The condom divide: disenfranchisement of Malawi women by church and state

The role of religious leaders on the use of HIV/AIDS prevention strategies among young people (15-24) in Lira district, Uganda

BACKGROUND

Young people (15-24 years) bear the highest burden of new infections and are particularly vulnerable because of their highly risky behavior such as early sexual activity. There is paucity of information on the role of religious leaders in the multi-sectoral fight against HIV/AIDS. We examined the role of religious leaders in the use of HIV prevention strategies among young people.

METHODS

A cross sectional study was conducted between March and April 2021 among 422 randomly selected young people in Lira district, Uganda. An interviewer administered a questionnaire to the young people in order to collect quantitative data. A total 20 key informants were purposively sampled and interviews were conducted with religious leaders using a key informant's interview guide. Data was collected on social demographics, HIV prevention messages, and awareness about HIV prevention strategies. Data was analyzed using Stata version 15 using proportions, means, percentages, frequencies, and logistic regression analysis at a 95% level of significance. Qualitative data was analyzed using thematic content analysis and the major themes were generated from the participants' responses.

RESULTS

About 57.1% (241/422) of the respondents were females. The prevalence of use of HIV prevention strategies among young people was 69.4%. Factors significantly associated with the use of HIV prevention included completing the primary level (aOR 4.95, p< 0.05), completing at least A level (aOR 8.85, p < <0.05), Awareness of HIV prevention strategies advocated for by religious leaders (aOR 0.02, p<0.001), religious leaders provided targeted HIV prevention messages (aOR 2.53, p<0.01), Advocacy for abstinence outside marriage and fidelity in marriage (aOR 35.6, p<0.01), Religious leaders preaching about HIV prevention (aOR 4.88, p<0.001). Qualitative data indicated that a section of religious leaders recommended abstinence/faithfulness. Condom use was the most discouraged HIV prevention strategy. However, most religious leaders agree with the fact that they have a role to play in HIV prevention, which includes sensitization, teaching and organizing sermons about HIV prevention.

CONCLUSION

The use of HIV prevention strategies advocated for by religious leaders among young people was nearly 70%. This finding indicates that religious leaders have a role to play in HIV/AIDS prevention among young people in the Lira district. This calls for the involvement of religious leaders in HIV prevention programs tailored to prevent new infections of HIV among young people.

Religious leaders' role in pregnant and breastfeeding women's decision making and willingness to use biomedical HIV prevention strategies: a multi-country analysis

Oral Pre-Exposure Prophylaxis (PrEP) is an established option, and the dapivirine vaginal ring is emerging as a promising strategy for HIV prevention option for women. Because of this, understanding the contextual and cultural factors that will support the increased uptake of these products is crucial. In sub-Saharan Africa, religious leaders may be important stakeholders to involve in product information, education and roll-out. We conducted a sub-analysis of data from 232 participants taking part in the MTN-041/MAMMA study to explore religious leaders' involvement in pregnant and breastfeeding women's health. Study participants viewed biomedicine and spirituality as interlinked and believed that women could seek health-related care from medical experts and turn to faith-based organisations for religious or spiritual needs. Religious leaders were invested in the health of their congregations, endorsed a variety of sexual health strategies, and were eager to learn more about emerging HIV prevention technologies. These data signal the role of religious leaders in supporting their communities, and the importance of involving religious leaders in efforts to roll out new HIV prevention products to facilitate uptake.

A qualitative study of childbirth fear and preparation among primigravid women: The blind spot of antenatal care in Lilongwe, Malawi

Objectives

This study aimed to explore childbirth fear and childbirth preparation among primigravid women in the late pregnancy from 36 to 40 weeks gestation.

Methods

We purposively recruited 18 primigravid women into in-depth interviews, 21 birth companions, and 13 health workers into focus group discussions. Participants were recruited from two community hospitals’ maternity waiting homes in Lilongwe, Malawi. Semi-structured interview guides were used to collect data that were analyzed using content analysis. NVivo11 computer software was used to organize the data.

