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Sex and the mission: the conflicting effects of early Christian missions on HIV in sub-Saharan Africa

Published online by Cambridge University Press:  22 September 2020

Julia Cagé  and
Valeria Rueda Open the ORCID record for Valeria Rueda [Opens in a new window]
Julia Cagé
Affiliation:
Sciences Po Paris and CEPR, Paris, France
Valeria Rueda*
Affiliation:
School of Economics, University of Nottingham, Nottingham, UK
*
*Corresponding author. E-mail: [email protected]
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Abstract

This paper investigates the long-term impact of historical missionary activity on HIV in sub-Saharan Africa. On the one hand, missionaries were the first to invest in modern medicine in the region. On the other hand, Christianity influenced sexual beliefs and behaviors that affect the risk of contagion. We build a new geocoded dataset locating Protestant and Catholic missions in the early 20th century, as well as the health facilities they invested in, that we combine with individual-level Demographic and Health Survey data. With these data, we can address separately these two channels, within regions close to historical missionary settlements. First, we show that proximity to historical missionary health facilities decreases the likelihood of HIV; persistence in healthcare provision and safer sexual behaviors in the region explain this result. Second, we show that regions close to historical missionary settlements exhibit higher likelihood of HIV. This effect is driven by the Christian population in our sample. This suggests conversion to Christianity as a possible explanatory channel. Our findings are robust to alternative specifications addressing selection.

Keywords

AfricaChristianityhealthcare infrastructurehistorical persistenceHIV/AIDSmissionssexual behaviors

JEL classification

N37: Africa • Oceania Z12: Religion Z13: Economic Sociology • Economic Anthropology • Language • Social and Economic Stratification D72: Political Processes: Rent-Seeking, Lobbying, Elections, Legislatures, and Voting Behavior N77: Africa • Oceania
Type
Research Papers
Information
Journal of Demographic Economics , Volume 86 , Special Issue 3: The Economics of Religion , September 2020 , pp. 213 - 257
Copyright
Copyright © Université catholique de Louvain 2020

