A child prays in a Jericho church in the north of Swaziland. (Photo by Alex Gallafent.)

In the history of the AIDS epidemic in Africa, there’s 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 songs when you’re simply waiting for a bus.

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, especially on one issue. Until recently, Swazi church leaders publicly rejected the use of condoms. But now there may be a change in thinking.

“We follow the scientific revelation that they need to make sure they use condoms, so they don’t continue infecting, or being infected," Pastor Johannes Masibuku said.

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 some do — and he’s changed his mind on how to protect them. That kind of shift in attitude might provide an opening, said 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, which 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 many young Swazis — even most, perhaps — said they don’t really pay attention.

“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’,” Zama Simelane, 21, said.

But Simelane goes to church. Public health advocates argue 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. Being part of a church in Swaziland means being with people you know and trust.

The services at Alliance Church are filled with song. Behind the scenes, Pastor Johannes Masibuko has instituted an HIV program. He himself is available to talk with people 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,” Masibuku said. “If they want to see a nurse, likewise. Or just 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, they hold HIV testing sessions 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 prevention.

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.

“We can lay hands to an HIV positive person, and that positive person can be negative, if really he believes in that,” Mhlanga, explained.

But that degree of belief is hard for public health advocates, like Aymeric Péguillan of Doctors Without Borders, to accept.

“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.”

And 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,” Masibuku said. “There it’s not easy for us to compromise. Because we have a mandate from the word of God.”

And that’s the key thing. Churches see themselves as instruments of God, not assets to be used by the public health community. There is a surge in interest in partnerships between the two groups, there’s also tension. But neither side expects to see eye-to-eye on everything.

But they do agree on this: the scale of the HIV crisis demands cooperation.

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