Results

The four categories developed were: “ambivalent pregnancy feelings” , “dependence on traditional childbirth counseling” ,“inadequate prenatal childbirth instruction” and “inconsistent roles of a birth companion” . The findings suggest that primigravid women who were mainly exposed to traditional childbirth mentoring rather than professional care providers, experienced childbirth fear, and lacked proper psychosocial childbirth preparation.

Conclusions

Childbirth fear among primigravid women emanate from personal; family; ineffective traditional counseling; and inadequate antenatal childbirth instruction. Birth companions may increase childbirth stress. However, our findings highlight birth companions as readily available psychosocial support resources among primigravid women. We recommend that professional childbirth instruction during antenatal care should be strengthened to surpass traditional childbirth counseling. Appropriateness and effectiveness of birth companions need to be carefully assessed.

"Even if she's really sick at home, she will pretend that everything is fine.": Delays in seeking care and treatment for advanced HIV disease in Kinshasa, Democratic Republic of Congo

INTRODUCTION

HIV prevalence in the Democratic Republic of Congo (DRC) is estimated to be 1.2%, and access to HIV testing and treatment remains low across the country. Despite advances in treatment, HIV continues to be one of the main reasons for hospitalisation and death in low- and middle-income countries, including DRC, but the reasons why people delay seeking health-care when they are extremely sick remain little understood. People in Kinshasa, DRC, continue to present to health-care facilities in an advanced stage of HIV when they are close to death and needing intensive treatment.

METHODS

This qualitative study was conducted in one health-care facility in Kinshasa. A total of 24 in-depth interviews with purposively selected health-care workers, patients and care-givers were conducted. Patients were currently or previously hospitalised with advanced HIV, defined as CD4 count <200 cells/μl. Patients included those who had previously started antiretroviral treatment (ART), and those who had not. Participant observation was also carried out. Interviews were audio-recorded, translated from French and Lingala into English, transcribed, coded and thematically analysed using NVivo.

RESULTS

The main reasons for delaying access to health-care were stigmatisation, religious beliefs and limited economic resources. Stigmatisation meant that people feared disclosing their HIV status and thus did not receive support from their families. Religious leaders were reported to have encouraged people not to take ART. Patients delayed seeking treatment as they could not afford it, and health-care workers believed that staff at other facilities in Kinshasa were delaying HIV diagnoses for economic benefit.

CONCLUSIONS

Delays in accessing care and treatment linked to stigma, religious beliefs and economic factors contribute to explaining the persistence of advanced HIV within this context. Access to free HIV-testing, ART and treatment of opportunistic infections; counselling; training of health-care workers; support for care-givers and stigma reduction strategies are urgently needed to prevent unnecessary deaths.

'We can act different from what we used to': Findings from experiences of religious leader participants in an HIV-prevention intervention in Zambia

Faith-based organisations (FBOs) have long been part of the fight against HIV and AIDS. International bodies continue to collaborate with FBOs to implement HIV-prevention programmes with mixed success. Zambia has been a target of such programmes in part due to its high HIV prevalence. The Trusted Messenger approach to provide religious leader networks with biomedical, science-focused education about HIV and AIDS was piloted in 2006, but participant experiences of the intervention have not been explored qualitatively. In 2016, in-depth interviews were conducted of 34 randomly chosen individuals who attended Trusted Messenger workshops between 2006 and 2016 in Livingstone, Lusaka, and the Copperbelt region. Findings indicate that the religious leader attendees gained scientific insights about HIV which motivated their action in personal, social, and religious contexts. Participants found the science comprehensible and empowering and identified workshop frequency and language as challenging. Utilising science-focused education within contextual settings of religious leader networks can combat the spread of HIV and the mistreatment of people living with HIV and AIDS.

Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review

Background

The HIV/AIDS epidemic remains of global significance and there is a need to target sub-Saharan Africa since it is the hardest hit region worldwide. Religion and more specifically faith-based organisations can have an effect on socio-cultural factors that increase or decrease the risk of infection; and offer preventative interventions to the wider community.

Objective

To understand the influence of faith-based organisations on HIV prevention in Africa.

Method

The main search engine of a British university ‘mysearch’ was used as this incorporates all relevant databases. Studies were also retrieved by searches within Google scholar, PubMed and reference lists of included papers were hand searched. The authors assessed the relevance of each article separately against the inclusion criteria. The data extraction form was piloted by the first author and cross-checked by the other authors.

