Uganda's population is 33% Roman Catholic, 33% Protestant and 16% Muslim. With such large followings, Catholicism, Anglicanism, and Islam are well-positioned in Uganda, as they are in many other African societies, to strongly influence what people know about HIV/AIDS and how they live their lives. The "C" in the Ugandan Government's ABC prevention programme is a sensitive issue among many religious communities. While most faith-based groups in Uganda do not condemn the government strategy of condoms as a "third line of defence" behind abstinence and being faithful in the ABC programme, they also do not openly condone the promotion of condoms for HIV prevention. Faith-based organisations tend to reject condom use because condoms provide a means for people to have sex outside of marriage.

While there are publications that focus on the link between faith-based HIV prevention in Uganda and the decline in HIV prevalence in the country, this crucial link has received far too little attention. In 1998, the well-known Ugandan Reverend Gideon Byamugisha published the book AIDS, the condom, and the Church: Are science and morality exclusively antagonistic?² and there have been numerous editorials in Western newspapers on the subject. But there is a significant gap in the vast body of AIDS research on the role that religious organisations can play in preventing the spread of HIV and specifically with regard to how the use of condoms is handled among faith-based organisations.

The diagram illustrates very generally how the three religious groups in Uganda approach condom use for HIV/AIDS education. Each faith group differs in its message about HIV/AIDS. Anglicans view condoms as tools for HIV prevention; Muslims use them for the preservation of life; and Catholics denounce condoms as instruments of immorality. Accordingly, Anglicans and Muslims in Uganda allow for condom use within a marriage setting, but among Catholics, condom use is strictly prohibited.

A pragmatic stance

The Anglican Church condones the use of condoms within marriage for family planning and STI control. Encouraging people to choose abstinence and faithfulness, the Anglican Church generally argues against condom use outside of marriage because of the belief that condoms are not 100% effective, and that they allow people the freedom to have "illicit" sex.

While the Islamic Medical Association of Uganda (IMAU) is just one Muslim organisation in Uganda, it is a unique example of a religious organisation that has made the transition from condemning to condoning condom use as a means of HIV prevention. In 1998, the IMAU programme officially incorporated condom education and informal distribution into its programmes. The rationale for this acceptance of condoms is detailed in an IMAU training manual for their community trainers:

"Condom use in legal marriage does not contradict Islamic teachings. Condom use outside marriage is bad and is not acceptable in Islam. But if one decides to commit a sin, Islamic Teachings say that there exist big and small sins. Unprotected sex which may lead to passing of HIV/AIDS to one's partner is a big sin. Having protected safer sex outside marriage which will prevent the spread of HIV/AIDS is definitely a smaller sin than the previous one."

Many of the core principles of Islam which are integrated into IMAU's programming are drawn from the Qur'an, in which sexuality is described as part of the revelations of God. The Qur'an states that unmarried persons shall remain chaste, so a person who cannot (afford to) marry should therefore refrain from having sex. Islam also emphasizes self-discipline, which is intertwined in HIV/AIDS discussions as components of prevention education in Uganda. As one of the five tenets of Islam, prayer is a key element in IMAU's HIV prevention education, teaching Muslims that putting trust in Allah will give them guidance to avoid temptation as well as AIDS.

So just as Anglican strategies for sensitisation and the promotion of abstinence and faithfulness align with the Anglican Church's ideals for suitable HIV prevention, the guiding principles of Islam frame how IMAU teaches its HIV/AIDS counsellors. Though not all Imams would support condom promotion for HIV protection in the way that IMAU does, IMAU has taken strides to incorporate the core principles of Islam into contemporary health strategies to combat the epidemic.

No need for condoms?

The Catholic Church is renowned world-wide for its stringent position against the use of all contraceptives. The rationale behind this is that people should only engage in sex within marriage and with the intent of procreating. Thus, the Church argues that as long as a person restricts sex to marriage, there is no need for condoms. "No one has ever died of abstinence," explained a Catholic community organisation coordinator.

Among its arguments against the use of condoms, the Catholic Church in Uganda focuses on the fact that condoms are not 100% effective in preventing HIV transmission. Echoing Vatican opinions, several priests interviewed by the author claim that the pores on a condom are larger than the HIV virus, so the condom cannot protect against its transmission. The Church also emphasizes the idea that promoting condoms is analogous to promoting prostitution and immorality. "In Africa, people try to go with many," explained the Kampala Archdiocese Medical Coordinator, "So if they think they're protected, they'll follow the urge to go with many." Hence, in the eyes of the Catholic Church, the ideal way to protect oneself from HIV transmission is abstention. Condoms allow for promiscuity and interfere with faithfulness, so they are, therefore, prohibited by the Church.

However, not all Catholics believe that condoms themselves are inherently immoral. As a Kampala AIDS officer for the Catholic Secretariat explained it, the Catholic Church takes a stand against the immoral behaviour that accompanies condom use. But, there are priests who would quietly suggest condoms within marriages for STI prevention.

Understanding the differences

Anglicanism, Islam and Catholicism all have their own rationales for their support or prohibition of condoms. Anglicans in Uganda view condoms as an HIV prevention mechanism, only to be utilized in good Christian marriages. Muslims justify the use of condoms through Qur'anic passages, whereby it is reasoned that the sanctity of life is greater than the sin of condom use. Catholics also place extraordinary value on the sanctity of life, but view condoms through a different lens than Anglicans and Muslims. They conceptualise condoms as preventing the creation of life through its function as a contraceptive. They reason that a person's faith should help him/her to resist sexual temptation and, therefore, HIV/AIDS, rather than a reliance on a piece of rubber for the preservation of life.

The HIV prevention programmes of these three faiths in Uganda share the goal of reducing new HIV infections, but are distinguished from each other based on how the condom is or is not incorporated. Understanding these differences can be useful to health workers, NGOs, CBOs, and FBOs as they apply the lessons learned from the successful involvement of Uganda's religious organisations in HIV prevention. Considering the dominant role that religion plays in the lives of so many Africans, it is clear that religious communities cannot be ignored as HIV/AIDS educators continue their efforts to inform people about HIV/AIDS.

2. Byamugisha, G. AIDS, The condom, and the church: Are science and morality exclusively antagonistic? Vol. 1, Tricolour Designers & Printers, Uganda, 1998.