HIV This Week

Rankin SH, Lindgren T, Kools SM, Schell E. The condom divide: disenfranchisement of Malawi women by church and state. J Obstet Gynecol Neonatal Nurs. 2008;37(5):596-604; quiz 604-6.

Rankin and colleagues examined the impact of 2 mitigating social institutions, religious organizations, and the state, on Malawi women’s vulnerability to HIV. In-depth interviews with a purposive sample of 40 central leaders from 5 faith-based organizations in Malawi were recorded and transcribed as part of an on-going larger study. Qualitative description was used to identify themes and categories. The study took place in primarily urban and periurban areas of south-central Malawi. A minimum of 6 leaders from each faith-based organization were interviewed; the mean age of the primarily male (68%) participants was 44 years (range 26-74). Analysis of religious leaders’ messages about HIV produced an overarching theme, the condom divide, which conceptualized the divergence between faith-based organizations and the state’s prevention messages related to HIV prevention strategies. The authors conclude that faith-based organizations have « demonized » state messages about condoms as promoting sin. The faith-based organizations’ insistence on abstinence and faithfulness leaves women with few options to protect themselves. As socially conscious citizens of the world, nurses can increase the responsiveness to the disparate levels of suffering and death in countries like Malawi.

Editors’ note: Whereas the Malawi government has broken the silence about sexual behaviours and their contributions to the HIV epidemic and is actively involved in HIV prevention, faith-based organisations in this country in which religion plays an important role are lagging behind. About 55% of the population is Protestant, 20% Catholic, and 15% Muslim, while 10% practice African traditional religions. This study of 40 religious leaders representing 5 faith-based organisations (3 mainstream Christian, 1 indigenous Pentecostal, and 1 Muslim) revealed that religious leaders, who are uniquely positioned to champion HIV prevention across Malawi, have largely refused or been reluctant to do so. Condoms are condemned except for discordant couples and there is little acknowledgement that the disadvantaged position of women along with double standards for sexual behaviour place women at heightened risk of HIV exposure. A human rights-public health approach that respects the right of everyone to sound scientific evidence to preserve health and encourages everyone to act responsibly would be a synergistic contribution that religious organisations could make now to the AIDS response in Malawi.