The Condom Divide: Disenfranchisement of Malawi Women by Church and State

Abstract

Objective-To examine the impact of two mitigating social institutions, religious organizations and the state, on Malawi women's vulnerability to HIV.Design-In-depth interviews with a purposive sample of 40 central leaders from 5 faith based organizations (FBOs) in Malawi were recorded and transcribed as part of an on-going larger study. Qualitative description was used to identify themes and categories.Setting-Primarily urban and peri-urban areas of south-central Malawi.Participants-A minimum of 6 leaders from each FBO were interviewed; the mean age of the primarily male (68%) participants was 44 years (range 26−74).Results-Analysis of religious leaders' messages about HIV produced an overarching theme, the condom divide, which conceptualized the divergence between FBOs and the state's prevention messages related to HIV prevention strategies.Conclusion-Faith based organizations have "demonized" state messages about condoms as promoting sin. The FBOs' insistence on abstinence and faithfulness leaves women with few options to protect themselves. As socially conscious citizens of the world, nurses can increase the responsiveness to the disparate levels of suffering and death in countries like Malawi. 2. The condom divide highlights the oppositional stances of the government and faith based organizations' messages about how to effectively prevent the spread of HIV.3. The plight of women in Malawi is complicated by the overwhelming poverty, regional migration, and global economic changes common across sub-Saharan Africa.

A Response to Edzi (AIDS): Malawi Faith-Based Organizations' Impact on HIV Prevention and Care

“…The fact that there was little room to make mistakes and learn possibly resulted in a de facto lack of influence on member behaviors because it forced people to hide “bad” behavior. Finally, the expectations surrounding being a good Christian or Muslim inhibited open discussions about risky sexual behaviors and condoms as a strategy for HIV prevention (Rankin et al, 2008). …”

“…Additionally, 49 PLWHs were qualitatively interviewed (Figure 2). Analysis of central leader data have been addressed elsewhere (Rankin, Lindgren, Kools, & Schell, 2008), and PLWH data are not included in this report. Interviews (both in-depth and quantitative survey questionnaires) were conducted in settings that were convenient and confidential for the respondent.…”

‘We can act different from what we used to’: Findings from experiences of religious leader participants in an HIV-prevention intervention in Zambia

“…This study adds significantly to the literature on engagement with faith-based organisations (FBOs) for effective HIV and AIDS prevention interventions in sub-Saharan Africa (SSA), an area of inquiry that is all too lacking (Lindgren et al, 2013;Olowu, 2015;Swidler & Watkins, 2017;Trinitapoli, 2009). It contributes to explicating impact of existing interventions, and addresses some major barriers that have hampered HIV-prevention efforts such as FBOs' anti-condom and abstinence-only messaging (Banda, 2017;Mukuka & Slonim-Nevo, 2006;Piot, Kazatchkine, Dybul, & Lob-Levyt, 2009;Rankin et al, 2008), emphasis on spiritual, rather than antiretroviral therapy (ART) for PLWH (Endeshaw et al, 2017;Kenworthy, Thomann, & Parker, 2018;Wanyama et al, 2007), fear of VCT (Jurgensen, Tuba, Fylkesnes, & Blystad, 2012) and stigmatisation of PLWH (Alubo, Zwandor, Jolayemi, & Omundu, 2010;Ansari & Gaestel, 2010;Rankin, Brennan, Schell, Laviwa, & Rankin, 2005;Williams, Haire, & Nathan, 2017). Other qualitative work has addressed the ongoing role that stigma plays in preventing uptake of VCT among Zambians (Jurgensen et al, 2012).…”

“…This is partly due to researchers' and interventionists' growing appreciation for the centrality of religious identity among sub-Saharan Africans and the influence of religious leaders on congregants (Dilger, Burchardt, & Van Dijk, 2011;Fort, 2017;Trinitapoli, 2009). Collaborative efforts between FBOs and secularoften internationalorganisations to implement HIV and AIDS programmes in the region achieve varying degrees of success (Alubo, Zwandor, Jolayemi, & Omundu, 2010;Bazant & Boulay, 2007;Boyd, 2009;Endeshaw et al, 2017;Global Health Council, 2011;Lindgren et al, 2013;Prince, Denis, & Van Dijk, 2009;Rankin, Lindgren, Kools, & Schell, 2008;Swidler & Watkins, 2017).…”

A qualitative study of childbirth fear and preparation among primigravid women: The blind spot of antenatal care in Lilongwe, Malawi

“…Moreover, with the introduction of the maternity waiting homes, Barta & Kiene [ 34 ] argued that the practice of leaving young men at home presents an increased opportunity for infidelity. Furthermore, in most societies in Malawi, male infidelity is socially acceptable [ 35 ] and this leaves a woman helpless to suffer in silence. We assert that primigravid women in Malawi live in a hostile sociocultural environment and require concerted efforts to manage their fears.…”