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

An exploratory qualitative study of the psychological effects of HIV diagnosis; the need for early involvement of mental health professionals to improve linkage to care

BACKGROUND

Diagnosing a life-threatening disease like the human immunodeficiency virus (HIV) can be unbearable to the individual, which has implications for their subsequent care-seeking decision-making. However, an essential element of HIV testing is identifying infected individuals and linking them with adequate care services, thus contributing to the UNAIDS 95-95-95 targets. The attainment of these targets has been particularly challenging for lower and middle-income countries (LMIC). This study explored the psychological reactions to a positive HIV status in a hospital treatment centre to provide insight into mental health interventions' role in improving HIV screening and early antiretroviral therapy (ART) initiation to enhance the quality of life.

METHODS

An exploratory qualitative study was investigated among adults who were diagnosed as HIV positive. Participants were purposively recruited from an HIV Treatment Centre. Data were collected with semi-structured interviews that explored the interpretations and psychological reactions to their positive HIV status. Overall, 18 participants were interviewed to reach saturation. Data were transcribed verbatim and analysed thematically to produce findings that address the study's objective.

RESULTS

Following analysis of participants' interpretations, understanding and implications of their HIV-positive diagnosis, two major themes emerged: (1) anxiety regarding the impact of the disease on self, family and society was overwhelming. Participants were anxious because of the stigma, fear, worry, shock, and shame they faced. (2) Participants expressed hopelessness and could not see meaning or purpose in life. Suicidal ideation, suicide plans and self-harm characterised hopelessness.

CONCLUSIONS

The initial reaction to the diagnosis of HIV in this LMIC context has the potential to impact linkage to care negatively and, thus, the attainment of the global 95-95-95 targets. It is, therefore, essential that mental health and psychological support services are integrated with testing services to manage the initial reactions and support individuals to improve early linkage to care and thus improve overall outcomes for the infected individual and society.

Impact of COVID-19 Pandemic on Organization of Religious Behaviour in Different Christian Denominations in Poland

Any pandemic disorganizes the life of wider society. One of the manifestations of social activity is religious life. Despite progressing secularization, both religion, churches, and denominational associations have an impact on individual ethical choices and business decisions. This is true especially in Poland, where over 90 percent of the citizens declare affiliation with some religion, mostly Christian. The purpose of the present article is to demonstrate what activities are undertaken by churches in Poland at the time of the COVID-19 pandemic, and what differences there are in their organization of religious life. In order to achieve the set goal, qualitative methods were implemented in the research. As part of the qualitative paradigm, in-depth individual interviews were used, involving individuals responsible for organizing religious life at the parish or congregation level. The interviewees were clergymen from the most important denominations, ranging from Catholic and Orthodox to broadly understood Protestant denominations. The paper contains a review of relevant literature. It presents the results and discussion of qualitative research, and it also indicates the research limitations. The study reveals that individual churches have limited (Catholic and Orthodox) or totally suspended (Protestants) their religious life in the actual community-based dimension. The decisions made by the clergymen, regardless of their personal views, resulted from the assumed ecclesiology and tradition. While changing the organization of religious life, the churches maintained contact with the believers in various ways, using modern technologies and access to public media in this regard. Although the churches are not changing their doctrinal positions, they declare different forms of cooperation.

Understanding HIV Transmission and Illness Stigma: A Relationship Revisited in Rural Rwanda

Integrating an understanding of HIV transmission with structural-behavioral prevention approaches remains a priority in low prevalence rural regions in Africa. Many national indicators use categorical survey responses which do not capture the cultural nuances of HIV transmission knowledge that potentially reify stigmatizing treatment of persons living with HIV (PL-HIV). We examined the relationship between quantitative and qualitative measures of HIV knowledge and four forms of stigma (individual attitudes, felt normative, social distance, and stigma perceived by PLHIV) among 200 rural residents in Rwanda. Forty-two percent qualitatively reported concurrent accurate and partial knowledge of HIV transmission. Being more knowledgeable about HIV transmission was associated with less desire for social distancing from PLHIV. Our findings highlight the continued importance of reinforcing an accurate understanding of HIV transmission and correcting misinformation by drawing on quantitative and qualitative assessments of HIV knowledge as critical arms of HIV stigma reduction programs in low prevalence rural regions.

