title: 'I thought if I marry the prophet I would not die': The significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe.
abstract: This study examines the association between religious affiliation and reasons for marriage, perceived church attitudes, and reproductive health-seeking behaviors, including HIV testing, among young women in eastern rural Zimbabwe. The sample comprised women (N = 35) who had married by 2012 while participating in a larger randomized controlled trial (RCT) to test the effects of school support on HIV-related risk. The RCT sample was identified in 2007 as all female sixth graders in 25 rural eastern Zimbabwe primary schools whose parents, one or both, had died (N = 328). In our previous RCT analyses, we found that participants who affiliated with an Apostolic church were more than four times more likely to marry than those from non-Apostolic churches and that control group participants were twice as likely to marry as those in the intervention group. Other studies had found that marriage greatly increased the odds of HIV infection among adolescent women. Given the link between Apostolic affiliation and marriage, we conducted semi-structured interviews to explore type of marriage, reasons for marrying, church affiliation and attitudes, family planning, HIV testing, schooling, and family life. We were interested in differences, as perceived by our sample of young married women congregants, among Apostolic sects and other denominations in their attitudes about marriage and health-seeking behaviors. We were also interested in the influence of church affiliation on intervention participants' decision to marry, since they had comprehensive school support and education is highly valued in Zimbabwe, but costly and often out of financial reach. Interviews were conducted from October 2012 through November 2013; data were analyzed using a general inductive approach. We found that pressure or perceived deception for coitus or marriage was reported only by intervention participants affiliated with Apostolic denominations. Other reasons for marriage were similar between Apostolic and non-Apostolic adherents, as well as intervention and control conditions. All participants believed HIV testing was important, but while all non-Apostolic denominations encouraged HIV testing and clinic/hospital care, there was considerable heterogeneity in attitudes among Apostolics, with ultraconservative denominations most likely to proscribe non-religious health care. We conclude that some, but not all, Apostolic-affiliated women are afforded discretion in their health-seeking behaviors. Since HIV screening and treatment depend on access to clinic/hospital care, continued public health efforts to engage Apostolic leaders is needed, along with monitoring of progress in access and outcomes.
authors.affiliation: a PhD Senior Research Scientist, is affiliated to Pacific Institute for Research and Evaluation , 1516 E. Franklin St., Suite 200, Chapel Hill , NC 27514 , USA.
authors.forename: Denise Dion
authors.initials: DD
authors.lastname: Hallfors
authors.affiliation: b MS, MA Associate Research Scientist, is affiliated to Pacific Institute for Research and Evaluation , 1516 E. Franklin St., Suite 200, Chapel Hill , NC 27514 , USA.
authors.forename: Bonita J
authors.initials: BJ
authors.lastname: Iritani
authors.affiliation: c PhD Associate Research Scientist, is affiliated to Pacific Institute for Research and Evaluation , 1516 E. Franklin St., Suite 200, Chapel Hill , NC 27514 , USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: d BA Research Associate, is affiliated to Pacific Institute for Research and Evaluation , 1516 E. Franklin St., Suite 200, Chapel Hill , NC 27514 USA.
authors.forename: Shane
authors.initials: S
authors.lastname: Hartman
authors.affiliation: e PhD Research Scientist, is affiliated to Pacific Institute for Research and Evaluation , 1516 E. Franklin St., Suite 200, Chapel Hill , NC 27514 , USA.
authors.forename: Winnie K
authors.initials: WK
authors.lastname: Luseno
authors.affiliation: f PhD, DEd Professor of Rehabilitation Counseling, is affiliated to Department of Rehabilitation Counseling , Faculty of Health Sciences, University of Sydney , Australia.|h PhD, DEd Professor of Rehabilitation Counseling, is affiliated to Department of Research and Innovation , Central University of Technology , Bloemfontein , South Africa.
authors.forename: Elias
authors.initials: E
authors.lastname: Mpofu
authors.affiliation: g PhD Professor and Chairman, is affiliated to Department of Community Medicine , University of Zimbabwe , PO Box A 178, Avondale , Harare Zimbabwe.
authors.forename: Simbarashe
authors.initials: S
authors.lastname: Rusakaniko
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008393:Marriage; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care; D012067:Religion; D060728:Reproductive Health; D012424:Rural Population; D055815:Young Adult; D015030:Zimbabwe
keywords: HIV testing; Zimbabwe; dépistage du VIH; la recherche qualitative; le mariage et la religion; les comportements de santé reproductive des femmes; marriage and religion; qualitative research; women’s reproductive health behaviors