Boyd, Lydia. 2015. Preaching prevention: born-again Christianity and the moral politics of AIDS in Uganda

Boyd, Lydia. 2015. Preaching prevention: born-again Christianity and the moral politics of AIDS in Uganda. Athens: University of Ohio Press.

Reviewed by Anna Eisenstein (University of Virginia)

Lydia Boyd’s Preaching Prevention charts two moments in Uganda’s recent history: the roll-out of the US President’s Emergency Plan for AIDS Relief (PEPFAR), and Uganda’s Anti-Homosexuality Bill. Asking what these two cases have in common, Boyd explores Ugandan born again Christians’ engagement with discourses on sexuality and health in the midst of rapid urbanization, neoliberal global health policies, and the international sexual rights movement. In classic anthropological fashion, she finds that “indigenous moral logics” animate and valorize specific sexual practices in this particular historical and cultural context. Far from a unidirectional “export” of American approaches to care and treatment, Ugandan born-again Christians re-oriented and re-purposed US-directed messages about sexuality and personal agency in light of longstanding, locally relevant models of hierarchal interdependence. By documenting the distinctive motivations of Ugandan Christians, the book forms an important corrective to assumptions that Ugandan Christian attitudes and activisms merely parrot American Christianity, or that the beliefs and interests of American and Ugandan Christians are interchangeable.

The book is based on Boyd’s fieldwork in Uganda’s capital city, Kampala, on and off for various lengths of time between 2005 and 2011. Although she spent some time in other churches too, Boyd’s research focused on members of a church she calls University Hill Church (UHC). The church catered to a growing population of educated urban youth in Kampala, reflected the dominant regional ethnic group’s culture (Ganda), and advanced a born-again theology (in contrast to Uganda’s mainline Anglican and Catholic churches). UHC actively sponsored and organized AIDS prevention activities, including public marches, concerts, workshops, and outreach and counseling programs, and was the recipient of a “modest amount” of PEPFAR funding through a church-founded NGO (p. 19). In the book’s opening chapter, Boyd points out PEPFAR’s emphases on compassion as a motivating ideal, on behavior change as a public health strategy, and on religious and community organizations as key nodes for distributing aid and education. The majority of the book, however, shifts from the policy itself to concentrate instead on the historical and social contours of the UHC church community’s attitudes toward marriage, sexuality, and family life.

UHC’s members were mostly students at Makerere University, and thus, were mostly young, well-educated, English-speaking elites. In considering the friendship, romantic, and sexual relationships available to them, these born-again Ugandans encountered and engaged multiple, contradictory models of “moral personhood” – what it looks like to be a good, healthy person. Throughout the book, then, Boyd traces two contrastive perspectives on healthy behavior and relationships – the accountable subject (an American, neoliberal construction) and ekitiibwa (a Kiganda notion of respectability) — and how these come to shape one another in these Ugandan born-again Christians’ experiences. With the phrase the accountable subject, Boyd means to note a particular approach to governance in which access to certain services “becomes dependent on one’s ability to demonstrate accountability for one’s condition, to be a good subject of compassion, and to be able to harness the will to be improved by a donor’s humanitarian attentions” (p. 7). It is this approach that she sees at work in PEPFAR’s ethics of distribution and public health programming, as well as in neoliberal education in Uganda’s universities more generally. The competing model, ekitiibwa, is an older model of respectability in which sexual self-control is a way to invest in the relationships of interdependence and obligation that give shape to social life and enable social reproduction (p. 91). Within ekitiibwa, ethical practice is not located in an individual’s autonomous intentions and actions, but rather, “is turned outward in a way that demands interrogation of one’s relationships with and responsibilities to others” (p. 90). These two models conflict over whether ethical success – moral personhood – fundamentally derives from personal accountability or from hierarchal patronage ties. Crucially, in Ugandan born-again Christian practice, both models are moving targets, evolving in relation to one another, and can be intricately intertwined even in the same individual’s life.

