Religious teachings and influences on the ABCs of HIV prevention in Malawi.

This study examines the relationship between religion and HIV risk behaviors in rural Malawi, giving special attention to the role of religious congregations, the organizations with which rural Africans have most immediate contact. It draws on 2004 data from a household survey in 3 districts (N=3386), and quantitative and qualitative data collected in 2005 from 187 leaders of religious congregations previously identified in the survey. The first aim is descriptive--to identify overall patterns and variations in what religious leaders in rural Malawi teach about HIV and about sexual behavior in light of the epidemic. The second aim is to assess how religious organizations impact the behavior of individual members. I examine three outcomes that correspond with the ABCs of HIV prevention: abstinence (for never married persons), fidelity (for married persons), and condom use (among sexually active persons). Multi-level models reveal that religious affiliation and involvement are not correlated with the sexual behavior of congregation members, but that beliefs about appropriate sexual behavior and particular congregational characteristics are associated with adherence to A, B, and C. Individuals belonging to congregations led by clergy who 1) frequently deliver formal messages about HIV, 2) monitor the sexual behavior of members, and 3) privately encourage condom use report greater adherence to the ABCs of HIV prevention, suggesting that religious congregations are relevant for the sexual behavior of members and for better understanding the forces shaping individual behavior in the context of the African AIDS epidemic.