Assessment of the Role of Religious Leaders in the Management of HIV/AIDS in Ibadan, Southwestern Nigeria.

1
Assessment of the Role of Religious Leaders in
the Management of HIV/AIDS in Ibadan,
Southwestern Nigeria.

• By
• Asekun-Olarinmoye IO, Asekun-Olarinmoye EO,
  Fatiregun AA and Fawole IO.
• Department of Epidemiology, Medical Statistics,
  and Environmental Health, College of Medicine,
  University of Ibadan, Oyo State, Nigeria
• Department of Community Medicine, College of
  Health Sciences, Faculty of Clinical Sciences,
  Ladoke Akintola University of Technology, PMB
  4400, Osogbo, Osun State, Nigeria

2
Background

• The HIV/AIDS pandemic is without doubt, one of
  the greatest health problems challenging science
  and man and may remain so for a long time
  (Salako, 2003).
• HIV is the fourth (4th) leading cause of death
  globally and the leading cause of death in Africa
  (WHO, 1999)
• Worldwide, people aged 15-24 account for about
  30 of the total HIV/AIDS count (UNAIDS/WHO, 2001)

3
Statement of the Problem

• The epidemic of HIV continues at alarming rates
  in Nigeria despite efforts to control it.
• Meaningful efforts aimed at combating the scourge
  must be multi-sectoral.
• Despite the high influence religious leaders have
  in our society, their roles in prevention and
  care of HIV/AIDS have not been well studied.

4
Study Justification

• Religion is one of the worlds largest
  institutions
• Probably the only institution which bridges the
  gap of race, class, occupation and nationality.
• Dispersed throughout the country, and thereby
  have the capacity to reach a much larger number
  of people.

5
Study Justification 2

• Therefore, religious leaders and their
  institutions can and do provide a good medium of
  communication to an audience, which is generally
  respectful and receptive to the
  teachings/preaching of such leaders.

6
Objectives

• To assess knowledge, attitudes, perceptions and
  role of conventional religious leaders in the
  management and control of HIV/AIDS in Ibadan,
  Nigeria.

7
MATERIALS AND METHODS

• Study Area Ibadan, Southwest Nigeria
• Study Design Descriptive, Cross-sectional .
• Study tool Self-administered, semi-structured,
  pre-tested questionnaire

8

• Sample Size 336 leaders of eight (8) different
  religious denominations
• Sampling technique multi-stage, cluster random
  sampling technique
• Inclusion criterion All adult members of the
  selected FBOs aged 15 years and above holding any
  leadership position

9
RESULTS

• SOCIO-DEMOGRAPHIC CHARACTERISTICS
• The mean age of respondents was 37.9 years 13.5
• male/female ratio of 2.31.
• Majority fell into the age group 25-34yrs and
  gt45yrs (30.1 and 30.7) respectively
• Were males (69.9), married (61.6),
• Had at least post-secondary education (84.6) and
  were Christians (72.6).

10
Table 1. Respondents knowledge, attitude and
practice scores about HIV/AIDS.
Variable scores Categories Categories Mean Standard deviation
Variable scores Poor () Good () Mean Standard deviation
Knowledge score 48 (14.3) 288 (85.7) 1.86 0.35
Attitude score 53 (15.8) 283 (84.2) 1.84 0.37
Practice score 17 (5.1) 319 (94.9) 1.95 0.22
11
Respondents knowledge score, attitudinal score
and practice score about HIV/AIDS

• Almost all,(97.6) were aware of the HIV/AIDS
  scourge. Most respondents had good knowledge of
  routes of transmission and modes of prevention
  (85.7), good attitude (84.2) and good practice
  of preventive measures (94.9).

12

• A few respondents had misconceptions that
  kissing, hugging, handshake, mosquito bites, and
  using the same toilet are routes of transmission
  of HIV infection.

13
Table 2 Distribution of Respondents by attitude
towards HIV
Variables Yes No
1. Do you think that your religion has/can have any influence on the combat/war against HIV/AIDS? 228 (85.7) 48 (14.3)
2. Do you think you have sufficient knowledge and skill to protect yourself if you have to care for a member of your congregation who is HIV-positive? 215 (64.0) 121 (36.0)
3. Do you believe HIV/AIDS exist? 331 (98.5) 5 (1.5)
4. Do you believe it exists in Nigeria? 331 (98.5) 5 (1.5)
5. Do you know your HIV status? 161 (47.9) 175 (52.1)
6. If no, do you want to know? (n175) 116 (66.3) 59 (33.7)
7. Would you like to do the HIV test if it were free? 217 (82.4) 59 (17.6)
14
Table 3 Distribution of Respondents by
perception of HIV
Variables Agree Disagree Not Sure
1. Should people with HIV/AIDS be isolated from the general congregation of worshippers? 2. Do you think you run the risk of ever contracting HIV/AIDS? 3. Do you believe that indulging in unprotected sexual intercourse puts one at risk of contracting HIV/AIDS? 4. Do you believe the disease is curable? 35 (10.4) 95 (28.3) 310 (92.3) 180 (53.6) 278 (82.7) 169 (50.3) 15 (4.5) 92 (27.4) 23 (6.8) 72 (21.4) 11 (3.3) 64 (19.0)
15

