Disclosure or disclosure of HIV status: the plight of religious believers in Ghana and metropolitan Seaman
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https://www.eduzhai.net Public Health Research 2013, 3(5): 116-123 DOI: 10.5923/j.phr.20130305.02 To Disclose or Not to Disclose HIV Status: The Dilemma of Religious Adherents of Tema Metropolis and Ashaiman Municipality in Ghana Benson Nkansa-Kyeremateng Presbyterian University College Ghana, Akuapem Campus, Eastern Region, Ghana Abstract HIV status disclosure rate has often been used as a proxy to measure the levels of perceived or real stigmatization of persons living with HIV/AIDS in a co mmunity. The study examined the willingness of relig ious adherents of the two study areas in Ghana to disclose their HIV/AIDS status in religious settings. Using hypothetical questions adherents of Orthodox, Pentecostal/Charis matic, African Independent Churches, Islam and African Tradit ional Religion were quizzed during periods of forenoon services to elicit the relevant information fo r the study. Overall, the outcome of the study indicated that more than half of the respondents in both areas were willingness to disclose HIV status especially to their religious leaders than to their respective whole congregations. Adherents of Pentecostal/Charis matic and African Independent Churches were more willing to disclose their HIV status. Female adherents as well as those with higher levels of education were also more willing to disclose their HIV status. The need for care and support, for prayers and counseling were the main motivation for disclosure while the fear of being gossiped about, isolated and blamed constituted disincentive for disclosure. To promote the level of HIV status disclosure within the relig ious setting there is the need for relig ious leaders to provide care and support for persons living with HIV/A IDS. Keywords HIV/A IDS, HIV Status Disclosure, Relig ious Adherents, PLW HA 1. Introduction Persons living with HIV/AIDS (PLWHA) when they have co me to kno w o f their HIV sero -posit ivity are normally faced with the problem of disclosure, that is, who m to share the information with, how to go about it and when to do it. Persons liv ing with HIV therefore find th emselves in a dilemma when con fronted with the pheno menon of HIV status disclosure in the light of the benefits and proble ms that co me with it . Acco rd ing to d isclosure of one’s HIV sero -pos it iv it y stat us may p ro v id e the oppo rtun ity o f receiving social support in order to cope with the disease. Disclosure also has the potential of reducing HIV infect ions, particularly, of the sexual partner, by raising awareness and decreasing risky behav iours. It may also lead to provision of appropriate med ical care for the PLW HA. On the other hand, not disclosing one’s HIV sero-positivity can be a way of protecting oneself against stigmat ization and discriminat ion , as the d isclosure has th e potent ial of leading to physical violence, fear, worry, shame, re jection or abandon ment . Non d isclosure o f on e’s HIV pos it ive * Corresponding author: email@example.com (Benson Nkansa-Kyeremateng) Published online at https://www.eduzhai.net Copyright © 2013 Scientific & Academic Publishing. All Rights Reserved status also has the potential of interfering with accessing and adhering to appropriate and critical medica l treat ment.  and have noted that most studies of HIV self disclosure in Sub Saharan A frica have focused primarily on disclosure to sexual partners and spouses especially among wo men. Few studies examined disclosure to others in the social network including the relig ious communit ies and such studies including,, and are main ly fro m the Eastern and Southern Africa., however, have stressed that religion is among the many factors which influences HIV positive status disclosure beyond the caregiver-patient dyad, though findings have been somewhat in co n s isten t. The virtual lack of research in the area of HIV status disclosure in the relig ious setting in West Africa and for that matter Ghana necessitated this study. The main concern of the study was therefore to assess HIV-self d isclosure in religious settings using hypothetical questions for religious adherents of Orthodox, Pentecostal/Charis matic, African Traditional Religion, African Independent Churches and Islam in two areas, namely, Ashaiman Municipality, an urban slums, and Tema Metropolis, an industrial hub of Ghana. Spec ifically, the study sought to probe into the nature of relig ious adherents’ HIV status disclosure to the religious community if they were to become infected; identify the reasons for disclosure or otherwise of HIV status in the Public Health Research 2013, 3(5): 116-123 117 diverse religious settings. 