Perceptions of South African Emerging Adult FET College Students on Sexual Practices in Relation to Religion

HIV and AIDS are rapidly spreading amongst the world's 15- to 24-year age group, particularly in sub-Saharan Africa. Despite vigorous government interventions and campaigns, 10 % of South African youth in the age cohort 15-24 are infected with HIV and AIDS. Furthermore, for the first time in history the world has its largest number of individuals under the age of 30 years. Researchers are desperately seeking a solution and have found religion to play an important role in moderating risky sexual behaviour amongst youth. This exploratory qualitative study aims to increase our understanding of emerging adult Further Education and Training (FET) students' perceptions of the role of religion and religious beliefs in their sexual decision-making and practices. The qualitative data emerged from five focus group discussions, each consisting of 12 heterosexual emerging adult FET college students aged 18-24 years, selected using random sampling. Participants were representative of all the major South African racial groups (Blacks, Whites, Coloured and Indians) as well as different religious and cultural groupings. Secularisation theory was used as a theoretical framework for this study. These focus group discussions revealed the following themes: Theme 1-religious institutions need to embrace change in order to become effective social agents of change. Theme 2-a need for open discussion and communication concerning current issues related to young people's sexual health (by religious institutions/religious leaders). Theme 3-perceptions of religion's negative sanctions towards sexual behaviour. Theme 4-religious leaders' indifference and abdication of responsibility to the problems that youth face. Theme 5-religion and condom-related beliefs. Theme 6-perceptions of religious leaders as role models. Theme 7-emerging adults general concern for the moral decay of society. Theme 8-perceptions of whether religion has an influence on young people's sexual decision-making and practices.

'They say God punishes people with HIV': experiences of stigma and discrimination among adults with HIV in Dili, Timor-Leste

Little is known about the experiences of people with HIV in the small island nation of Timor-Leste. This study explored the HIV-related stigma experiences of adults aged between 18 and 40 living with HIV in Dili, Timor-Leste. Participants were interviewed on topics related to living with HIV, both as key informants describing the experience of others with HIV known to them, and also with respect to their own personal experiences. Findings suggest that people with HIV in Timor-Leste face stigma and discrimination in various contexts. In this predominantly Catholic country, perceptions of HIV and attitudes towards people with HIV appear to be commonly shaped by religious beliefs. In families and communities, participants encountered gossip, social exclusion and threats of violence. In health settings, participants experienced discrimination from health providers in the form of failing to maintain confidentiality and inappropriate treatment. The impact of stigma was profoundly negative and influenced participants' decision to disclose their status to others. Participants attributed stigma to a lack of information about HIV among the general public. Unless stigma reduction interventions also address the Church's role in shaping perceptions of HIV, education campaigns are unlikely to be effective in reducing HIV-related stigma.

Women and HIV in a moderate prevalence setting: an integrative review

Background

Almost 32,000 people are living with human immunodeficiency virus (HIV) in Papua New Guinea (PNG). The primary route of transmission in this moderate prevalence setting is through heterosexual sex. Thus a gendered understanding of HIV is required to inform HIV prevention, treatment and care options. The aim of this review is to investigate understandings specifically about women and HIV in PNG and to identify gaps in the literature to inform future HIV research.

Methods

An integrative review of literature about women, HIV and PNG was conducted using a systematic search of online databases, including book chapters and grey literature. Prior to inclusion, literature was assessed using inclusion and exclusion criteria, and the Critical Appraisal Skills Programme (CASP) appraisal tool. Selected articles, book chapters and reports were coded and a constant comparative method of analysis used to construct a series of themes.

Results

The 26 articles, book chapters and reports included in the review were predominantly descriptive, original research (23/26 pieces of literature). Six themes were identified in the literature: economic, social and cultural factors (including mobility); gender issues (including violence against women); knowledge about HIV (including perception of risk of HIV); religious beliefs about HIV; women perceived as responsible for HIV transmission; and prevention of HIV. Literature about women and HIV in PNG is predominantly focussed upon women who sell sex, women as mothers or young women. Women are usually represented as either victims of HIV or responsible for transmitting HIV. Anthropological and social research has described the economic, social and cultural context along with the lived experience of HIV in PNG, but there is limited operations research or implementation research available.

Conclusions

The literature reviewed has highlighted the importance of a gendered analysis of HIV prevention, care and treatment in PNG. There is an opportunity for operations, implementation and health systems research about HIV in PNG to shift research from description to action.