Revelations of epidemic threat: Factors informing religious leaders about HIV/AIDS epidemic severity in rural Malawi Open Access
Burns, Jordan (2015)
Abstract
Religious leaders in Sub-Saharan Africa (SSA) play a central, influential role in the health and wellbeing of communities they serve. Among other functions, leaders are particularly knowledgeable as key informants for health research on community attitudes, worries, and behaviors regarding disease epidemics. They are uniquely exposed to information from their congregations and communities that informs their perceptions, which can play a role in their responses. The objective of this study was to quantitatively assess the effect that different sources of information (within and outside of the religious community) and individual characteristics have on a religious leader's perception of high HIV/AIDS epidemic severity.
Data come from 187 religious leaders interviewed through the 2005 Malawi Religion Project, and identified via hypernetwork sampling from a list of congregational affiliations of 3,243 adults in the 2004 Malawi Diffusion and Ideational Change Project (MDICP) cohort. Bivariate descriptive analyses and multivariate logistic regression models were performed to identify associations between information sources and leader assessments of HIV/AIDS epidemic severity. After controlling for congregation size, district, and education, leaders who had discussed HIV/AIDS with other leaders were only 36% as likely to perceive high epidemic severity as leaders who had not (OR= 0.36; 95% CI: 0.16, 0.79). Each additional adult death they observed generated a 40% increase in the odds of perceiving the epidemic as severe (OR=1.40; 95% CI: 1.00, 1.97). Among leaders without secondary education, having frequent discussions with members resulted in the leader being almost four times as likely to perceive high epidemic severity (OR= 3.80; 95% CI: 1.24, 12.28). Religious leaders were more likely to report high epidemic severity in southern Balaka compared with those in northern Rumphi (OR= 3.19; 95% CI: 1.28, 7.94), mirroring epidemiological trends in prevalence. In the presence of religious affiliation, the effect of observed adult deaths on assessing high epidemic severity was reduced. These findings highlight specific observations and sources that religious leaders in SSA use to assess the severity and impact of HIV/AIDS in their communities, particularly through communication with other religious leaders and their members. Perceiving high epidemic threat is associated with participation in HIV/AIDS prevention activities.
Table of Contents
CHAPTER I: BACKGROUND/LITERATURE REVIEW.....1
Introduction: Religion and AIDS in Africa.....2
Religion and AIDS in Context: Malawi.....3
Religious Interpretations of Disease and Stigma in SSA.....6
Religious Leaders and Health Outcomes.....8
Epidemic Severity Assessments.....10
Potential Factors Informing Epidemic Severity Assessments.....12
High Epidemic Severity as a Call to Action.....13
Purpose of Study.....14
Literature Review Tables/Figures.....15
References.....18
CHAPTER II: MANUSCRIPT (PEER-REVIEWED JOURNAL ARTICLE STYLE).....22
ABSTRACT.....24
INTRODUCTION.....25
METHODS.....29
Data Source and Study Population.....29
Outcome Variable of Interest.....30
Predictor Variables of Interest.....31
Socio-demographic Variables of Interest.....32
Data Analysis.....33
RESULTS.....35
Descriptive Analyses.....35
Bivariate Analyses.....35
Multivariate Analyses.....38
Exploratory Analyses: Outcome as Predictor.....41
DISCUSSION.....43
Information from Outside the Community.....44
Information from Within the Community.....45
Religious Affiliation and District.....47
Perceiving Epidemic Severity as a Motivator for Action.....47
Strengths and Limitations.....48
Conclusion.....50
DRAFT MANUSCRIPT TABLES & FIGURES.....52
REFERENCES.....59
CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, POSSIBLE FUTURE DIRECTIONS.....62
Summary.....63
Public Health Implications.....63
Possible Future Directions.....64
References.....66
APPENDICES.....67
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