2. Methodology The study was situated in the t wo co mmun ities of Ashaiman Municipality, an urban sprawl, and Tema Metropolis, an industrial hub and the main harbour city of Ghana. The t wo study areas lie along the eastern coast of Ghana, about 30 kilo metres away fro m Accra, the capital city of Ghana, with Ashaiman Municipality ly ing a litt le inland. While Tema Metropolis is planned with all the modern facilities that one can thin k of, Ashaiman Municipality is an unplanned co mmunity developed into urban sprawl with all its associated problems. The two communit ies have numerous relig ious groups which co-exist peacefully, with the Pentecostals constituting the largest group followed by the Protestants. The data for this research were secured from a survey carried out by the researcher in the two study areas in 2010.The main research instrument used was self-ad ministered questionnaire. The structured questionnaire apart fro m capturing the demographic characteristics of the respondents also had questions which measured the following: i. HIV status Disclosure to the relig ious Co mmunity: This was captured using an index made up of two questions: a. If you were HIV positive, would you tell your pastor? Yes /No b. If you were HIV positive, would you want your congregation to know? Yes/No An affirmat ive answer (that is, Yes) to any of the questions meant that the respondent was in total agreement with the index being measured. The disclosure of HIV/AIDS status to the religious commun ity in the two study areas was examined in the light of an index which was constructed as well as the individual questions that make up the index with respect to religious affiliation, gender and leve l of education of relig ious adherents. ii. Reasons for Disclosure and non Disclosure of HIV status: These were solicited fro m respondents using this q u es tio n : If you were HIV positive, would you tell your relig ious leader? If Yes, give reasons, If No, give reasons. The study population for the research was made up of Relig ious adherents of the following religious traditions found in the study areas: Orthodox Churches (Presbyterian, Methodist, Catholic and Anglican Churches), Pentecostal/ Charismat ic Churches (Pentecost, Assemblies of God, Apostolic Churches), African Independent Churches (Kristo Asafo, African Faith Tabernacle and Church of the Lord), Islam (Ah madiyya and the Sunni) and African Tradit ional religion (Worshippers who worship the Supreme Being through the lesser gods). A mu lti-staged sampling method comprising purposive and convenience sampling methods as well as stratification procedures was employed to sample 100 religious adherents fro m Ashaiman Municipality and 150 relig ious adherents fro m Tema Metropolis. The sample sizes chosen for the respective areas as well as the various relig ious adherents were in proportion to their populations according to the 2000 population census of Ghana. The data for the research were analyzed using the SPSS package. The data thereof were presented in the form of tables and bar charts. 3. Results and Discussions 3.1. Sample Description The number of re ligious adherents selected in the study for the Tema Metropolis was 150 wh ile that of Ashaiman Municipality was 100. In terms of gender, 52 percent of religious adherents from Tema Metropolis were males wh ile in Ashaiman Municipality they constituted 46 percent. The age distribution shows that 70 percent of the respondents fro m the Tema Metropolis were within the age group of 18 to 35 years, 22 percent were within the age group of 36 to 49 while those who were aged 50 years and above made up 8 percent. In the case of Ashaiman Municipality the 18 to 35 years were made up of 71 percent of the respondents, the 36 to 49 age group constituted 19 percent while those were aged 50 and above made up 10 percent of the respondents. What was clear in both study areas were that the respondents were chosen to reflect the youthful nature of the population which is characteristic of urban populations. The small percentage of respondents reflect ing 50 years and above also reflected what pertains at the national level. The educational background of respondents showed that in Tema Metropolis 9 percent did not have any formal education, 13 percent had primary education while 39 percent