the role of faith-based organisations in hiv prevention and services

caribbeanhivaidsalliance.org

the role of faith-based organisations in hiv prevention and services

THE ROLE OF FAITH-BASED ORGANISATIONS

IN HIV PREVENTION AND SERVICES:

A Situational Analysis in Barbados

An HIV and AIDS Situational Assessment

With the support of


This research was made possible by support from the United States Agency for International Development (USAID) through Cooperative Agreement number: 538-A-00-07-00100-00.

The authors’ views expressed in this publication do not necessarily reflect the views of USAID or the United States Government.

Authors: Caribbean HIV&AIDS Alliance and the University of California, San Francisco

Published by: Caribbean HIV&AIDS Alliance

Date of Publication: February 2012


TABLE OF CONTENTS

Foreword 3

List of Acronyms 4

Acknowledgements 5

Executive Summary 6

1. Introduction 14

2. Background 15

2.1 HIV in the Caribbean 14

2.2 HIV in Barbados 15

2.3 Religious affiliation in Barbados 16

2.4 Recent HIV initiatives involving Caribbean FBOs 17

2.5 FBOs’ involvement in national HIV initiatives in Barbados 18

3. Methods 20

4. Findings 23

4.1 Profile of FBOs 23

4.2 Health and Welfare Activities at FBOs 27

4.3 HIV-related Activities at FBOs 31

4.4 Messages around HIV prevention 36

4.5 Attitudes to Vulnerable Populations 38

4.5.1 Attitudes to Sex Workers 39

4.5.2 Attitudes to men who have sex with men 40

4.5.3 Attitudes to single mothers 41

4.6 Attitudes to PLHIV 42

4.7 Stigma and Discrimination 43

4.7.1 Stigma and Moral Judgements 44

4.7.2 Fear of Casual Contact with PLHIV 44

4.7.3 Lack of Confidentiality of Personal Information 45

4.7.4 Measurement of HIV‐related Stigma 45

4.8 Future Programmes 48

5. Discussion 50

6. Recommendations 53

Appendices 55

Appendix 1: Consent Forms 55

1. Consent form for potential respondents in surveys 55

2. Consent form for potential participants in semi-structured interviews 58

Appendix 2: Interview Guide 61

Appendix 3: Survey Questionnaire 65

Appendix 4: Matrix for Analysis of Data from Qualitative Interviews 75

References 77


Foreword

It is with pleasure that we present this report, “The Role of Faith Based Organisations in HIV Prevention

and Services: A Situational Analysis in Barbados.” The study was undertaken by the International HIV/

AIDS Alliance (IHAA)/Caribbean HIV&AIDS Alliance (CHAA) and the University of California at San

Francisco (UCSF) with funding from the United States Agency for International Development (USAID).

The goal of this situational analysis was to understand Faith‐Based Organisations’ willingness and

capacity to engage in HIV prevention and care services. The study also sought to understand better

the barriers and facilitators to design and implementation of HIV activities by FBOs.

CHAA is the largest regional NGO working specifically to mobilise vulnerable communities to carry

out HIV prevention and education activities, counselling and testing and promoting access to care

and support. Three key populations provide the focus of CHAA activities: men who have sex with men

(MSM), sex workers (SW) and people living with HIV (PLHIV). The portfolio of the CHAA consists of

five main elements, as follows:

1. Prevention;

2. Promoting and facilitating access to health services;

3. Care, support and empowerment of PLHIV;

4. Peer support; and

5. Acceleration of the private sector response to HIV and AIDS.

The overall aim of the Eastern Caribbean Community Action Project (EC‐CAP) being carried out by the

CHAA is to work with key populations to increase access to HIV and AIDS services in four countries

of the Eastern Caribbean; Antigua and Barbuda, Barbados, St. Kitts and Nevis and St. Vincent and the

Grenadines. The research carried out under this project assists in building programmes that are

relevant, culturally appropriate and effective within the countries, in partnership with National AIDS

Programmes and civil society. The research will also inform behaviour change, counselling and testing

and palliative care/home based care projects or capture lessons learnt for application to future efforts.

In keeping with the philosophy that partnerships are a critical part of our strategic vision, this report

was developed as a joint effort of a team of researchers from CHAA, UCSF, local researchers from

Barbados and with the support of the Government of Barbados. It represents a strategic and proactive

approach to HIV programming and demonstrates a model of systematic programme‐oriented research.

This study builds on an effort initiated by the Pan Caribbean Partnership Against HIV/AIDS (PANCAP)

when, in November 2005, it hosted the Champions for Change II Regional Conference of Faith‐

Based Organisations to Reduce Stigma and Discrimination. One key result of this conference was the

Declaration of Commitment by Faith Based Organisations to reduce Stigma and Discrimination against

People Living with, and affected by HIV and AIDS. This assessment extends the options for reaching

people at risk for HIV transmission and PLHIV through partnerships with faithbased organisations.

CARIBBEAN HIV&AIDS ALLIANCE 3


List of Acronyms

AIDS

BBSS

BCC

CAREC

CIDA

CCC

CDC

CHAA

FBO

GLBT

HIV

IEC

IHAA

IRB

MSM

NGO

NAP

NAS

PHSC

PLHIV

PLWA

S&D

SISTA

STD

STI

SW

UCSF

UNAIDS

UNGASS

US

USAID

VCT

WHO

Acquired Immunodeficiency Syndrome

Biological/ Behavioural Surveillance Surveys

Behaviour change communication

Caribbean Epidemiology Centre

Canadian International Development Agency

Caribbean Conference of Churches

US Centers for Disease Control and Prevention

Caribbean HIV&AIDS Alliance

Faith-based organisation

Gay, lesbian, bisexual or transgender

Human Immunodeficiency Virus

Information, education and communication

International HIV/AIDS Alliance

Institutional Review Board

Men who have sex with men

Non-governmental organisation

National AIDS Programme

National AIDS Secretariat

Protection of Human Subjects Committee

People living with HIV

People living with AIDS

Stigma and discrimination

Sisters Informing Sisters on Topics about AIDS

Sexually Transmitted Disease

Sexually Transmitted Infection

Sex workers

University of California, San Francisco

Joint United Nations Programme on HIV/AIDS

United Nations General Assembly Special Session on HIV/AIDS

United States of America

United States Agency for International Development

Voluntary Counselling and Testing

World Health Organisation

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Acknowledgements

The research team for this study consisted of Dr. Janet Myers, Principal Researcher (UCSF); Andre

Maiorana, Co‐ Investigator/Qualitative Analyst (UCSF); Caroline Allen, Evaluation Director (CHAA);

Marissa Thomas, Research Assistant (CHAA); and Audrey Christophe, Research Officer (CHAA).

The Caribbean HIV&AIDS Alliance and the University of California at San Francisco would like to

express their sincere gratitude to all those individuals and organisations who contributed to the

successful planning and execution of this study. Special thanks to the staff of the Ministry of Health

and the National HIV/AIDS Commission for their guidance during the process and for freely providing

us with requested information as well as the local researchers who collected data for the quantitative

component of the study, Cristianne Andrew‐Rose, Malissa Bovell, Mark Holder and Kelly‐Ann Murphy.

We acknowledge the contribution of the following for their assistance and advice in the organisational

phase of the study: Anglican Diocese of Barbados, Barbados Christian Council, the Church of God

Reformation Movement, the Church of the Nazarene, the East Caribbean Conference of Seventh Day

Adventists, the Ichirouganaim Council for the Advancement of Rastafari, the Jehovah’s Witnesses

of Barbados, the Methodist church of Barbados, the New Testament church of God, the Pentecostal

Assemblies of the West Indies, the Roman Catholic Diocese of Bridgetown and the Wesleyan Holiness

Church.

We also acknowledge the support from CHAA Barbados country office staff. This study would not

have been possible without the participation of the representatives of the Faith‐Based Organisations

who gave us a lot of their precious time, provided extremely useful information, and openly discussed

sensitive issues. Finally, special thanks are extended to USAID for providing the funding to support this

much needed situational assessment.

CARIBBEAN HIV&AIDS ALLIANCE 5


Executive Summary

Background

Faith‐based organisations (FBOs) play an important role within Caribbean societies and religious

leaders have considerable influence. Many FBOs are already engaged at various levels in HIV prevention

and services or have acknowledged their potential leadership role in the response to HIV and AIDS,

including engaging in HIV prevention and care services. However, little is known about the roles they

are playing or could play in HIV and AIDS programming in the Caribbean. In light of this, a study

was carried out with FBOs in four countries: Antigua and Barbuda, Barbados, St. Kitts and Nevis and

St. Vincent and the Grenadines. The research was conducted by the International HIV/AIDS Alliance,

Caribbean HIV&AIDS Alliance (CHAA), in partnership with the University of California at San Francisco

(UCSF), with funding from the United States Agency for International Development (USAID).

The study was developed to assess the feasibility and acceptability of implementing HIV prevention

interventions and other services through FBOs. The specific aims of the study were:

1. To assess the willingness and capacity of FBOs to participate in HIV prevention activities;

2. To assess the level of HIV related stigma among those organisations; and

3. To identify the barriers and facilitators to implementing HIV prevention interventions

by or in partnership with FBOs.

Methods

The qualitative and quantitative data collection methods used in Barbados were the same as in the

other countries included in this study. Primary data were collected via two methods. First, the research

team conducted interviews with representatives of selected denominations using a semi‐structured

interview guide.

In Barbados, ten FBO representatives were interviewed using this method. Second, a survey was

conducted using a standardised questionnaire to interview representatives from a broad cross‐section

of FBOs. Forty‐four FBO representatives participated in the survey in Barbados. Secondary data from

published reports available from government and online sources provided context for the design

of the instruments and for the findings from the interviews and surveys.

Results

The results presented here are from the research carried out in Barbados. Findings from the other

countries are presented in separate reports.

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Background

Review of documentation on FBO initiatives on HIV in the Caribbean revealed active involvement of

pan‐Caribbean bodies in seeking to mobilise a faithbased response. Among the most significant are:

• The development of a Declaration of Commitment by Faith Based Organisations to reduce

Stigma and Discrimination against People Living with, and affected by HIV and AIDS, under the

auspices of the Pan Caribbean Partnership Against HIV/ AIDS (PANCAP) in 2005

• A project by the Caribbean Conference of Churches (CCC), funded by the Canadian International

Development Agency (CIDA) including a number of sensitisation and training workshops such

as a workshop on provision of home‐based care to people living with HIV. The project also

included the production of Guidelines for Caribbean Faith Based Organisations in Developing

Policies and Action Plans to Deal with HIV/ AIDS in 2004.

Within Barbados, such regional initiatives are supplemented by the involvement of FBOs in the

institutional structure and initiatives of the National HIV/AIDS Commission (NHAC). FBOs have had

major representation on the NHAC’s Life Skills Education Committee, which is mandated to provide

advice and guidance on the implementation of abstinence and stigma reduction initiatives. The

Committee has conducted workshops on HIV Sensitisation, Advocacy and Behaviour Change

Communication. Among other initiatives, the NHAC has also supported a Home Based Care for PLHIV

Training Workshop, and a regional forum hosted by the Barbados Evangelical Association, Faith based

Forum on Inclusion and Human Sexuality.

Participant description

The denominations represented by the participants in the 10 qualitative interviews were Anglican,

Church of God Reformation, Church of the Nazarene, Jehovah’s Witnesses, Methodist, New Testament

Church of God, Pentecostal Assemblies of the West Indies, Roman Catholic, Seventh Day Adventists

and Wesleyan Holiness.

Forty‐four of the 50 FBOs selected for the sample participated in the quantitative survey. The main

reason for non‐participation was unavailability of a representative of the FBO to participate in a survey

during the period allowed for data collection. Attempts to replace some of these potential respondents

with others from the same denomination were unsuccessful.

FBO congregations

More than half of respondents said their weekly services were attended by up to 100 people, while

5% said they were attended by more than 500 people. All interviewees stated that female members

outnumbered male members in the FBOs of which they were members.

Health and welfare activities at FBOs

Most respondents (82%) said that their organisation had health‐related programmes or activities.

The great majority of programmes focussed on health and wellness (82%) followed by outreach (44%)

and counselling (30%). Some of the health‐related activities were seasonal (such as health fairs) or

sporadic (such as health checks). Some FBOs invited guest speakers or church members to present

on health topics. Health and relationships were among topics included in activities for youth such as

camps and fellowship programmes.

CARIBBEAN HIV&AIDS ALLIANCE 7


HIV related activities at FBOs

Of 44 survey respondents, only 8 (18%) responded “Yes” to the question, “Does your group currently

provide any kind of HIV and AIDS‐related activities or programmes” All 8 had a focus on HIV/AIDS

education and prevention and 7 had developed counselling workshops on human sexuality. Two or 3

mentioned risk reduction counselling, prison outreach, spiritual counselling, meal/ food programmes

or bereavement support.

Interest in deepening the involvement of the FBO in HIV‐related activities was found to be high. The

great majority of participants (84%) stated that it was “very important” to establish or further develop

an HIV/AIDS ministry. Only 4% said they were very knowledgeable about how HIV programmes are

planned in Barbados.

Most expressed interest in receiving support to develop HIV/AIDS activities, such as support to establish

HIV ministries (83%), to build collaborative relationships with community organisations (81%), to

understand health issues among parishioners (78%), to conduct strategic planning (74%), to

manage volunteers (69%) and to raise funds (60%).

Interviewees in the qualitative component of the research appeared from their responses to be more

involved in HIV‐related activities and programmes than most survey respondents, perhaps because they

were selected by their church leadership to represent their FBOs’ position on HIV. Four interviewees

said they had an HIV ministry in place. These ministries included activities such as counselling,

a feeding programme, initiatives to provide clothing for PLHIV, assistance to families of deceased

PLHIV and HIV‐related seminars for youth and adults in the church. Other initiatives (not necessarily

connected to the existence of an HIV Ministry), included:

• Promoting an event as part of the multimedia “Live Up” campaign on HIV run by the Caribbean

broadcast media partnership

• Participating in training by chaa on hiv‐related stigma and discrimination

• Training of pastors in HIV counselling and testing

• Hosting a national HIV symposium for the denomination

• Providing HIV counselling

• Providing home‐based care to PLHIV

• Establishing a social centre with life‐skills development for PLHIV

Messages around HIV prevention

HIV prevention messages delivered by FBOs include abstinence for unmarried people and fidelity for

those who are married. Condom use was suggested by some, but was considered as appropriate only

when abstinence and fidelity were not achieved. Several FBOs had active programmes to encourage

abstinence among youth. It was noted by some interviewees that opinions on appropriate HIV

prevention strategies for particular FBOs may vary but that they tended to be dictated by the hierarchy

of the denomination at national or international level. Church leaders may have difficulty presenting a

full range of HIV prevention options but it was noted that some may be willing to invite a guest speaker

to provide more information.

Attitudes to sex workers and men who have sex with men

Interviewees emphasised that certain forms of sexual activity are regarded by FBOs’ dogma as sinful,

namely homosexual sex and sex for financial gain (sex work).

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This conditioned the way in which they regarded men who have sex with men (MSM) and sex workers

(SW) – populations vulnerable to HIV infection. Most interviewees, however, were at pains to emphasise

that “God loves the sinner but not the sin”, so that people who engaged in these acts would not be

rejected by the church but efforts would be made to encourage them to stop. The attitude to MSM was

generally less tolerant than towards SW, based on the idea that same sex relationships/intercourse

was considered sexual deviance in contrast with the notion that people may become involved in SW

through circumstances beyond their control (e.g. financial need).

Attitudes to PLHIV

For the most part, interviewees expressed having an accepting attitude toward PLHIV based on

Christian notions of compassion and care for the sick and needy. However, several interviewees noted

that the way an individual contracts HIV was a determining factor in the ways members treat them.

Persons who contracted HIV through socially deviant behaviour (such as people believed to be MSM)

would be treated differently by churchgoers to those who contracted HIV through, for example, sex

with their spouse. This was illustrated by the case of an HIV‐positive Sunday school teacher who was

able to continue her duties and be accepted by the congregation since she was believed to have

been infected by her husband.

Not all FBOs were said to be welcoming toward PLHIV. One leader gave the example of a woman whose

responsibility was to clean the church. When the woman died it was discovered that her death was

HIV‐ related. During the funeral, the corpse was not brought into the church, but was driven straight to

the cemetery.

Stigma and discrimination

USAID has developed a framework for understanding different domains of HIV‐related stigma and

discrimination (R. Parker, P. Eggleton, 2002). (REF) The main domains are:

1. Values: shame, blame and judgement

2. Fear of casual contact and refusal of contact with PLHIV

3. Enacted stigma (discrimination)

4. Disclosure

Discrimination and disclosure are said to be outcomes of levels and experiences of stigma (1). The

current research explored these domains, with the major emphasis on the first two listed.

