Preventing HIV by providing support for orphan girls to stay in school: does religion matter?
OBJECTIVE
The paper examines the influence of religion on attitudes, behaviors, and HIV infection among rural adolescent women in Zimbabwe.


METHODS
We analyzed data from a 2007 to 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 and many Apostolic sects discourage 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.
Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA. Hallfors@pire.org
Denise D
DD
Hallfors
Hyunsan
H
Cho
Bonita J
BJ
Iritani
John
J
Mapfumo
Elias
E
Mpofu
Winnie K
WK
Luseno
James
J
January
D000293:Adolescent; D000367:Age Factors; D054540:Child, Orphaned / Q000193:education / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D017533:Marital Status / Q000208:ethnology* / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012068:Religion and Medicine; D012071:Religion and Sex; D012309:Risk-Taking; D012424:Rural Population / Q000706:statistics & numerical data; D012574:Schools / Q000191:economics; D012944:Social Support; D013332:Student Dropouts / Q000706:statistics & numerical data; D014146:Training Support; D014933:Women's Rights; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology