Elsevier

Social Science & Medicine

Volume 56, Issue 6, March 2003, Pages 1221-1234
Social Science & Medicine

Religion and women's health in Ghana: insights into HIV/AIDs preventive and protective behavior

https://doi.org/10.1016/S0277-9536(02)00122-3Get rights and content

Abstract

Since the late 1970s when the first cases of HIV/AIDS were identified in Africa, there has been an upsurge of research on the epidemic. Although religious involvement may be germane to AIDS protective and risk behavior, few of these studies deal with religion and AIDS. This article contributes to the discourse on religion and health in Africa by analysing the interrelationship between religion and AIDS behavior in Ghana, a West African country at the early stages of the AIDS epidemic, and one where religious activities are more pronounced. We explore whether a woman's knowledge of HIV/AIDS is associated with her religious affiliation, and whether religious affiliation influences AIDS preventive (protective) attitudes. Findings from our analysis of Ghanaian data indicate that religious affiliation has a significant effect on knowledge of AIDS. However, we did not find religious affiliation to be associated with changes in specific protective behavior, particularly the use of condoms. The limitations and implications of the study are discussed, promising directions for further research on religion and AIDS protective and risk behaviors are also discussed, and the design and development of culturally sensitive programs to help in the ongoing AIDS prevention efforts in the region are proposed.

Introduction

There has been a recent and growing interest in studies dealing with religion in the lives of contemporary Africans, which appears to be motivated in part by the reported resurgence or revival in religious activities in many African countries during the last several decades (Woodward, 2001; Ojo, 2000; Ghana Review International (GRI), 2000; Meyer, 1995; Bediako, 1995; Gifford (1994a), Gifford (1994b).1 In Ghana, Assimeng (1989) counted over 500 Christian denominations during the early 1980s. Since then, the number of Ghanaians who view themselves as religious has increased substantially, with La Verle (1994) reporting that the percentage of the general population claiming to be Christians rose sharply from a reported 42 percent prior to the 1980s to about 62 percent during the mid-1980s. More recently, Gallup International (2000) interviewed 50,000 people in 60 different countries as part of a millennium survey and reported that the majority of Ghanaians (98 percent) polled professed belonging to a religious denomination, with about 82 percent reporting regular church attendance.

Not only are Ghanaians becoming more religious, it has been suggested that the types of religious organizations in the country continue to change as well (Assimeng, 1986). Alongside the mainstream traditional Christian denominations (i.e., old established churches such as Protestant2 and Catholic), a collection of groups that include African syncretic, faith healing organizations, charismatic, evangelical, as well as Pentecostal Churches have emerged (Yirenkyi, 1999; Gifford, 1994b; Nukunya, 1992; Assimeng (1981), Assimeng (1986), Assimeng (1989)).3 Both Nukunya (1992) and Assimeng (1986) suggest that the growing popularity of these “new” Christian groups reflect the growing disenchantment with the monotony of the old denominations, and the fact that these new churches often involve the use of “healing” and “salvation,” something which seems to appeal to the needs of an impoverished population dissatisfied with their current socioeconomic condition.

While the reasons behind the resurgence in religious activities in Africa overall and Ghana in particular are still not clear, the social and political ramifications of these faith-based organizations have not gone unnoticed.4 Indeed, literature examining the relationship between religion and various aspects of social life in the region has burgeoned (Garner, 2000; Yirenkyi, 2000; Lagarde, Enel, & Seck, 2000; Adongo, Phillips, & Binka (1999), Addai (2000); Adongo, Phillips, & Binka, 1998; Ellis & ter Haar, 1998; Riviere, 1997; Kirby (1993), Kirby (1997); Gifford, 1995; Meyer, 1995; Aboagye-Mensah, 1994; Pobee, 1991; Assimeng, 1989). In the case of Ghana, several scholars have pointed out that religion has emerged as a potent social force in both private and public life (Noretti, 2002; Yirenkyi (1999), Yirenkyi (2000); ter Haar, 1998; Kirby (1993), Kirby (1997); Gifford, 1995; Meyer, 1995). For example, Yirenkyi (2000) and Aboagye-Mensah (1994) have reported that since the 1980s, the Christian churches in Ghana have taken a more activist role in national politics than ever before. Recently, Addai (1999) also investigated the connections between religion and contraceptive use and found religion to be a significant predictor of contraceptive use. In another study, Addai (2000) reported that women who belonged to liberal religious groups (defined here to include Protestants and Catholics) were more likely to report engaging in premarital sex than women from conservative religious groups. Writing about the ongoing fertility transition, Takyi and Addai (2001) have also observed significant variations in overall family size by religious affiliation.