Stigma and moral judgements

As noted above, attitudes to vulnerable populations were conditioned by the idea that they engage in

“sinful” activity, and such attitudes were extended to those PLHIV who were presumed to have engaged

in these activities. HIV was still often regarded as associated with homosexual practices. Stigma was

found to be heavily associated with perceptions regarding how a person acquired HIV, and thus the

extent of moral “blame”. Interviewees generally did not hesitate to point out the shame in engaging

in homosexual sex or sex work. Compound stigma, that is, HIV stigma layered on top of pre‐existing

stigmas towards SW and MSM (1) was found to be strong.

Fear of casual contact and refusal of contact with PLHIV

Some FBOs were reported to have been involved in activities to reduce stigma, with a lot of emphasis on

dispelling fear of casual contact. These included preaching from the pulpit and a variety of sensitisation

and training workshops provided by FBO denominations, the government and pan‐Caribbean agencies.

CARIBBEAN HIV&AIDS ALLIANCE 9


The survey included measuring items to capture various attitudes to PLHIV. It was found that most

respondents thought that some people in their denominations had stigmatising attitudes based on

fear of casual contact. The highest proportions reported to have stigmatising attitudes related to

items about sharing food and drink, such as:

• Not wanting an HIV infected person to feed their children

• Not sharing dishes or glasses with someone who has HIV

• Not wanting an HIV infected person cook for them

Slightly fewer numbers thought that PLHIV had engaged in “wrong behaviours”. While this result might

suggest that attitudes to PLHIV were less focussed on values than on fear of casual contact, the results

in previous sections show that the extent of stigma was highly conditional on perceptions about how

an individual acquired HIV (the extent of shame and blame).

Disclosure and confidentiality

Public disclosure of HIV status among members of church congregations was said to be rare. A few

PLHIV had, however, revealed their status to church leaders privately. One interviewee noted that in

the FBO he represented, the HIV positive status of a member had been revealed to the congregation by

another member in whom he had confided, with negative consequences for the PLHIV member. He

said that this FBO had “learned” from this “mistake.” of breach of confidentiality.

Discussion

This study is the most wide‐ranging to date of the engagement of FBOs in Barbados in HIV activities

and programming. A combination of qualitative and quantitative methods was used to generate both

in‐depth knowledge of context, values and experiences and survey data on the extent and types of

programmes and approaches in a broad range of FBOs. There are nevertheless some study limitations:

1. The report focusses only on Christian FBOs.

2. To protect privacy, the research team has not disaggregated the results by organisation

or denomination which makes it difficult to have targeted interventions for specific

denominations.

3. Random sampling methods and statistical sample size calculations were not used, thus the

FBOs included may not represent the picture for FBOs in Barbados as a whole.

Recommendations

Recommendations arise from key findings of the study.

KEY FINDING 1

The potential reach of HIV related activities by FBOs is considerable:

• Most Barbadians express a religious faith and many attend religious institutions.

• FBOs are already heavily involved in the decision making bodies and activities of the NHAC.

• Most members of Christian FBOs in Barbados are women.

• Most FBOs already have in place health promotion activities, personnel and infrastructure.

These often focus on the health and development of young people.

• Most respondents (84%) stated that it was “very important” to establish or further develop an

HIV Ministry within the FBO.

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RECOMMENDATIONS

1.1 The NHAC and its partners should continue to seek to strengthen FBO involvement in the expanded

HIV response in Barbados.

1.2 FBOs are instrumental in the effective engagement of women in the national HIV response.

1.3 The NHAC and its partners should encourage and support FBOs in their efforts to integrate HIV

into health promotion and build on their existing health promotion work.

1.4 Consultations with youth should take place to ensure the development of relevant, attractive

approaches to HIV prevention and care.

1.5 To attract men to participate in HIV programmes via FBOs, they should be encouraged to assume

more active roles in the church, be engaged in community‐oriented programmes, be involved in

mentorship programmes and included in discussions about meanings of masculinity and ways to

prolong their lives.

KEY FINDING 2

Few FBOs (18%) were reported to be currently engaged in HIV-related activities or programmes,

and a further 21% had discussed beginning any kind of HIV/AIDS related programme. Most

expressed interest in receiving support to develop HIV/AIDS activities.

RECOMMENDATIONS

2.1 Efforts should be made by the NHAC and high‐profile FBO leaders to deepen the involvement

of other FBO ministers and ordinary church members in the HIV response.

2.2 Greater efforts should be made to provide practical skills and tools for FBOs to set up HIV‐related

programmes. CHAA and other non‐governmental organisations can complement the work

of the government and FBO leaders in providing skills in, for example, building collaborative

relationships with community organisations, marketing church programmes to the community,

understanding health issues among the congregation, strategic planning, managing volunteers

and fundraising.

2.3 International best practice should be followed in developing and deepening the involvement

of FBOs in HIV work. Programme implementers should try to make material on these

initiatives available to FBOs in Barbados or direct them to websites and sources of support such

as the Ecumenical AIDS Alliance, the World Council of Churches and Christian Aid.

KEY FINDING 3

At national and Caribbean regional levels, training initiatives and public information campaigns, some

of them involving FBOs, have sought to reduce HIV -related stigma and discrimination. However, stigma

remains. Highest levels of stigma measured in our study related to items expressing fear of casual

contact regarding sharing food or drink.

CARIBBEAN HIV&AIDS ALLIANCE 11


RECOMMENDATIONS

3.1 Fear of casual transmission and refusal of contact with PLHIV should continue to be contested via

public information and sensitisation campaigns or those campaigns need to be reassessed since

they don’t seem to be working.

3.2 Being trusted purveyors of information, FBOs can continue to be at the forefront of such

educational efforts.

3.3 Scientific information on risks of transmission via food and drink should be presented to Faith

based organisations.

KEY FINDING 4

FBOs were interested in becoming involved in efforts to reduce HIV -related stigma and discrimination

and in providing care and support to PLHIV, based on Christian notions of compassion for the sick and

needy. At the same time attitudes to PLHIV church members were conditional on judgements regarding

the morality of their past behaviour. People perceived to have contracted HIV through infidelity, multiple

partnerships and especially through sex work or homosexual relations were seen as blameworthy.

Acceptance into the church of SW and MSM was conditional on them renouncing their “sinful” sexual

activities. This resulted in what is termed “compound stigma” in which HIV stigma is layered on top of

pre existing stigmas, especially towards MSM and SW (1).

4.1 Therefore, in areas such as support and empowerment for key populations (e.g. SW, MSM) NGOs

whose focus and expertise is on reaching the above mentioned populations (e.g. CHAA) should

provide the bulk of services and interventions. FBOs on the other hand should concentrate their

efforts on developing prevention and support strategies for the general population, and providing

care and support to PLHIV based on their Christian notion of compassion for the sick and needy..

FBOs can expand HIV counselling and testing options for the general population.

4.2 FBOs should debate the values they associate with HIV/AIDS and how these can serve to

differentiate between individuals who “deserve” and “do not deserve” full access to high quality

HIV care and support. In some FBOs, messages from the pulpit may be effective and could, for

instance, provide Biblical illustrations of instances when Jesus embraced people who were sick

or were socially marginalised. Messages could emphasise forgiveness, mercy and unconditional

love.

KEY FINDING 5

Majority of FBOs promoted abstinence and fidelity as their main HIV prevention methods. Condom use

was regarded as either unacceptable or as an inferior choice to be made if abstinence or fidelity could

not be sustained, being only accepted by some FBOs as a mean of contraception within the bond of

marriage

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RECOMMENDATION

5.1 The NHAC and its partners should continue to support FBOs in specialising and developing their

skills in promoting abstinence and fidelity and where possible messages and programmes must

be tailored to the ability and willingness of individual FBOs to engage further in HIV prevention.

They may, for instance, be more willing to participate in HIV counselling and testing and palliative

care than condom promotion.

5.2 A range of governmental and non‐governmental agencies should lead condom promotion

strategies for HIV prevention.

Conclusion

The information in this report may be utilised to extend the options for reaching people at risk for

HIV transmission and PLHIV through partnerships with FBOs. Informed by these findings, further

collaboration between FBOs, the NAP, NHAC, CHAA and other agencies, will augur well in increasing

the impact of HIV prevention and care programmes in Barbados. Working with FBOs holds the promise

to:

• Improve hiv care and support.

• Change social attitudes in the interest of reducing the impact of HIV and reduce S&D against

PLHIV.

• Increase knowledge on HIV and STIs.

• Uphold the value of compassion.

CARIBBEAN HIV&AIDS ALLIANCE 13


1. Introduction

Faith‐based organisations (FBOs) play an important role within Caribbean societies and religious

leaders have considerable influence among their congregants. The importance of religious bodies in

mobilising the response to HIV in the Caribbean is demonstrated by the emphasis which continues to

be placed on FBOs in regional and national strategic plans. Many FBOs are already engaged to some

extent in HIV prevention and services or have acknowledged their potential leadership role in the

response to HIV and AIDS, including engaging in HIV prevention activities and other related services.

However, little is known about the roles they are playing or could play in HIV and AIDS programming

in the Caribbean.

The United States Agency for International Development (USAID) provided funding to the International

HIV/AIDS Alliance (IHAA) for the Eastern Caribbean Community Action Project, which was

implemented by the Caribbean HIV&AIDS Alliance (CHAA). This included an assessment of FBOs

in four Eastern Caribbean countries, as follows: Antigua and Barbuda, Barbados, St. Kitts and Nevis

and St. Vincent and the Grenadines. These studies were conducted in partnership with the University

of California at San Francisco (UCSF) and were developed to assess the feasibility and acceptability of

implementing HIV prevention interventions and other services through FBOs. The specific aims of the

study were:

1. To assess the willingness and capacity of FBOs to participate in HIV prevention activities.

2. To assess the level of HIV related stigma among those organisations.

3. To identify the barriers and facilitators to implementing HIV prevention interventions

by or in partnership with FBOs.

This report includes findings for Barbados. Reports are also available from the research in each of the

other countries. Research was conducted solely among Christian FBOs, who represent the majority of

the population in the countries included in the study.

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2. Background

2.1 HIV in the Caribbean

The Caribbean ranks second in the world with regards to HIV prevalence, only surpassed by Sub‐Saharan

Africa. Since the first HIV cases of the epidemic in the region arose in the early 1980s, AIDS has become

one of the leading causes of death for those aged 25 to 44 years. The overall Caribbean regional adult

HIV prevalence in 2007 was estimated at 1.1%, ranging from 0.1% in Cuba to 3% in the Bahamas,

with Barbados standing at 1.2% (see figure 1). This compares to 0.6% in North America and 0.5% in

Latin America (2). In the Caribbean, HIV is transmitted mainly through sexual intercourse. While high

in the general population in several Caribbean countries, HIV infection is also concentrated among key

populations, leading to the characterisation of the region’s epidemic as mixed (both generalised and

concentrated).

Figure 1

Source: UNAIDS (3)

Data from the region shows that prevalence among key populations is as high as 27% among female sex

workers and 32% among men who have sex with men (MSM) (3).

2.2 HIV in Barbados

In Barbados, the national population stands at almost 287,000 (4). HIV surveillance data for 2008

indicate men continue to outnumber women among PLHIV (60% male). For 1984 – 2008, males

were 63% of PLHIV, 68% of People Living with AIDS (PLA) and 73% of those who died of HIV/ AIDS,

indicating that men in Barbados appear to present especially late for testing. The proportion of male

PLHIV who are MSM is not known. There has been a trend towards proportionally more female HIV

cases, with the percentage of new cases standing at 40% female in 2008. Among young people 10‐29,

66% of PLHIV newly diagnosed in 2008 were female (5). The proportion of pregnant women tested for

HIV is relatively high at 93%. Thirty‐five women with HIV had babies in 2008, of which 32 received a

complete course of antiretroviral therapy (ART) for prevention of mother‐to‐child transmission.

CARIBBEAN HIV&AIDS ALLIANCE 15


In 2002, ART was made available for treatment of HIV. The risk of dying from HIV since then has declined

substantially; there was a 4.7 times greater risk of dying from HIV in Barbados before the introduction

of ART prior in 1995‐2001 as compared with 2002‐2008. ART is available from the government facility,

the Ladymeade Reference Unit. While mortality rates fell sharply after 2002, approximately 10% of

PLHIV still die within a year of diagnosis, indicating that many present for testing and treatment at

advanced stages of disease. The Barbados HIV surveillance report 2010 recommends the augmentation

of HIV testing through Provider‐Initiated Testing and Counselling, HIV rapid testing and initiatives to

promote testing among most‐at‐risk populations. It also recommends the development of prevention

programmes specific to PLHIV (prevention with positives) (5).

2.3 Religious Affiliation in Barbados

Christianity is the dominant religion in Barbados. The Barbados Statistical Service provides the

following figures for religious affiliation by sex, based on the previous census (figures for the 2010

census are not yet published).

Table 1: Barbados Population Distribution by Sex & Religion

RELIGION MALE FEMALE TOTAL PERCENTAGE OF POPULATION PERCENTAGE MALE

Adventist 5989 7737 13726 5.5 43.6

Anglican 32240 38465 70705 28.3 45.6

Baha’i 79 99 178 0.1 44.4

Baptist 1942 2747 4689 1.9 41.4

Bretheren 646 954 1600 0.6 40.4

Church of God 2031 2935 4966 2.0 40.9

Hindu 430 410 840 0.3 51.2

Jewish 53 43 96 0.0 55.2

Jehovah Witness 2005 2897 4902 2.0 40.9

Methodist 5299 7366 12665 5.1 41.8

Moravian 1387 1965 3352 1.3 41.4

Mormon 89 125 214 0.1 41.6

Muslim 882 775 1657 0.7 53.2

Pentecostal 18686 28040 46726 18.7 40.0

Rastafarian 2245 614 2859 1.1 78.5

Roman Catholic 4492 5951 10443 4.2 43.0

Salvation Army 417 640 1057 0.4 39.5

Other Christian 7243 9366 16609 6.6 43.6

Other Non-Christ. 667 626 1293 0.5 51.6

None 28391 14854 43245 17.3 65.7

NR 4713 3475 8188 3.3 57.6

Source: (6)

Total 119926 130084 250010 48.0

According to these figures, the largest denominations are Anglican (28.3% of the population)

and Pentecostal (18.7%). Males account for a minority in most denominations, being no more than

45.6% in any of the Christian denominations listed.

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2.4 Recent HIV initiatives involving Caribbean FBOs

The Caribbean Conference of Churches (CCC), founded in 1973, serves as an implementing agency

that promotes development and sustainability through various initiatives of churches from

several denominations in 34 territories of the Caribbean. Among the CCC’s initiatives was the 3

year regional programme, “Building a Faith‐based Response to HIV and AIDS in the Caribbean”, funded

by the Canadian International Development Agency (CIDA). The programme’s aim was “to mobilise

and enhance the response of FBOs to the HIV epidemic”. Among the outputs was the publication of

Guidelines for Caribbean Faith Based Organisations in Developing Policies and Action Plans to Deal with

HIV/ AIDS (7). The guidelines of the action plan are based around the following headings: leadership;

prevention; care, support and counselling; human rights and advocacy; death and burial; education;

and gender. The report identified youth and young adults, especially females between the ages of

15‐19, as being most vulnerable to HIV infection in the region.

The CCC/ CIDA project also included a study on Caribbean Faith Based Organisations’ Response to

the HIV Epidemic in the Sub Region. Four hundred and nine (409) questionnaires were

distributed during CCC sensitisation workshops organised in 16 project countries. Of these, 259

questionnaires were completed (63% response rate). Among the results were:

• 53% of agencies reported they were already involved in HIV/AIDS initiatives, and a further

36% were not involved but interested in being involved.

• The most common source of funding for HIV/AIDS initiatives was donations (46%), followed

by fundraising (31%), grants (20%) and other (20%).

• 86% of respondents identified the types of HIV activities they did. Of these, 69% indicated

involvement in education and awareness, 22% counselling, 15% support including shelter,

food and clothing, financial assistance and visits and 6% clinical services.

• The most common beneficiaries of FBO initiatives on HIV/AIDS were community members

(60%), the congregation (45%) and persons external to the congregation (43%) (7).

The current study, informed by the CCC action plan, was designed to provide more detail and an

update on the actual engagement, capacity and needs of FBOs in four Eastern Caribbean countries

with regard to HIV prevention, care and support, using a combination of qualitative and quantitative

methods.

