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Religion and AIDS in Africa

October 30, 2012

If you are reading this, I am guessing you are either a)Interested in some way in Religion and/or AIDS and/or Africa OR b)Misdirected. In the latter case, you can probably stop reading. In any other case, you should probably read this book.

If, as a religious person, you think African religion and AIDS don’t matter to your church, Religion and AIDS in Africa may challenge you to think again. It provides one of the best empirical investigations of practical theology (how what people believe affects daily life) I have seen and it will challenge you to think more carefully about the importance of everything you say and do.

If you’re interested in the AIDS epidemic or sub-Saharan African society at all, I challenge you to read it without coming away believing that religion is somehow critical in this whole thing. Not only that, it is never preachy or didactic, presenting the data in a compelling manner without making blanket statements about what is right or wrong or even trying to guilt the reader into caring.

The layout is very straightforward: after a few chapters of introduction and background for the AIDS crisis and international response in sub-Saharan Africa, the authors launch into explorations of nearly every conceivable means religion might play a role in the spread, care, or social meaning of HIV and AIDS. In the process, Trinitapoli and Weinreb draw on a fantastic array of high-quality data regarding every country in sub-Saharan Africa, enriched by rich historical research, interviews, and even sermon transcripts collected both in their Malawi study and throughout Africa. Finally, the authors make an unusual claim, at least coming from demographers: HIV and AIDS are changing the churches in turn. In every chapter, the reasoning is compelling, the facts are clear, and the authors are forthright about the limits on what they can reasonably conclude.

To be fair, I was a little skeptical when I picked it up. I knew the research and statistics would be the good, coming as they did from people who have spent the last few years flying back and forth to Africa devising clever ways to get better information on rural life. But I never intended to read the whole thing; I just figured it would be a good skim on the airplane so I could be a little more informed about the world. Instead, I ignored my other (required) reading on the flight home, too absorbed to stop. By the time I finished, I had already started plotting ways to extend their arguments and use new methods on them.

So, a few highlights (in my own words):

AIDS is confusing to Africans too (and why): The low single-event likelihood of infection, the long pre-symptom (latent) period, the inability of science to fully address it, the relational (social) nature of transmission, and the remarkable (yet often unsuccessful) involvement of the international community leave tastes of doubt and distrust in the mouths of many Sub-Saharan Africans. It is impossible to understand the ways in which HIV/AIDS interacts with culture and religion without getting a handle on these. Thankfully, the authors are as clear and intentional in their cultural analysis as they are in their demography. To top it off, HIV/AIDS infection rates vary dramatically across the sub-continent, both within and between nations.

Forget the absolute: Over and over we discover how just learning a little more about people or religions really helps understand the demography and numbers. One example: gender and church attendance explain risky behavior better when you also consider the overall religiosity of the village, probably because of normative pressure and risk pools within and nearby the village.

What you “know” is probably wrong: Polygamy, education, and wealth didn’t predict the likelihood of having an extramarital sexual partner in Malawi, but religious affiliation did (mission Protestants and Pentecostals were less likely to have one). Even more important, though, those who are more religiously active had less extramarital partners across religious groups and it appears to be social control and accountability to religious leaders driving this, rather than selection or education and beliefs.

C is for Condoms and Complicated: Beyond the internationally promoted ABCs of HIV prevention (abstain, be faithful, use a condom), local cultures address prevention in a variety of ways ranging from the timing of marriage to curbing alcohol consumption. All of this is mediated through local cultures and religious groups.

As a sociologist, all of the above discussions interest me, particularly when the arguments are supported by data and well written, but the central questions as a religious leader remain for the later portions of the book: How do congregations impact the HIV/AIDS epidemic and how are they affected in return.
Most of a chapter consists of an application of Quantitative Comparative Analysis (QCA) looking at HIV prevalence across congregations with different combinations of prevention strategies: moral, faith-healing, divorce (of cheating or HIV-positive spouses), and biomedical (ABC methods). For my money, this is the central analysis of the entire book. Overall, the authors found that the combination of moral teaching and support for biomedical approaches insulates congregations against HIV/AIDS to some extent while emphasis on faith-healing predicts higher prevalence. The meat, though, consists of the authors’ more detailed exploration of what exactly the patterns mean, in terms of beliefs, practices, and the way everyday congregation members describe their daily lives.