• Only 10.4 of respondents thought PLWHAs should
  be isolated from the general congregation of
  worshippers.

16

• Only 95 (28.3) respondents had a correct
  perception of their vulnerability to HIV
  infection while about half (50.3) thought that
  they do not risk ever contracting HIV/AIDS
  another 53.6 of respondents believe that
  HIV/AIDS is a curable disease.

17
Table 4 Distribution of Respondents according to
response on stigmatizing behavior towards PLWHAs
Variables Agree Disagree Not Sure
1. Can you do the following with an HIV-positive person or AIDS patient? a. Shake hands b. Hug c. Sleep on the same bed d. Live in the same house e. Share the same office space at work f. Be closely-knit friends g. Eat from the same plate 299 (89.0) 288 (85.7) 237 (70.5) 282 (83.9) 286 (85.1) 247 (73.5) 226 (67.3) 23 (6.8) 28 (8.3) 75 (22.3) 37 (11.0) 34 (10.1) 56 (16.7) 77 (22.9) 14 (4.2) 20 (6.0) 24 (7.1) 17 (5.1) 16 (4.8) 33 (9.8) 33 (9.8)
18
Role played respondents in control of HIV/AIDS
amongst congregation

• A little over half (56.5) of the respondents
  ever preached about health issues relating to
  HIV/AIDS transmission and treatment to their
  congregations while 76.5 used their position as
  a medium of educating their congregation about
  the dangers of HIV/AIDS.

19
Role played respondents in control of HIV/AIDS
amongst congregation contd.

• Preventive means mostly advocated include marital
  faithfulness (95.7), abstinence for the
  unmarried (77.8) and monogamy (61.5).

20
Role played respondents in control of HIV/AIDS
amongst congregation contd.

• 58.3 of respondents organizations have
  programmes currently being run aimed at educating
  their members on preventive measures against
  HIV/AIDS. The most commonly used measures are
  health education talks/seminars, youth forums,
  and volunteer counseling units by 91.3, 88.3
  and 71.9 respectively.

21
Measures of dealing with stigmatizing issues in
the congregation

• Measures of dealing with stigmatizing issues in
  the congregation included Counseling, visitation
  and involvement in church activities by 57.2,
  6.3 and 7.2 of respondents while 35.4 of
  respondents did not have any measures put in
  place for dealing with such issues.

22
Distribution of respondents based on scope of
their efforts in the control of HIV/AIDS
23
Scope of respondents activities in HIV prevention
and control

• The scope/reach of efforts/programmes by the
  respondents and their organizations- The
  programme is limited to local congregation in 145
  (43.2), extended to local community in 70
  (20.8) and interstate in 26 (7.7) while 94
  (28.0) of respondents and their organizations
  have no programmes in place.

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limited scope of reach

• This result shows limited scope of reach.
• This may be due to the fact that, as results
  further revealed, only
• Only 12.5 of the organizations have partnerships
  with other organizations such as SACA, NACA, ADRA
  (Adventist Development and Relief Agency),
  UNICEF, UNAIDS, WHO etc, limited capacity.
• Only 102 (30.4) respondents have programmes
  running to take care of PLWHAs in their
  congregations.

25
Table 5 Distribution of Respondents by type of
programmes being run for PLWHAs in congregations
Variables (n102) Yes No
Type of programmes being run for PLWHAs in congregations a. financial support through church charity/individuals b. social support c. physical/emotional support e.g. food shelter donations 91 (89.2) 76 (4.5) 83 (81.4) 11 (10.8) 26 (25.5) 19 (18.6)
26

• Bivariate analysis showed statistically
  significant relationship between good attitudinal
  score and individual role (plt0.05). Multivariate
  analysis revealed attitude (p0.000, OR3.013
  p0.038, OR1.872) as predictors of both
  individual and organizational roles.

