Can Churches Play a Role in Combating the HIV/AIDS Epidemic? A Study of the Attitudes of Christian Religious Leaders in Madagascar

INTRODUCTION Churches occupy an important social and cultural position in Madagascar. The sexual transmission of HIV raises controversies about the role that Churches can play in preventing HIV/AIDS. This cross-sectional survey investigated recommendations by religious leaders for condom use and other preventive strategies in the context of international guidelines. METHODS A questionnaire was self-administered to a random sample of religious leaders. The questions related to preventive methods against HIV/AIDS such as: condom use, marital fidelity, sexual abstinence before marriage, and HIV-testing. Associations with recommendations for condom use were evaluated using univariate and multivariate logistic regression analyses. RESULTS Of 231 religious leaders, 215 (93.1%) were willing to share their knowledge of HIV/AIDS with their congregations. The majority received their information from the media (N=136, 58.9%), a minority from their church (N=9, 3.9%), and 38 (16.4%) had received prior training on HIV. Nearly all (N=212, 91.8%) knew that HIV could be sexually transmitted though only a few (N=39, 16.9%) were aware of mother-to-child transmission or unsafe injections (N=56, 24.2%). A total of 91 (39.4%) were willing to, or had recommended (N=64, 27.7%), condom use, while 50 (21.6%) had undergone HIV testing. Only nine (3.9%) had ever cared for a person living with HIV/AIDS (PLHIV). Multivariable logistic regression shows that condom use recommendations by religious leaders were negatively associated with tertiary level education (OR: 0.3, 95% CI 0.1-0.7), and positively associated with knowing a person at risk (OR: 16.2, 95% CI 3.2-80.2), knowing of an ART center (OR: 2.6, 95% CI 1.4-4.8), and receiving information about HIV at school (OR: 2.6, 95% CI 1.2-5.6). CONCLUSIONS Malagasy church leaders could potentially become key players in HIV/AIDS prevention if they improved their knowledge of the illness, their commitment to international recommendations, and extended their interaction with people most at risk.