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References

Acemoglu, Daron, Gallego, F. A. and Robinson, James A. (2014) Institutions, human capital, and development. Annual Review of Economics 6, 875–921.CrossRefGoogle Scholar
Akyeampong, Emmanuel, Bates, Robert H., Nunn, Nathan, and Robinson, James (2014) Africa's Development in Historical Perspective. New York: Cambridge University Press.CrossRefGoogle Scholar
Alesina, Alberto, Easterly, William and Matuszeski, Janina (2011) Artificial states. Journal of the European Economic Association 9(2), 246–277.CrossRefGoogle Scholar
Alsan, Marcella (2015) The effect of the tsetse fly on African development. American Economic Review 105(1), 382–410.CrossRefGoogle Scholar
Alsan, Marcella M. and Cutler, David M. (2010) Why did HIV Decline in Uganda?. Working Paper 16171, National Bureau of Economic Research.CrossRefGoogle Scholar
Alsan, Marcella M. and Cutler, David M. (2013) Girls? Education and HIV risk: evidence from Uganda. Journal of Health Economics 32(5), 863–872.CrossRefGoogle ScholarPubMed
Anderson, Siwan (2018) Legal origins and female HIV. American Economic Review 108(6), 1407–1439.CrossRefGoogle ScholarPubMed
Angrist, J. D., and Pischke, J. S. (2009) Mostly Harmless Econometrics: An Empiricist's Companion. New Jersey: Princeton University Press.CrossRefGoogle Scholar
Baird, Sarah J., Garfein, Richard S., McIntosh, Craig T. and Ozler, Berk (2012) Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. The Lancet 379(9823), 1320–1329.CrossRefGoogle ScholarPubMed
Beach, Harlam (1903) A Geography and Atlas of Protestant Missions: Their Environment, Forces, Distribution, Methods, Problems, Results and Prospects at the Opening of the Twentieth Century. New York: Student Volunteer movement for foreign missions.Google Scholar
Bertocchi, Graziella and Dimico, Arcangello (2015) The Long Term Determinants of Female HIV Infection in Africa: The Slave Trade, Polygyny, and Sexual Behavior. CEPR Discussion Paper 10654.Google Scholar
Brodeur, Abel, Lekfuangfu, Warn N. and Zylberberg, Yanos (2017) War, Migration and the Origins of the Thai Sex Industry. Working Papers 1706E, University of Ottawa, Department of Economics.CrossRefGoogle Scholar
Cagé, Julia and Rueda, Valeria (2016) The long-term effects of the printing press in Sub-Saharan Africa. American Economic Journal: Applied Economics 8(3), 1–31.Google Scholar
Calvi, Rossella, and Mantovanelli, Federico G. (2018) Long-term effects of access to health care: medical missions in colonial India. Journal of Development Economics 135, 285–308.CrossRefGoogle Scholar
Davies, J. N. P. (1956) This history of syphilis in Uganda. Bulletin of the World Health Organization 15(6), 1041–1055.Google ScholarPubMed
Dell, Melissa (2010) The persistent effects of Peru's mining Mita. Econometrica 78(6), 1863–1903.Google Scholar
Dell, Melissa, Lane, Nathan and Querubin, Pablo (2017) The Historical State, Local Collective Action, and Economic Development in Vietnam. Working Paper.CrossRefGoogle Scholar
Dell, Melissa and Olken, Benjamin (2017) The Development Effects of the Extractive Colonial Economy: The Dutch Cultivation System in Java. Working Paper.CrossRefGoogle Scholar
DellaVigna, Stefano and La Ferrara, Eliana (2015) Economic and Social Impacts of the Media. Working Paper 21360, National Bureau of Economic Research.CrossRefGoogle Scholar
de Sousa, João Dinis, Müller, Viktor, Lemey, Philippe and Vandamme, Anne-Mieke (2010) High GUD incidence in the early 20th century created a particularly permissive time window for the origin and initial spread of epidemic HIV strains. PLoS One 5(4), 1–16.CrossRefGoogle ScholarPubMed
Doyle, Shane (2013) Before HIV: Sexuality, Fertility and Mortality in East Africa, 1900–1980. Oxford: Oxford University Press.CrossRefGoogle Scholar
Doyle, Shane, zu Selhausen, Felix Meier and Weisdorf, Jacob (2018) The blessings of medicine? Patient characteristics and health outcomes in a Ugandan mission hospital, 1908–1970. Technical Report, University of Sussex.CrossRefGoogle Scholar
Duflo, Esther, Dupas, Pascaline and Kremer, Michael (2015) Education, HIV, and early fertility: experimental evidence from Kenya. American Economic Review 105(1), 2257–2297.CrossRefGoogle ScholarPubMed
Dupas, Pascaline (2011) Do teenagers respond to HIV risk information? Evidence from a field experiment in Kenya. American Economic Journal: Applied Economics 3(1), 1–34.Google Scholar
Dupas, Pascaline, Huillery, Elise, and Seban, Juliette (2018) Risk information, risk salience, and adolescent sexual behavior: experimental evidence from Cameroon. Journal of Economic Behavior and Organization 151–175.CrossRefGoogle Scholar
