468 MY AFRICA doi: 10.3325/cmj.2010.51.468 “I Can’t Use a Condom, I Am a by Adamson S. Muula [email protected] Christian:” Salvation, Death, and… Naivety in Africa The countries of the Southern African Development Com- supposed to serve. Mukonyora (5) has suggested that “con- munity – Angola, Botswana, Democratic Republic of the dom use is purely a public health issue and not a spiritual Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozam- issue” and also described church’s anti-condom message bique, Namibia, Seychelles, Swaziland, South Africa, Tanza- as “mass murder.” Her writing was prompted by a banner at nia, Zambia, and Zimbabwe – continue to be hardest hit a church building reading – “HIV/AIDS: Using a condom is by the HIV and AIDS pandemic. There is a whole range of like walking on a tight rope, one slip could kill you.” social, biological, economic, and political factors respon- sible for such a situation. In most of the countries of the I, however, believe that considering HIV purely as a medi- Southern African region, HIV infection prevalence esti- cal issue with no concerns of the contextual factors such mates among adults are beyond 10%; and even higher in as religion, socio-political, cultural, and economic factors, is young women, especially pregnant ones. Besides being a at best, naive, and similar to the “denialist” stance that HIV consequence of AIDS, malnutrition contributes to HIV vul- is not the cause of AIDS. I believe that religion, religious be- nerability, further deteriorating HIV infection. liefs, and affiliation do have a role to play in the stemming, and in some cases, the spread of HIV in much of Southern The common mode of HIV spread in Africa is heterosexual Africa. intercourse, as opposed to the Americas and Eastern Eu- rope, where injecting drug use and male homosexual in- This article is intended to describe the situation in a Chris- tercourse are the common mode. tian denomination in Malawi regarding HIV and AIDS. The official position of that church, messages on condoms and The extent of the contribution of heterosexual intercourse sexuality, and the apparent confusion created by various to the spread of HIV in Africa is not accepted by all medical positions of the Church are also discussed. scientists across the world. Gisselquist et al have suggested that the role of unsafe medical injections in the transmission NUMBER OF CHURCH MEMBERS IN THE SOUTHERN of HIV within the health sector has been underestimated (1). AFRICAN REGION This observation has been corroborated by other research- In the southern African region, there were 1 765 578 mem- ers (2,3). Lopman et al, however, have not found sufficient bers of this Christian denomination in 2004. The full distri- evidence to support the suggestion that medical injections bution of church members in different countries or geo- could contribute the HIV infection in Zimbabwe (4). graphical regions is shown in Table 1. PREVENTION PRACTICE Table 2 shows the distribution of new members, members As the major mode of HIV transmission in Africa is con- who dropped out, and members who died in 2004 in Ma- sidered to be heterosexual intercourse, the major mode lawi. It is noteworthy that Malawi death rates between 1995 of prevention has been the ABC approach, ie, sexual ab- and 2004 ranged from 0.57% in 1997 to 1.40% in 1999, with stinence, being faithful (fidelity or mutual monogamy) to an average of about 0.9%. These death rates are extreme- one sexual partner, and consistent and correct condom ly high, ie, the church population in Malawi annually loses use. Multiple and concurrent partnerships fuel the spread about 1% of its members due to death. While the cause of of HIV in Africa. deaths has not been documented, in an environment where adult HIV infection rates are estimated at 14%, AIDS is likely The Christian church has at times been suggested as an to be one of the main causes of death. It is noteworthy that impediment toward the promotion of condoms. At least the distribution follows the distribution of HIV rates in Ma- in Europe, this has caused interesting and bitter discus- lawi, ie, lower infection rates in the North and higher rates in sions, with some people suggesting that the church the South (6). The church’s response to HIV and AIDS in Ma- is insensitive to the real needs of the people it was lawi ought therefore to consider these statistics. www.cmj.hr Muula 469 TABLE 1. Distribution of church members in different countries tween the community and the agent that has promoted or geographical regions* condom use, first for family planning and later for diseases Country Churches Companies Members Population prevention, shapes the acceptability of the device. The fe- Angola 