Book Review: Preaching Prevention: Born-Again Christianity and the Moral Politics of AIDS in Uganda

Preaching Prevention: Born-Again Christianity and the Moral Politics of AIDS in Uganda. Lydia Boyd, Athens: University of Ohio Press,2015, 252pp.

Preaching Prevention contributes to the growing literature on the response to AIDS in Africa by addressing the controversial emphasis on abstinence and faithfulness, rather than condoms, as modes of preventing infection. The first phase of PEPFAR (President’s Emergency Plan for AIDS Relief) earmarked 80% of its massive resources for treatment; of the remaining funds for prevention, 30% were required to support interventions that gave priority to abstinence before marriage and faithfulness thereafter. Churches, especially of the charismatic variety, took up this message and received financial support from PEPFAR to promote it. Boyd’s study was based in one such church, whose congregation included many university students in Kampala. It is thus an exploration of the local appropriation of an intervention.

The book makes two interrelated arguments: that the notion of the accountable subject is fundamental to global health interventions in the era of neoliberalism and that the moral sentiments inherent to this approach are contested in practice in today’s Uganda. It contrasts individual with community-based approaches to intervention, arguing that PEPFAR promoted the former at the expense of the latter, which had characterized earlier prevention efforts. The abstaining/faithful accountable subject cultivated self-development, interiority, discipline, reflection, and intentionality in relationships. Self-control was also an element in older more community-oriented Ugandan principles of personhood, but mainly in relation to others, as an aspect of ascribed kin relationships rather than as a dimension of self-development. In accepting abstinence, young people navigated between a neoliberal and an older inter-dependent model of moral personhood.

The focus on one aspect of one policy in one church is rather narrow. However, the book’s first and second chapters provide context in describing the background of the PEPFAR program and briefly summarizing AIDS prevention in Uganda. Importantly, there is also a discussion of the politics of moral reform in 20th-century Uganda, showing how gender, generation, and kin relationships have been objects of concern by Christian missionaries and traditionalists alike. While there has been disagreement on the place of particular ceremonies and modes of spiritual and social authority, there has been consensus on the value of stable, socially recognized marriage.

Two chapters on abstinence and one on faithfulness form the heart of the book. Boyd’s informants saw abstinence as a response to the temptations of city life and more deeply as a way of developing character, of focusing on studies and church, and of reflecting on the kinds of relationships they wanted to cultivate. They contrasted the hierarchical relations of obligation in traditional Ganda families with the considered, chosen, and enlightened relations they wanted for their own future families. Reflecting on current and past relationships was thought necessary to maintain or regain physical health. Deliverance prayer, an important tool in dealing with unhealthy or sinful aspects of relationships, allowed young people to manage “non-Christian spirituality” that made demands on them as members of families. It also helped them deal with recent romantic relationships that were troubling them. Church messages promoted abstinence as far safer than condoms, since condoms might fail while faith and spirituality provided security beyond what a specific technology could give.

At some point, abstinence gives way to faithfulness. Ideally, a couple that has abstained together and waited for marriage will form a happy, loving, and sincere partnership, in contrast with traditional marriage and current notions of romantic love. For the young church members in Boyd’s study, this meant a wedding with bridewealth (i.e., the exchange of gifts that signified recognition by the extended families on both sides). Boyd describes how the church provided support for meeting wedding expenses and negotiating with parents about bridewealth. However, there is little about how faithfulness was pursued in marriage, perhaps because few of her informants were actually married.

In 2009, PEPFAR was renewed for a second phase, but without earmarking funds for abstinence and faithfulness as prevention strategies. Lacking financial support, activism around these aspects of gender relations declined. By 2010, attention shifted to another mode of sexual morality, the anti-homosexuality movement. Boyd’s informants were active in promoting the Anti-Homosexuality Bill, and she devotes the last chapter of her book to the counterpoint between abstinence/faithfulness and homophobia. American donors, including partner churches, were highly critical of the anti-gay sentiment expressed by Ugandan Christians and they withdrew donations.

The pastor and young people in the church Boyd studied found the vagaries of support confusing; they were puzzled by the shift from financial assistance for promoting abstinence to sanctions, in the name of human rights, for crusading against homosexuality. The ideal of the neoliberal accountable subject enjoying self-determination could be made to fit with the concerns of these born-again university students; however, in their view, it did not extend to self-realization as a homosexual. Boyd provides a nuanced and insightful discussion of the Ugandan discourses on homosexuality that goes beyond the simplistic explanation that U.S. fundamentalist Christians stirred up homophobia in Uganda. The pastor with whom she worked closely did not deny that same-sex relations had long existed in Uganda; he objected to the “preaching” from Global North governments and NGOs that homosexuality was a human right.

Preaching Prevention highlights two themes in Ugandan public culture that have fired the critical imagination in the Global North: abstinence and homosexuality. It is narrowly focused and tightly argued, giving it sharpness and sophistication. For these reasons it will be attractive for teaching and as an analytical contribution to debates about the principles of global health interventions. These virtues make it perhaps a bit limited as ethnography. There is little “surplus” empirical material. The larger landscape of churches in Uganda is not sketched out. Readers do not get much experience-near description of the relations of these young people to their families, friends, and to one another, nor of the place of the church in their daily lives. But the book’s purpose is another: to analyze principles of moral personhood as they are embedded in global health initiatives and appropriated in local settings. In this it succeeds very well.

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