27
Relationship between Individual Role (Ever
Preach) and Variable Scores

• Respondents who have good attitudes are more
  likely to ever preach about HIV/AIDS issues than
  those with poor attitudes. This is statistically
  significant at p 0.000. Furthermore,
  respondents with good practice of preventive
  measures are more likely to preach than those
  with bad practice, though this is not
  statistically significant (p 0.418).

28
Relationship between Individual Role (Ever
Preach) and Variable Scores
Variable scores Variable scores Ever preach Ever preach X2 values df p value Remarks
Variable scores Variable scores Yes () No () X2 values df p value Remarks
Knowledge score Poor 31 (64.6) 17 (35.4) 1.472 1 0.225 NS
Knowledge score Good 159 (55.2) 129 (44.8) 1.472 1 0.225 NS
Attitude score Poor 18 (34.0) 35 (66.0) 13.063 1 0.000 S
Attitude score Good 172 (60.8) 111 (39.2) 13.063 1 0.000 S
Practice score Bad 8 (47.1) 9 (52.9) .656 1 0.418 NS
Practice score Good 182 (57.1) 137 (42.9) .656 1 0.418 NS
S Significant, NS Not Significant
29
Logistic Regression Model to test the
relationship between Individual Role Ever
Preach and Attitude Score
B S.E. Wald Df Sig. OR - Exp(B) 95.0 C.I. for EXP(B) 95.0 C.I. for EXP(B)
Lower Upper
Attitude Score 1.103 .315 12.294 1 .000 3.013 1.626 5.582
Constant -.438 .122 12.940 1 .000 .645
Logistic Regression Model to test the
relationship between Organizational Role and
Attitude Score
B S.E. Wald df Sig. OR - Exp(B) 95.0 C.I. for EXP(B) 95.0 C.I. for EXP(B)
Lower Upper
Attitude score .627 .302 4.324 1 .038 1.872 1.037 3.382
Constant -.438 .122 12.940 1 .000 .645
30

• Respondents with good attitudes were three times
  more likely to have ever preached about
  HIV/AIDS/health-related issues from their
  pulpits. (p 0.000, OR 3.013).
• Respondents with good attitudes were about two
  times more likely to have programs aimed at
  educating their congregations running in their
  organizations (p 0.038, OR 1.872).

31
Table 22 Logistic Regression Model to assess the
relationship between Individual Role Ever
preach and Socio-demographic variables
Variable scores Variable scores Ever Preach Ever Preach X2 values df p value Remarks
Variable scores Variable scores Yes () No () X2 values df p value Remarks
Religion Christianity 147 (60.2) 97 (39.8) 4.960 1 .026 S
Religion Muslim 43 (46.7) 49 (53.3) 4.960 1 .026 S
Marital Status Never Married 59 (46.5) 68 (53.5) 8.461 1 .004 S
Marital Status Ever Married 131 (62.7) 78 (37.3) 8.461 1 .004 S
Gender Male 146 (62.1) 89 (37.9) 9.907 1 .002 S
Gender Female 44 (43.6) 57 (56.4) 9.907 1 .002 S
Educational Level Primary 4 (26.7) 11 (73.3) 5.729 2 .057 NS
Educational Level Secondary 21 (56.8) 16 (43.2) 5.729 2 .057 NS
Educational Level Tertiary 165 (58.1) 119 (41.9) 5.729 2 .057 NS
Age group lt 25yrs 22 (37.9) 36 (62.1) 10.278 3 .016 S
Age group 25 34 yrs 60 (59.4) 41 (40.6) 10.278 3 .016 S
Age group 35 44 yrs 47 (63.5) 27 (36.5) 10.278 3 .016 S
Age group lt 44 yrs 61 (59.2) 42 (40.8) 10.278 3 .016 S
S Significant, NS Not Significant
S Significant, NS Not Significant
32
Relationship between Individual Role (Ever
Preach) and Socio-demographic variables

• The study showed that respondents who were
  Christians (p 0.026), had ever married (p
  0.004), and were males (p 0.002) were more
  likely to have ever preached about health issues
  to their congregations.

33

• The study also showed that respondents who had
  tertiary education were more likely to have ever
  preached compared to those with primary and
  secondary education, though this was found not to
  be statistically significant at p 0.057. In
  addition, it shows that respondents within the
  age group 35-44yrs were more likely to have ever
  preached. This is statistically significant (p
  0.016).

34
Predictors of individual role (ever- preached)

• After adjusting for the effects of other
  variables, only gender (p 0.001, OR 2.260)
  and marital status (p 0.026, OR 0.495) were
  found to be statistically significant predictors
  of individual role in a multiple logistic
  regression analysis.

