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INTRODUCTION
Religious responses to HIV and AIDS: Understanding the role of religious cultures and institutions in confronting the epidemic
Miguel Muñoz-Laboya, Jonathan Garciab, Joyce Moon-Howarda, Patrick A. Wilsona and Richard Parkera
a Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; b Center for Interdisciplinary Research on AIDS, Yale School of Public Health, Yale University, New Haven, CT, USA
Since the very beginning of the HIV epidemic, few social institutions have been as important as religion in shaping the ways in which individuals, communities and societies have responded to HIV and AIDS. In societies around the world, what are sometimes described as religious belief systems or religious cultures have been fundamental to the interpretation of AIDS – to the ways in which a newly emerging infectious disease was incorporated into existing understandings of the world. Over the course of more than three decades now, religious meaning systems have mediated the attitudes and policies related to the epidemic and public health programmes, and religious organisations have been central to the response to HIV and AIDS in countries and cultures around the world (Lagarde et al. 2000, Agadjanian 2005, Global Health Council 2005, McGirk 2008, Garcia et al. 2009, Akintola 2010, Murray et al. 2011, Trinitapoli 2011). This impact has been profoundly complex and often contradictory.
At the same time, religious organisations play a key role globally in providing front-line access to primary and terminal care, advocating for health and social welfare resources and influencing public health and social policies (Sanders 1997, Chatter 2000, DeHaven et al. 2004, Pargament et al. 2004). This has been especially visible in relation to the global HIV epidemic, and has expanded significantly over the past decade as part of the global scale-up of HIV programmes (Shelp and Sunderland 1992, Global Health Council 2005). Agencies such as the World Health Organisation, Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Emergency Plan for AIDS Relief (PEPFAR) programme have all called for increased involvement of and partnerships with community-based organisations (CBOs) and faith-based organisations (FBOs) as part of the expanded global response to AIDS (Global Health Council 2005, United Nations Population Fund [UNFPA] 2008a, 2008b, UNAIDS 2009). With the assistance of international donor agencies, millions of dollars are now spent annually to support interventions by religious institutions and FBOs for HIV prevention and treatment in the developing world, and the WHO estimates that at least one in five organisations involved in HIV/AIDS programming is now faith-based (WHO 2004, Agadjanian 2005, Global Health Council 2005, Agadjanian and Sen 2007, Akintola 2010). However, concerns have been raised that this growing emphasis on the role of FBOs has been based more on ideological convictions than on empirical evidence about their effectiveness. A scientific understanding of the role of FBOs in responding to the HIV epidemic remains almost non-existent. The few assessments that exist all point to the urgent need for further empirical investigation of the activities of FBOs and more rigorous evaluation of the interventions they deliver in response to HIV and AIDS (Global Health Council 2005).
One of the key reasons for the lack of meaningful research on the many complex dimensions of the religious response to HIV and AIDS has been the fact that much of the research examining religion in relation to population health needs has tended to focus primarily on identifying the effects of what have been described as religious beliefs on individual health behaviour and outcomes (Woods and Ironson 1999, Duan et al. 2000), without looking critically at religion as a social force that shapes social, cultural, and institutional responses to health conditions and health disparities (Remle and Koenig 2001, Simoni and Ortiz 2003, Prado et al. 2004). In the study of religious responses to the epidemic, as in HIV and AIDS research more broadly, there is thus an urgent need to move towards a broader focus aimed at understanding not just individual health behaviours and outcomes, but the broader social and cultural settings within which behaviour takes place – and the broader social and political forces that shape it.
Religious responses to HIV and AIDS provide an ideal focus from which to examine institutional religious involvement in health precisely because of the controversies that the AIDS epidemic has brought to the forefront of social, scientific and policy debates (Muñoz-Laboy et al. 2011). In distinct contexts throughout sub-Saharan Africa, Asia, Latin America and North America researchers have increasingly shown how social inequality, combined with rising HIV incidence rates and the presence of international organisations, has affected the way in which religious cultures and institutions have responded to the epidemic, often creating tension between traditional beliefs and ‘new’ religious cultures that have entered countries along with NGOs and donor agencies (Pfeiffer 2002, 2004, 2005, Agadjanian 2005, Swidler 2009, Paiva et al. 2010, Garcia and Parker 2011, Murray et al. 2011).
The articles that have been included in this Special Supplement of Global Public Health provide important examples of some of the kinds of research that we think is so urgently needed in order to more fully understand the complexity of religious traditions and FBOs as they have responded to the HIV/AIDS epidemic both globally and locally. While the work that is presented in these articles is highly diverse, it is nonetheless characterised by a focus on religious cultures and institutions. The articles that are included here draw heavily on a long history of research in fields such as the sociology and anthropology of religion, and in the multidisciplinary field of the comparative study of religions (Bellah 1970, Calhoun 1991, Dillon 2003). They approach the study of religion as a social and cultural system (Bellah 1970, Geertz 1973, Lessa 1979, Lambek 2002). This approach focuses on the ways in which these systems are articulated through the organisational structures of different religious denominations (and different currents of thought within specific denominations), in seeking not only to shape the behaviour of religious believers, but also to influence and impact the secular world more broadly (Bellah 1970). It thus helps us to understand the ways in which religious organisations can become among the most important institutional actors in civil society in relation to a wide range of social and political issues (Bellah 1970, Geertz 1973, Calhoun 1991). While this approach has seldom been utilised in the study of public health issues, it nonetheless suggests a number of ways in which religious organisations can have a major impact in shaping vulnerability and prevention as well as treatment and care – an impact that has still been only minimally investigated in the research literature on HIV and AIDS.
The articles focus on systems of cultural meaning and social and structural factors that both shape the epidemic and condition the responses that different communities and societies are able to offer in relation to it, and the understanding of religion as a social and cultural system. This is articulated through organisational structures that constitute among the most important institutional actors in civil society. These articles also highlight the extent to which religious organisations must be understood as key institutional actors within social movements that have emerged as part of the broader social response to the epidemic. One of the major outcomes of the comparative study of religious systems as they impact social action has been a growing sense that religions must themselves be understood as social movements (often highly conservative, but sometimes very progressive as well) precisely because they often explicitly seek to take steps aimed at transforming the world around them, frequently in the name of poor, marginalised and excluded population groups (Yarnold 1991, Scheie and Markham 1994, Wittberg 1994, Lucas and Robbins 2004).
The articles in this Special Supplement document the complex ways in which diverse religious traditions in different societies have contributed to the broader social response to HIV and AIDS, as well as they ways in which they have shaped the more localised responses of their followers. Religious meaning systems, practices and institutions have been central to the articulation of projects for social change of diverse types in response to HIV and AIDS. Sometimes, religious cultures have reproduced values and practices that have seriously impeded more effective approaches to mitigate the epidemic. At other times, religious movements have provided among the most powerful forces for the mobilisation of individuals and communities in response to the social vulnerability, economic exclusion and public health risk associated with HIV. By highlighting these complex and sometimes contradictory social processes, the analyses developed in this Special Supplement provide new insights not only into the relationship between religion and the HIV epidemic, but between religion and global public health more broadly, thus helping to open up a crucial new area of global public health research.
Acknowledgements
The articles that have been included in this Special Supplement were all originally prepared for the conference ‘Religious Responses to HIV and AIDS’ that was organised with support from a grant (#1 R13 HD066966-01) from the US Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Additional support for the conference, and for the publication of this Special Supplement, has been provided by the Center for the Study of Culture, Politics and Health, Department of Sociomedical Sciences, Mailman School of Public Health at Columbia University. The views expressed here are solely those of the authors and do not reflect the opinions of any of the institutions that have provided support for this publication.
