Faith-Based Organisations and HIV Prevention in Africa

This review aims to examine the role of faith-based organisations (FBOs) in HIV prevention in Africa by providing a systematic study of their potential strengths and weaknesses in effecting behaviour change. "The questions posed were:

• What are the strengths and weaknesses of FBOs in terms of HIV prevention?
• What is the influence of FBOs on sexual behaviour in Africa?
• What are the factors that enable FBOs to have an influence on sexual behaviour?" [Foot notes are removed throughout by the editor.]

The researchers conducted a literature review of medical and religious journals and found that FBOs can provide affordable interventions due to use of existing church infrastructure and personnel, including church members as volunteers. Their cultural acceptability in communities includes a perception of their "positive values such as justice, compassion, and respect for human dignity. FBOs can have a positive role in facilitating behaviour change with a large constituency on a weekly basis, affording opportunities for information-sharing and teaching. Religions uphold the principles surrounding family, marriage and sexuality; promoting abstinence outside of marriage; and fidelity within marriage."

Weaknesses of FBOs in HIV prevention work include: stigma; lack of comfort with speaking openly about sexuality and such topics as sexually active adolescents, gender, and homosexuality; the barriers of patriarchy and hierarchy; and negativity on condom use.

Of the studies reviewed, rates of sexual coercion were sometimes high amongst church youth. "One study showed higher levels of sexual activity amongst religious girls, as compared with non-religious girls....They may...conform to religious teaching to be submissive, finding it harder to either refuse sex or negotiate for condom use." Sexual debut, number of sexual partners, and sexual activity did not appear to be different amongst church youth compared to the local community in most studies. However, some studies showed a reduction in condom use and, in South Africa, an increase in oral and anal sex in order to maintain a technical virginity. "Because the church often views these subjects as ‘taboo’ they are possibly exposing youth to risk through a lack of information."

Factors determining behavioural influences of FBOs include "moral and religious teaching, socialisation within the group, level of attendance and commitment to the group." Topics can include teaching on extramarital sex, use of alcohol, and use of condoms. According to researchers, church teaching methods are not succeeding in changing behaviours in the direction of prevention of HIV. "In order to adopt and internalise new values, interactive dialogical methods of teaching are likely to be more effective. Through participatory educational methods, young people can apply their spiritual values to the area of sexuality as well as develop a critical consciousness around their gender roles that protects them better from unsafe sex."

The review suggests that: "Religion helps people in their search for meaning and associations have been found between self-efficacy and religiosity." It found that frequency of meeting of some religious groups helped youth abide by rules, while "absence of youth groups or choirs (socialisation) and the lack of specific teaching on sex-related matters (indoctrination) the influence of these churches on sexual praxis is limited....Social capital can be increased as young people become more involved in the church through positive peer pressure and by building relationships with adults who are positive role models."

The review concludes that FBOs "have the potential to be an important role player in terms of HIV prevention. However, in order to be more effective, the church needs to take up the challenge of empowering young women, recognising the need for their sexually-active youth to use protection, reducing judgemental attitudes and changing the didactical methods used."