For congregational leaders and practical theologians, whether or not you have ever even thought about going to Africa, this discussion is probably one of the most solid, data-based, approaches to the nitty-gritty reality that we like to talk about for positive but not negative things— what we do in church can dramatically alter the course of lives for individuals and communities. And part of the value of the demographic data is exactly that: it is often impossible to see the implications of practice on a case-by-case basis, while the same implications become clear and un-ignorable once considered at the right level.

Also important are community practices of support and/or stigmatization for the HIV positive and their families. This is one of the dimensions where differences between congregations were quite evident, begging the question of practitioners: How am I directly or indirectly encouraging those we worship with to love those around us? And while strong moral stances may appear contradictory to the goal of compassion toward all, these African congregations often showed that discipline and compassion are not polar opposites.

Finally, the authors deal with an often unexamined question (although Rodney Stark tackled it in The Rise of Christianity): how does the epidemic influence religion. For one thing, the AIDS epidemic has by necessity brought sexuality and medical discourses into congregations. On an individual level though, the authors consider two tougher empirical variants: does exposure to HIV/AIDS predict subsequent shift in affiliation and does it cause people to become more deeply committed to their faith? They find that people living with HIV and AIDS are more likely to switch to congregations which “are actively engaged in providing social support” (201) and to become born-again. In other words: disease matters to religion. This shouldn’t be a surprise to people familiar with the gospel narratives in the Christian New Testament or the history of plagues, but it is an important empirical confirmation and challenge to faith leaders.

Religion and AIDS in Africa is powerful and well worth reading, both for social scientists and religious leaders, for one primary reason: it challenges us to think carefully about the processes that actually make up social and religious life, how they impact people, how they impact the ways we understand religion, and how we can begin to understand them in their beautiful complexity. Mixed methods studies can at times suffer from split personalities and end up lopsided or mediocre. This study, however, demonstrates the power and necessity of an all of the above approach in tackling tough, important questions with real implications. Bravo.


Full disclosure: One of the authors is currently a professor in my department but does not supervise or evaluate me in any way. I was provided a review copy of the book, but no other consideration.

  1. etseq permalink

    Sounds like an interesting book but I noticed one subject missing from your very thorough review. Did the book address the role of religion in the stigmatization of sexual minorities? Although HIV/AIDS is primarily heterosexual in Africa, there is still a significant percentage of sexual minorities that are infected or at risk. Additionally, due to high levels of homophobia and criminalization of same sex activity, there are large numbers of MSM (men who have sex with men but still identify as heterosexual). In the west, the closest analogy would be to the closeted married men who live a secret life of sex with men, which was common before the 1970s (and occurs to this day).

    I did a quick google books word search of the book for the terms gay, homosexual, LBGT, MSM and only found one hit and it was only a footnote that referenced stigma for gay people but sentence footnoted did not mention homosexuality at all – just sex outside of marriage.

    Without addressing sexual minorities and the role religion plays in their repression, I seriously question either the competence or the integrity of the work in question, It seems to validate my suspicion that this is more a work of apologetics than social science.

    I’d also note that both authors are well known conservative christians, who along with Christian Smith, Mark Regnerus, Rodney Stark, Brad Wilcox, etc. have a long history of shfiting the subfield of sociology of religion away from critical scientific evaluation of religion. I am not saying they cannot produce objective work but it certainly makes me a bit more skeptical of their conclusions and the exclusion of homosexuality.

    You did mention at the beginning of your review that you were skeptical as well. How would you account for the avoidance of sexual minority issues?


    —Jimmy Green

    • Thanks for taking the time to comment and express your reservations. I can’t speak to everything you wrote, because I don’t study sexuality. I can say a few things though. I agree with you that considering sexual minorities is important in the long run, but much of what controls the research is the types of data that can be gathered. This is already an ambitious mixed-methods project and, to my reading at least, stands well on its own in addressing the more normative situation without pretending to deal with other situations.

      The one thing I can say for certain is that you are mistaken about the authors. I know one personally and know enough of the other to assure you they are not conservative Christians, well-known or not. I would also argue you’re fairly mistaken about the other people you list “shifting the subfield… away from critical scientific evaluation of religion” unless you mean outright dismissal of religion. Aside from the recent Regnerus controversy (which was not directly part of the study of religion, and which this is not the place to discuss) those people and their colleagues have led the field away from an evolutionary perspective that says religion is just how people content themselves or fill in what they don’t know, and toward a study of how religion as it is functions without evaluating its fundamental correctness. I count that as a substantial contribution, and one I

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