Sex and the Mission: The Conflicting Effects of Early Christian Investments on the HIV Epidemic in Sub-Saharan Africa

This article investigates the long-term historical impact of missionary activity on the prevalence of HIV/AIDS in sub-Saharan Africa. On the one hand, missionaries were among the first to invest in modern medicine in a number of countries. On the other hand, Christianity influenced sexual beliefs and behaviors. We build a new geocoded dataset locating Protestant and Catholic missions in the early 20th century, as well as their health investments. Using a number of different empirical strategies to address selection in missionary locations and into health investments, we show that missionary presence has conflicting effects on HIV today. Regions close to historical mission stations exhibit higher HIV prevalence. This negative impact is robust to multiple specifications accounting for urbanization, and we provide evidence that it is specific to STDs. Less knowledge about condom use is a likely channel. On the contrary, among regions historically close to missionary settlements, proximity to a mission with a health investment is associated with lower HIV prevalence nowadays. Safer sexual behaviors around these missions are a possible explanatory channel.