God’s Hands are in our Drugs:
ARVs, Religion and Power in Northern
By Matthew Wilhelm-Solomon
Department of International
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.
Multi-cited qualitative study in Gulu, Amuru and
Lira districts (2 towns, 6 camps, 5 rural sub-
8 months field-work between July 2006 and June
Individual interviews : 128 people living with HIV;
72 medical workers ;41 other key informants
(NGOs, political leadership, community
Focus Groups: 25 with PHAs, and 9 with members
of the community whose status is unknown
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”
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.
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.
HIV responses and social history
The long history of missionary medication in
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
The rapid expansion of antiretroviral therapy to
conflict affected areas from 2005 onwards.
Biomedicine, religion and power
Religion provides a response to uncertainty. Missions and
churches provided spaces for support groups, and psycho-social
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
Faith-based ARV provision may limit reproductive health choices.
The linking of Christian and biomedical approaches exclude
“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
“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)
“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”
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.