The Pan Caribbean Partnership Against HIV/AIDS (PANCAP) held the Champions for Change II

Regional Conference of Faith Based Organisations to Reduce Stigma and Discrimination in November

2005. A result of this conference was the Declaration of Commitment by Faith Based Organisations

to reduce Stigma and Discrimination against People Living with, and Affected by HIV and AIDS. In

addition, the CCC was nominated to work with CARICOM / PANCAP “to establish a working committee

to carry forward the elements of the Plan of Action arising from the Champions for Change II Regional

Conference” (8, 9).

In January 2010, CHAA partnered with the Methodist Church in the Caribbean and the Americas to

provide a session on HIV‐related stigma and discrimination (S&D) at the South Caribbean District

Methodist Conference, which took place in Barbados. This followed a request to CHAA from the HIV

Officer of the Methodist Church in St. Vincent and the Grenadines for support in developing initiatives

to address S&D in the church.

CARIBBEAN HIV&AIDS ALLIANCE 17


The annual meeting, including the session on S&D, was attended by around 125 church leaders from

around the Caribbean region. Issues covered and discussed with leaders in the session included:

1. HIV and AIDS: the basics

2. Stigma and discrimination

3. Attitudes towards differences

4. Stigma, discrimination and scripture

5. Advocacy

6. Ways forward

As a result of this intervention, CHAA was invited by the Methodist Youth Ministry in Barbados to

facilitate a workshop in Barbados in February 2010 for young people from the churches, on the theme

‘Fighting stigma & discrimination: advocacy as ministry’, focussing on what individuals can do to help

their families and churches to speak out S&D. The collaboration between CHAA and the Methodist

church also contributed to the involvement of a member of the Methodist church youth group in

a newly formed NGO in Barbados conducting advocacy on behalf of key populations: MOVADAC,

Movement Against Stigma & Discrimination. Finally, CHAA supported an activist from the Caribbean

Regional Network of People Living with HIV (CRN+) to participate in a regional meeting in October

2010 to develop a policy to guide the South District of the Methodist Churches in the Caribbean and

the Americas in its response to S&D.

2.5 FBOs’ involvement in National HIV initiatives in Barbados 1

The entity primarily responsible for HIV programming in Barbados is the National HIV/AIDS

Commission (NHAC). This was one of the first intersectoral bodies responsible for HIV in the

Caribbean, having been established in 2001 by former Prime Minister Owen Arthur in conformity

with UNAIDS’ Three Ones principles:

• One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of

all partners.

• One National AIDS Coordinating Authority, with a broad based multi‐sector mandate.

• One agreed country level Monitoring and Evaluation System.

The NHAC is now within the Ministry of Youth, Family and Sports and seeks to coordinate HIVrelated

activities of a wide range of governmental, non‐governmental and private sector actors. Each

government ministry employs a focal point responsible for HIV‐related activities within that ministry.

Several committees carry forward initiatives and activities in support of Barbados’ National Strategic

Plan for HIV Prevention and Control 200813. FBOs have had major representation on the Faith‐based

Committee (disbanded 2009) and the Life Skills Education Committee (started in 2009). The Life Skills

Education Committee is mandated to “provide advice and guidance on the implementation of abstinence

and stigma reduction initiatives” (Terms of Reference of the Life Skills Education Committee).

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Among its activities have been:

• An HIV Sensitisation Workshop

• An Advocacy Workshop 8

• A Regional Behaviour Change Communication Workshop for FBOs

A national workshop on stigma and discrimination is planned for the faithbased community in

2011. FBOs hold membership on the Board of the Commission, specifically representatives of the

Barbados Evangelical Association and the Barbados Christian Council. The faithbased community

is also represented at the NHAC’s monthly HIV coordinators’ meetings, which is a partnership forum

presenting the opportunity for various agencies to report on their activities, hear from their colleagues

and obtain assistance with their programmes.

Financial support has been provided by the NHAC for HIV‐related FBO initiatives such as:

• A Home‐Based Care for PLHIV Training Workshop in 2007. The workshop was held in

conjunction with the CCC and primarily sponsored by CIDA.

• A regional forum hosted by the Barbados Evangelical Association, “Faith‐based Forum on

Inclusion and Human Sexuality”. This was attended by 315 persons from nine Caribbean

countries in 2007. Proposals from the forum included the formation of groups of different

faiths to discuss HIV activities they could do together.

FBOs are also represented at national consultations including those on Universal Access to Prevention,

Treatment, Care and Support. FBOs have also carried out their own investigations to inform HIV

programmes. In 2009, a leader of the Anglican Church carried out a survey at some Anglican churches

as well as one Adventist, one Methodist, and one Pentecostal church, with fewer than 150 respondents

who answered the brief questionnaire on their way out from church services. The purpose was to gauge

their knowledge base, attitudes and practices as they relate to PLHIV and also to assess whether these

differed between Anglicans and members of the other churches. Questions focussed on knowledge and

attitudes, such as:

HIV can be spread from coughing in one’s face, sitting next to an infected person, drinking from the

same cup. (Answer: True or False)

Attitudinal questions included (among others):

• Would you hug a person known to have HIV infection or AIDS (Answer: Yes or No)

• Would you accept communion from a priest/minister/pastor who is known to have HIV

infection or AIDS (Answer: Yes or No)

It was found that more than 90% of respondents had correct HIV knowledge on most indicators. The

percentages of respondents indicating undesirable or stigmatising attitudes to PLHIV ranged from

2.6% to 19.5% by question for Anglicans and between 4.9% and 36.1% by question for the other

churches. For most questions, the percentages exhibiting stigmatising attitudes were roughly similar

and below 15%. However, with regard to accepting communion from a priest/minister/pastor who is

known to have HIV infection or AIDS, the percentage of people with stigmatising attitudes was much

higher among non‐ Anglicans (36.1%) than Anglicans (19.5%).

1 Thanks are extended to Ms. Nicole Drakes and Dr. Henrick Ellis of the National HIV/ AIDS Commission for the provision of the information in this section.

CARIBBEAN HIV&AIDS ALLIANCE 19


3. Methods

A combination of qualitative and quantitative data collection methods was used to carry out this study

among Christian FBOs in Barbados. Primary data were collected via two methods. First, the

research team conducted 10 in‐depth interviews with representatives from selected denominations

using a semi‐structured interview guide. Second, a survey was conducted using a standardised

questionnaire to interview 44 representatives from a broad cross‐section of FBOs. Secondary data

from published reports available from government and online sources provided context for the

instruments’ design and for the findings from the interviews and surveys.

Consent

Interviewees and respondents were given a consent form which outlined the reasons for the study;

procedures to be followed, privacy of data and other relevant information (see Appendix 1). Once

verbal consent to proceed was obtained the interviews began.

Ethical Approval

The study approach and methodology was reviewed and approved by the Institutional Review

Board (IRB) at UCSF and by the University of the West Indies‐Cave Hill/ Barbados Ministry of Health

Institutional Review Board.

Qualitative Interviews

Representatives from 10 denominations were invited to attend in‐depth interviews. A semistructured

guide (Appendix 2) was used for the discussion with participants during the interviews.

Meetings were set up with representatives from FBO umbrella organisations, during which the study

was introduced and next steps outlined. A list of representatives from each denomination was

compiled based on their recommendations and ten of these representatives were contacted to provide

nominations for interviews. The sample selected for interviews was based on an understanding of the

major denominations in Barbados. The determining characteristic of the nominees were that they be:

• Knowledgeable about their faith and how it functions within the context of Barbados.

• Have had experience and/or knowledge of programmes within the FBO arena which address

HIV and AIDS.

• Knowledgeable about the capacity of their organisation to conduct HIV prevention activities

and HIV‐related stigma work.

Nominees were received from the FBOs selected and interviews conducted.

Participants were asked about their role in the organisation and to describe the level of involvement

of their organisation in work related to HIV prevention, their willingness and capacity to conduct

such, and barriers and facilitators to doing so. Questions also asked about HIV‐related stigma among

members of each FBO. The interviews lasted approximately 60 minutes and were audio‐recorded.

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Quantitative Survey

Four researchers from Barbados were trained to collect the data. Fifty representatives of different

FBOs were invited to participate in interviews. Potential interviewees were first contacted by phone,

the purpose of the study was explained and an appointment sought. If a potential interviewee asked

for a written invitation to participate, an official invitation from the Chief of Party of the CHAA

EC‐CAP was provided via email or in person by the interviewer. This letter was provided to all

potential interviewees on arrival at the interview appointment, along with an information sheet

about the study and their rights as participants. Potential respondents were then invited to read

the information sheet and this was accompanied by a brief verbal explanation and invitation of

questions. Verbal consent to participate was then sought before the survey was administered.

If a representative of a selected FBO was unavailable on three attempts at contacting this FBO, the

interviewer attempted to include another FBO in the same denomination. This second choice FBO

was chosen from the same parish if available, or the nearest adjacent parish. The data collection

period was extended from four to eight weeks (June 11 to August 5, 2010) given initial challenges in

recruiting potential respondents.

The surveys were completed using a standardised questionnaire administered by the surveyor

(Appendix 3). The questionnaire was adapted from another instrument developed by the

US organisation Balm in Gilead (10) as well as stigma scales validated through other research (11).

The instrument included questions about the organisation; estimated size of congregation; health

and HIV‐related services currently offered by the denomination; their willingness and capacity to

implement HIV related programmes; barriers and facilitators to doing that kind of work and finally

stigma levels. Data collection lasted approximately 20 minutes with each respondent.

Sampling

For the purposes of the quantitative survey, the research team sought to include in the sample FBOs

from different denominations, geographical areas and parishes. First, a comprehensive list of FBOs

in Barbados was compiled according to denomination and parish. FBOs were then selected according

to the number of churches per denomination in each parish and geographical area. After sampling

across the denominations most often represented, the team selected smaller denominations so that

diverse denominations were represented across geographical areas.

Data Analysis

Qualitative and quantitative data were first analysed separately as two distinct datasets as described

below. Subsequently, the qualitative and quantitative datasets were compared in order for both the

qualitative and quantitative findings to inform, supplement and complement each other. In this report,

qualitative and quantitative findings have been integrated and are reported together unless specified

or indicated otherwise. Participants in the qualitative, semi‐structured interviews are referred to as

interviewees” while participants in the quantitative survey are referred to as “respondents”.

CARIBBEAN HIV&AIDS ALLIANCE 21


Qualitative Interviews

Three researchers at CHAA, including one of the two people who conducted the interviews, participated

in data analysis. Each of the transcribed interviews was summarised onto a standardised matrix

(Appendix 4). The matrices were organised into categories in order to include the topics covered in

the semi‐structured guide for interview participants, as well as any salient themes that emerged from

the interviews. The analysts first worked in dyads. One analyst summarised each interview onto the

matrix. Then a second analyst read and compared each of those summaries to the interview transcripts

in order to verify the information in the matrix and capture any relevant information missing

from the summaries. After that, three analysts worked together to compare the matrices in order

to identify similarities and differences among the different denominations interviewed. Differences

and discrepancies in the findings noted by each analyst were resolved through discussion among the

team. This iterative process of summarising and verification helped to ensure that the research team

captured the salient themes emerging from the data and relevant to the study questions.

Quantitative Surveys

Quantitative survey data were entered into a spreadsheet programme. Analysis was performed by

running frequencies and descriptive statistics.

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4. Findings

The findings have been organised to describe the characteristics of study participants and FBOs

included in the study, the health and HIV activities and services they provide, FBO messages around

HIV, attitudes to vulnerable populations, attitudes to PLHIV, stigma and discrimination and plans for

future programmes.

4.1 Profile of FBOs

Denominations of FBOs represented in the interview sample

The denominations represented by the participants in the 10 qualitative interviews were Anglican,

Church of God Reformation, Church of the Nazarene, Jehovah’s Witnesses, Methodist, New Testament

Church of God, Pentecostal Assemblies of the West Indies, Roman Catholic, Seventh Day Adventists

and Wesleyan Holiness.

Ten interviews were conducted with 12 people. The interview with Roman Catholics was conducted

with 2 representatives, as was the interview with the Church of God Reformation.

Roles of interviewees within their FBOs

Interviewees represented a variety of leadership positions within their FBO, and some interviewees

reported more than one role within their FBO. Self‐defined roles of interviewees included pastor, youth

minister, chief administrator, sister, elder, medical doctor, nurse, health educator, HIV counsellor, and

coordinator for the denomination’s HIV programme.

Denominations of FBOs represented in the survey sample

Forty‐four of the 50 selected FBOs participated in the study. The main reason for non‐ participation

was unavailability of a representative of the FBO to participate in an interview during the period

allowed for data collection. In one case, the contact details appeared to be out of date. Three potential

respondents refused to participate, two because they said they were too busy, and a third because

he said he was already sufficiently involved in HIV prevention activities at his FBO. One potential

respondent had died. Two said they did not feel that their position within the FBO allowed them to

make authoritative statements about the FBO’s activities regarding HIV. Attempts to replace some of

these potential respondents with others from the same denomination were unsuccessful.

Table 2 provides an overview of the denominations represented in the survey sample. This sample

contained greatest numbers of Anglicans, Church of the Nazarene, New Testament Church of God,

Seventh Day Adventist and Wesleyan Holiness, each with 4 to 6 respondents. The other respondents

were from denominations illustrating the diversity of FBOs across Barbados.

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Table 2: Denominations of churches of which survey respondents were members

Denomination

Number of

respondents

Percentage of

respondents

Abundant Life Assembly (Pentecostal Association of the West Indies) 1 2

Anglican 5 11

A Sure Foundation (non-denominational) 1 2

Berean Bible Church 1 2

Church of God Reformation 3 7

Church of God Prophecy 2 5

Church of the Nazarene (Evangelical) 4 9

H2 El Shaddai Inn (Pentecostal Association of the West Indies) 1 2

Jehovah’s Witnesses 2 5

Jesus Christ of the Latter Day Saints 1 2

Methodist 1 2

Moravian 2 5

New Testament Church of God 6 14

Roman Catholic 2 5

Salvation Army 1 2

Seventh Day Adventist 5 11

United Holy Church of America (Pentecostal) 1 2

Wesleyan Holiness 5 11

Total 44 100

Roles of survey respondents within their FBOs

Among survey respondents, more than half identified themselves as pastors (n=25 or 57%). The second

largest group was ministers (n=6). The rest of the respondents represented a variety of roles within

their FBO. There were 3 priests, and the remaining people classified themselves as spiritual leader,

administrator, congregation elder, church leader, administrative bishop and district superintendant.

There were 3 whose roles were not stated.

FBO Affiliations

Most FBOs were affiliated with one umbrella group; however, nine FBOs reported being affiliated

with two umbrella organisations. The following table shows the umbrella organisations to

which respondents said they were affiliated.

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Table 3: FBO Affiliations to Umbrella Organisations

Name of Umbrella Organisation

Number of Affiliated

FBOs*

Percentage of FBOs

Barbados Evangelical Association 11 25

Barbados Christian Council 9 20

Caribbean Council of Churches 3 7

Anglican Communion 2 4

Church of God Prophecy 2 4

Eastern Caribbean Conference of Seventh Day Adventists 2 4

Wesleyan Holiness 2 4

General Council of Seventh Day Adventist 2 4

PAWI 2 4

Anglican Diocese of Barbados 1 2

Catholic Body of Guyana 1 2

Christian Congregation of Jehovah’s Witnesses 1 2

Church in the Province of the West Indies 1 2

Church of the Nazarene in the United States 1 2

Church of God Reformation Movement in Indiana 1 2

General Assembly Church of God Barbados 1 2

Jesus Christ Latter Day Saints 1 2

Keswick 1 2

Moravian Church of Barbados 1 2

New Testament Church of God International 1 2

Only the Jehovah’s Witnesses International 1 2

Roman Catholic Church 1 2

Seventh Day Adventist Church Worldwide 1 2

Prayer Intercessory Ministry Barbados 1 2

World Council of Churches 1 2

World Wide Wesleyan 1 2

No affiliation 1 2

Total 55

Note: *The number of respondents answering questions about their affiliations was 44. Some FBOs reported being affiliated to more than one umbrella

organisation, which accounts for the total of 55.

CARIBBEAN HIV&AIDS ALLIANCE 25


The affiliations above were stated by the respondents. Some of the stated affiliations and umbrella

groups may be local terms used by the respondents to refer to other official umbrella groups with

similar names.

FBO personnel

There is a range of leadership structures. A small number reported having only full time spiritual

leaders, and most did not state clearly whether or not these individuals are paid.