Results

Seven studies met all inclusion criteria and were reviewed. Seven individual themes were identified. However, for the purposes of focus within this paper only two themes were focused on.

Conclusion

Given the accessibility of faith-based organisations (FBOs) and the coverage of religion among the population, FBOs are potentially important players in HIV prevention. Therefore, more resources and support should be given to support their health promotion strategies.

Myths about HIV and AIDS among serodiscordant couples in Malawi

Purpose

The purpose of this paper is to report on research that uncovered myths about HIV and AIDS held by serodiscordant couples in Malawi, and the sources of these myths. The paper reflects on how the myths affect serodiscordant couples’ engagement with HIV and AIDS information.

Design/methodology/approach

Van Manen’s (1997) approach to analysis of phenomenological data was used to analyse data from in-depth interviews conducted in Malawi with 21 serodiscordant couples and three individuals who had separated from their partners because of serodiscordance.

Findings

Serodiscordant couples in Malawi believe and hold on to some inaccurate HIV and AIDS information that can be seen as “myths”. Some of these myths are perpetuated by official HIV and AIDS information when it is translated into the local languages. Other myths derive from social norms of the societies where the couples live.

Practical implications

The findings of this paper have practical implications for how HIV and AIDS information providers should engage with target audiences to understand the origins of the myths they hold. The findings also imply that some myths have technical, religious, moral and cultural bases which need to be addressed before challenging the myth itself.

Originality/value

Using real-life descriptions of experiences of HIV and AIDS information provided by serodiscordant couples, the authors reveal how myths can affect engagement with the information. The authors make recommendations on how to address myths in ways that contribute to a positive experience of HIV and AIDS information by serodiscordant couples.

Sources of Social Capital for Malawi People Living With HIV

With one of the highest rates of poverty and HIV in the world, Malawi faith-based organizations (FBOs), non-governmental organizations (NGOs), and community-based organizations (CBOs) are expected to provide tangible and emotional support to people living with HIV (PLWH). Using Lin’s social capital theoretical approach, we examine the perspective of PLWH regarding the adequacy of support responses. Forty-six rural Malawi HIV+ adults provided interviews that were recorded digitally, translated, and transcribed by Malawi research assistants. Atlas.ti was used to organize the data and to aid in the analytic process. Participants expressed disappointment in the lack of resources that could be accessed through the FBOs although their expectations may have been unrealistic. Outcomes from accessing and mobilizing the FBO network were negative in terms of stigmatization by FBO leaders and members, whereas outcomes related to CBOs and NGOs were generally positive in terms of empowerment through HIV information and attendance at support groups.

Involving religious leaders in HIV care and treatment at a university-affiliated hospital in Ethiopia: Application of formative inquiry

In sub-Saharan Africa, religious views strongly influence how people relate to illness, health, and healing. Belief in the curative power of religion, including for HIV, persists in many communities. As such, many funding agencies and organisations working in the field of HIV have incorporated religious institutions into their programmes in various capacities. Yet, debate continues regarding the benefits and drawbacks of including sectarian organisations in the fight against HIV. In the current study, we sought to explore whether patients with HIV would be amenable to receiving HIV-related psychosocial support from religious leaders. We interviewed 48 Ethiopian Orthodox Church followers who presented for routine HIV care at Gondar University Hospital ART (antiretroviral treatment) clinic. Although almost half (46%) of participants self-identified as 'very religious', the majority of them (73%) had not disclosed their HIV status to a religious leader. Study participants highlighted multiple factors that could potentially affect their willingness to involve religious leaders in their HIV care. We discuss these findings in relation to religion and HIV in the African context. Our findings support the use of formative qualitative work prior to developing and implementing programmes that integrate faith and medical communities.

