Preventing HIV by providing support for orphan girls to stay in school: does religion matter?

Abstract

Objective The paper examines the influence of religion on attitudes, behaviors, and HIV infection among rural adolescent women in Zimbabwe. Design We analyzed data from a 2007-2010 randomized controlled trial in rural eastern Zimbabwe testing whether school support can prevent HIV risk behaviors and related attitudes among rural adolescent orphan girls; supplementary data from the 2006 Zimbabwe Demographic and Health Survey (ZDHS) were also analyzed. The present study design is largely cross-sectional, using the most recent available survey data from the clinical trial to examine the association between religious affiliation and religiosity on school dropout, marriage, and related attitudes, controlling for intervention condition, age and orphan type. The ZDHS data examined the effect of religious denomination on marriage and HIV status among young rural women, controlling for age. Results Apostolic Church affiliation greatly increased the likelihood of early marriage compared to reference Methodist Church affiliation (odds ratio=4.5). Greater religiosity independently reduced the likelihood of school dropout, increased gender equity attitudes and disagreement with early sex, and marginally reduced early marriage. Young rural Apostolic women in the ZDHS were nearly four times as likely to marry as teenagers compared to Protestants, and marriage doubled the likelihood of HIV infection. Conclusions Findings contradict an earlier seminal study that Apostolics are relatively protected from HIV compared to other Christian denominations. Young Apostolic women are at increased risk of HIV infection through early marriage. The Apostolic Church is a large and growing denomination in sub-Saharan Africa that discourages medical testing and treatment in favor of faith healing. Since this can increase the risk of undiagnosed HIV infection for young married women and their infants in high prevalence areas, further study is urgently needed to confirm this emerging public health problem, particularly among orphan girls. Although empirical evidence suggests that keeping orphan girls in school can reduce HIV risk factors, further study of the religious context and the implications for prevention are needed.

Educational Outcomes for Orphan Girls in Rural Zimbabwe: Effects of a School Support Intervention

“…From our study experience, we found that rural girls, particularly those who do not have school fees, are increasingly likely to drop out and marry as they get older (Hallfors et al, 2015). From other analyses, we found that Apostolic religious affiliation was strongly associated with greater likelihood of early marriage and school dropout among rural orphan girls (Hallfors et al, 2013). We presently find that Apostolic affiliation is also associated with poorer educational performance.…”

Influence of school support on early marriage experiences and health services utilization among young orphaned women in Zimbabwe

“…As expected, more control group participants mentioned a lack of school fees as a reason for dropping out, but surprisingly, intervention group members were more likely to report having felt coerced into marriage. Advancing age was a strong predictor of marriage independent of condition (Hallfors et al, 2015) and certain religious sects are also associated with early marriage in Zimbabwe (Hallfors et al, 2013) and may have over-ridden the beneficial effects of the intervention.…”

“…Among adolescent girls in sub-Saharan Africa, older age and orphan status are important risk factors for child marriage, pregnancy, school dropout and HIV (Birdthistle et al, 2008; Chae, 2013; Hallfors et al, 2013; Luseno, Zhang, Rusakaniko, Cho, & Hallfors, 2015; Operario, Underhill, Chuong, & Cluver, 2011; Palermo & Peterman, 2009). Orphans defined by UNICEF (2006) as one or both parents deceased are more likely than non-orphans to have lower educational attainment because they tend to start school late, repeat at least one grade, and/or attend school irregularly (Birdthistle et al, 2009; Guo, Li, & Sherr, 2012; Pufall et al, 2014).…”

The Impact of School Subsidies on HIV-Related Outcomes Among Adolescent Female Orphans

“…Girls’ sexual debut is later in Zimbabwe than in any other sub-Saharan country, and it is typically associated with marriage [8]. Marriage doubled the risk of HIV for rural 15-19 year old Zimbabwe women, based on data from the 2006 Zimbabwe Demographic and Health Survey [9]. Among a large sample of urban young women in Zimbabwe, about half of whom were orphans, marriage increased the age-adjusted odds of HIV by 2.6 and the odds of genital herpes (HSV-2) by 7.7 [10].…”

“…We also found, however, that religion can be a powerful contextual influence, and that girls affiliated with Apostolic sects were at much higher risk of early marriage and school dropout than those from other religious denominations in Zimbabwe [9]. For this reason, we included religion as a covariate in our models.…”