The number of full time staff reported by survey respondents ranged from none to 12. The median

number of full time staff was 2. Most churches (n=29 or 66%) were able to support at least 1 full

time office staff member. The FBO that employed 12 full time workers included secretaries, business

administrators, accountants, pastors, directors and receptionists. In another FBO, part time workers,

including members of the worship team and cleaners, receive a stipend. Part time staff included

professions such as janitor, cleaners, organist, sexton, cook, groundskeeper, secretary, pastor, and

Christian literature sales people.

One interviewee considered all 43 assemblies within the FBO he represented when answering

questions about size and structure. This was because he was administratively responsible for all these

assemblies. The 43 assemblies were said to have 46 persons as staff, of which 4 were employed full

time. The 4 full time staff comprised an administrative bishop, a minister, and office staff, whereas the

part time staff comprised ministers.

Most FBOs reported having bi‐vocational spiritual leaders, with the exception of one where this was

not stated. Most reported having a combination of full time and part time spiritual leaders such as

ministers, lay persons, apostolic administrators, assistant and associate pastors, elders, and part time

priests. None of the FBOs reported having a shortage of leaders.

Size of Congregation

Main religious services were said by interviewees to be attended by between 20 to 1200 congregants.

Most of the survey respondents indicated that up to 100 people attended their weekly services (n=26

or 63% of those who answered this question). Only two respondents (5%) said services were attended

by more than 500 people each week (Fig. 1).

Fig. 1: Number of people attending weekly services

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Six respondents reported that their FBO does not have main services on Sunday morning. Three of them

have main services that occur on Sunday evening instead. The remaining three of these respondents

reported that they have services on Sunday evening and on Saturday, which is considered their Sabbath.

As reported by the interviewee of the Jehovah’s Witnesses, their services are referred to as meetings.

This leader emphasized that of the meetings, one day is not any more important than another. However,

the attendance at meetings at weekends may be higher because few people work at the weekend.

Demographic Characteristics of Congregants

All interviewees stated that female members outnumbered male members in the FBOs of which they

were members. The proportion of female members was said to vary from 60% to 70%.

According to interviews, levels of education in FBOs vary. Some noted a relatively high percentage of

members with graduate level or college education (Anglican, Church of God Reformation, Wesleyan,

PAWI) while others had members who were predominantly high school or secondary school graduates

(Jehovah’s Witnesses, Nazarene, Seventh Day Adventists, New Testament Church of God Reformation,

Methodist).

All of the interviewees except one reported the percentage of youth ages 18‐30 to be in a range of

25‐50%. One interviewee said he was unable to estimate this percentage. One interviewee reported

that between the ages of 17 and 24 there is a dip in attendance as young adults explore the direction

their lives will take.

4.2 Health and Welfare activities at FBOs

Activities and services for the general population

Survey respondents were asked about the health‐related programmes or activities provided by the

FBOs of which they were members. Thirty‐six of the 44 respondents (82%) said that their organisation

did have health‐related programmes or activities. Twenty of these 36 respondents (55%) mentioned

that their FBO had just one health‐related programme, while the remainder mentioned more than one

programme (Fig. 2).

Fig. 2

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A total of 57 programmes were identified by respondents. Programmes had a number of interesting

names, some of them Biblically inspired, such as “Jesus Plus Education or Skill Equals Success”, “Medical

Sunday” and “The Group Called Luke”. Others names indicated a focus on particular populations, such

as “Senior Citizens Meeting” and “Marriage Enrichment Programme”. Some focused on a holistic health

promotion approach, such as “Eight Steps to Wellness” and several focused on nutrition, such as “Some

so All May Eat” and “Vegetarian Cooking Class”. Only three names suggested a focus on particular

diseases, namely “Presentations on HIV/AIDS”, “Diabetes Seminar” and “Blood Pressure and Blood

Sugar Testing”.

Several of the 57 programmes covered more than one programme type or area of health targeted or

target population. Table 4 helps to describe the balance between types of programmes, areas of health

targeted and target populations.

The great majority of programmes focussed on health and wellness (82%), followed some way behind

by outreach (44%), counselling (30%) and dissemination of information (26%).

Programmes most commonly targeted physical health (77%), followed by nutritional health (67%),

with between 35 and 44% of programmes being concerned with emotional, mental, psychological or

spiritual health.

Health‐related programmes were most commonly reported to be directed at the entire community

(65%) or entire congregation (47%), with programmes targeting youth and women each accounting

for 11% and those for men accounting for 7%.

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CARIBBEAN HIV&AIDS ALLIANCE 29


The semi‐structured interviews enriched understanding of the health‐related programmes provided,

and seemed to suggest that the involvement of some FBOs was somewhat sporadic or seasonal

rather than being sustained throughout the year. Some interviewees stated their FBOs did not have

current health promotion programmes, but one stated that most churches had what is referred to

as a health initiative that occurs at least once or twice each year. Another stated that there were no

health promotion programmes in the FBO, but there are periodic health checks such as cholesterol, HIV

testing, blood pressure and diabetes. This is said to occur monthly, and a nurse attends to the members’

health needs. One noted that the FBO had not established a health promotion programme, but that this

was addressed sometimes in the magazine published by the denomination.

Some interviewees reported having established partnerships with organisations that assist with their

FBO’s health programmes. The organisations reported to have had partnerships with the FBOs include

the Barbados Evangelical Association, the National HIV/AIDS Commission, St. Vincent de Paul, the

HIV Food Bank, The Alzheimer’s Association of Barbados, the Asthma Foundation, The AIDS Society

of Barbados, PAHO, and CHAA (see below for further details of work with organisations focussing on

HIV). One FBO representative noted that in that NGO there is no interest to partner with any health

promotion agency, because the FBO’s main mission is religious.

Activities and services for youth

Several interviewees noted that there were special initiatives in FBOs that aimed to attract and retain

young people as members. These included, for one FBO, “an aggressive evangelistic campaign targeted

at young people.” It was noted that a decline in the influence of the family may contribute to some

extent to challenges in retaining youth, and especially young men.

FBOs have a variety of activities for their youth aimed at their spiritual, physical, relational and

educational improvement. Some of these are spiritual in nature, including Bible reading and prayer, Bible

quizzes, Sunday school, general Bible studies, youth fellowship programmes, leading church worship,

courses on baptism and church doctrine, spiritual forums, conferences and programmes focussing on

morals. There are also discussion sessions on issues such as peer pressure and pre‐marital sex.

Activities that involve physical or cultural activities include summer camps, weekend retreats, sporting

events and non sporting events such as picnics, cookouts, music, concerts, dance, culinary arts,

drumming and drama. Some FBOs offer human and skills development programmes.

Some activities focus on building and improving relationships and interpersonal skills. These include

young adult and singles ministries, leadership development, stress management, and programmes for

young married persons. Programmes planned by youth themselves were said to include topics such

as parenting, financial planning and managing relationships. One FBO had a programme to promote

abstinence, called “Keep your Underwear On”.

One interviewee stated that in his FBO there are no social programmes especially for youth as the

emphasis is placed on parental responsibility to ensure that their children’s needs are met in a balanced

way, through recreation, spiritually and emotionally.

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4.3 HIV-related activities at FBOs

Of 44 survey respondents, only 8 (18%) responded “Yes” to the question, “Does your group currently

provide any kinds of HIV and AIDS‐related activities or programmes” Between 1 and 8 HIV and AIDSrelated

activities or programmes were named by these 8 respondents. Half mentioned only 1 or 2

activities or programmes.

A summary of the types of activities mentioned by these 8 respondents is provided in Table 5. This

shows that all 8 had a focus on HIV/ AIDS education and prevention. Other types of activities were

mentioned only by a minority of the respondents who said their FBOs had HIV‐related programmes.

Only one FBO representative reported conducting HIV testing or referral for testing.

Table 5: Type of HIVrelated programmes or activities provided by FBOs (n=8)

Type of activity

Number of FBOs

HIV /AIDS education & prevention 8

HIV /AIDS risk reduction counselling 3

HIV-related prison outreach 3

HIV-related spiritual counselling 3

Meal (Food) programmes for PLHIV 2

HIV-related bereavement support programme 2

HIV testing services (on site) 1

Referrals for HIV testing 1

HIV-related outreach services 1

The 8 respondents who had HIV‐related programmes or activities were then asked, “What type(s) of

organisation(s) are you currently collaborating with to provide HIV/AIDS‐related services” Table 6

shows that half were collaborating with community groups and smaller numbers were collaborating

with the national or international health agencies. Three were conducting their programmes without

collaboration.

Table 6: Collaboration with agencies by FBOs that had HIVrelated programmes or activities (n=8)

Collaborating agencies

Number of FBOs

Not collaborating 3

Other FBOs 2

Social service agencies 1

Health Departments 2

National AIDS Secretariat 1

Community groups 4

International Agencies (USAID, Red Cross, etc) 2

Other 2

Note: Other = St. John HIV/AIDS Commission, Wycliff Operation Mobilization

CARIBBEAN HIV&AIDS ALLIANCE 31


All eight of these respondents reported that their HIV‐related programmes or activities had resulted in

increased HIV/AIDS knowledge in the congregation. Most (n=7) had conducted counselling on human

sexuality. Half of the FBOs they represented had begun HIV testing or started an HIV ministry. Only one

FBO reported having developed an HIV policy (Table 7).

Table 7: Changes reported as a result of FBO provision of HIV-related services

Reported change

Increased HIV/AIDS knowledge in congregation 8 8

Began HIV testing 4 4

Started an HIV/AIDS ministry 4

HIV/AIDS policy development 1

Counselling workshops on human sexuality 7

Other 2

Number of FBOs

Note: Other = 1. Decrease in young people’s sexual activity (based on internal survey) 2. “More scope for home based care for persons with HIV/AIDS and

caregivers. More training for care-givers who take care of HIV patients at home.”

Of the remaining 36 respondents that stated there were no current HIV-related programmes in their

FBOs, a quarter (n=9, 25%) replied “Yes” to the question, “Have members of your church discussed

beginning any kind of HIV/ AIDS-related programme” Thus, of 44 respondents, only 17 (39%) either

had established an HIV-related activity or programme or had discussed establishing one. However,

interest in deepening the involvement of the FBO in HIV‐related activities was found to be high. The

great majority of participants (37, or 84%) in response to the question, “In fulfilling your church mission,

how important is it for you to establish or further develop an HIV/ AIDS ministry or programme in

order to reduce and prevent the spread if HIV/ AIDS”, said that this was “very important.” A further

11% thought this was “somewhat important” (Fig. 3).

Fig 3.

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All respondents were asked how much they knew about how HIV programmes are planned in

their country. Only 4% said they were “very knowledgeable about this process.” The need for more

information was stated by most respondents. Almost half (48%) said they did not know much, and a

further 36% reported they had some knowledge, but would like more information.

Respondents expressed interest in several forms of support that could assist them in conducting further

health or HIV-related programmes or activities. Table 8 shows the percentages of respondents who

responded to each of these questions (of the 41 or more respondents who answered each question).

Notably, the greatest levels of interest were in support to establish HIV ministries, to build collaborative

relationships with community organisations and to understand health issues among parishioners.

Table 8: Services Churches may be interested in

Services

Percentage of respondents

Fundraising 60%

Conduct Strategic Planning 74%

Manage Volunteers 69%

Understand health issues among parishioners 78%

Establish HIV ministries 83%

Market church programmes to the community 74%

Build collaborative relationships with community organisations 81%

Other 14%

Interviewees in the qualitative component of the research appeared from their responses to be

more involved in HIV-related activities and programmes than most survey respondents. This may be

associated with the fact that they were selected by their church leadership to represent their FBOs’

position on HIV in the interviews, whereas the survey is likely to have reached a broader cross-section

of FBO representatives. Four interviewees said they had an HIV ministry in place. These ministries

included activities such as counselling, a feeding programme done in conjunction with St. Vincent de

Paul, initiatives to provide clothing for PLHIV and assistance to families of deceased PLHIV and leading

a programme called AIDS Care Education Programme. One interviewee reported that the HIV ministry

included the provision of counselling for people living with or affected by HIV, and the involvement of

persons in this congregation in promoting HIV related seminars for youth and adults in the church.

One interviewee reported not having an HIV ministry, but stated that the FBO had passed a resolution

to establish such a Ministry. His enthusiasm for such a ministry is shown in the following quote:

This has been my passion. When it comes to HIV/ AIDS now you will see a different me cause I’ve

been here for 24 years in terms of HIV/ AIDS… I’ve worked with government, I’ve worked with

NGOs, I’ve worked with the police... It’s very big! The [FBO] has accepted that we need to establish

this ministry because Barbados has had its first, it has experience since 1984 with HIV and AIDS

and after 25 years there’s been no ministry. The Church has ministry for Mother’s Union, Men’s

fellowship, youth, even the shutins you go to their home, but no ministry about people with HIV

AIDS, so… that has been a problem.

CARIBBEAN HIV&AIDS ALLIANCE 33


In order for HIV-related initiatives to occur, FBO leaders expressed the need for certain resources such

as a proper infrastructure, space, funding, and assistance with planning programmes. One leader stated

that the FBO he represented was almost ready to carry out HIV-related programmes:

I think now at this stage we are very open and all that we would need to do is to put the infrastructure

in place. We have the resources, we have the plant because we have ample space now, and umm,

we’re in the process of completing, building which is part of the problem in terms of running

programs and workshop and what have you. I don’t think there is anything to prevent us except the

planning of the activities, and distribution of the activities, and enhancing the resources to do so.

Nevertheless, he noted that the HIV-related activities of the FBO would benefit from capacity-building,

technical support and some funding:

We could always do with such some help in, in clarifying and planning programmes, especially

sustainable programmes. I think that we will always need some help, … also in terms of which

resource persons are identified of resource persons, and I believe that depending on the needs of

the programme we may also need access to financial resources.

Interviewees described their personal involvement in HIV-related activities, as well as initiatives that

involve members of their respective FBOs. One interviewee had been involved in promoting an event as

part of the multimedia “Live Up” campaign on HIV run by the Caribbean Broadcast Media Partnership.

He praised the campaign for communicating HIV messages consistently:

It was a good programme cause every time you see… the television every ad that comes over this

television something about HIV! Don’t wait ’til you’re going to have World AIDS Day, Love Safety

Week!

One interviewee was a participant in the South Caribbean District Methodist Conference meeting in

Barbados in which CHAA provided a session on HIV‐related S&D (see section 2.4). This person said

the FBO was planning to implement a training programme for pastors to conduct HIV counselling

and testing, which would include pastors from Guyana and the Leeward Islands. This training

has already been conducted among the FBO’s current pastors during their final year of seminary.

Another interviewee reported that the body of churches in one denomination had hosted a National

HIV Symposium called “Life is Love” two years previously.

Five interviewees mentioned that HIV counselling was provided to persons infected or affected by

HIV. For two of these, there did not appear to be an organised HIV counselling programme. Rather,

counselling and sometimes financial support were provided to people who came forward as HIV

positive. One interviewee noted that the availability of counselling for PLHIV, their relatives and

others affected by the disease was advertised in the Sunday bulletin of the church but there were

challenges in attracting people to come forward. He suggested it could be advertised more frequently,

but even so, some people may prefer to go to another church for counselling rather than risking being

recognised by people in their own church.

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The counselling has been ongoing from 2006 and sometimes you have to remind them in the

bulletin, each Church has a bulletin every Sunday. So it’s not, it’s not there often enough, it needs to

be, people need to be reminded. So, some things you have to go back and do it again, but they’ve

been told that there’s services there. But…. we hardly find people coming out, what may likely

happen is that somebody in a particular Church may not go to the people trained in that Church.

They may go to another Church, which is why, when I train them I always say that somebody may

not come to you, but somebody from St. Lucy, if they know about the service may come to you

because they don’t know you and you don’t know them. But people think if you too close to them,

they don’t want you to know their business may go somewhere else.

In another FBO, a nurse from the local polyclinic was asked to visit the FBO on a regular basis, to provide

HIV counselling and testing along with other health checks such as cholesterol levels and diabetes.

One FBO was reported to provide home based care for PLHIV, including home visits by a volunteer to

assist with housework, support in taking medication, financial assistance, and donation of toiletries on

request: “We have people who have come and ask for things like toiletries, that kind of stuff, and the

church if possible have tried to help in that regard.”This church also partners with the food bank.

HIV/AIDS awareness training from the Barbadian government had been received by one interviewee,

who reported having then done HIV‐related outreach to homeless people. The interviewee noted that

she had noticed an association between HIV and homelessness in Barbados through her work at a

Centre for the Homeless.

“I worked at the Emerald Phillips centre for two years and that’s a government centre for people

who are homeless. Because I was there I realized that um, there was need to work with the families.