each constituted those who had secondary and tertiary education. In the case of Ashaiman Municipality those who did not have formal education formed 12 percent, 18 percent were those who had prima ry education, 46 percent were those who had secondary education while those with tertiary education constituted 24 percent. The emp loyment status of respondents showed that in Tema Metropolis 28 percent had formal emp loyment, 29 percent were self-employed, 7 percent were unemp loyed, 34 percent were students and 2 percent were ret ired. In the case of Ashaiman Municipality 19 percent of respondents were formally emp loyed, 40 percent were self-employed, 8 percent were unemployed, 31 percent were students and those on retirement constituted 2 percent. With respect to marital status, the study showed that 57 percent of respondents from Tema Metropolis were not married, 3 percent of the respondents were cohabitating, while 37 percent were in marriage relationships with only 3 percent in other relationships (divorced or widowed). In the case of Ashaiman Municipality, 47 percent of the respondents were not married, 14 percent were cohabitating, and 37 percent were married while 2 percent were in other relationships, either divorced or widowed. Apart fro m the religious affiliations of respondents which have been dealt 118 Benson Nkansa-Kyeremateng et al.: To Disclose or Not to Disclose HIV Status: The Dilemma of Religious Adherents of Tema M etropolis and Ashaiman M unicipality in Ghana with in the methodology, 89 percent of respondents attended religious activity at least once a week in his or her religious organization in Tema Metropolis. In the case of Ashaiman Municipality 96 percent of respondents attended a religious activity at least once a week. 3.2. Willingness to Disclose HIV Status and Religious Affiliation Disclosure rates are often seen as a proxy for the amount of real o r perceived stigma in a society. Disclose rates have also been noted to be generally low in Sub-Saharan Africa, partly due to high levels of stigmatizat ion. Disclosure within the Church, and for that matter in the religious commun ity, is seen as a way of reducing stigma. This assertion was affirmed by when it stated that if one can ‘break the silence’ by d isclosing, and be accepted by one’s fello w congregants, this may d isrupt the perception that ‘other’ people get HIV, and that it is morally reprehensible. Several factors including education, religion, gender and relations hip to the one to whom the dis clos ure is made have also been shown to influence disclosure of positive sero-status beyond caregiver-patient dyad. Table 1 shows the performance of the index used in the two study areas. Fro m the table, religious adherents in Tema Metropolis were more likely to disclose their HIV status to the religious community than those in Ashaiman Municipality. This is because 67.7 percent of religious adherents in Tema Metropolis were willing to disclose to the religious community as against 53 percent of religious adherents in Ashaiman Municipality. Table 1. Willingness to Disclose HIV Status to Religious Community by Religious Affiliat ion Religious Affiliation Orthodox Churches Tema Met rop o lis 55.3 % (32)* Ashaiman Municipality 52.6%(20) P ent eco st al/Ch arismat ic Churches AIC Islam AT R Tot al 83.3%(45) 72.2%(13) 58.3%(7) 0.0%(0) 67.7% (97) 45.9%(17) 80.0%(8) 55.6%(5) 50.0%(3) 53 % (53) *Numbers in parentheses are the absolute numbers of respondents What is striking was the fact that no respondent of African Traditional Relig ion fro m Tema Metropolis was willing to disclose his or her HIV status to his/her religious commun ity. In Ashaiman Municipality, however, relig ious adherents less willing to disclose their HIV status to relig ious community were the Pentecostal/Charis matic Churches (45.9%). Their unwillingness to disclose might have been borne out of the conviction that they would not receive the sympathy and care of their religious commun ities. Table 1 further revealed that religious adherents most willing to disclose their HIV status to relig ious communities were Pentecostals in Tema Metropolis (83%) (X2=25.8; P<0.005) and African Independent Churches in the Ashaiman Municipality (80%) (X2=3.713; P>0.005). In a similar study in Tanzania, adherents of Pentecostal Churches were also found to be more willing to disclose to the religious community than the Lutherans. The reason given for this was that Pentecostals have a more emotive worship type, with the expectation of disclosure of sins and pietistic