HIV/AIDS and the Church: Kenyan Religious Leaders Become Partners in Prevention

In Kenya, winning over a skeptical clergy to the cause of HIV/AIDS prevention has created a powerful grassroots campaign based in the churches and the communities they serve.

Like many pastors in rural western Kenya, Reverend Jacob Onyalo had long been reluctant to discuss HIV/AIDS in his church sermons.

"My community believed that AIDS affects only the 'immoral,' " he said.

But one Sunday, Rev. Onyalo stood at the pulpit, faced his congregation, and finally ended the silence on the disease that has plagued their nation for so long. He spoke of the need to show compassion for people with HIV/AIDS and to help care for them when they become sick, and encouraged his parishioners to protect themselves from HIV by avoiding extramarital and premarital sex. Since that breakthrough sermon, his congregation has heard him speak again and again about AIDS.

"Now I address AIDS in every message I give," he said.

The inspiration for these sermons comes from an "awareness packet" Rev. Onyalo received from MAP International, a nonprofit Christian relief and development organization. It included sermon outlines with the themes and information he needed to break the ice on HIV/AIDS with his congregants. This kind of outreach is a fundamental part of the unique program that MAP -- with funding from the AIDS Control and Prevention (AIDSCAP) Project -- has created to tackle one of the greatest challenges to prevention education in Kenya: a powerful religious leadership that has been divided about the epidemic and how to deal with it.

"Throughout the early 1990s, most religious groups in Kenya either ignored AIDS or explained it as the result of aberrant or immoral behavior," said Bill Rau, AIDSCAP's associate director for policy.

At one extreme, in fact, were religious leaders who led anti-condom crusades and rallies where HIV/AIDS brochures were burned, in the belief that teaching people about prevention measures encourages promiscuity. But MAP staff were also aware that a much larger but far less vocal group of clergy hoped to find a way to express their sympathy for the human tragedy of AIDS and help prevent the epidemic's spread. The time had come to tap that support -- and the MAP Kenya HIV/AIDS Project was born.

"The Kenyan people are very religious, and moral arguments from their church leaders and religious organizations are extremely influential," said Rau. "There are few other institutions in Kenyan society with such ability to change hearts and minds about this epidemic."

Persuasive Data

Helping Kenyan religious groups confront the HIV/AIDS epidemic grew naturally out of MAP's decade of experience in Kenya working on health care and community-based development with churches, government agencies and other institutions. The organization's nondenominational status and the relationships it had built with religious leaders gave MAP the credibility to encourage church involvement in HIV/AIDS prevention and care.

Those links with the religious community had the potential to help MAP reach millions of Kenyans. In sheer numbers alone, churches are perhaps the most important grassroots organizations in Kenya. Some 70 to 80 percent of Kenyans belong to a Christian denomination.

"Churches in Kenya are right where the people are in the community," said Debbie Dortzbach, the first director of the MAP Kenya HIV/AIDS project. "There's a good structure for a multiplier effect when church leaders talk to their congregations."

What helped MAP motivate many of these churches to first get involved were eye-opening data collected from research surveys and focus group discussions conducted at the beginning of the project. Hoping to identify issues important to local churches and national religious organizations, the researchers reported findings that astonished many church leaders. They found that 32 percent of the pastors surveyed reported they knew other pastors who had been unfaithful to their spouses, and also that 49 percent of young churchgoers had had premarital sex.

"One pastor came to me in shock," recalled Paul Robinson, the MAP project's second director. "He said that if this high a percentage of youth in our churches is sexually active, then we definitely have to do something about it."

Widespread misconceptions about HIV/AIDS that the surveys revealed also surprised many clergy, who had not realized how ignorant -- and thus how vulnerable -- many Kenyans were about the epidemic.

"In some areas of the country, AIDS cases were being treated as malaria or as a curse or a bewitching," said Robinson. "Only a third of the respondents understood it to be an epidemic."

Pastoral Counseling

In the MAP studies, ministers and priests cited counseling as one of their biggest concerns. Few of them had appropriate training in counseling HIV-positive persons and their families.

To fill that need, MAP created an intensive pastoral counseling course. It consisted of one week of introductory instruction, several months for the trainees to apply at home what they had learned, and then a second week-long session to review their experiences, further strengthen their counseling skills, and discuss sensitive issues such as cultural practices and prevention measures. Both workshops included case study discussions and counseling role plays.

The two-part counseling instruction was held six times, and 160 ministers, priests and other church leaders participated. Far exceeding MAP officials' expectations, trainees conducted more than 575 counseling sessions, educational meetings or other activities in the months between the first and second workshop sessions, reaching more than 56,000 persons in churches, schools, health centers, government agencies and elsewhere.

A 50-page counseling manual MAP had developed earlier helps trainees and other clergy members counsel HIV-positive individuals and their families. It covers basic counseling skills such as how to listen and ask questions, how to help an individual develop a personal prevention action plan, and how to give advice and encouragement, as well as specific questions and concerns about HIV/AIDS. It also suggests ways to help people and families living with HIV/AIDS find significance in life and deal with feelings of loss and grief. Like other MAP materials, the manual cites Bible passages that reinforce the counseling messages.

To provide additional background for pastoral counseling work, MAP created two other manuals. "Facts and Feelings about AIDS" covers basic medical information about HIV and AIDS and helps users deal with their concerns about the epidemic. "AIDS in Your Community" guides readers in researching the extent of the problem in their regions and the available resources to help them tailor a response to local conditions and plan an effective HIV/AIDS education program.

