush and his advisers, abstinence and faithfulness had evolved into a singular abbreviation for individual choices that emphasized personal accountability for disease risk and prevention—choices that could be promoted and exported globally. This was an interpretation of prevention success that buttressed other objectives of American humanitarianism of the era, an orientation to compassionate aid that helped outline and reinforce the dominant frameworks of neoliberal social action—autonomy and individual agency—that often obscured alternative ethical practices and modes of action that had figured prominently in earlier Ugandan efforts to mobilize against the AIDS epidemic. In chapter 2, I take up the Ugandan context more directly, focusing on the history that lead up to the introduction of PEPFAR. This is a history not of the epidemic itself but of forms of moral activism in the face of social change, activism that informed the more recent iteration of moral authority so effectively claimed by Walusimbi and his peers.

       2

      AIDS AT HOME

       Urbanization, Religious Change, and the Politics of the Household in Twentieth- and Twenty-First-Century Uganda

      In 2006, I attended a gospel music concert, organized by local churches to promote youth abstinence, at the upscale Serena Hotel in central Kampala. At the beginning of the concert a high-profile army colonel gave an introductory speech drawing surprising corollaries between AIDS and the ongoing war in northern Uganda.¹ The main emphasis of his speech was that both tragedies—the war and the epidemic—had been caused by an erosion of cultural values. Young people, he explained, had forgotten how to “behave.” AIDS, he continued, was “not being helped СКАЧАТЬ