Dilemmas and tensions facing a faith-based organisation promoting HIVprevention among young people in South Africa

Faith-based organisations (FBOs) are receiving growing attention for their roles in addressing HIV and AIDS in southern Africa. These roles, however, are not without philosophical challenges. Yet, to date, most references to the successes or limitations of FBOs have remained the domain of theoretical and, often, ideological debate. In this context, discussions about the roles of faith and FBOs in responding to HIV and AIDS often evoke extreme positions-either advocating for or critiquing their involvement. In place of this there is a need for empirical evidence and analyses that shed light on both the challenges and opportunities of faith-based HIV-prevention programming. This article presents a critical sociological analysis of the complexities confronting one FBO in its effort to deliver an abstinence-focused HIV-prevention programme to school-going adolescents in a poor peri-urban area of South Africa. As one aspect of a larger mixed-methods evaluation, this analysis is based on 11 focus group discussions, variously held with parents, teachers, learners and programme facilitators, in an effort to determine how and why the participants perceived the programme to work. We present and analyse four sources of tension appearing within the data which relate to the programme's faith-based orientation: a) enthusiasm for sexual abstinence despite awareness of the structural constraints; b) a dichotomous framing of behaviours (i.e. good versus bad); c) mixed messages about condoms; and d) administering faith-based programming within secular public schools. Through this analysis we aim to identify opportunities and challenges for faith-based HIV-prevention efforts more broadly. We argue that any assessment of faith-based HIV-prevention programming ought to respect and reflect its complexity as well as the complexity of the context within which it operates.

Predictors of sexual behaviour among church-going youths in Nairobi, Kenya: a cross-denominational study

We surveyed church-going youths in Nairobi, Kenya, to investigate denominational differences in their sexual behaviour and to identify factors related to those differences. In comparison with youths attending mainline churches, the youths surveyed at Pentecostal/evangelical churches were less likely to have ever had sex. Furthermore, although male youths in the mainline churches were more likely than their female counterparts to have ever had sex, no such difference emerged between the male and female youths attending Pentecostal/evangelical churches. For youths from both types of churches, not only individual religious commitment (being 'born again') but also contextual religiosity (i.e. the extent of socialisation in their faith communities) explained the variations in their sexual behaviour and attitudes. Finally, the effect of denomination on one's intention to have sex in the next 12 months was mediated by the frequency of talk about spiritual issues with church confidants.

Can interfaith research partnerships develop new paradigms for condom use and HIV prevention? The implementation of conceptual events in Malawi results in a 'spiritualised condom'

Objectives

The aim of this intervention research study was to engage senior leaders of faith-based organisations (FBOs) in Malawi in a participatory process to construct an interfaith theology of HIV/AIDS. This process was designed to enhance the capacity of faith leaders to respond more effectively to the HIV/AIDS pandemic.

Methods

An evidence-driven combination of ethnographic and participatory action research methodologies was utilised. Conceptual events—innovative participatory action research processes—were held over the 4-year project and brought together health service providers, policy makers and a non-governmental organisation in partnership with FBOs and grassroots faith-based communities.

Results

Through facilitated dialogue, an interfaith theology of HIV/AIDS emerged, resulting in the proposition that a ‘spiritualised condom’ endorses a ‘theology of protecting life’. This proposition was based on the following convictions: (1) life is sacred and to be protected, (2) to kill or murder is a ‘greater sin’ than the ‘lesser sin of infidelity’, (3) protection of the innocent is a moral and religious requirement, (4) condoms have the potential to prevent the death of an innocent person and (5) condoms need to be encouraged, even in the context of marriage.

Conclusions

Clinicians, non-governmental organisations, health service providers and policy makers, assisted by health social scientists, can successfully partner with FBOs and their leaders to (1) modify and transform faith-based understandings of HIV risk and (2) bring about attitudinal and behaviour changes that help to address the challenges associated with HIV/AIDS.

Conflicts between conservative Christian institutions and secular groups in sub-Saharan Africa: ideological discourses on sexualities, reproduction and HIV/AIDS

Religious and secular institutions advocate strategies that represent all points on the continuum to reduce the spread of HIV/AIDS. Drawing on an extensive literature review of studies conducted in sub-Saharan Africa, we focus on those secular institutions that support all effective methods of reducing HIV/AIDS transmission and those conservative religious institutions that support a limited set of prevention methods. We conclude by identifying topics for dialogue between these viewpoints that should facilitate cooperation by expanding the generally acceptable HIV/AIDS prevention methods, especially the use of condoms.