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Impact Data - Family AIDS Education and Prevention through Imams

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Family AIDS Education and Prevention Through Imams (mosque leaders) aims to help Muslim leaders incorporate accurate information about HIV/AIDS prevention into their spiritual teachings, by linking the teachings of the Qur'an with recommended risk reduction behaviour. The programme is an effort to provide culturally appropriate, HIV/AIDS prevention education to Muslim families living in rural communities and trading centres in Uganda. It was was developed in response to a cross-sectional baseline survey carried out in March 1992 of respondents (n=1,907) living around randomly selected mosques, which was designed to identify topics for intensive education among Muslim families in northeastern Uganda, such as:

  • mother-to-child HIV transmission (at birth or through breastfeeding);
  • using the same razor to circumcise many male infants; and
  • ritually washing the dead (ablution).


In this context, the Islamic Medical Association of Uganda undertook training of religious leaders and community volunteers to provide education, basic counselling, and motivation for behaviour change through individual home visits and during congregational prayers. Specifically, Imams at about 200 mosques in two districts - Mpigi and Iganga - with large populations of Muslims were chosen for the pilot intervention. Twenty-three IMAU trainers delivered the HIV prevention curriculum to Imams and their lay assistants, termed family AIDS workers (FAWs), at 3-day workshops. Outcome measures included correct knowledge of HIV transmission and prevention, use of condoms, number of sexual partners, and risk perception of practices such as circumcision and ablution of the dead. Only half of Iganga district received the programme. The other half of Iganga district provided a comparison site.

Methodologies
Evaluators obtained qualitative data through focus group discussions and interviews with key informants. Nine focus group discussions were held: three each in Mpigi, the intervention area of Iganga, and the non-intervention area of Iganga. In each location, the three focus group discussions consisted of: adult married males, ages 25 to 40; adult married females, ages 20 to 29; and unmarried females, ages 15 to 19. All of these participants (n=75) were from rural areas.

Focus groups, with gender-specific moderators, used a story and asked questions about the story to guide discussion. Evaluators also interviewed 25 key informants, including FAWs, Imams, Imams' assistants, county sheiks, and district kadhis. They were asked about the community's response to the project, the strengths and weaknesses of the project, and the community's response to an anticipated condom availability and sales programme.

At follow-up, the questionnaire included the same questions as the baseline survey, with some questions added or modified. At both baseline and follow-up, 21 mosques were selected from each district, with 12 selected at random from among rural mosques and 9 selected at random from among mosques in trading centres. Individual respondents (n=1,826) were then selected.
Knowledge Shifts
Between baseline and follow-up (2 years later), a statistically significant proportion of respondents in the intervention areas showed increases in correct knowledge of:
  • Sexual transmission of HIV (from 86% to 97%); among respondents from the comparison area, proportions rose only from 86% to 90%.
  • Mother-to-child transmission (from 1% to 10%); among respondents from the comparison area, proportions rose only from 1% to 2%.
  • Risk of non-sterile, skin-piercing instruments (from 36% to 80%); among respondents in the comparison area, proportions rose only from 36% to 51%.
  • Condoms as protective against HIV (64% to 82%); among respondents from the comparison area, proportions dropped from 64% to 60%.
Practices
Between baseline and follow-up, a statistically significant proportion of responding youth from the intervention areas reported a reduced number of sex partners versus responding youth from comparison areas. Among males ages 15 to 24 from the intervention areas, the proportion reporting two or more partners fell from 45% at baseline to 32% at follow-up while rising from 45% to 59% among male youth from the comparison area. Among females ages 15 to 24 from the intervention areas, the proportion reporting two or more partners fell from 13% at baseline to 6% at follow-up while rising from 13% to 16% among female youth from the comparison area.

Instruction about the importance of using condoms was included in the programme only in the second year, when Imams acknowledged that condoms were an HIV prevention tool that could not be ignored. Reports of ever use rose from 15% at baseline to 25% at follow-up among males from the intervention areas; reports of ever use of condoms also rose among males from the comparison areas (from 15% to 21%). The comparative rise, though slight, was statistically significant for males from the intervention areas.
Attitudes
A statistically significant proportion of respondents from the intervention areas showed increased perception of risks posed by traditional Muslim practices:
  • Proportions who viewed as risky the circumcising of several male infants with the same razor rose from 45% to 78% while remaining unchanged at 45% among those from the comparison area.
  • Proportions of respondents from the intervention areas who perceived risk from ablution of the dead rose from 27% to 60% while dropping from 27% to 24% among those from the comparison area.
Source
Sue Alford, MLS, Nicole Cheetham, MHS, and Debra Hauser, MPH, "Science and Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections" [PDF] (Advocates for Youth, 2005).