Religion, authority and their interplay in the shaping of antiretroviraltreatment in western Uganda

Abstract

The article explores how religious actors have increasingly shaped the nature of antiretroviral treatment (ART) services in Kabarole district, western Uganda. As have the regular health services, Christian donors, non-governmental organisations (NGOs), and churches in the district have also stepped up to provide money for antiretroviral drugs and care for people living with HIV. The article explains how, at the ground level, formal public structures in the district are sometimes superseded—both literally and figuratively—by religious actors: such as when ART services are attuned not only to the intentions of the Ministry of Health but also to those of the Catholic bishop, when ART service provision is restricted to the diocese's boundaries rather than those of the district, and when the coverage and nature of ART is discussed with NGOs and donors, both within and above the district-level, instead of with local government. Although Kabarole district's health department is formally involved as project owner, its position has been increasingly marginalised due to the power and wealth of religious actors.