The people became homeless because when they were stricken with HIV/ AIDS and their families

did not want them.”

This interviewee worked with the government to provide housing and/ or pay the rents of homeless

PLHIV. The programme was said to cater to 59 persons, and the leader clarified that approximately

three‐quarters of such persons are single, and the rest are cared for along with their families. Although

the food programme is geared toward PLHIV, anyone who needs food, regardless of their HIV status

can ask for assistance, and are not turned away. The FBO also partners with the St. Vincent de Paul

Society and sends persons there if the food bank is out of food. At one FBO, HIV was said to be part of

the teaching curriculum of the Sunday programme, because the Sunday school teacher is a PLHIV and

had disclosed his/her status to the congregation.

Three interviewees expressed that their FBOs had little involvement in HIV activities to date. One stated

that the need for an HIV/AIDS awareness programme has not translated into an actual programme for

the FBO because there needs to be a “champion” toward this cause within the FBO. In another, HIV

is not considered a priority because there is the belief that the incidence of HIV positive members

in the FBO is low. Another interviewee stated that the fact that the FBO refuses to admit that their

youth community is sexually active is a significant barrier to the implementation or possibility of HIV

prevention programmes.

Two interviewees made mention of services that are provided toward PLHIV. A programme has been

implemented to benefit PLHIV at the Holy Family Centre in Wellington Street, which is in an economically

depressed area of the country.

CARIBBEAN HIV&AIDS ALLIANCE 35


The interviewee expressed a desire to use the facility to educate persons about HIV and topics such as

self‐development through activities such as cooking, and activities for their children. These persons

are said to be deprived, or from the lower income bracket. Although she identified there is both a

skill development component and an informational and awareness component, there is no specific

prevention component at the moment, but the interviewee envisioned it to be premised on the

abstinence message promoted in the FBO. Self‐development would also be enhanced, because the

leader believed that “when people see themselves as important and as good, I don’t think that they

would want to, to destroy themselves.”

In another FBO, there is a transportation service for PLHIV through the use of a van that was donated

by an individual in Canada who works in the field of HIV. This individual donated the van to assist in

providing meals on wheels and home cleaning services to PLHIV. This service was initially provided

to PLHIV who are members of the FBO’s churches; however, it is now made available to all churches

in Barbados that have members who are PLHIV who are in need of food, cleaning services, medication,

or assistance to get to the hospital. There were reported to be 6 persons making use of this service.

4.4 Messages around HIV Prevention

HIV prevention messages delivered by FBOs include abstinence for unmarried people and fidelity for

those who are married. Condom use was suggested by some for persons who consider themselves

unable to abstain from sexual activity. One interviewee went to extreme lengths to emphasise the

abstinence message when he said, “Abstinence, abstinence, abstinence, abstinence, abstinence, more

abstinence and abstinence. (Laughs out) Wait until you get married, get tested before you get married”.

Interviewees used terms such as “sexual chastity” and “purity” to describe their outlook on abstinence

and HIV prevention. One leader added that being sensitive toward people infected with HIV was a

message promoted in his FBO. This leader stated that the term “benevolence” is used to describe

this sensitivity toward PLHIV.

Another leader described a five‐step process in messages to be conveyed about how men and women

can protect themselves against becoming HIV positive or infecting others:

One, know your status. Two, abstain until marriage, and be faithful within marriage. Three, if you

are infected, its not a death sentence because you can live for a long time, and have a good life.

Four, the importance of health, healthy life styles, because HIV is only one aspect of it, but taking

care of yourself, eating right, exercise and that kind of stuff. And fifth, you would also want to have

a strong spiritual emphasis, you know, that God can give you the strength to cope and to manage

whatever the situation might be.

Despite the stress on abstinence and fidelity, several interviewees acknowledged different realities:

You know what people are supposed to be doing, and so you’re preaching abstinence, but what is

the actual practice We know that there are a lot of the young people who are still promiscuous.

We know that it’s happening because we see people get pregnant….. [But] in some churches people

kind of bury their head under the sand and pretend that it’s not happening.

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There was the feeling that FBOs should develop messages to address infidelity, but it was not clear

whether this was actually done:

Not everyone in the church has a partner who is in the church, and some men and some women are

in the church and their partners are not, and they have relationships outside of their relationship

with the partner, even though the partner is in the church. So the message… should be clear that

you could get HIV even if, when you are in the church.

In at least four FBOs, there was said to be variation in messages about HIV prevention. Among church

board members, leaders who are older, long‐standing members, whose opinions are strongly expressed,

would be most readily heard. FBOs involve a power structure and the leaders of organisations at church,

national or international levels can influence the nature and content of HIV prevention messages. In

one FBO, the world governing body decides on the appropriate prevention messages with respect

to HIV or other STDs. One leader receives direction from the regional office of the denomination in

Trinidad. Interviewees also emphasised that leaders at local or international level generally engaged

in information‐gathering and consultation before reaching decisions. Within churches, there may be

dissenting voices “but they’re not loud.” This implies that views that do not concur with established

doctrine tend to be ignored.

Some churches had an active programme to encourage abstinence among youth. A message was that

“just one sexual act can throw you over the edge for life”. In one FBO, both male and female youth were

encouraged not to be ashamed to proclaim their virginity. This leader expressed that there was the

understanding that there are youth who may “fall through the cracks, but you still keep loving them

and working with them”. Another interviewee acknowledged that youth tend to be curious about sex,

but said that they are encouraged to abstain and are given educated reasons as to why they should do

so, based on Christian values and principles. Some FBOs used testimonies from people affected

by HIV to reinforce the message. An interviewee gave the example of a female member who spoke of

her experience of nursing her daughter until she died, and the woman was said to have described the

experience in graphic detail. The interviewee recalled,

[She described] terrible suffering and I think that jolted some young people. I mean I have not

heard her message the last five years but I still remember it. It was so vivid, and it was said with

passion when she pleaded with… children and young people about the preservation of themselves.

Opinions regarding condom use varied. Some interviewees completely disapproved condom use,

whereas others acknowledged them as methods of HIV prevention among youth, or as birth control

for married couples. Among the latter condoms were seen as an inferior alternative to abstinence

and fidelity, not to be used “as a first line [of defence]”. Some interviewees stressed that condoms

should only be used by married couples as they were the only people supposed to have sex. This was

somewhat ironic since another interviewee pointed out that husbands are especially unwilling to use

condoms with their wives, though they may be willing to use them with their other partners.

CARIBBEAN HIV&AIDS ALLIANCE 37


One said that, while church leaders would have difficulty presenting condoms as an acceptable HIV

prevention method, it may be appropriate to ask a guest to present the information that may not be

available to young people otherwise:

When you have young children coming up in life they are exposed to everything at school and the

best place for them to learn about sex and whatever is from in the church, they know the right way.

But when they go out there and hear it from people that don’t know how to use a condom… So I’m

saying is not that you want to promote the condom use but … if you have somebody to come in to

do that and show that there are, are ways for preventing to getting HIV, it’s worthwhile.

4.5 Attitudes to vulnerable populations

Interviewees emphasised that certain forms of sexual activity are regarded by Christians as sinful,

namely homosexual sex, sex for financial gain (sex work) and sex outside marriage. This conditioned

the way in which people in FBOs regarded MSM, SW and unmarried mothers – populations vulnerable

to HIV infection. Most interviewees, however, were at pains to emphasise that “God loves the sinner but

not the sin”, so that people who engaged in these acts would not be rejected by the church but efforts

would be made to influence them to stop.

In discussing sex work, one interviewee said that sex work was considered immoral, but not the

individual who engages in it: “The person remains good, because [a person] is made by God and He

says, ‘It was good’.” When discussing homosexuality, another interviewee said:

You can’t stop somebody from having a feeling. It is what he does with the feeling. If he acts it

out it’s a totally different matter... We don’t believe that God dislikes the homosexual. He doesn’t

like what the homosexual does, and so the Church takes that position that he would embrace the

homosexual, but not his act, and the Church makes a distinction between homosexual feelings and

homosexual act.

Likewise, a third interviewee noted that homosexual orientation could be accepted by the church

but sex between people of the same sex could not. He made an analogy between homosexuality and

alcoholism, apparently seeing both as forms of harmful addiction:

They accept that there are persons in the church who were formerly homosexuals. [What they ]

do not support [is] to be practicing homosexuals while in church… It’s like an alcoholic, I would

say, when you go to Alcoholics Anonymous, and you say that you’re an alcoholic you’re always an

alcoholic, if you understand where I’m coming from. So somebody may be in our church, whereas

he may always be a homosexual, but they can’t be practicing homosexuals.

While most interviewees stated that MSM and SW would be accepted into the church more or less on

a conditional basis, in one FBO potential members were said to be screened via an interview prior to

acceptance as members of the faith. People who said they were currently or had ever been engaged in

homosexual acts or sex work would not be accepted.

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The attitude to MSM was generally less tolerant than towards SW and much less tolerant than towards

single mothers. For instance, when asked about what action would be taken if a member of the church

was found to be engaging in sex work one interviewee suggested that the person may be “disciplined”,

though he did not make clear what this discipline entailed. At the same time he emphasised that the

church members would try to help the person stop sex work:

It doesn’t mean that we don’t want to see you or we don’t want you to come to church anymore…

It’s just that we can’t support your actions; the church members will still fellowship with you, talk

with you, you know, interact with you, try to help you through your situation.

In contrast, when asked about action concerning MSM, the person thought the person would be

excluded from the church:

Interviewer: And what would be the, in church, um, actions if somebody who is suspected to be a

homosexual and who’s continuing in the lifestyle

Interviewee: Yes, they’d get... dis -fellowship probably.

Dis‐fellowship meant that the individual’s name was taken off the church books (i.e. the membership

list). This punishment did not necessarily mean that those penalised could not attend the church.

While the individual can still attend services and fellowship, s/he could not lead in church functions

such as conduct a song, do a public prayer, or be part of the platform rostrum. Further in the interview,

the person made reference to MSM being given “the boot” from the church. Another interviewee also

made a distinction between sex workers and MSM when talking about attitudes of people in church

congregations:

If somebody in the church is a practicing homosexual, ok, take for instance if you have somebody

who’s a sex worker, you will find that person will more close on that person, with more light, will

more likely to close on that person than a person who is a practicing homosexual.

Some interviewees noted that the attitudes of the general church members towards HIV vulnerable

populations were somewhat less tolerant than among the spiritual leaders. A typical attitude among

members of the congregation was said to be:

Those people are the people you don’t get involved with, they are the dregs of society, so they’re

really termed social outcast. People, homosexuality, sex workers, people with HIV AIDS, some

people act that way. I don’t think that they are treated that well. Maybe some people still think

that people with HIV/ AIDS should be put somewhere else. Those attitudes have softened, but the

beliefs would be clearly, these are people who are, um, are not welcomed.

It should be noted that the methodology used for this study did not permit statements about

the attitudes of church congregations to be validated via collection of data from members of the

congregations themselves.

CARIBBEAN HIV&AIDS ALLIANCE 39


4.5.1 Attitudes to Sex Workers

Some interviewees expressed views about sex workers that showed empathy or at least a wish

to understand the social circumstances that may lead people to become involved in sex work. One

interviewee wanted to know:

Is it economic Is it a rebellion We need to find out, why do people go into prostitution

They are various reasons, and so, a lot of times though it seems to be economic, people are not,

either they’re not working, or they’re not making enough, and they have children and they have

bills.

Another noted that sex work may not be a matter of choice: “Most people don’t end up doing sex work,

because they say, get up in the morning and say, hey, I can make this my profession!”

One leader suggested the provision of supportive counselling to help a person stop engaging in sex

work. The approach would entail a “kind of affirmation…with the hope that after a period of time we

could have …helped him or her to move on from that kind of activity”. This quote notes the involvement

of both men and women in sex work, while other interviewees seemed to consider only women when

discussing sex work. This leader expressed that “affirmation” in this sense would mean:

Moral support, supporting the individual. I might not necessarily agree with what he or she may

be doing… but I think certainly from the leadership level I think we are open minded enough to be

able to accept that this is the choice somebody has made and help if you want to help to guide…if

that’s what they want.

An interviewee noted that attitudes to sex workers may vary depending on the social status of people

in the congregation: “You will find persons who may come from the upper echelon in society may be

inclined to… actual snobbery”, whereas “persons who have come from a lower status may… be a little more

tolerant and even acceptable.”

4.5.2 Attitudes to men who have sex with Men

As noted above, there was a general attitude that people engaged in “sinful” sexual activity should give

up these activities to enable them to continue their life comfortably within the church. In the case of

MSM, membership in an FBO was highly conditional:

If I was a homosexual male and I had accepted God and I came into the church and… I decided to

walk on the straight and narrow, and… I attended church for a few months and I was doing the

right things and whatever, and I wasn’t practicing, I was a dry gay…

This interviewee noted a level of distrust amongst the male membership toward gay men, whereas

female members were thought to get along better with homosexual men who may have converted in

the FBO. Another leader expressed the view that most church members believe that homosexuality

is not part of God’s intent, and “God will destroy anyone who practices it”. Further, the leader stated,

“God made males for females”.

Most interviewees stated that their congregations did not include any openly gay, lesbian, bisexual or

transgender (GLBT) members. They expressed that GLBT members were generally not known or were

only suspected or rumoured. One leader expressed having knowledge that there are GLBT persons in

the FBO who have not disclosed their sexual orientation.

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Two FBO representatives indicated that there were GLBT members who had approached leaders for

assistance or counselling. In one case, members who were made aware of the person’s situation prayed

for the individual to renounce his lifestyle. However this person was not ostracised by the church

members because of his sexual orientation. One of the interviewees stated that someone known to be

a practicing GLBT would only be considered/ accepted as a spiritual leader, only under the condition of

renouncing his/her lifestyle and converting to a Christian way of living.

A concrete example was given by one interviewee of how a transgendered man was treated when he

attempted to join a church:

When I was working at the clinic there was a gentleman that I, who I used to look after. He was

transgendered, and he subsequently became a Christian, he was actually one of the top drag queens

in Barbados. When he accepted and became a Christian, accepted and he was attending church on

a regular basis and stuff like that, but his problem was that he was never closened … They never

close with him. None of the men, the men didn’t trust him.

In this example the person became a church member but there was still a certain level of social ostracism

as people (men in particular) did not trust him and did not get close to him.

One leader noted that he had personal experience of counselling MSM living with HIV and expressed

his view that many of these individuals lacked direction and self‐esteem. He emphasised the belief that

sex between men was not motivated by emotion or love:

A lot of the, the, the young men, who, who come and are HIV positive, are homosexual and when

you begin to talk to them, you realise that they have no sense of their self and therefore they allow

themselves to be used, so they get into this act, so it’s it has nothing about emotion or love or

anything like that you know. It has nothing to do with that. Nothing at all. Some of them were

abused as young people, and they get, and so they just, um, and I see them as being used.

While the statements above show at least some ambivalence towards, if not rejection of homosexual

behaviour, there was some inconsistency in the accounts of interviewees, in that several of them claimed

that MSM were treated the same way as other people in the church. For instance, one leader made

reference to a gay man who sought counselling in reference to his homosexual lifestyle. Members who

were aware of his situation prayed for him, and the leader noted he was not ostracised, even though the

individual did not denounce his lifestyle. She stated, “He expected us to accept him. We have.” Another

leader noted that homosexual and bisexual persons are treated “normal”. One interviewee expressed

uncertainty about how MSM would be treated in the FBO, based on his perception that there were

few members who were MSM. However, he believed that MSM, like a vagrant or unkempt person, would

be welcomed into the church hall, and “a few people might express an opinion, but generally speaking, I

think they’ll probably say we’re happy you’re here, you know, we can wait on you to do adjustments right.”

No FBOs in the interview sample had regulations or guidelines regarding homosexual sex or sex work,

except where FBO leaders were discovered to be engaging in these activities, in which case disciplinary

action could be taken by several of the FBOs.

4.5.3 Attitudes to Single Mothers

Unmarried mothers are not generally considered populations most at risk of HIV according to

international agencies such as UNAIDS. However, in the Caribbean context, they may be considered a

vulnerable population.

CARIBBEAN HIV&AIDS ALLIANCE 41


They may have less access to resources than married women and are subject to gender norms that prevent

condom negotiation and may encourage sequential partnering in order to achieve social status and economic

security for themselves and their children. Unmarried fathers are rarely charged with so much responsibility

for childcare as unmarried mothers and may be less vulnerable regarding involvement in transactional sex

(12, 13). While a large proportion of births in Caribbean countries take place outside marriage, this practice

remains subject to societal disapproval, especially from FBOs which traditionally uphold the value of marriage

and hold negative views of sex outside marriage. FBO views of single mothers were therefore explored in this

research.

