In the history of the AIDS epidemic in Africa, there has long been a divide between public health advocates and churches.
Religious leaders often promote ideas about HIV and the use of condoms that run counter to public health campaigns. But that's starting to change, in at least one country in southern Africa.
Swaziland is an overwhelmingly Christian nation. There are churches everywhere you look, from warehouses in the city to concrete huts in the countryside. It's not unusual to hear praise choirs singing in markets or at bus stations.
Swaziland is also one of the hardest hit countries in the world when it comes to AIDS. It's estimated that as many as a quarter of all Swazi adults are HIV-positive.
Churches have long played an important role in caring for the sick, but in terms of HIV prevention they've been at odds with the public health community. It has often come down to one issue: until recently, Swazi church leaders publicly rejected the use of condoms by their congregants. But now you hear many comments that suggest a change in thinking.
Pastor Johannes Masibuku said, "We follow the scientific revelation that they need to make sure they use condoms, so [that] they don't continue infecting, or [be] infected."
Masibuku heads the Alliance Church in the Swazi capital, Mbabane. He's an independent church leader which means that unlike, say, a Catholic priest, he's free to adjust his teachings, including on the use of condoms.
Along with other local pastors, Masibuku is fiercely opposed to people having sex outside of marriage. But he knows that some do, and he's changed his mind on how to protect them. That kind of shift in attitude might provide an opening, according to Tessa Dooms, a sociologist at Wits University in neighboring South Africa.
"The bridge between religious and non-religious sectors of society is the biggest gulf in dealing with HIV/AIDS," she said.
Churches that are willing to partner with the public health sector could bridge that gulf, and that could be important in Swaziland's fight against HIV.
Swaziland's not short on anti-HIV campaigns. You can't move without encountering billboards advocating single-partner relationships, or leaflets promoting circumcision. But virtually all the young Swazis I met said they don't really pay attention.
21-year-old Zama Simelane said, "When you come to me and say, 'Zama we have to talk about HIV/AIDS', I don't need this because now it's boring. We'll just say, 'ah, they've started with their AIDS thing'."
But every week Simelane goes to church. Public health advocates argue that young people like her may be more likely to listen to HIV prevention messages if they hear them coming from a pulpit. Churches provide context for HIV messages. The way you behave has an effect on your community and being part of a church in Swaziland means being with people you know and trust.
At Alliance Church in Mbabane Pastor Johannes Masibuko has instituted a formal HIV program. He makes himself available to talk with churchgoers about their concerns, but the Alliance program goes beyond that.
"If they want to see a medical doctor they come on a certain day to see the doctor," said Masibuku. "If they want to see a nurse, likewise. Or [if they] just [want] to get some information on what to do, the people who are trained are available."
At the the New Light Zion church, in the city of Manzini, HIV testing sessions are held in the church hall. Church president Stephen Mhlanga sets the example for his congregation.
"I can show you my card. You test today, they say wait for three months. Test again. Come again after three months. Test again", he said.
Public health advocates in Swaziland are pleased to see churches promoting medical education like this, but they also see downsides. Some of the beliefs expressed in Swazi churches run counter to the science of HIV.
On a Sunday morning at New Light Zion church, a visibly sick woman sits in a chair. Members of the congregation dressed in white robes walk around her in a circle. They pray and touch her as they pass. The priest, Stephen Mhlanga, explained:
"We can lay hands to an HIV positive person, and that positive person can be negative, if really he believes in that," he said.
But that degree of belief is hard for public health advocates to accept. Aymeric Péguillan is with Doctors Without Borders in Swaziland.
"It's obviously difficult for us as a medical, scientific organization to listen to messages such as 'let's pray HIV away'," he said. "Clearly there is a need to have a coherent message and not to raise doubt."
There is one more point on which the public health community remains sharply divided from churches in Swaziland: their unwillingness to reach out to men who have sex with men.
"There are what we call essentials when it comes to Christian values," said Johannes Masibuku of Alliance Church. "There it's not easy for us to compromise, because we have a mandate from the word of God."
That's the key thing. Churches see themselves as instruments of God, not as assets to be used by the public health community. There is a surge in interest in partnerships between the two groups. There's also a tension: neither side expects to see eye-to-eye on everything.
On this, however, they do agree: the scale of the HIV crisis demands the effort.
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