Faith-based groups can aid response to HIV in Central America, study finds

While the role of religious groups often is seen as limited because many do not support certain prevention measures such as condoms, researchers say building on the traditional role of faith-based groups provides an important opportunity to improve a range of services and support.

"Faith-based organizations are important to HIV efforts in Latin America because they have a broad reach and influence, and have played critical roles providing support and care to those affected by the disease," said Kathryn Pitkin Derose, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization. "Not every community in Central America has health providers, but most have some type of faith-based organization."

Researchers say that faith-based organizations, which historically have played a key role in delivering health and social services in developing countries, could play an expanded role in helping raise awareness of HIV and reduce the stigma that surrounds HIV and AIDS.

In addition, faith-based organizations could advocate for greater access to health care and provide resources such as nutritious food and income-generating assistance to those with HIV, according to the study.

Although faith-based organizations' role in prevention remains controversial, RAND researchers concluded that most faith-based organizations could promote HIV testing in ways consistent with their overall mission.

"If faith-based groups partner with health providers to provide testing, it would send a constructive message that HIV is a disease that is treatable and people should know their HIV status," Derose said.

HIV/AIDS in Latin America has been called the "overlooked epidemic" because it has been overshadowed by epidemics of larger scale and severity in sub-Saharan Africa and Asia. Although AIDS accounts for a small fraction of deaths in most Latin American countries, the economic effects can be magnified because AIDS often strikes adults during their most-productive years.

Advocates have called for improved efforts to combat HIV in Latin America to prevent the type of devastating outbreaks that have occurred in sub-Saharan Africa. However, most Latin American governments have not responded as vigorously as advocates believe is necessary.

RAND researchers examined the current and potential future role of faith-based organizations in HIV prevention and care in three Central American countries that, at the time the study began, had the region's highest prevalence of HIV -- Belize (2.5 percent), Honduras (1.5 percent) and Guatemala (0.9 percent). They visited the countries and interviewed officials from governmental health agencies, faith-based groups, other non-governmental organizations serving people with HIV, and bilateral assistance agencies. They also visited clinics, hospices and other HIV-related programs sponsored by faith-based organizations.

In the three countries studied, HIV affects mostly young adults, men who have sex with men and sex workers. In all three countries, but especially Guatemala, care for HIV and AIDS is not widely available, and hospitals and health care personnel with experience in the illness are located mainly in major cities.

Researchers found that governments tend to emphasize treatment more than prevention, although the need to sustain antiretroviral medication long term for those with HIV infection has not been addressed.

While researchers are optimistic about the potential for help from faith-based organizations, they recognize that substantial obstacles exist. Judgmental attitudes and limited engagement with gays, men who have sex with men and commercial sex workers may limit the effectiveness of faith-based organizations' HIV efforts. There also is no single structure that brings together all faith-based groups and this often makes coordination between faith and health sectors difficult, according to researchers.

"There is a need for greater recognition among leaders of health and faith-based organizations of the unique and complementary strength that each sector can provide to the response to HIV and AIDS," Derose said. "Public health leaders need to think creatively about ways to make effective use of the strengths and capabilities of faith-based organizations in addressing the challenges posted by the HIV epidemic."

Funding for this study was provided by the RAND Investment in People and Ideas program, which combines philanthropic contributions from individuals, foundations, and private-sector firms with earnings from the RAND endowment to support research on issues that reach beyond the scope of traditional client sponsorship. Other support came from RAND Health and the National Institute of Child Health and Human Development.

The study, "The Role of Faith-Based Organizations in HIV Prevention and Care in Central America," can be found at www.rand.org. Other authors of the study are David E. Kanouse, David Kennedy, Alice Taylor, Kristin J. Leuschner and Homero Martinez of RAND, and Kavita Patel of the New America Foundation.