Single motherhood was noted to occur in all the FBOs. In general, single mothers were said to be accepted,

received, and offered help, despite the fact that having children outside of wedlock is considered sinful

behaviour. In some FBOs, single mothers were highly regarded as being significant members of the

congregation. Yet, there is still a certain disapproval attached to the fact of persons engaging in pre‐marital

sex, which explains why single mothers in at least one FBO were described to be “tolerated”. This interviewee

said that if a woman has several children with different fathers, none of whom are apparently in a partnership

with her, the individual is thought to be promiscuous.

However, single parenting is not discussed in the same manner as sex work. Single mothers are permitted to

attend church and are allowed to function “to a certain level”, whereas sex workers are not typically afforded

this opportunity. It was not clear from this interviewee to what “level” single mothers are allowed to function

within the church.

Members of some FBOs are encouraged to provide special assistance to help, such as with managing their

children and assisting with finances. FBOs are also said to assist single mothers with coping to deal with the

“stresses, anxieties and fears” associated with being pregnant as a teenager or being a single mother. Through

a programme from the St. Vincent de Paul Society, at one FBO, an un‐wed mother is assigned to someone such

as a nurse or teacher who would be responsible for their wellbeing and to provide monetary, spiritual and

physical assistance. In another FBO, if a teenage member of the FBO becomes pregnant, an adult would be

asked to provide individual support to the teenager. It is suggested that the teenager would be embraced, and

members would try to prevent that individual from feeling ashamed. It is left to the adult who is assigned to

the teenager to relay prevention messages and guide the teenager accordingly. However, the leader noted that

“sometimes they come back with a second child within a year or two”.

Financial and practical support were offered by several FBOs. For example:

If a mother have five or six children and she is not working we supply them with groceries when the

month come. That fund also helps to pay light and water or whatever. We also seek to find work for them

in some capacity where they are able to help themselves, even if the home wants repairing, the house

they’re renting. We try to assist them wherever … we find work for some of them… we try to place the

children where they can get their meals, although [they] get food … they’re still entitled to food here at

the church on Thursdays.

The procedures in dealing with single mothers varied. In one FBO, a member who is a teenager and becomes

pregnant is “spoken to”, with the implication of being admonished for her behaviour. There appears to be

stricter measures taken toward older women who hold positions of leadership in the FBO and become

pregnant. This is because it would appear to be “strange” in that the pregnancy would be an indicator that the

woman had acted in discordance with church messages of abstinence.

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In another FBO, persons who hold an office of authority would not be “cheated” from that particular position;

however, there is the inference that this would be the case if a single mother engaged in cohabitation. In one

FBO punishment for becoming pregnant outside marriage could include a period of prohibition from

leading services or other church functions.

4.6 Attitudes to PLHIV

For the most part, interviewees expressed having an accepting attitude toward PLHIV based on Christian

notions of compassion. According to one interviewee, PLHIV are to be treated “as human persons, as

anybody else because they have a right to be treated as human persons”. This interviewee went on

to say that they should be treated “as persons with another disease, whether it’s diabetes or hypertension”.

Interviewees generally stated that PLHIV were welcome as members of the FBO. One interviewee seemed to

indicate that PLHIV would be welcome in the FBO based on the idea that the church provides sanctuary for

those who are sick and needy. He stated that there “ought to be no limitations” as the church is considered to

be “like a casualty department”.

In fact, in two instances the existence of PLHIV who held active positions within the church was

acknowledged. In one church, two individuals were mentioned, whose HIV status had not been made

known to the membership. The interviewee suggested that if members discovered that these members were

HIV positive, they would still be able to function within the church “in their own way”. However, he suspected

that they would not receive as much support from the other church members.

They are all up in everybody and they hugging and whatever but I always ask myself, ‘If they really knew,

if they would get that same response’ They would not! Not from the Barbadian mentality.

In the second case, the church member was said to be “fairly well accepted in the church” in which members

were said to be aware of the individual’s status. . Marks of affection and caring had been observed during

services where persons would be seen hugging that PLHIV member “like everybody else”. The interviewee,

however, suggested that sympathy for this person may have been enhanced by the fact that it was thought

that the member had been infected by his now deceased spouse.

Indeed, several interviewees noted that the way an individual gets infected with HIV was a determining factor

in the way members treat PLHIV. Persons who were infected with HIV through what was perceived by church

members as socially deviant behaviours (such as through homosexual intercourse, or intercourse with a sex

worker) they would be treated differently, as opposed to those who were infected with HIV through, sexual

intercourse with their spouse. More support would be given towards such a person as it was believed he

would have been infected “through no fault of [his] own. Discussing a woman who had been infected by her

husband, one interviewee said:

Some people were sympathetic to her plight. A lot of people can kind of see themselves in that scenario

where, say, they’re married and figure that my husband will be faithful and you know, the whole story

so. From that perspective she got sympathy, unlike persons like suppose somebody had ten different

sex partners, or they were MSM or whatever. Those persons tend not to be seen in such, guess they take

a harder burning for it, like people, the judgmental generally speaking. That’s one of the challenges in

terms of a programme that reaches out to people with AIDS.

Not all FBOs were said to be welcoming toward PLHIV. One leader gave the example of a woman whose

responsibility was to clean the church. When the woman died it was discovered that her death was HIVrelated.

During the funeral, the corpse was not brought into the church, but was driven straight to the cemetery.

CARIBBEAN HIV&AIDS ALLIANCE 43


4.7 Stigma and Discrimination

Some interviewees expressed their belief that there was little S&D against PLHIV in the FBOs they

represented. Two believed that levels of S&D had been greatly reduced in the FBO as a result of teachings

on the subject during church services. One of them said

The Church has developed a lot of tolerance, and that is one of the things we are working on in the

Church right now…. People might say, ‘You know, it’s not my lifestyle’, but you know, they’re not

going to refuse to shake his hand or anything when they greet the priest, no.

Another interviewee noted that there was still a lot of sensitivity about HIV among churchgoers and

that they are “guarded” in their attitude to PLHIV.

[HIV is] still a very sensitive issue, in terms of people being HIV positive. Even though we know

they have membership who are [HIV positive], most people don’t say it. No one wants to hear, ‘I

am positive, what is your status’ Most people tend to be a little guarded, even in a church setting

where they supposed to be faithful, trust, and love and all those kinds of things….No, but I’m being

honest

This interviewee believed that S&D in that church did not differ significantly from that in the wider

society of Barbados.

4.7.1 Stigma and Moral Judgements

As noted above, attitudes to vulnerable populations were conditioned by the idea that they engage in

“sinful” activity, and such attitudes were extended to PLHIV who were presumed to have engaged in

these activities. HIV was still often regarded as associated with homosexual practices:

HIV when it first started out, it was basically a homosexual disease; it has transitioned to being a

heterosexual disease now [but] people have not really seen it as, seen the transition, they’re still

seeing it as, if you get this, you or somebody that you were with, were behaving in dirty practices

As noted in the section on attitudes to PLHIV, S&D would be influenced by perceptions regarding means

of HIV transmission:

[Acceptance] probably would depend on where they’re coming from, in terms of if they see them as

somebody who’s a victim. They would embrace that person because they are seen as a victim and

they’re trying to help the victim…If they see the person as somebody who went looking for it, you

know how it is, a kind of Bajan kind of thing. If they went looking for it and found it, you know a lot

of them then might not.

This quote uses the common West Indian expression indicating that a person who “looks for” trouble

through undesirable behaviour deserves the consequences.

4.7.2 Fear of casual contact with PLHIV

In Barbados, there was little evidence from the semi‐structured interviews that fear of casual contact

was a major motivating factor for S&D. One interviewee noted that, despite education, persons would

perhaps always be “scornful” toward PLHIV, even though it appears to be widely known that HIV cannot

be transmitted “like the common flu”.

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Thus scorn appears to be based on moral censure rather than fear of infection. At the same time, our

survey results (see below) and some interview statements suggest that people are unwilling to be in

close physical contact with PLHIV. For example, “Still today, there are people who don’t want to drink

from the same Communion cup. You still have that.”

One interviewee noted that PLHIV should be treated like anyone else because the risks of infection

from casual contact were minimal:

Just as we treat anybody else, that’s the first thing, we need to treat people as we like to be treated,

because infection is not transmitted by social activity or social intercourse, it’s transmitted by

sexual intercourse, OK. So sharing a meal, hugging, sitting, chatting, sharing the same bed, as long

as the person’s blood doesn’t get into your body. Sharing the same utensils, toilet, bath. So that

it’s not transmitted by having ordinary contact with people, everyday contact, that’s a very strong

message that we have to let them know. And so they must be treated the way everybody else needs

to be treated, because their rights are human rights, their concerns are human concerns. They’re

no different from anybody else.

In this statement by a person who was heavily involved in HIV prevention activities, the argument

seems to be that a way to try to reduce S&D in the congregation may be to promote the view that risks

of casual contact are minimal.

4.7.4 Lack of confidentiality of Personal Information

In at least one FBO, the issue of confidentiality was thought important. The leader made reference to

“learning by mistake” in that a person’s HIV status became known at one church in the denomination

he represented, and suggested that “you have to keep [HIV positive status] under wraps”.





Q. How many of your members or congregants do you think would accept an HIV positive

person into fellowship

A. We do accept them; we do because we have a good few. But the confidentiality is what

you have to keep under wraps.

Q. Okay you mean if the congregants don’t..., once the members don’t know it would be

fine

A. Yeah I don’t know how well as I tell for one church [in this denomination] that happen.

So since that happen at one… church we don’t give out that type of information, we don’t

say anything any more. When you learn by one mistake you don’t wait for a second one.

Information on FBO members who are sick is now kept confidential, and volunteers in the church were

said to be sworn to secrecy regarding the identity of PLHIV. This interviewee suggested the need for the

development of “leaflets” containing guidelines for FBO members on appropriate treatment of PLHIV.

4.7.5 Measurement of HIV-related Stigma

The survey included responses to a scale to measure perceived levels of S&D among church congregations

and communities.

Table 9 gives the reports of survey participants on the S&D‐related perceptions of members of FBO

congregations. The scale of 0 to 3 was used to quantify the responses which represent the following

possible answers: No one (0), Very few people (1), Some people (2) and Most people (3). Table 9 and

Fig. 4 provide scores on each indicator. The diagram ranks the statements from those that elicited

responses indicating the highest level of stigma to those indicating the lowest.

CARIBBEAN HIV&AIDS ALLIANCE 45


Table 9 shows that S&D in church congregations, across all indicators, covered the full spectrum from

“no one” holding stigmatising views to “most people”. Across the ten indicators, there were six median

scores of 1 or 0, showing that half of respondents thought that no one or very few people held the views

expressed by these six indicators. Levels of stigma appeared higher for the other four indicators. This

was reflected in the highest average scores for these indicators, showing fears about casual contact

concerning sharing food and drink and that some people think that PLHIV have done wrong. Attitudes

indicating extreme rejection of PLHIV, such as that people would avoid visiting the homes of PLHIV or

that PLHIV are disgusting, were thought to exist among very few members of FBOs.

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CARIBBEAN HIV&AIDS ALLIANCE 47


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4.8 Future Programmes

As noted above, 79% of survey respondents thought it was very important to establish or further

develop an HIV and AIDS ministry or programme. Likewise, several interviewees expressed interest

in deepening the involvement of their FBOs in HIV prevention, care and support. However, one

pointed out that the ability of individual FBOs to become involved would depend on decisions of the

denominational leadership:

Whatever we do we still have to take it to the Bishop, we can’t do anything, anything on our own.

Even this meeting that I have I would have to let him know what went on in the meeting. He has

the last say.

A major interest was in the development of programs targeting young people. Typically, an interviewee

expressed the wish for them to become

more aware and more exposed to the dangers of HIV/AIDS. Some of them are a little, a little too I

wrestle with that a lot a little too careless or callous or, what you would say, don’t carish about the

effect that HIV and AIDS can have. I think that they need to be more aware of the dangers.

Another leader expressed the view that there are many young persons who are affected by HIV “through

no fault of their own.” As such, this leader expressed interest in seeing an HIV‐ specific programme for

young adults, and the leader stated that the FBO would be willing to conduct this.

For some interviewees, HIV initiatives for young people should be included within broader initiatives

for youth development. Church leaders would address faith issues as well as other youth‐relevant

topics. In one FBO, a determination of future programmes would involve consultations with young

people.

So my first thing will be, what is it that the youths want to do If the youth want to maybe have

some parts of the service done differently, or they want to use different kinds of music Or what is it

that they want I wouldn’t want to set out a programme for them. I want to find out what it is they

want… If they establish a program, they own it and they will support it. If you have a programme

and you give to them a top down, chances are they may not support it.

This interviewee suggested that future programmes in the FBO should target young men. They should

be encouraged to assume more active roles in the Church, such as within the lay ministry. He believes

involving men as mentors would encourage positive sexual behaviour.

Similarly, another interviewee noted that special efforts, involving practical community‐oriented

activities, should be made to include men in efforts to prevent HIV, since male attendance at church

was low:

We have for example the men’s fellowship and we think that needs to be a little more practical in

terms of getting men to do things rather than emulating the women and coming to sit down and

pray and sing hymns for an hour, hour and a half. I think if we had men doing more community

oriented activities that there would be a larger percentage of men in the organization and

consequently in the church. I also think that the questions that we are answering are very often

not the questions that men are asking and we tend to answer the questions that women are asking.

CARIBBEAN HIV&AIDS ALLIANCE 49


Engagement of men could be promoted by active discussion of living longer and of masculinities:

I think that men ask a lot of more questions about….. the issue of not so much health but perhaps

longevity, (Laughs) the issue of of of role, what it mean to be a man within the context of the

society, within the context of the church, within the context of the family. I think these are some of

the fundamental issues that for some reason we have not really addressed.

Two interviewees expressed interest in developing initiatives with people as young as 12 years old.

One reasoned that many Caribbean young people are sexually active from around age 10 and therefore

it is important to address issues such as parenting responsibilities and skills. Another noted that

intervening at a young age had the potential to mould later behaviour and to ensure conformity with

church teachings. Interventions should begin

before they begin to become too sexually aware of who they are, so it can tie them in with what

is expected behaviour and hopefully the expected outcome will be what we’ll be looking for in the

children.

One interviewee explicitly expressed an interest in providing HIV counselling and testing, and noted

that plans had been put in place for this. A facility had been identified in Bridgetown that required

renovation and it was anticipated that the service may be available “in a couple of years”. This

leader also expressed a desire to establish a gym and a variety of health checks as part of a holistic

health programme.

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5. Discussion

This study is the most wide‐ranging to date of the engagement of FBOs in Barbados in HIV activities

and programming. A combination of qualitative and quantitative methods was used to generate both

in‐depth knowledge of context, values and experiences and survey data on the extent and types of

programmes and approaches in a broad range of FBOs. There are nevertheless some study limitations:

1. The report focusses only on Christian FBOs. It therefore presents some salient issues for the

majority of people in Barbados who are of Christian faith, but does not cover the concerns of

people from other faiths such as Hinduism, Islam or Rastafari.

2. To protect privacy, the research team has not disaggregated the results by organisation or

denomination.

3. Random sampling methods and statistical sample size calculations were not used in the

selection of the FBOs included in the survey component of the research. Thus the FBOs

included may not represent the picture for FBOs in Barbados as a whole.

4. The use of qualitative methods to generate much of the data on FBO representatives’ views and

attitudes is appropriate for understanding a situation through the voices and perceptions of

participants, but this approach limits generalising the results.

Low involvement but high interest in HIV related activities

The 2004 CCC study among 259 FBOs across 16 Caribbean countries generated some data that can

be compared with the present study. In the CCC study, 53% of agencies reported they were already

involved in HIV/ AIDS initiatives, and a further 36% were not involved but interested in being involved.

In contrast, in Barbados in 2010, only 18% reported that their group currently provides any kinds of

HIV and AIDS‐related activities or programmes. However, 84% stated that it was “very important” to

establish or further develop an HIV/ AIDS ministry or programme. Though the percentage involved in

HIV activities appears lower in Barbados than in the pan‐Caribbean study, the interest in expanding

involvement is very high.

In the CCC study, 69% indicated that involvement in HIV‐related activity included education and

awareness, 22% counselling, 15% support including shelter, food and clothing, financial assistance

and visits and 6% clinical services. The small number indicating involvement in HIV activities in

Barbados (n=8) likewise emphasised the focus on education, awareness and counselling, with some

also focussing their attention on the other areas covered in the CCC study. In Barbados, broader healthrelated

activities carried out by far larger numbers of FBOs also focussed predominantly on health and

wellness, counselling and outreach for the broader community as well as the congregation. Given the

expressed interest in expanding HIV activities, the existing structures for FBOs’ broad health‐related

activities could be employed.