understanding of sin and forgiveness. Th is reason could be applicable to Pentecostal/ Charismat ic adherents in this study. Encouraging HIV status disclosure in the religious setting would no doubt help in the fight against the pandemic as it facilitates the initiation of and adherence to ARV treatment. A closer look at Figure 1 also showed that relig ious adherents were more willing to disclose their HIV status to their relig ious leaders rather than to their congregations in both study areas. For instance, in Tema Metropolis 66 percent of religious adherents were mo re likely to disclose to their relig ious leaders as against 33.3 percent of adherents ready to disclose to their congregations. In Tema Metropolis also Pentecostals (83.3%) (X2=24.878; P<005) were mo re willing to disclose their HIV status to their religious leaders than in the case of the other adherents. In the case of Ashaiman Munic ipality, adherents of AIC (80%) (X2=3.906; P>0.005) were mo re willing to disclose than the other adherents. In almost all the denominations adherents were more willing to disclose to relig ious leaders than to their congregations. For instance in Tema Metropolis, 58.2 percent of adherents of Orthodox Churches were willing to disclose to religious leaders as against 30.9 percent to the co n g reg atio ns . The low levels of disclosure of HIV status to congregations compared to the religious leaders might be due to fear of stigmatization, abandonment and blame on the part of congregational members. These findings buttress the importance of enhancing and fostering spiritual relat ionships with God on the part of PLWHA as a way of providing support to them. They also generally support the work done among Anglican Churches in Southern African where it was established that disclosure within the Church co mmunity was less common than disclosure to family and friends. In that study only 20 percent of PLW HA involved had disclosed to the relig ious commun ity. Even in Tanzan ia in the work done by, less than 2 percent was willing to disclose to the relig ious community. 3.3. Res pondents Gender and Educational Background and Willingness to Disclose The HIV status disclosure was also examined using the index and individual questions composing it in the light of the gender and educational background of religious ad h eren ts . Public Health Research 2013, 3(5): 116-123 119 Percentage of Respondents willing to disclose HIV status 100 80 60 40 20 0 Orthodox Pentecostal AIC Islam ATR Total Leader Congregation Tema Metropolis 58.2 30.9 83.3 37 72.2 50 58.3 25 0 0 66 33.3 Leader Congregation Ashaiman Municipality 52.6 35.1 45.9 45.9 80 30 44.4 33.3 50 0 52 36.4 NOTE: Figures presented in percentages Fi gure 1. Disclosure of HIV St at us to Religious Leaders and Congregat ions Percentage of religious adgherents 70 60 50 40 30 20 10 0 Male Female Total Yes No Tema Metropolis 62.5 37.5 67.1 32.9 64.7 35.3 Yes No Ashaiman Municipality 47.8 52.2 57.4 42.6 53 47 Not e: Figures present ed in percent ages Figure 2. Hiv Status Disclosure to Religious Community by Gender Using Index 120 Benson Nkansa-Kyeremateng et al.: To Disclose or Not to Disclose HIV Status: The Dilemma of Religious Adherents of Tema M etropolis and Ashaiman M unicipality in Ghana In terms of gender, female adherents in both areas were more willing to disclose their HIV status to the religious community than their male counterpart (Figure 2). For example, in Ashaiman Municipality, 57 percent of female adherents were willing to disclose to the religious community as against 47.8 percent of their male counterpart (X2= 0.915; P > 0.005). This finding contradicts the one made by that wo men who are living with the virus are less likely to talk to their religious leaders about their problems. It also contradicts the findings of in Ku masi, Ghana, that males were mo re likely to be in favour of disclosure of HIV positive status than females. A further examination of Figure 2 shows that it was only in Ashaiman Municipality that more than 50 percent of male adherents were unwilling to disclose their status to the religious community. When examined fro m the perspectives of the individual questions as shown in the Table 2, both male and female adherents in the study areas felt mo re co mfortable in disclosing their HIV status to their religious leaders than to their whole congregations. This could be due to the following reasons: ● Firstly, that religious adherents did not trust their congregational members as far as keeping the information about their HIV status