The sins of the church: The long-term impacts of Christian missionary praxis on HIV and sexual behaviour in Zambia

ABSTRACT

This study examines the long-term effect of Christian missionary exposure on HIV infection and related sexual behaviour in Zambia. I use distance to a historical missionary church and health facility as proxies for missionary exposure. I constructed a geocoded data set combining information on the historical locations of churches and missionary health centres with contemporary individual-level data. I find that individuals who live close to a historical missionary church have a higher likelihood of being infected with HIV. I find no significant effect of proximity to a missionary health centre on HIV. Considering that heterosexual transmission is the main channel of HIV transmission in Zambia, I analyse the effect of missionary exposure on sexual behaviour. The following patterns emerge: individuals who live close to a Protestant church are less likely to engage in premarital sexual abstinence; they also have their first sexual encounter at an earlier age, with the effect being stronger for men than women. Living near a Catholic church is associated with having a higher number of sexual partners.

KEYWORDS:

• Zambia
• Christian missionary exposure
• HIV
• sexual behaviour

JEL CODES:

• N01
• I1
• Z12
• N97

Acknowledgements

I thank Jutta Bolt, Ellen Hillbom, Jeanne Cilliers, Alexandra Lopez Cermeno, Felix Meier zu Selhausen, Shane Doyle, Sarah Walters, Martin Andersson, Christian Thibon, the participants of the Laboratory for The Economics of African Past (LEAP) webinar 2020, and two anonymous reviewers for their valuable comments on the previous drafts of this paper. I also acknowledge the financial support from the Knut and Alice Wallenberg Foundation (KAW 2016.0184) to complete this project.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 Polygyny is a type of polygamy that allows men to have multiple wives (Falen 2008).

2 Kaposi’s sarcoma is a rare type of cancer caused by a virus. Kaposi’s sarcoma is mostly seen in people with an advanced HIV infection; see https://www.nhs.uk/conditions/kaposis-sarcoma/.

3 More information on biomarkers can be found at https://dhsprogram.com/.

4 The missionary health centres include both dispensaries and hospitals.

5 All Euclidean distances are measured in metres and then converted to kilometres in Stata.

6 In 1 Corinthians 7:2, it can be seen that sex is only acceptable within the confines of marriage, and any sex outside the confines of marriage is considered a sin: ‘But since sexual immorality is occurring, each man should have sexual relations with his own wife, and each woman with her own husband’, see also 1 Thessalonians 4:3–4, 1 Corinthians 5:9–11.

7 See the argument put forward by Tiruneh (2009) in section 4.2.1.

8 See footnote 7.

9 For a technical explanation of how the Oster method works, see the Appendix.

Additional information

Funding

This work was funded by the Knut and Alice Wallenberg Foundation (grant number KAW 2016.0184).