Need to deepen the involvement of FBOs in HIV programming

The study revealed the involvement of FBOs in policy‐making and programme design at national level,

notably through major involvement in the National HIV/ AIDS Commission’s structures and activities.

It is remarkable, therefore, that relatively few FBOs in the survey (18%) reported involvement in HIVrelated

programmes. A possible explanation is that the NHAC may traditionally seek the involvement of

high‐profile church leaders and that the broader population of FBO ministers and congregations have

been less involved to date.

CARIBBEAN HIV&AIDS ALLIANCE 51


The leaders who have been involved may furthermore have had little impact on the practical

involvement of FBOs in provision of HIV‐related services. The implication is that greater efforts should

be made to provide practical skills and tools for FBOs to set up HIV‐ related programmes. CHAA and

other non‐governmental agencies can complement the work of the government and FBO leaders in

providing skills in, for example, building collaborative relationships with community organisations,

marketing church programmes to the community, understanding health issues among the congregation,

strategic planning, managing volunteers and fundraising.

Dimensions of stigma and discrimination

The standard point of departure in defining stigma is the work of Erving Goffman, who described it

as “an attribute that is deeply discrediting” and results in the reduction of a person or group “from

a whole and usual person to a tainted, discounted one” (cited in (1)). One aspect of stigma is fear of

casual contact and refusal of contact with PLHIV (1). A study carried out in Barbados in 2009 examined

stigmatising attitudes concerning casual contact or willingness to include PLHIV in church activities

among approximately 150 churchgoers. It was found that on most items, a minority (less than 15%)

exhibited stigmatising attitudes. However, with regard to accepting communion from a priest/

minister/pastor who is known to have HIV infection or AIDS, the percentage of people with stigmatising

attitudes was much higher. In our study, stigmatising attitudes were most apparent with regard to

fears of casual contact regarding sharing food and drinks, according to quantitative stigma indicators.

Another aspect of stigma that has perhaps received less attention in anti‐stigma initiatives in Barbados

concerns values: shame, blame and judgement (1). Our study revealed that FBOs were interested

in becoming involved in efforts to reduce HIV‐related stigma and discrimination and in providing

care and support to PLHIV, based on Christian notions of compassion for the sick and needy. At the

same time attitudes to PLHIV were conditional on judgements regarding the morality of their past

behaviour. It was said that PLHIV could expect to receive support from FBOs if they were “victims”

of HIV transmission as opposed to if they “went looking for it”. An example given of a “victim” of HIV

transmission was of a wife infected via the infidelity of her husband. In contrast, people who contracted

HIV through infidelity, multiple partnerships and especially through sex work or homosexual relations

were seen as blameworthy. Acceptance into the church of SW and MSM was also conditional on them

renouncing their “sinful” sexual activities.

This division of PLHIV according to perceived innocence or guilt is in fact stigmatising since it effectively

separates the “whole or usual” PLHIV from the “tainted, discounted ones”. It results in what is termed

“compound stigma” in which HIV stigma is layered on top of pre‐ existing stigmas, especially towards

MSM and SW (1). It is clear that the professed wish to reduce stigma towards PLHIV may in fact be

conditional on the “types” of PLHIV concerned.

In areas such as support and empowerment for key populations such as SW and MSM, an effective

strategy may be for NGOs such as CHAA to provide the bulk of services and interventions while FBOs

concentrate their attention on developing prevention and support strategies for the general population

whose behaviour is assumed to be less deviant. Along the same lines, FBOs can build on their strengths

in seeking to promote abstinence and fidelity, leaving condom promotion to other agencies for which

this provides less of a moral dilemma.

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The potential reach of FBOs

Most of the population of Barbados profess a religious faith, with female members of Christian FBOs

outnumbering males. Churches have a strong infrastructure that already supports numerous health

and welfare initiatives and events as well as community outreach. Through this the potential

impact of HIV‐related activities by FBOs is immense, though there remain weaknesses with regard to

the involvement of men. Considering that in many cases congregants are mainly women, HIV‐related

activities may have an impact on them, but not on the men who do not attend church.

CARIBBEAN HIV&AIDS ALLIANCE 53


6. Recommendations

Recommendations arise from key findings of the study.

KEY FINDING 1

The potential reach of HIV -related activities by FBOs is considerable, and most respondents expressed

interest in expanding their involvement.

RECOMMENDATIONS

1. The NHAC and its partners should continue to seek to strengthen FBO involvement in the

expanded HIV response in Barbados

2. FBOs are instrumental in the effective engagement of women in the national HIV response

3. The NHAC and its partners should encourage and support FBOs in their efforts to integrate HIV

into health promotion and build on their existing health promotion work.

4. Consultations with youth should take place to ensure the development of relevant, attractive

approaches to HIV prevention and care

5. To attract men to participate in HIV programmes via FBOs, they should be encouraged to

assume more active roles in the church, be engaged in community‐ oriented programmes, be

involved in mentorship programmes and included in discussions about meanings of masculinity

and ways to prolong their lives.

KEY FINDING 2

Few FBOs were reported to be currently engaged in HIV related activities or programmes, but most

expressed interest in receiving support to develop these.

RECOMMENDATIONS

1. Efforts should be made by the NHAC and high‐profile FBO leaders to deepen the involvement

of other FBO ministers and ordinary church members in the HIV response.

2. Greater efforts should be made to provide practical skills and tools for FBOs to set up HIVrelated

programmes. CHAA and other non‐governmental organisations can complement

the work of the government and FBO leaders in providing skills in, for example, building

collaborative relationships with community organisations, marketing church programmes

to the community, understanding health issues among the congregation, strategic planning,

managing volunteers and fundraising.

3. International best practices should be followed in developing and deepening the involvement

of FBOs in HIV work.

KEY FINDING 3.1

Highest levels of stigma measured in our study related to items expressing fear of casual contact

regarding sharing food or drink.

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RECOMMENDATIONS

1. Fear of casual transmission and refusal of contact with PLHIV should continue to be contested

via public information and sensitisation campaigns

2. Being trusted purveyors of information, FBOs can continue to be at the forefront of such

educational efforts

3. Scientific information on risks of transmission via food and drink should be presented

KEY FINDING 3.2

Attitudes to PLHIV were conditional on judgements regarding the morality of their past behaviour.

People perceived to have contracted HIV through infidelity, multiple partnerships and especially

through sex work or homosexual relations were seen as blameworthy.

1. In areas such as support and empowerment for key populations such as SW and MSM, NGOs

such as CHAA should provide the bulk of services and interventions while FBOs concentrate

their attention on developing prevention and support strategies for the general population

whose behaviour is assumed to be less deviant.

2. FBOs can expand HIV counselling and testing options for the general population.

3. FBOs should debate the values they associate with HIV/ AIDS and how these can serve to

differentiate between individuals who “deserve” and “do not deserve” full access to high quality

HIV care and support.

KEY FINDING 4

FBOs promoted abstinence and fidelity as their main HIV prevention methods

RECOMMENDATION

1. The NHAC and its partners should continue to support FBOs in specialising and developing

their skills in promoting abstinence and fidelity

2. A range of governmental and non‐governmental agencies should lead condom promotion

strategies for HIV prevention.

CONCLUSION

The information in this report may be utilised to extend the options for reaching people at risk for

HIV transmission and PLHIV through partnerships with FBOs. Informed by these findings, further

collaboration between FBOs, the NAP, NHAC, CHAA and other agencies, will augur well in increasing

the impact of HIV prevention and care programmes in Barbados.

Working with FBOs holds the promise to:

• Improve HIV care and support

• Change social attitudes in the interest of reducing the impact of HIV and reduce S&D against

PLHIV and other vulnerable populations

• Increase knowledge on HIV and STIs and

• Uphold the value of compassion.

CARIBBEAN HIV&AIDS ALLIANCE 55


Appendices

APPENDIX 1: Consent Forms

1. CONSENT FORM FOR POTENTIAL RESPONDENTS IN SURVEYS

CARIBBEAN HIV&AIDS ALLIANCE

&

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

Study Title:

SURVEY INFORMATION SHEET REGARDING PARTICIPATION IN A RESEARCH STUDY

Eastern Caribbean Community Action Project Needs Assessment of Faith-Based

Organisations’ Willingness to Participate in HIV Prevention and Services

This is a research study about working with faithbased organizations to develop strategies to prevent

the spread of HIV, to encourage HIV testing and to provide care and treatment services to people with

HIV. The study researchers from the Caribbean HIV and AIDS Alliance will explain this study to you.

Research studies include only people who choose to take part. Please take your time to make your

decision about participating. If you have any questions, you may ask the researchers.

You are being asked to take part in this study because you are a person working at a faithbased

organisation.

Why is this study being done

The purpose of this study is to learn more about culturally appropriate faithbased strategies we can

develop in order to reach people at risk for HIV and to develop services for people living with HIV and

AIDS.

Who pays for this study

The United States Agency for International Development (USAID) pays for the conduct of this study,

including paying the study researchers. Other than fees for interviews, the data collection team has no

financial interest in this study or its outcomes.

How many people will take part in this study

About 200 people will take part in this study in four countries (50 per country).

What will happen if I take part in this research study

If you agree, the following procedures will occur:

• You will be interviewed using a questionnaire administered by a researcher.

• The survey will take about 20 minutes to complete.

• All these procedures can be done at your organization’s office, or, if you prefer, at the office of

the Caribbean HIV and AIDS Alliance at Beaumont House, Hastings, Christ Church.

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CARIBBEAN HIV&AIDS ALLIANCE


How long will I be in the study

The interview will take a total of about 20‐30 minutes.

Can I stop being in the study

Yes. You can decide to stop at any time. Just tell the study researcher or staff person right away if you

wish to stop being in the study.

Also, the study researcher may stop you from taking part in this study at any time if he or she believes

it is in your best interest, or if the study is stopped.

What side effects or risks can I expect from being in the study

• It is possible that you may feel uncomfortable during the survey, but you are free to decline to

answer any questions you do not wish to answer or to stop answering questions at any time.

• For more information about risks and side effects, ask one of the researchers.

Are there benefits to taking part in the study

There will be no direct benefit to you from participating in this study. However, the information that

you provide may help health professionals better understand/learn more about faithbased strategies

for preventing the transmission of HIV and about how HIV providers can work with faithbased

organizations to improve services.

What other choices do I have if I do not take part in this study

You are free to choose not to participate in the study. If you decide not to take part in this study, there

will be no penalty to you.

Will information about me be kept private

All the information you give in the interview will be kept confidential.

Organizations that may look at and/or copy your research records (without your name or other

identifying information) for research, quality assurance, and data analysis include:

• The University of California San Francisco’s Committee on Human Research

• The United States Agency for International Development (USAID)

• The International HIV/AIDS Alliance and their regional office, the Caribbean HIV and AIDS

Alliance

If information from this study is published or presented at scientific meetings, your name and other

personal information will not be used.

What are the costs of taking part in this study

The only cost of taking part in this study is your time

Will I be paid for taking part in this study

You will not be paid for participating in this study.

CARIBBEAN HIV&AIDS ALLIANCE 57


What are my rights if I take part in this study

Taking part in this study is your choice. You may choose either to take part or not to take part in the

study. If you decide to take part in this study, you may leave the study at any time. No matter what

decision you make, there will be no penalty to you.

Who can answer my questions about the study

You can talk to the interviewer or to the researcher below about any questions or concerns you have

about this study. Contact the Evaluation Director at the Caribbean HIV and AIDS Alliance, Dr. Caroline

Allen on (1 246) 228 4306 or the researcher Dr. Janet Myers at UCSF at 1 (415) 597‐8168.

If you have any questions, comments, or concerns about taking part in this study, first talk to the

researcher (above). If for any reason you do not wish to do this, or you still have concerns after doing

so, you may contact the office of the Committee on Human Research, UCSF’s Institutional Review Board

(a group of people who review the research to protect your rights).

You can reach the CHR office at 415 476 1814, 8 am to 5 pm, Monday through Friday. Or you may write

to: Committee on Human Research, Box 0962, University of California, San Francisco (UCSF), San

Francisco, CA 94143, USA.

CONSENT

You have been given a copy of this information form to keep.

PARTICIPATION IN RESEARCH IS VOLUNTARY. You have the right to decline to be in this study, or to

withdraw from it at any point without penalty or loss of benefits to which you are otherwise entitled.

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CARIBBEAN HIV&AIDS ALLIANCE


2. Consent Form for potential participants in semi-structured interviews

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

INTERVIEW INFORMATION SHEET REGARDING

PARTICIPATION IN A RESEARCH STUDY

Study Title: Eastern Caribbean Community Action Project Needs Assessment of Faith‐ Based

Organisations’ Willingness to Participate in HIV Prevention and Services

This is a research study about working with faithbased organisations to develop strategies to prevent

the spread of HIV to at‐risk people, to encourage HIV testing and to provide care and treatment services

to people with HIV. The study researchers from the Caribbean HIV&AIDS Alliance or from the University

of California, San Francisco will explain this study to you.

Research studies include only people who choose to take part. Please take your time to make your

decision about participating, and discuss your decision with your family or friends if you wish. If you

have any questions, you may ask the researchers.

You are being asked to take part in this study because you are a staff member at a faithbased organisation.

Why is this study being done

The purpose of this study is to learn more about culturally appropriate faithbased strategies we can

develop in order to reach people at risk for HIV.

Who pays for this study

The United States Agency for International Development (USAID) pays for the conduct of this study,

including salary support for the study researchers. Other than salary support, the researchers have no

financial interest in this study or its outcomes.

How many people will take part in this study

About 40 people will take part in this study in four countries.

What will happen if I take part in this research study

If you agree, the following procedures will occur:

• The researcher will interview you for about an hour and a half (90 minutes) in a private room.

The researcher will ask you to describe your role in your organisation and to describe whether

your organisation currently conducts any work related to HIV prevention, your organisation’s

willingness and capacity to do so, and barriers and facilitators to doing that kind of work.

Questions will also explore the level of HIV‐related stigma existing among your organisations

and its parishioners and what approaches and points of entry you consider useful to your

faithbased organisation to conduct HIV prevention and to decrease stigma.

• The researcher will make a sound recording of your conversation. After the interview, someone

will type into a computer a transcription of what’s on the tape and will remove any mention of

names. The sound recording will then be destroyed.

• Study location: All these procedures will be done in a private space that is convenient for you,

most likely in your church.

CARIBBEAN HIV&AIDS ALLIANCE 59


How long will I be in the study

Participation in the study will take a total of about 90 minutes.

Can I stop being in the study

Yes. You can decide to stop at any time. Just tell the study researcher or staff person right away if you

wish to stop being in the study.

Also, the study researcher may stop you from taking part in this study at any time if he or she believes

it is in your best interest, if you do not follow the study rules, or if the study is stopped.

What side effects or risks can I expect from being in the study

• It is possible that you may feel uncomfortable in the interview, but you are free to decline to

answer any questions you do not wish to answer or to leave the group at any time.

• For more information about risks and side effects, ask one of the researchers.

Are there benefits to taking part in the study

There will be no direct benefit to you from participating in this study. However, the information that

you provide may help health professionals better understand/learn more about faithbased strategies

for preventing the transmission of HIV to at‐risk people and about how HIV providers can work with

faithbased organisations to improve services.

What other choices do I have if I do not take part in this study

You are free to choose not to participate in the study. If you decide not to take part in this study, there

will be no penalty to you.

Will information about me be kept private

We will do our best to make sure that the personal information gathered for this study is kept private.

However, we cannot guarantee total privacy. Your personal information may be given out if required

by law. If information from this study is published or presented at scientific meetings, your name and

other personal information will not be used.

Organisations that may look at and/or copy your records (without your name or other identifying

information) for research, quality assurance, and data analysis include:

• The University of California San Francisco’s Committee on Human Research

• The United States Agency for International Development (USAID)

• The International HIV/AIDS Alliance and their regional office, the Caribbean HIV&AIDS Alliance

What are the costs of taking part in this study

The only cost of taking part in this study is your time.

You will not be charged for any of the study procedures.

Will I be paid for taking part in this study

You will not be paid for participating in this study.

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CARIBBEAN HIV&AIDS ALLIANCE


What are my rights if I take part in this study

Taking part in this study is your choice. You may choose either to take part or not to take part in the

study. If you decide to take part in this study, you may leave the study at any time. No matter what

decision you make, there will be no penalty to you.