divulged to them as s ecretiv e/con fid en tial, ● Secondly, relig ious adherents might doubt whether they would receive the needed care and support fro m the congregation, and ● Lastly, relig ious adherents might also entertain the fear that the congregation would end up blaming them of their situation instead of helping them. Table 2 further shows that female adherents in the two study areas were more likely to disclose their HIV status to the relig ious leader and the whole congregation than their male counterparts. Examined fro mthe perspective of the level of education of adherents, there appeared to be no relationship between HIV status disclosure and the level of education in both study areas as shown in the Tab le 3. Ho wever, there was the general tendency for adherents with h igher level of education to disclose to the religious commun ity than those with lower level o f education in both Tema Metropolis (X2 =2.956; P>0.005) and Ashaiman Municipality (X2 = 0.891; P>0.005). This findings support an earlier wo rk in French Antilles and French Guiana where it was established that less educated people disclose less often to both steady partners and their social network. The possibility that adherents with higher level of education were mo re likely to disclose their status might be due to the fact that they knew and appreciated the importance of disclosing one’s HIV/AIDS s tatus . An examination of the indiv idual questions and the level of education in two areas ( in Table 4) show that wh ile in Tema Metropolis 33 percent o f adherents without education were willing to disclose their status to their relig ious leaders, 41.7 percent of their counterpart in Ashaiman were willing to do so. Furthermore, while in Tema Metropolis no adherents without education was willing to disclose to the whole congregation, in Ashaiman Municipality as many as 16 percent were willing to disclose to the whole congregation. At all levels of education, relig ious adherents in Tema Metropolis were more likely to disclose to their religious leaders than their counterpart in Ashaiman Metropolis except those without education. Table 2. Hiv Status Disclosure to Religious Community by Gender Using Individual Questions HIV ST ATUS DISCLOSURE TEMA MET ROPOLIS MALE FEMALE ASHAIMAN MUNICIPALITY MALE FEMALE IF YOU WERE PLWHA YES WOULDTELL YOUR RELIGIOUS LEADER? NO IF YOU WERE PLWHA YES WOULD YOUTELL YOUR CONGREGATION? NO 64.1(50) 35.9(28) 32.1(25) 67.9(53) 68.1(47) 31.9(22) 34.8(24) 65.2(45) 47.8(22) 52.2(24) 32.6(15) 67.4(31) 55.6(30) 44.4(24) 39.6(21) 60.4(32) Table 3. Hiv St at us Disclosure to Religious Communit y by Level of Educat ion Using Index LEVEL OF EDUCATION NO EDUCATION P RIMARY SECONDARY TERTIARY TOTAL TEMA YES 33.3% (2) 68.4%(13) 64.4% (38) 67.8%(40) 65.0% (93) HIV ST ATUS DISCLOSURE TO RELIGIOUS COMMUNITY MET ROPOLIS ASHAIMAN MUNCIPALIT Y NO YES NO 66.7% (4) 41.7% (5) 58.3% (7) 31.6% (6) 38.9% (7) 61.1% (11) 35.6% (21) 54.3% (25) 45.7% (21) 32.2%(19) 66.7%(53) 33.3%(8) 35.0% 53.0% 47.0% (50) (53) (47) Public Health Research 2013, 3(5): 116-123 121 Table 4. Hiv Status Disclosure of Respondents by Level of Education Using Individual Questions LEVEL OF EDUCATION NO EDUCATION P RIMARY SECONDARY TERTIARY TOTAL TEMA METRO POLIS IF YOU WERE PLWHA WILL YOU TELL YOUR RELIGIOUS LEADER? IF YOU WERE PLWHA WILL YOU TELL YOUR CONGREGATION? YES NO YES NO % % % % ASHAIMAN MUNICIPALITY IF YOU WERE PLWHA WILL YOU TELL YOUR RELIGIOUS LEADER? YES NO % % IF YOU WERE PLWHA WILL YOU TELL YOUR CONGREGATION? YES NO % % 33.3 66.7 0.0 100.0 41.7 58.3 16.7 83.3 (2) (4) (0) (6) (7) (7) (2) (10) 68.4 31.6 36.8 63.2 38.9 61.1 27.8 72.2 (13) (6) (7) (12) (7) (11) (5) (13) 66.7 (38) 33.3 (19) 29.8 70.2 (17) (40) 52.2 (24) 47.8 (22) 42.2 (19) 57.8(26) 69.0 (40) 31.0 (18) 39.7 60.3 (23) (35) 66.7 (52) 33.3 (8) 41.7 (10) 58.3(14) 66.4 33.6 33.7 66.4 52.0 48.0 36.4 63.6 (93) (47) (47) (93) (52) (48) (36) (63) 3.4. Reasons for HIV Status Disclosure and Non Disclosure In the ma in questionnaire questions were asked to solicit reasons for why respondents will or will not disclose their HIV status in a relig ious setting. The study realized three main reasons why religious adherents were ready to disclose their status. These were a) the need to be prayed for so that they could be healed b) to receive care and support and c) for counseling as shown in figure 3. Percentage of religious adherents 100 90 80 70 60 50 40 30 20 10 0 To be prayed for Tema Metropolis 68 Ashaiman Municipality 63 To receive care and support 85 91 To receive counseling 79 80 