Feyrer, James and Sacerdote, Bruce (2009) Colonialism and modern income: islands as natural experiments. The Review of Economics and Statistics 91(2), 245–262.CrossRefGoogle Scholar
Foster, Elizabeth Ann (2013) Faith in Empire: Religion, Politics, and Colonial Rule in French Sénégal 1880–1940. Oxford: Oxford University Press.Google Scholar
Fox, Ashley M. (2010) The social determinants of HIV serostatus in Sub-Saharan Africa: an inverse relationship between poverty and HIV? Public Health Reports 16–24.CrossRefGoogle ScholarPubMed
Frankema, Ewout H. P. (2012) The origins of formal education in sub-Saharan Africa: was British rule more benign? European Review of Economic History 16(4), 335–355.CrossRefGoogle Scholar
Gallego, Francisco A. and Woodberry, Robert (2010) Christian missionaries and education in former African colonies: how competition mattered. Journal of African Economies 19(3), 294–329.CrossRefGoogle Scholar
Good, Charles M. (1991) Pioneer medical missions in colonial Africa. Social Science & Medicine 32(1), 1–10.CrossRefGoogle ScholarPubMed
Grosfeld, Irena and Zhuravskaya, Ekaterina (2015) Cultural vs. Economic legacies of empires: evidence from the partition of Poland. Journal of Comparative Economics 43(1), 55–75.CrossRefGoogle Scholar
Grosjean, Pauline (2014) A history of violence: the culture of honor and homicide in the US south. Journal of the European Economic Association 12(5), 1285–1316.CrossRefGoogle Scholar
Grosjean, Pauline and Khattar, Rose (2014) It's Raining Men! Hallelujah?. Discussion Papers 2014–29C, School of Economics, The University of New South Wales.CrossRefGoogle Scholar
Hardiman, David (2006) Healing Bodies, Saving Souls. Amsterdam: Brill Academic.CrossRefGoogle ScholarPubMed
Hastings, Adrian (1996) The Church in Africa, 1450–1950. Oxford: Oxford University Press.CrossRefGoogle Scholar
Hemelaar, Joris (2012) The origin and diversity of the HIV-1 epidemic. Trends in Molecular Medicine 18(2), 182–192.CrossRefGoogle Scholar
Huillery, Elise (2009) History matters: the long-term impact of colonial public investments in French West Africa. American Economic Journal: Applied Economics 1(2), 176–215.Google Scholar
Huillery, Elise (2011) The impact of European settlement within French West Africa: did pre-colonial prosperous areas fall behind? Journal of African Economies 20(2), 263–311.CrossRefGoogle Scholar
Idler, Ellen L. (2014) Religion as a Social Determinant of Public Health. Oxford: Oxford University Press.CrossRefGoogle Scholar
Jappah, Jlateh V. (2013) The convergence of American and Nigerian religious conservatism in a biopolitical shaping of Nigeria's HIV/AIDS prevention programmes. Global Public Health 8(3), 312–325.CrossRefGoogle Scholar
Jedwab, Remi, zu Selhausen, Felix and Moradi, Alexander (2018) The economics of missionary expansion: evidence from Africa and implications for development. Technical Report, University of Sussex.Google Scholar
Jha, Saumitra (2013) Trade, institutions, and ethnic tolerance: evidence from south Asia. American Political Science Review 107(4), 806–832.CrossRefGoogle Scholar
Johnson, Hildegard B. (1967) The location of Christian missions in Africa. Geographical Review 57(2), 168–202.CrossRefGoogle Scholar
Lachenal, Guillaume (2014) Le médicament qui devait sauver l'Afrique: Un scandale pharmaceutique aux colonies Les Empêcheurs de penser en rond, La Découverte.CrossRefGoogle Scholar
Lange, Matthew K. (2004) British colonial legacies and political development. World Development 32(6), 905–922.CrossRefGoogle Scholar
López-Trujillo, Alfonso Cardinal (2003) Family Values Versus Safe Sex. Vatican City: Pontifical Council for the Family.Google Scholar
Lowes, Sara and Montero, Eduardo (2017 a) Blood Rubber: The Effects of Labor Coercion on Institutions and Culture in the DRC. Working Paper.Google Scholar
Lowes, Sara and Montero, Eduardo (2017 b) Mistrust in Medicine, the Legacy of Colonial Medical Campaigns in Central Africa. Working Paper.Google Scholar
Mantovanelli, Federico G. (2016) Christian Missions, HIV, and Sexual Behaviors in sub-Saharan Africa. Technical Report, Boston College.Google Scholar
Mash, Rachel, and Mash, Robert (2013) Faith-based organisations and HIV prevention in Africa: a review. African Journal of Primary Health Care and Family Medicine 5, 464–470.CrossRefGoogle Scholar
McCleary, Rachel (2015) Oxford Handbook of Latin American Christianity. Oxford: Oxford Handbooks Online.Google Scholar
Michalopoulos, Stelios and Papaioannou, Elias (2013) Pre-colonial ethnic institutions and contemporary African development. Econometrica 81(1), 113–152.Google ScholarPubMed
Michalopoulos, Stelios and Papaioannou, Elias (2016) The long-run effects of the scramble for Africa. American Economic Review 106(7), 1802–1848.CrossRefGoogle Scholar