References
Agadjanian, V., 2005. Gender, religious involvement, and HIV/AIDS prevention in Mozambique. Social Science and Medicine, 61 (7), 1529–1539.
Agadjanian, V. and Sen, S., 2007. Promises and challenges of faith-based AIDS care and support in Mozambique. American Journal of Public Health, 97 (2), 362–366.
Akintola, O., 2010. Perceptions of rewards among volunteer caregivers of people living with AIDS working in faith-based organizations in South Africa: a qualitative study. Journal of the International AIDS Society, 13 (22), 1–10.
Bellah, R.N., 1970. Beyond belief: essays on religion in a post-traditional world. New York: Harper & Row.
Calhoun, C.J., 1991. Comparative social research: religious institutions. Greenwich, CT: JAI Press.
Chatter, L., 2000. Religion and health: public health research and practice. Annual Review of Public Health, 21, 335–367.
DeHaven, M.J., Hunter, I.B., Wilder, L., Walton, J.W., and Berry, J., 2004. Health programs in faith-based organizations: are they effective? American Journal of Public Health, 94 (6), 1030–1036.
Dillon, M., 2003. Handbook of the sociology of religion. Cambridge: Cambridge University Press.
Duan, N., Fox, S.A., Derose, K.P., and Carson, S., 2000. Maintaining mammography adherence through telephone counseling in a church based trial. American Journal of Public Health, 90 (9), 1468–1471.
Garcia, J., Muñoz-Laboy, M., de Almeida, V., and Parker, R., 2009. Local impacts of religious discourses on rights to express same-sex desires in peri-urban Rio de Janeiro. Sexuality Research and Social Policy, 6 (3), 44–60.
Garcia, J. and Parker, R., 2011. Resource mobilization for health advocacy: Afro-Brazilian religious organizations and HIV prevention and control. Social Science and Medicine, 72 (12), 1930–1938.
Geertz, C., 1973. Religion as a cultural system. In: The interpretation of cultures. New York: Basic Books, 87–125.
Global Health Council, 2005. Faith in action: examining the role of faith-based organizations in addressing HIV/AIDS [online]. Available from: http://www.globalhealth.org/view_top.php3?id=448 [Accessed 12 June 2010].
Lagarde, E., Enel, C., Seck, K., Gueye-Ndiaye, A., Piau, J., Pison, G., Delaunay, V., Ndoye, I., and Mboup, S., 2000. Religion and protective behaviours towards AIDS in rural Senegal. AIDS, 14 (13), 2027–2033.
Lambek, M., 2002. A reader in the anthropology of religion. Malden, MA: Blackwell.
Lessa, W.A., 1979. Reader in comparative religion: an anthropological approach. 4th ed. New York: Harper & Row.
Lucas, P.C. and Robbins, T., 2004. New religious movements in the 21st century: legal, political and social challenges in global perspective. New York: Routledge.
McGirk, J., 2008. Religious leaders key in the Middle East’s HIV/AIDS fight. Lancet, 372 (9635), 279–280.
Muñoz-Laboy, M., Murray, L.R., Wittlin, N., Garcia, J., Terto, V., and Parker, R., 2011. Beyond faith-based organizations: using comparative institutional ethnography to understand religious responses to HIV and AIDS in Brazil. American Journal of Public Health, 1 (6), 972–978.
Murray, L., Garcia, J., Muñoz-Laboy, M., and Parker, R., 2011. Strange bedfellows: the Catholic Church and Brazilian National AIDS Program in the response to AIDS in Brazil. Social Science and Medicine, 72 (6), 945–952.
Paiva, V., Garcia, J., Rios, L.F., Santos, A., Terto, V., and Muñoz-Laboy, M., 2010. Religious communities and HIV prevention: an intervention study using a human rights-based approach. Global Public Health, 5 (3), 284–290.
Pargament, K.I., McCarthy, S., Shah, P., Ano, G...
