Churches can help increase HIV testing in South African men

An HIV testing campaign conducted within South African churches successfully recruited 43% of the congregation for HIV testing on campaign days and was most successful at reaching men and particularly men who had never tested before.

HIV testing rates were significantly higher among men than women, with 52% deciding to test versus 40% of women. In addition, a higher proportion of men (35%) than women (18%) were first-time testers.

Men historically have very low rates of HIV testing and are considered a hard-to-reach population for HIV services. In South Africa, just 78% of men living with HIV know their status compared to 89% of HIV-positive women and innovative interventions are needed to bridge the gap. Previous research reveals low rates of HIV testing among men for three reasons: fear of damaging their reputation and loss of masculinity; fear of possible community rejection; and fear of losing emotional control from the psychological burden of knowing they are HIV-positive.

While several approaches to reach men have been implemented, there has been relatively little research that uses religious leaders to promote HIV testing. Churches have traditionally focussed on HIV prevention messaging and HIV support for those who are ill, with little evidences of churches or congregations directly participating in the delivery of HIV testing. But with 86% of South Africans reporting being Christian, and just over half (52%) reporting attending a church service in the last week, this approach requires further investigation.

In this study, researchers used a three-phase intervention in partnership between Anova Health Institute and the International Network of Religious Leaders Living with or Affected by HIV & AIDS (INERELA+) with churches and religious leaders in rural Mopani District of Limpopo Province, South Africa.

The first phase included increasing knowledge of HIV among religious leaders through a three-day course that included information on HIV transmission, their own attitudes towards HIV and people living with HIV and coaching them on how they could discuss HIV in their congregations and communities. Religious leaders from 47 churches were trained.

The second phase included mentoring and support of the religious leaders as they began to discuss HIV in their sermons. Two ‘HIV champions’ and a healthcare worker in each community were also recruited to discuss HIV with men and raise awareness around the benefits of testing.

In the third phase, Anova staff supported a total of 27 churches to hold HIV testing campaigns during which HIV testing was discussed in the service, and congregation members were encouraged to test. Over a 15-month period, the churches reached an estimated population of 5,250 church members with their testing campaigns.

Of those who tested HIV-positive, they were actively linked to a local health service, and positivity rates were similar between men and women (2.1% vs. 3.7%). But when analysed by age, all the men who tested positive were older men over 40, which showed that this intervention was highly successful at reaching an important population of people living with HIV with knowledge of their status.

In their discussion, the authors note that religion is a significant social force in sub-Saharan Africa, that has played both positive and negative roles in the HIV response there. Religion plays a key role in many people’s lives, and religious leaders can influence people’s knowledge about HIV and how they perceive HIV.

“In the case of this intervention, the decision to work directly with RLs [religious leaders] appears to have been appropriate in creating an enabling environment for men to access HTS [HIV testing services],” say the investigators. “It is possible that the perceived authority of RLs and their ability to integrate information about health into their sermons using biblical references contributed to encouraging men in their congregation to participate in HTS.”

In their conclusion, the authors note that further research is needed around the role faith-based organisations (FBOs) can play to support the delivery of HIV testing to hard-to-reach populations. “There is also a need for renewed investment in work with FBOs as a potentially effective aspect of the broader HIV response.”