Population Council Research that makes a difference

Abstract

Church leaders promoting partner reduction: An evaluation of an HIV prevention program in churches in the Eastern Cape, South Africa 
Poster presentation at the XVIII International AIDS Conference, Vienna, 21 July
Tun,Waimar; Sohaba,Nathi; Saliwa,Nancy; Gujulwa,Bonisiwa; Maroga,Edwin; Qwabaza,Mpumelelo
Publication date: 2010


Background
The South African HIV epidemic is fueled by the common practice of multiple concurrent sexual partnerships. The Eastern Cape Council of Churches and the Population Council implemented and evaluated an intervention using church leaders to promote mutual monogamy (MM).

Methods
Church leaders (n=161) were trained in HIV prevention, HIV impact on families, gender equity, MM, and group facilitation skills. Church leaders facilitated workshops on these topics to fellow church members. Workshop participants were encouraged to consider challenges of MM specific to their community and elements needed to make MM work. The program was implemented in 40 churches over 15-17 months, reaching 2,792 church members through congregation-wide sermons and 848 through workshops. We assessed changes in knowledge, attitudes, intentions, and practices around MM through baseline (n=437) and endline (n=382) surveys with congregants in 12 of the participating churches.

Results
Of the 382 endline congregants surveyed, one-half did not attend any workshops, 8 percent attended 1-2 workshops, and 41 percent attended 3-5 workshops (considered "exposed"). There were no differences in workshop attendance by gender. Exposed congregants had significantly greater HIV knowledge of HIV prevention compared to baseline (78%) and those unexposed at endline (89% vs. 78% and 79%; p< 0.05). In multivariate analysis, exposed congregants were more likely to have greater HIV prevention knowledge (adjusted odds ratio [AOR]: 2.2; p< 0.005) and less likely to perceive practicing MM as difficult (AOR: 0.7; p< 0.05). Exposure was also significantly associated with increased intention to practice MM (AOR: 2.4; p< 0.05) and increased likelihood to have tested for HIV in the last six months among women only (AOR: 2.1; p< 0.005).

Conclusions
This church-based program was associated with positive changes in knowledge, intentions to be mutually monogamous, and HIV testing. Programs should build the capacity of community church leaders to promote HIV prevention, including HIV testing.