In the first part of the book, Boyd reviews the social history of AIDS prevention in Uganda, documenting “a history not of the epidemic itself but of forms of moral activism in the face of social change” (p. 54). In 2003, President George W. Bush set in motion the President’s Emergency Plan for AIDS Relief (PEPFAR), which provided unprecedented quantities of AIDS treatment and HIV prevention programming to targeted “resource-poor” countries, of which Uganda was one. One-third of PEPFAR monies ($1 billion of the total $3 billion) were to be dedicated to abstinence and faithfulness-only programs. Although Euro-American critics viewed these as needless and controversial limitations, for their part, Ugandans, Boyd writes, “embraced” and “celebrated” Bush’s “more moral” approach to solving the problems behind the epidemic (p. 4). In Uganda, PEPFAR programming met a milieu in which moral authority was already very much in debate, where traditional and Christian moralities had been dynamically re-shaping one another since the colonial era. Ultimately, Boyd says, “the epidemic intensified questions about what types of persons are morally correct in Ugandan society, and about the social costs of both modern and traditional ways of being” (p. 15).

Having described the accountable subject and ekitiibwa and their interrelated histories in part one of the book, part two goes on to unpack how UHC members thought about PEPFAR’s message of “abstinence and faithfulness” through locally relevant lenses. For the Kampala youth Boyd knew, “abstinence and faithfulness” became a discourse through which to articulate a distinctive stance toward both “modern” and “traditional” sexual ideals. (Throughout the text, Boyd uses traditional and modern as emic terms, and I follow her usage in this review.) Abstinence privileged youth agency and choice in the face of demands from kin and clan. What such demands might entail might include avoidance of eye contact between sons-in-law and mothers-in-law and “varying practices of marriage, initiation, and terminal abstinence on the part of seniors” (p. 92). Strikingly, instead of eschewing the validity and power of interdependence, UHC members engaged directly with interdependent relationships through “deliverance prayer.” Boyd writes, “in Buganda and Uganda more broadly, physical and material substances have spiritual significance and import, giving shape to the spirit and also making the body vulnerable to evil and the ill will of others” (p. 113). Deliverance prayer provided a mechanism through which youth could “manage their lived relationships and the effects those relationships were thought to have spiritually, mentally, and physically” (p. 126). So then, abstinence (the practice of which included deliverance prayer) became a way for Kampala youth to “reassert and also reframe ideas about traditional persons and obligations” by appealing to the autonomy and agency of the self as a protection against the dangers posed by traditional sexual relationships (p. 105).

But if abstinence served to insulate individuals from accountability to the obligations of interdependence, it simultaneously served to critique modern attitudes about sexuality. Modern sexual relationships were sites of vulnerability, where demands of time and money threatened to derail youth from their pathway to personal success; abstinence provided a mode of inhabiting the modern as an autonomous self who reflected upon and resisted such hazards. Working hand-in-hand with abstinence, the ideal of faithfulness promised to “resolve the tensions surrounding forms of material and emotional affection that coexisted in both traditional familial love and romantic love” (p. 136). Boyd draws out how faithfulness closely related to Christian concepts of love, the transformational power of which was supposed to neutralize any inequality in material exchanges (male money and female care), and protect a couple from sinful transgressions including divorce, domestic violence, and infidelity (and thus, HIV). Boyd thus frames her discussion of faithfulness in light of recent anthropological scholarship on love, emotion, and affect, arguing that by appealing to a supposedly universal human emotion (love), faithfulness as an AIDS prevention strategy obscures the immense social and economic pressures affecting Ugandan sexual relationships (p. 151). While the discourse of faithfulness in Ugandan born-again churches may seem to be a model of love well-suited to Uganda’s neoliberal era, it “may also be making other behaviors and habits — multiple concurrent partnerships, the use of condoms – not less socially prevalent, but less socially acceptable” and thus further inaccessible for open discussion (p. 152).

The third and final segment of the book deals with Ugandan views on homosexuality, which Boyd treats as a new imbrication of the country’s ongoing struggle between the competing ethical ideals of autonomy and interdependence. While the discourse on abstinence worked to mediate between different models of sexual personhood, homosexuality seems to have exacerbated the conflicts between them. Interrogating what is the meaningful difference between abstinence and homosexuality here, Boyd finds that many Ugandans have embraced the ideal of accountability (central to abstinence), but have vehemently rejected the ideal of personal freedom upon which the figure of the sexual rights-bearing subject depends. Kampala’s modern, urban environment poses too many temptations and not enough social control, rendering young people “too free” to be misled by unchecked desires, and thereby wreak havoc on the spiritual and social fate of kin and clan: here, personal rights violate the relational experience of rights (p. 167).

