God’s Hands are in our Drugs:
ARVs, Religion and Power in Northern
Uganda




                    By Matthew Wilhelm-Solom...
Context
 A two decade civil war between the Government of
 Uganda and the Lord’s Resistance Army (1987 to 2006)
 1.5 milli...
Research Methodology
 Multi-cited qualitative study in Gulu, Amuru and
 Lira districts (2 towns, 6 camps, 5 rural sub-
 co...
AIDS and Power

 “We are on the brink of an unparalleled life-controlling
 intrusion into African societies, and we just d...
Antiretroviral Provision
 The AIDS Support Organization: Site-based, outreach
 and home-based distribution. Distributes co...
HIV responses and social history
 The long history of missionary medication in
 Northern Uganda
 Conflict, forced displace...
Opit
Biomedicine, religion and power
 Religion provides a response to uncertainty. Missions and
 churches provided spaces for s...
“What was very clear when I worked in Northern Uganda was we
had a dilemma of reproductive health for all patients, partic...
“Comboni tell us that when you are sick with
HIV, you shouldn’t give birth. They don’t agree
on the issue of condoms, and ...
Agnes Odoch

“I think I now have
power. I think now I
am more powerful in
the household because
I left relationships
aside...
Conclusions
 The moralized nature of treatment interventions should be
 acknowledged, and open to debate, by public health...
03 Wilhelm Solomon W Ppt0000013
03 Wilhelm Solomon W Ppt0000013
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03 Wilhelm Solomon W Ppt0000013

  1. 1. God’s Hands are in our Drugs: ARVs, Religion and Power in Northern Uganda By Matthew Wilhelm-Solomon DPhil Candidate, Department of International Development Oxford University
  2. 2. Context A two decade civil war between the Government of Uganda and the Lord’s Resistance Army (1987 to 2006) 1.5 million displaced 2005 free ARV programmes expanded in conflict affected areas, 15 000 on treatment by 2009 in towns and rural areas. 2007 mass return movement from camps and towns to villages starts in Gulu and Amuru, in Lira major movements in 2006.
  3. 3. Research Methodology Multi-cited qualitative study in Gulu, Amuru and Lira districts (2 towns, 6 camps, 5 rural sub- counties). 8 months field-work between July 2006 and June 2009 Individual interviews : 128 people living with HIV; 72 medical workers ;41 other key informants (NGOs, political leadership, community informants) Focus Groups: 25 with PHAs, and 9 with members of the community whose status is unknown
  4. 4. AIDS and Power “We are on the brink of an unparalleled life-controlling intrusion into African societies, and we just don’t know what it will look like” (De Waal, 2006:115). “at the juncture of the ‘body’ and the ‘population’ sex became a crucial target of a power organized around the management of life rather than the menace of death” (Foucault, 1998:148).
  5. 5. Antiretroviral Provision The AIDS Support Organization: Site-based, outreach and home-based distribution. Distributes condoms. Ministry of Health: Decentralized distribution at health centres. No community based support until 2008. Condom distribution. AIDS Relief: Site based provision through St Mary’s Hospital Lacor, with extensive community support through local adherence monitors by Comboni Samaritan. Catholic and abstinence based.
  6. 6. HIV responses and social history The long history of missionary medication in Northern Uganda Conflict, forced displacement and the developmental marginalization of Northern Uganda, including from the Ugandan HIV “success story”. The shift in global funding regimes, in particular PEPFAR 2003. The rapid expansion of antiretroviral therapy to conflict affected areas from 2005 onwards.
  7. 7. Opit
  8. 8. Biomedicine, religion and power Religion provides a response to uncertainty. Missions and churches provided spaces for support groups, and psycho-social healing. HIV/AIDS as well as ARVs received and interpreted in religious and moral ways (“Gods hands are in our drugs”). Religious convictions, particularly, abstinence for those with HIV, may place impossible expectations on patients. They construct an ideal sexuality. Faith-based ARV provision may limit reproductive health choices. The linking of Christian and biomedical approaches exclude indigenous healers.
  9. 9. “What was very clear when I worked in Northern Uganda was we had a dilemma of reproductive health for all patients, particularly for HIV positive patients. The ideological background for the biggest hospitals in Northern Uganda is that they are Catholic based and Catholic run and in that sense we know the Catholics don’t condone forms of family planning. They have natural family planning methods, and they don’t believe in abortion, and all sorts of other things. So you have a situation where you have an HIV positive patient, at most you can discuss, but you cannot provide the full reproductive health care to which they are entitled. And this is a moral dilemma for the whole country,” Doctor, St Mary’s Lacor Hospital
  10. 10. “Comboni tell us that when you are sick with HIV, you shouldn’t give birth. They don’t agree on the issue of condoms, and they will tell people to stay apart. It becomes hard. As human beings when you are weak, you may not have sexual desire, but when you gain and have strength, the sexual desire returns, and you will find yourself having sex. This is with both men and women” (31 year old woman, Opit)
  11. 11. Agnes Odoch “I think I now have power. I think now I am more powerful in the household because I left relationships aside and am sticking to the medication”
  12. 12. Conclusions The moralized nature of treatment interventions should be acknowledged, and open to debate, by public health practitioners and by patients themselves. Faith-based and secular treatment organizations should form a working consensus to increase choices available to patients. The spatial equality of diverse reproductive and contraceptive health options is important. Life saving treatment confers a power over life. The expansion of antiretrovirals to resource poor settings is important for social justice, but also confers authority in the hands of providers.

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