35

• This study also found out that respondents who
  were Christians (p 0.001), had ever married (p
  0.021), and were males (p 0.008) were more
  likely to belong to organizations who had
  programs running aimed at educating and informing
  their members on preventive measures against
  HIV/AIDS.

36
Logistic Regression Model to examine the
relationship between Organizational Role and
Socio-demographic variables

• Using logistic regression analysis, after
  adjusting for the effects of other variables,
  only religion and gender were found to be
  statistically significant predictors of the
  organizational role with the role being twice
  more likely to occur in Christians than Moslems,
  and in males than in females (p 0.004, OR
  2.086 p 0.007, OR 1.951 respectively).

37
Logistic Regression Model to examine the
relationship between Organizational Role and
Socio-demographic variables
B S.E. Wald df Sig. Exp(B) 95.0 C.I. for EXP(B) 95.0 C.I. for EXP(B)
B S.E. Wald df Sig. Exp(B) Lower Upper
Religion .735 .257 8.166 1 .004 2.086 1.260 3.454
Gender .668 .248 7.268 1 .007 1.951 1.200 3.171
Marital Status -.449 .240 3.518 1 .061 .638 .399 1.020
Constant -1.429 .628 5.179 1 .023 .240
38
Relationship between Organizational Role (Have
programs) and Socio-demographic variables
Variable scores Variable scores Organizational Role Organizational Role X2 values df p value Remarks
Variable scores Variable scores Yes () No () X2 values df p value Remarks
Religion Christianity 156 (63.9) 88 (36.1) 11.502 1 .001 S
Religion Muslim 40 (43.5) 52 (56.5) 11.502 1 .001 S
Marital Status Never Married 64 (50.4) 63 (49.6) 5.295 1 .021 S
Marital Status Ever Married 132 (63.2) 77 (36.8) 5.295 1 .021 S
Gender Male 148 (63.0) 87 (37.0) 6.941 1 .008 S
Gender Female 48 (47.5) 53 (52.5) 6.941 1 .008 S
Educational Level Primary 8 (53.3) 7 (46.7) 1.854 2 .396 NS
Educational Level Secondary 18 (48.6) 19 (51.4) 1.854 2 .396 NS
Educational Level Tertiary 170 (59.9) 114 (40.1) 1.854 2 .396 NS
Age group lt 25yrs 28 (48.3) 30 (51.7) 4.306 3 .230 NS
Age group 25 34 yrs 59 (58.4) 42 (41.6) 4.306 3 .230 NS
Age group 35 44 yrs 49 (66.2) 25 (33.8) 4.306 3 .230 NS
Age group lt 44 yrs 60 (58.3) 43 (41.7) 4.306 3 .230 NS
39

• The study found out that Age is a positive
  predictor of the organizational role (have
  infrastructure or means to care for PLWHAs),
  where as the organization grows in age, it is
  more likely to have infrastructure or means of
  taking care of PLWHAs (p 0.113, OR 1.223).

40
Conclusions

• The study shows that the religious leaders have
  high and good knowledge of routes of transmission
  and mode of prevention of HIV accompanied by
  good/positive attitudes.

41

• They also performed roles in educating, informing
  and raising the awareness of their congregations
  on HIV preventive measures and practices
• They can, thus, be used as vital instruments to
  occupy a pivotal role in the war against the
  HIV/AIDS scourge in Nigeria.

42

• However, their current role and scope of
  activities are limited and/or inadequate.

43
Recommendations

• Seminars and workshops should be organized for
  this target group (Religious leaders) to address
  areas of misconceptions, inadequate knowledge and
  lack of skill to handle issues relating to
  HIV/AIDS among the members of their
  congregations, if and when affected.

44

• Partnerships should be encouraged between FBOs,
  governmental and non-governmental agencies to
  increase capacity building, sustainability and
  funding to enable FBOs play an even greater and
  more active role in fight against HIV/AIDS.

45

• Efforts should be made by the government/policy
  makers to involve more FBOs in the on-going HIV
  prevention programmes as results from this study
  show that 28 of the respondents, and their
  organizations by extension, currently do not have
  any programmes (educative/preventive) in place
  for their congregations.

46

• Finally, I recommend that FBOs, on the other
  hand, develop strong and sound policy statements
  on HIV/AIDS and that they work increasingly in
  collaboration with other advocates to bring
  greater moral urgency to the fight against
  HIV/AIDS

47

• Thank you for listening!!!