Michalopoulos, Stelios and Papaioannou, Elias (forthcoming) Historical legacies and African development. Journal of Economic Literature.Google Scholar
Michalopoulos, Stelios, Putterman, Louis and Weil, David N. (2016) The Influence of Ancestral Lifeways on Individual Economic Outcomes in Sub-Saharan Africa. Working Paper 21907, National Bureau of Economic Research.CrossRefGoogle Scholar
Miguel, Edward, Saiegh, Sebastian M. and Satyanath, Shanker (2008) National Cultures and Soccer Violence. Working Paper 13968, National Bureau of Economic Research.CrossRefGoogle Scholar
Moscona, Jacob, Nunn, Nathan and Robinson, James A. (2017) Keeping it in the family: lineage organization and the scope of trust in Sub-Saharan Africa. American Economic Review Papers and Proceedings 107(5), 565–571.CrossRefGoogle Scholar
Murdock, George Peter (1967) Ethnographic Atlas: a summary. Ethnology 6(2), 109–236.CrossRefGoogle Scholar
Nunn, Nathan (2008) The long term effects of Africa's slave trade. Quarterly Journal of Economics 123(1), 139–176.CrossRefGoogle Scholar
Nunn, Nathan (2010) Religious conversion in colonial Africa. American Economic Review Papers and Proceedings 100(2), 147–152.CrossRefGoogle Scholar
Nunn, Nathan and Wantchekon, Leonard (2011) The slave trade and the origins of mistrust in Africa. American Economic Review 101(7), 3221–3252.CrossRefGoogle Scholar
Oster, Emily (2005) Sexually transmitted infections, sexual behavior, and the HIV/AIDS epidemic. The Quarterly Journal of Economics 120(2), 467–515.Google Scholar
Oster, Emily (2010) Estimating HIV prevalence and incidence in Africa from mortality data. The B.E. Journal of Economic Analysis & Policy 10(1), 1935–1682.CrossRefGoogle Scholar
Oster, Emily (2012) Routes of infection: exports and HIV incidence in Sub-Saharan Africa. Journal of the European Economic Association 10(5), 1025–1058.CrossRefGoogle Scholar
Oster, Emily (2016) Unobservable selection and coefficient stability: theory and validation. Journal of Business Economics and Statistics 37(2), 187–204.Google Scholar
Pépin, Jacques (2011) The Origins of AIDS. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Ranger, Terence O. (1981) Godly medicine: the ambiguities of medical mission in Southeast Tanzania, 1900–1945. Social Science and Medicine 15(3), 261–277.Google ScholarPubMed
Reniers, George and Watkins, Susan (2010) Polygyny and the spread of HIV in Sub Saharan Africa: a case of benign concurrency. AIDS (London, England) 24(2), 299–307.CrossRefGoogle ScholarPubMed
Santelli, John S., Speizer, Ilene S. and Edelstein, Zoe R. (2013) Abstinence promotion under PEPFAR: the shifting focus of HIV prevention for youth. Global Public Health 8(1), 1–12.CrossRefGoogle ScholarPubMed
Setel, P. (1999) A Plague of Paradoxes: AIDS, Culture, and Demography in Northern Tanzania. Chicago: University of Chicago Press.Google Scholar
Streit, Karl (1913) Atlas Hierarchicus. Paderbornae: Tipographiae Bonifacianae.Google Scholar
Streit, Karl (1929) Atlas Hierarchicus, Paderbornae: sumptibus typographiae Bonifacianae.Google Scholar
Thornton, Rebecca L. (2008) The demand for, and impact of, learning HIV status. The American Economic Review 98(5), 1829–1863.CrossRefGoogle ScholarPubMed
Trinitapoli, Jenny, and Weinreb, Alexander (2012) Religion and AIDS in Africa. Oxford: Oxford University Press.CrossRefGoogle Scholar
UNAIDS (2015) Ending the AIDS epidemic: the advantage of cities. Technical Report, UNAIDS and UN-Habitat.Google Scholar
Valencia-Caicedo, Felipe (2018) The mission: human capital transmission, economic persistence, and culture in South America. Quarterly Journal of Economics 507–555.Google Scholar
Vaughan, Megan (1991) Curing Their Ills: Colonial Power and African Illness. Cambridge: Polity Press.Google Scholar
Voigtländer, Nico and Voth, Hans-Joachim (2012) Persecution perpetuated: the medieval origins of anti-semitic violence in Nazi Germany. The Quarterly Journal of Economics 127(3), 1339–1392.CrossRefGoogle Scholar
Waldinger, Maria (2017) The long-run effects of missionary orders in Mexico. Journal of Development Economics 127, 355–378.Google Scholar
Wantchekon, Leonard, Klašnja, Marko and Novta, Natalija (2015) Education and human capital externalities: evidence from colonial Benin. The Quarterly Journal of Economics 130(2), 703–757.Google Scholar
Woodberry, Robert (2004) The Shadow of Empire: Christian Missions, Colonial Policy, and Democracy in Postcolonial Societies. PhD dissertation, University of North Carolina at Chapel Hill.Google Scholar
Woodberry, Robert D. (2012) The missionary roots of liberal democracy. American Political Science Review 106(2), 244–274.Google Scholar
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