In sum, Preaching Prevention stands a rich and readable volume on sexuality as it is enacted and contested in relation to a policy-in-context. The ethnographic material presented adds nuance and force to anthropological cries for public health campaigns to attend carefully to communities’ own motivations and concerns; we must ask what abstinence means to whom, and why. Against any semblance of universality, Ugandan born-again Christians’ abstinence, faithfulness, and homosexuality are not the same as Americans’.

Regionally, the text joins a growing body of literature that tracks the continued and evolving relevance of gendered, hierarchical interdependence relationships in contemporary Uganda and elsewhere in East and Southern Africa (see Scherz 2014 and Moore in prep. on Uganda; see Swidler and Watkins 2007 on Malawi, Haynes 2012 on Zambia, Ferguson 2013 on South Africa). Boyd’s distinctive contribution to this conversation is her attention the way the materiality and spirituality of the body constitutes a vital aspect of interdependent relations. In her analysis of wellbeing, Boyd connects physical health to one’s relationships with others, and argues that born-again Christianity provides a unique way of pursuing that relational and physical wellness through the practices of abstinence and deliverance prayer. It would be interesting to compare her data with studies of physical wellbeing in other nearby areas of East Africa, which document a concept of the body-as-conduit through which vital substances and sentiments flow and cause effects across networks of people (see Taylor 1990 and 1992 on Rwanda; Neema 1994 and Vokes 2013 on western Uganda; Geissler and Prince 2010 on western Kenya). Comparing and contrasting young Ugandan born-again Christians’ ideas with these other ethnophysiologies might yield further specificity to our understanding of how individuals are imagined to relate to others (whether through the individual will, physical contagion, exchange practices, or spiritual engagements), and how and why these ideas vary from one social group to another.

On a theoretical level, Boyd’s work compellingly shows that when indigenous moralities meet with the kinship structures of modernity, both modernity and tradition are re-worked in the process. Here the book might have taken the opportunity to speak more directly to theories of globalization and translation: does Boyd see the processes at work in this ethnographic situation as vernacularization? Hybridization? Syncretism of some kind? These questions notwithstanding, Boyd’s argument that Ugandan born-again Christianity renders traditional practices available for reflection in new ways bears similarity to Geissler and Prince’s (2010) material on the Christian objectification of traditional ethical practices in western Kenya. Together these works might form the beginnings of a powerful commentary on East African Christian relationships to both modernity and tradition, and the lived cultural effects of Christian forms ethical reflection.

Works Cited:

Ferguson, James. 2013. “Declarations of dependence: labour, personhood, and welfare in southern Africa.” Journal of the Royal Anthropological Institute 19 (2): 223-242.

Geissler, Wenzel, and Ruth Jane Prince. 2010. The land is dying: contingency, creativity and conflict in western Kenya. New York: Berghahn Books.

Haynes, Naomi. 2012. “Pentecostalism and the morality of money: prosperity, inequality, and religious sociality on the Zambian Copperbelt.” Journal of the Royal Anthropological Institute 18 (1): 123-139.

Moore Erin. Forthcoming. Translating feminine development: the circulation and transformation of “Girls’ Empowerment” in Kampala, Uganda. PhD Dissertation University of Chicago.

Neema, Stella B. 1994. Mothers and midwives: maternity care options in Ankole, Southwestern Uganda. Copenhagen: Institute of Anthropology, University of Copenhagen.

Scherz, China. 2014. Having people, having heart: charity, sustainable development, and problems of dependence in Central Uganda. Chicago: University of Chicago Press.

Swidler, Ann, and Susan Cotts Watkins. 2007. “Ties of dependence: AIDS and transactional sex in rural Malawi.” Studies in Family Planning 38 (3): 147-162.

Taylor, Christopher C. 1990. “Condoms and cosmology: the ‘fractal’person and sexual risk in Rwanda.” Social Science & Medicine 31 (9): 1023-1028.

—. 1992. Milk, honey, and money: changing concepts in Rwandan healing. Washington: Smithsonian Institution Press.

Vokes, Richard. 2013. “New Guinean Models in the East African Highlands.” Social Analysis 57 (3): 95-113.