MAP printed 2,000 English-language copies and 1,000 Kiswahili translations of each of the three manuals and distributed them mainly in the four regions of the country where the project has focused its efforts. The majority of Kenyans live in those areas, which are also the ones most heavily affected by the HIV/AIDS epidemic.

Another resource for clergy members, MAP's awareness packet, draws on the Scriptures to help clergy members broach sensitive issues of sexuality, morality and HIV/AIDS. It includes the sermon outlines that Rev. Onyalo found so helpful, such as "Are You a Good Shepherd?" which deals with compassion and care, and "The Sure Solution," which promotes abstinence and fidelity. The awareness packet also contains posters, brochures and a Bible study text, "The AIDS Challenge."

In order to encourage Kenya's various religious groups to institutionalize the use of these materials, MAP has included them in a package of curriculum modules. Several of the country's major denominations are now considering officially adopting them for use in their theological or pastoral training institutions.

Growing Together

Another concern MAP identified through its research was the lack of communication between parents and children about HIV/AIDS and other sex education issues. The problem was in part cultural: traditionally, young Kenyans learned about sex from their aunts, uncles or grandparents, but with growing urbanization and the decline of the extended family, that important source of information no longer exists for many youth.

"Young people said they were learning about sex and AIDS from their peers and the mass media, but they wanted to get more information from their parents," reported Ndunge Kiiti, who served as director of communications in MAP's eastern and southern Africa regional office in Nairobi, Kenya.

To help parents bridge this difficult communications gap, MAP developed a guide entitled "Growing Together."

"It's something a family can walk through together and use in their own way," Kiiti said.

Within three months of its initial printing, 5,000 copies of the guide had been distributed through churches and a series of day-long workshops for religious leaders, churchgoers and the general public. The demand for the guide was so high that MAP had 6,000 additional copies printed.

Clergy members use the guides to help advise parents and to improve their own communication with young churchgoers. MAP's startling research findings on youth sexuality have inspired a growing number of churches to establish special programs for young people. The Methodist Church, for example, assigned a pastor as the full-time director of a new HIV/AIDS prevention program for youth in the Nairobi region.

Broad Consensus

Another fundamental component of the MAP program was its work with leaders of Kenya's various denominations on policy issues. MAP conducted periodic policy workshops and conferences for church officials, helping to establish the Kenya Christian AIDS Network (KCAN), an organization for religious groups to share information and resources and to encourage church-policy reform. Since its establishment in 1994, KCAN has grown to include 30 local and regional branches.

In November 1994, religious leaders met and adopted a short general position statement on HIV/AIDS, committing churches to a "ministry of Christian hope, reconciliation and healing in our congregations and communities through prevention, education and care for persons and families." Although it was only two sentences long, the declaration was the Kenyan religious leadership's first unified public statement on HIV/AIDS, and it has served as a cornerstone for later efforts.

The pronouncement has helped keep the various denominations unified in the face of dissension, reported Dortzbach.

"When we had disagreements, we'd go back to that statement as a call to unite around," she said. "That was common ground that everyone could relate to."

Respect for alternative views is a guiding principle for MAP. In the pastoral counseling training, for example, the potentially divisive issue of condoms was incorporated into a session on helping "discordant" couples with one HIV-positive spouse and one HIV-negative spouse. Trainees voluntarily divided themselves into two groups, one to discuss condoms and the other to consider abstinence and nonpenetrative sex. After their separate deliberations, the groups shared their conclusions with one another.

"It worked out well," said Kiiti. "It was nonthreatening, and the two groups learned from each other."

Religious leaders met again in February 1996 and expanded on the position statement with a list of 14 HIV/AIDS priority issues on which churches should develop policies. They included providing education on family life and sexuality, developing support groups, implementing premarital counseling and HIV testing, caring for orphans and people living with AIDS, and supporting the rights and needs of women.

The leaders also said churches should develop policies on "appropriate and acceptable methods of protection" without naming any specific practices, such as condom use. And in an unprecedented acknowledgement that clergy members do not always practice what they preach, they called for a revitalization of moral values in church leadership.

"At this point, the tide really turned," said AIDSCAP's Bill Rau. "There were still a few priests publicly bashing prevention efforts, but finally there was true acceptance by the religious community that AIDS is a major problem and that they have a responsibility to do something about it."

Changing Attitudes and Behavior

MAP's comprehensive approach has had a significant impact on Kenyan church involvement in HIV/AIDS prevention and support, according to surveys conducted in the fall of 1996 with religious leaders and with youth who regularly attend church. Results from regions where MAP had and had not worked showed that churches in the MAP areas were more likely to provide home care for people living with HIV/AIDS, develop peer counseling programs, and hold retreats and other marriage enrichment activities.

Only 42 percent of church officials in MAP areas said they would be likely to counsel the use of condoms when one marriage partner was unfaithful -- but that was higher than the corresponding 30 percent in other areas of the country.

Sexual activity had actually increased during the two years among all churchgoing youth surveyed. Sixty percent said they had had sexual relations at some point, versus 49 percent in the baseline study two years earlier. Nevertheless, in the MAP areas only about 10 percent of the church youth had had more than one sexual partner in the preceding six months; in non-MAP areas, the figure was 30 percent.

Differences like that make MAP officials optimistic that the evolution experienced by church leaders will produce further changes in the behavior of congregation members.

"The project created an awareness in the church, and helped put new policies into place," Kiiti said. "In the future I think we'll see even more behavior change."

-- Bill Black