873 1015 253 410 13 459 000 male condom is yet to become acceptable to the majority Botswana 71 114 24 349 1 684 000 of women and their partners (11). Zachariah et al (12) in their Indian Ocean 424 822 89 325 20 416 000 study of commercial sex workers in Thyolo, southern Mala- Malawi 1205 1471 233 300 11 938 000 wi, reported that too much lubrication, too great size, and Mozambique 937 2614 186 724 19 182 000 noise during sex were some of the technical problems ex- Zimbabwe 824 2014 427 762 12 672 000 perienced with use of the female condom. Jivasak-Apimas Total 6608 11861 1 765 578 141 986 000 et al (13) from Thailand reported pain, difficulties with inser- *Source: Seventh Day Adventist Church. World Church statistics; tion, and itching as the most frequent problems. Despite the available from: http://www.adventiststatistics.org/view_Summary. shortfalls associated with condom use, some reports have asp?FieldID=D_SID&Year=2004&submit=Change suggested that condom use is an effective and presently vi- TABLE 2. Membership status of one denomination in Malawi, tal aspect of HIV and other sexually transmitted infections 2004* prevention globally (14,15). Region of Beginning Dropped/ the country membership Accession (%) Death (%) missing (%) ChuRCH AND CONDOM CONTROVERSY Central 37 552 6363 (17.0) 299 (0.8) 2008 (5.4) The role of the church in the prevention and control of North 30 190 2765 (9.2) 138 (0.5) 1273 (4.2) HIV and AIDS in Africa has been fraught with controversy, South 166 118 11 647 (7.0) 2327 (1.4) 4032 (2.4) especially in regard to condom use (16). Bernadette Muk- Total 233 860 20 775 (8.9) 2764 (1.2) 7313 (3.1) onyora (5) suggests that churches, “instead of advocating *Source: Seventh Day Adventist Church. World Church statistics; available from: http://www.adventiststatistics.org/view_Summary. for the preservation of human ‘life’ and exercising ‘love’ for asp?FieldID=D_SID&Year=2004&submit=Change mankind, are slowly but surely becoming public enemies by discouraging the use of condom.” Mukonyora argues If we exclude HIV deaths, it is estimated that the total num- that “The Zimbabwean youth of today are growing up in ber of adult deaths in Malawi would be around 22 000, ie, a world where they are exposed to sex, violence, nudity, 0.18% of the current 80 000 deaths (7). and vulgar language at a tender age. Youths lose their vir- ginity at a very young age;” that “Gone are the days when Absolute annual increase in Church membership ranged only one discourse ruled the day and dictated how people from 7255 in 2004 to 17 722 in 1992. However, there was a should live their lives, what they should believe and who net membership loss of 39 591 in 1998. they should love;” and that “The Church should not con- fuse issues. Condom use is purely a public health issue and CONDOms AND HIV PREVENTION not a spiritual issue.” Mukonyora also quotes Lois Lunga of Consistent and correct condom use in penetrative vaginal SAfAIDS, “By calling against condom use, the churches are and anal sex has been demonstrated as an effective way of encroaching in a domain that is not theirs…out of curios- preventing HIV transmission (7). Condoms also prevent the ity why haven’t the churches spoken against treatment of transmission of other sexually transmitted infections such sexually transmitted infections.” as syphilis and gonorrhea. These other sexually transmitted infections also facilitate the efficiency of transmission and Arie’s (17) claim in the British Medical Journal that “the con- acquisition of HIV. dom corrupts and weakens people... destroys families and individuals... and spreads promiscuity.” provoked an inter- Users of male latex condoms have reported discomfort, vag- esting discussion. Estraviz (18) commented: “I am Catho- inal or penile irritation, and lack of sensation as some of the lic. I know what is a condom and how to use it. I am free impediments toward consistent use (8). Also, condoms have and I can use it or not. I choose not to do it. Why can’t the especially been promoted out of primary relationship and in Catholic Church explain its doctrine in this or any other commercial sex (9). Kaler (10) has described condom use in field?” Baschetti (19) quoting Good (20) wrote: “Men never rural Malawi in regard to “the symbolic nexus in which they do evil so completely and cheerfully as when they do it are fused with disease, population control, and malevolence from religious conviction,” implying that the prohibition will be an ongoing challenge in the struggle to prevent the of condom use was evil and opponents of condom use spread of HIV/AIDS…” They suggest that the relationship be- were not any different from religious fanatics. How- www.cmj.hr 470 MY AFRICA Croat Med J.