Despite recent research interest on religion and the behavior of contemporary Africans, few studies focus on religion and HIV/AIDS.5 As Agadjanian (2001) has reported, in contemporary Africa, church participation is relevant for the analysis of overall reproductive health, not so much as a direct measure of religious piety, but also as an indicator of social exposure and interaction. Besides, some recent findings from the few studies that have looked at religion and AIDS in Africa have found religion to be an important predictor of AIDS protective and risk behavior (UNAIDS, 1998).6 In a study in Edendale, South Africa, Garner (2000) found that some Christian churches encouraged their members to reduce engaging in extra- and pre-marital sexual activity (EPMS), thereby reducing their risks for AIDS.

Another salient reason for studying religion and sexual behavior derives in part from the social capital and network ties that it fosters (Agadjanian, 2001; Kohler, Behrman, & Watkins, 2001; Valente, Watkins, Jato van der Straten, & Tsitsol, 1997; Sherkat & Wilson, 1995; Cornwall (1988), Coleman (1990); Cornwall, 1987). Given that many women in Ghana spend considerable time in faith and other church-based interactions where the diffusion of AIDS information is more likely to occur, it is likely that social capital gained through the network of relationships and church-based social ties could lead to the dissemination of AIDS information. Rather than facilitate the diffusion of new ideas, it is possible, however, that the influence of religious organizations could constrain individual actions such as not using condoms because they go against Church tenets. Such an expectation is possible, for, as Garner (2000) points out, religious organizations manifest “extensive” and “intensive” power, power that has the potential to influence the behavior of their members. 7

Section snippets

Background

The rapid spread of HIV/AIDS in sub-Saharan Africa and the toll the epidemic is exacting on societies in the region have attracted considerable research attention during the past two decades (Caldwell, 2000; Ezzell, 2000; McGeary, 2001; Bosompra, 2001; Latré-Gato Lawson, 1999; UNAIDS, 1999a; Caldwell, 1999; Bongaarts, 1996; Anarfi (1993), Anarfi (1995); Awusabo-Asare, 1995; Caldwell & Caldwell, 1993; Hunter, 1993; van de Walle, 1990). In part, the increased attention given to the region

Methods

The data employed in this analysis are taken from the 1998 Ghana Demographic Health Survey (GDHS98). GDHS98 is the third of a series of nationally representative probability sample surveys conducted in Ghana during the past three decades.17 These cross-sectional surveys were designed to provide policy makers with the most up-to-date information on demographic processes in that country (GSS and Macro International

Results

We begin our analysis by assessing whether religious affiliation affects AIDS risk status (Table 2). As reported in Table 2, the effect of religious affiliation on self-reported HIV/AIDS risk status is significant (p<0.001). For the most part, women from the Christian churches (56 percent of Protestants, 55 percent of Catholics, and a similar percentage of other Christians) were more likely to report a lower level of AIDS risk than those among the non-Christian groups (49 percent for Muslims

Discussion and conclusions

Surprisingly few studies examine the impact of religion on AIDS-preventive behavior in West Africa even though religious beliefs and norms may be salient to AIDS prevention. As Agadjanian (2001) has pointed out, church participation in Africa creates an environment for social exposure and interaction to new ideas, which could then influence AIDS prevention. Furthermore, Garner (2000) has suggested that religious groups have different levels of power that could influence the behavior of their

Acknowledgements

I am grateful to Drs. Mark Tausig, Gabriel Fosu, Kwasi Yirenkyi, Isaac Addai, and anonymous reviewers of this journal for their valuable comments on an earlier version of this paper.

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