NOTE: Figures presented in percentages Figure 3. Reasons for Disclosure Of Hiv Status to the Religious Community in T ema Metropolis and Ashaiman Municipality 122 Benson Nkansa-Kyeremateng et al.: To Disclose or Not to Disclose HIV Status: The Dilemma of Religious Adherents of Tema M etropolis and Ashaiman M unicipality in Ghana Percentage of Religious adherents 100 80 60 40 20 0 Tema Metropolis Ashaiman Municipality Fear of being blame d 70 75 Fear of isolati on 83 87 Fear of being gossip ed about 91 94 NOTE: Figures presented in percentages Figure 4. Reasons for Non-Disclosure of Hiv Status to the Religious Community in Tema Metropolis and Ashaiman Municipality Fro m the bar chart about 68 percent of religious adherents fro m the Tema Metropolis were willing to disclose their HIV status to be prayed for mainly by the religious leader in order to be healed as against 63 percent of respondents from Ashaiman Municipality. The idea of PLWHA d isclosing their status to their pastors with the hope that they are prayed for is supported by the work of in Kinshasa, Democrat ic Republic of Congo, where wo men were ready to disclose their status to their pastors they believed have got the power to influence the course of their illness. With respect to care and support, 85 percent of relig ious adherents from Tema Metropolis were willing to disclose their HIV status for this reason compared to 91 percent of relig ious adherents from Ashaiman Municipality. The desire of many religious adherents fro m both study areas to disclose their status for this reason might be due to the fact that PLWHA always need to be supported in the form o f food and money in order to buy the daily med ications that they needed always. This finding appears to be supported by in their study in South Africa where the majo rity of the PLWHA reported receiving more support of all types after disclosing their HIV status. With respect to the desire to receive counseling, almost the same percentages of adherents in the two study areas (79 percent from Tema Metropolis and 80 percent fro m Ashaiman Municipality) were ready to do this. In the case of the findings fro m the Anglican Churches in Southern Africa only 13.8 percent of PLWHA felt loved and supported after their disclosure. The high percentage of adherents in this study who were willing to disclose their status for the above reasons discussed was quite encouraging since most religious organizations could conveniently provide for PLWHA in o rder to increase their willingness to disclose. On the other hand the fear of being gossiped about constituted the major reason for non-disclosure in the two study areas as shown in figure 4. The questions concerning the reasons were indiv idually an s wered . In Tema Metropolis, 91 percent of the adherents gave this reason for not willing to d isclose their status if they became infected, compared to 94 percent in Ashaiman. The next major reason why adherents in the two study areas might not be willing to disclose their status was fear of isolation, that is, social isolation which might involve the lost of social networks (friends, family members). Th is finding is supported by the works of in Uganda in which the most common reason for non disclosure was fear of abandonment, though this was mostly associated with disclosure to spouse/partner and friends. In the present study, the next reason for not disclosing HIV status was fear of b lame, that is, where relig ious members would accuse them of having lived contrary to the word of God. These fears were given credence in the study done among adherents of Anglican Churches in the Southern Africa. Of those who disclosed their status to the church, 19.3 percent reported having often or sometimes lost friends with in the relig ious organization, and 25.4 percent felt of somet imes or often gossiped Public Health Research 2013, 3(5): 116-123 123 about. 4. Conclusions In general the willingness to disclose HIV status among adherents in the two areas was above average. In both areas, adherents were more willing to disclose their HIV status to their religious leaders than to their congregations. Female adherents were more willing to d isclose their status than their male counterparts. Adherents with higher levels of education were also more willing to d isclose their status than those with lower levels of education. This means that religious leaders need to be equipped with HIV counseling skills so that they can be of help to PLW HA who co me to them. 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