Who can answer my questions about the study

You can talk to the interviewer or to the researcher below about any questions or concerns you have

about this study. Contact the researcher Dr. Janet Myers at UCSF at 1 (415) 597‐ 8168 or Rosemary Lall

at the Caribbean HIV&AIDS Alliance in Trinidad at (868) 623-9714. Collect calls will be accepted at this

number.

If you have any questions, comments, or concerns about taking part in this study, first talk to the

researcher (above). If for any reason you do not wish to do this, or you still have concerns after doing

so, you may contact the office of the Committee on Human Research, UCSF’s Institutional Review Board

(a group of people who review the research to protect your rights).

You can reach the CHR office at 415 476 1814, 8 am to 5 pm, Monday through Friday. Or you may write

to: Committee on Human Research, Box 0962, University of California, San Francisco (UCSF), San

Francisco, CA 94143, USA.

CONSENT

You have been given a copy of this information sheet to keep.

PARTICIPATION IN RESEARCH IS VOLUNTARY. You have the right to decline to be in this study, or to

withdraw from it at any point without penalty or loss of benefits to which you are otherwise entitled.

CARIBBEAN HIV&AIDS ALLIANCE 61


APPENDIX 2: Interview Guide

Interview #

Country:

Name of FBO or Faith Based Movement :

Denomination:

FBO Address:

Town/Area of Island:

FBO Telephone:

Fax: Email:

Pastor or Contact Person:

Introduction

Thanks for agreeing to talk with me today. As you know, many people, especially young people, are

at high risk for HIV. Although many different HIV prevention programmes have been developed and

implemented we think that faithbased organisations or spiritual movements can play an important

role in this effort considering that many men and women feel connected to their faith communities

and to their sense of spirituality. The University of California San Francisco (UCSF) and the Caribbean

HIV&AIDS Alliance (CHAA) are working together on this collaborative project to speak to members of

faithbased organisations (FBOs) to learn more about culturally appropriate faithbased strategies we

can develop in order to reach people at risk for HIV.

I. Faith Based Organisation Profile

Please tell me a little bit about your organisation. (Let participants describe the group. Probe as

needed to cover the following issues)

a. What is the name of the religious/spiritual movement/group to which you belong

b. Please describe your movement’s/FBO’s organisational structure or hierarchy. Council

Board Community representation

c. Do you have bivocational (part time) spiritual leaders If yes how many

d. Do you have full time paid spiritual leaders If yes How many

e. Do you have a central administrative office for your movement/FBO

f. How many full time staff work at this office What are their main duties

g. Do you have spiritual/religious services regularly If so, at what intervals

h. Approximately how many members of the movement/FBO do you have at your main

(weekly, monthly, etc) service

i. Approximately, what percentage of these members are men and women

j. What proportion of the men and women are between 18 to 30 years old

k. Please estimate the proportion of your members with the following levels of education

(make sure this adds up to 100%):

−−

Graduate/Professional School (includes University)

−−

−−

−−

College (includes Bible School, Seminary etc.)

Vocation School or Other Two‐Year Degree

High School Graduate

−−

Less Than High School

l. Does your movement/FBO have a fellowship hall or place where social activities take place

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CARIBBEAN HIV&AIDS ALLIANCE


If so, describe in detail

m. Are you aware of any gay, lesbian, bisexual, or transgender (GLBT) people in your movement/

FBO

n. How are they treated by other members of your movement/FBO

II. Health Promotion and Disease Prevention Programmes in the FBO

1. Does your movement/ FBO have any kind of health promotion/disease prevention programmes

If so, please describe. If not, why not

Does your movement/FBO partner with any private/public health promotion agencies If so,

please describe

2. Does your movement receive any kinds of grant monies for its health promotion/disease

prevention programming/Ministries If yes, please describe. If no, why not

If no, would your movement/FBO be interested in applying for/receiving outside funding

to start new programme dedicated to HIV prevention

3. How big a priority is HIV/AIDS for your movement/FBO Please explain.

4. Does your movement/FBO have an HIV/AIDS ministry/programme If so, please describe. If

not, ask whether there is a need for that [Probe: If it does not come up ask if they conduct any

HIV programmes with other FBOs]

5. What would you say is the level of knowledge about HIV and other STDs in your movement/

FBO Is it low, moderate, or high

6. What type of messages about HIV/AIDS awareness and prevention are talked about or

preached

[Probe here e.g. Let me give you a scenario what if someone comes to you and says they want to

go for an HIV test what would you do at that point]

7. How much is being done about HIV/AIDS outside your movement/FBO in your country

Probe, Other FBOs, NGOs, Ministry of Health

8. How does your movement view sex work (probe for teachings, doctrines, etc). Is that

something that is mentioned/discussed at all

a. In what forums do these ideas get communicated

b. What do your members/congregants believe about sex work

c. How do you think your movement’s/FBO’s teachings about this topic differ from other

FBOs, if at all

9. How does your movement view homosexuality (probe for teachings, doctrines, etc).

Is that something that is mentioned/discussed at all

a. In what forums do these ideas get communicated

b. What do your members/congregants believe about homosexuality

c. How do you think your movements/FBOs teachings about this topic differ from other

FBOs, if at all

d. Does you church have any laws/policy/guidelines on GLBT

10. What types of programmes does your movement/FBO have for young adults (under 30 years

old)

Please describe these programmes for me.

CARIBBEAN HIV&AIDS ALLIANCE 63


OR IF THEY DO NOT HAVE ANY

11. If your movement were to run a programme for young adults, what do you think would be

needed

12. Who do you think would come/often come to those programmes

a. Please describe the different types of young adults from your movement that such a

programme would likely miss

b. What strategies do you think would be effective in reaching out to them

13. What kinds of barriers do you see to conducting HIV prevention programmes in your

movement [Probe for barriers to other kinds of HIV programming other than prevention

as well]

14. What kinds of programmes do you think your movement would be willing to run

a. How likely would your movement/FBO be to support the following types of activities or

events (Probe: Ask about the ones they did not mention as well as any mentioned as part

of the earlier qu on health promotion programmes. Also, what would their willingness be

dependent on Also, In terms of capacity what help would they need to be able to run/

expand these programmes):

• Distribution of safer sex and HIV‐related literature

• Social activities or parties for young adults

• Small discussion groups on safer sex topics

• Condom distribution

• Counselling and testing for HIV

• Small discussion group for young adults

• Programmes for people who are HIV‐positive

• Palliative care (home based programmes)

15. What kinds of barriers do you see to conducting HIV prevention programmes in other FBOs

[Probe for barriers to other kinds of HIV programming other than prevention]

16. If your movement/FBO were to run an HIV prevention programme, what are messages

that your movement would want to convey about how men and women can protect themselves

against becoming HIV‐positive or infecting others

17. If your movement were to run a programme that provided HIV counselling and testing,

what are the messages that your movement would want to convey related to HIV testing

18. If your movement were to run a programme that provided support services for people who

were HIV infected, what are the messages that your movement would want to convey about

how men and women with HIV should be treated

19. How many members/congregants do you think accept an HIV positive person into fellowship

20. What do you think are the levels of stigma and discrimination in your movement/

FBO Can you think of a situation or scenario related to stigma and discrimination

21. Would a PLHIV be a spiritual/religious leader in your church/movement

22. Would someone who is openly GLBT be a spiritual/religious leader in your church/movement

23. Are there members/congregants who are more respected or influential among your members

How likely are they to influence beliefs among your members/congregants

24. What makes them be more influential Their profession, personality, beliefs, financial situation

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CARIBBEAN HIV&AIDS ALLIANCE


APPENDIX 3: Survey Questionnaire

Faith-Based Organisation Survey - CHAA/ UCSF

Survey # Date of Survey RA Initials Country

Barbados

Name of FBO:

Denomination: Town/Area of Island:

FBO Telephone: (246)

Email:

Pastor or Contact Person:

Record sex of the respondent: 1. Male 2. Female

ABOUT THE ORGANISATION:

1. What is your role within your organisation

2. Does your denomination hold regular spiritual/religious services

3. IF YES: What is the average attendance at these spiritual/religious services

(NOTE to interviewer: This is to get an idea of the size of the denomination. Find out about their regular

Sunday or Sabbath services and any other services, e.g. Women’s Fellowship, Youth Fellowship, weekday

services, Bible study, Sunday school, prayer meeting etc.)

Type of Service How often # of People Attending

4. Is your denomination affiliated with an umbrella organisation or organisations (such as the

Caribbean Council of Churches) IF YES: Which one/s

(NOTE to interviewer: National, Caribbean regional or international organisations can be

included)

5. Are there any paid staff working within your organisation

(NOTE to interviewer: this is to get an idea of human resources available to the organisation. Volunteers

with stipends may be included under part-time staff, but please write a note to indicate this)



No

Yes

CARIBBEAN HIV&AIDS ALLIANCE 65


If yes, how many

# Full Time Staff Position/Title

# Part Time Staff

ABOUT HEALTH-RELATED PROGRAMS:

6. Does your group currently provide any health-related programs or activities (These are

programs which contribute to the physical, mental, emotional, nutritional and psychological

well being of an individual)



No

Yes

If yes, what are the names of those programs and areas of health What are the target population/s for

these programs

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CARIBBEAN HIV&AIDS ALLIANCE


CARIBBEAN HIV&AIDS ALLIANCE 67


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CARIBBEAN HIV&AIDS ALLIANCE


ABOUT HIV/AIDS-RELATED PROGRAMS:

7. Does your group currently provide any kind of HIV/AIDS-related activities/programs


No ANSWER 7.b


Yes SKIP to 8

7.b If No, Have members of your church discussed beginning any kind of HIV/AIDS-related

activities/programs THEN SKIP TO QUESTION 11



No

Yes

Comments:

8. If Yes, which of the following does your organisation/group provides (or support)

WHILE SHOWING CARD WITH DIFFERENT ACTIVITIES/ PROGRAMS, READ AND ASK

And how long have you been providing these activities

How often are they provided

How long do they last on each occasion

CARIBBEAN HIV&AIDS ALLIANCE 69


How Long (specify months or years) How often Type of Activity

HIV/AIDS Education and Prevention

HIV Testing Services (directly on site)

HIV/AIDS Risk Reduction Counselling

Referrals for HIV Testing

Condom distribution

AIDS Orphan support services

Diagnosis and treatment of tuberculosis and other sexually

transmitted infections

Prison Outreach

Medical treatment for HIV/AIDS

HIV/AIDS Housing and/or Housing Assistance

Substance Abuse/Counselling/Prevention Services

Spiritual Counselling

Meal (Food) programs for Persons with HIV/AIDS

Bereavement Support Program

Outreach services

Employment of PLWH

Advocacy for Employment for PLWH

Advocacy for Legislation supporting PLWH

Palliative care (such as home based care

Other (please specify)

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CARIBBEAN HIV&AIDS ALLIANCE


9. What type(s) of organisation(s) are you currently collaborating with to provide HIV/AIDSrelated

services

CHECK ALL THAT APPLY


Not Collaborating with other organisations











Other faith-based organisations

Social Service agencies

Health Departments

National AIDS Secretariat

University/College

Businesses or the business community

Community Groups

International Agencies (e.g. USAID, Red Cross)

Schools

Other (specify)

10. What changes have taken place in your organisation or group as a result of providing HIVrelated

services (CHECK ALL THAT APPLY)








N/A

Increased HIV/AIDS knowledge in congregation

Began HIV testing

Started an HIV/AIDS ministry

HIV/AIDS policy development

Counselling workshops on human sexuality

Other (please specify)

11. In fulfilling your church’s mission, how important is it for you to establish, or further develop

an HIV/AIDS ministry/programme in order to reduce and prevent the spread of HIV/AIDS

Would you say very important, somewhat important or not important

(READ FOLLOWING SCALE TO RESPONDENT)


Very important important Somewhat important Not important

12. Can you tell me how much you know about how HIV programs are planned in your community

(READ FOLLOWING SCALE TO RESPONDENT)





Not much

Have some knowledge, but would like more information

Very knowledgeable about this process

Other:

CARIBBEAN HIV&AIDS ALLIANCE 71


IN GENERAL (NOT HIV-specific)

13. Now I’d like to ask you about services your church might be interested in. Tell me, would

your church benefit from training or consulting services to enhance your ability to…

READ FOLLOWING SCALE TO RESPONDENT

Do fundraising Yes No

Conduct Strategic planning Yes No

Manage volunteers Yes No

Understand health issues among parishioners Yes No

Establish HIV/AIDS ministries Yes No

Market church programs to the community Yes No

Build collaborative relationships with other community organisations Yes No

Other (please specify)

STIGMA

We are almost done, but before we finish, we are going to switch topics and I have a series of questions

about how people in this community relate to people with HIV/AIDS.

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CARIBBEAN HIV&AIDS ALLIANCE


READ TO PARTICIPANT WHILE SHOWING CARD WITH QUESTIONS AND THE SCALE

14. I will describe some stories that some people may have heard. Tell me whether you have

heard about any of these things happening to others. After each story, I will ask you how often

you have heard it: Never, Rarely, Sometimes or Frequently:

(INTERVIEWER: Begin each story with the following :)

HS1.

In the last year, how often have you heard stories

about…

…People being forced by family members to leave their home

because they had HIV

Never Rarely Sometimes Frequently

0 1 2 3

HS2. …A village/community isolating someone because they had HIV 0 1 2 3

HS3.

…Someone being refused care from their family when they were sick

with HIV

0 1 2 3

HS4. …People looking differently at those who have HIV 0 1 2 3

HS5. …Families avoiding any relative who has HIV 0 1 2 3

HS6.

…People being refused medical care or denied hospital services

because of their HIV

0 1 2 3

HS7. …People being mistreated by hospital workers because of their HIV 0 1 2 3

HS8.

…A healthcare worker not wanting to touch someone because of his

or her HIV

0 1 2 3

HS9. …A healthcare provider talking publicly about a patient with HIV 0 1 2 3

HS10.

…A hospital worker making someone’s HIV infection publicly known

by marking HIV on their medical records

0 1 2 3

READ TO PARTICIPANT WHILE SHOWING CARD WITH QUESTIONS AND THE SCALE

15. Based on your own experiences and what you’ve seen and heard, please tell us how many

people in your congregation believe each of the following statements. After each statement, I

will ask you how many people in your congregation believe it according to the following: No

One, Very Few People, Some People, or Most People.

CARIBBEAN HIV&AIDS ALLIANCE 73


In the last year, how often have you heard stories

about…

No One

Very Few

People

Some

People

Most

People

FS1.

FS2.

FS3.

FS4.

FS5.

FS6.

FS7.

FS8.

FS9.

FS10.

In your congregation, how many mothers would not want someone

with HIV to hold their new baby

In your congregation, how many mothers would not want an HIV

infected person to feed their children

In your congregation, how many people would not share dishes or

glasses with someone who has HIV

In your congregation, how many people would not want an HIV

infected person cooking for them

In your congregation, how many people avoid visiting the homes of

people with HIV

In your congregation, how many people think that HIV-infected

people have brought shame on their families

In your congregation, how many people think that if you have HIV

you have done wrong behaviors

In your congregation, how many people think people with HIV are

paying for their karma or sins

In your congregation, how many people think that people with HIV

should feel guilty about it

In your congregation, how many people think that a person with HIV

is disgusting

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

16. How long have you been in this church/organisation / yrs

17. How old are you / yrs

WRAP UP:

Thank you for your time completing this survey. Please write any additional comments below.

Notes:

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CARIBBEAN HIV&AIDS ALLIANCE


APPENDIX 4: Matrix for Analysis of Data from Qualitative Interviews

UCSF/CHAA FBO Study

Name:

Location:

Profile of FBO Yes No Comments

Profile of FBO

Role of Interviewee

Structure of FBO

Independent

Bi-vocational spiritual leaders

Full-time paid leaders

Hierarchy, Decision- Making/Leaders/groups within FBO

Central admin office

Full-time staff in office

Services

FBO Hall

Member Profile

# of attendees

% of: men/women

Age

GLBT members

Education

Current Health Promotion

Health Promotion programs

Partnerships

Grant Monies

If not, why not

HIV/AIDS ministry/ program

Response from congregants to HIV activities

Potential Health Promotion

A need for HIV AIDS awareness program

Support for the following activities/events:

Distribution of safer sex literature

Distribution of HIV-related literature

Social activities/ parties for young adults

Small discussion groups on safer sex topics

Condom distribution

Testing for HIV

Counselling for HIV

Small discussion group for young adults

Programmes for people who are HIV- positive

Palliative care (home based programs)

FBO needs to run/expand these activities

CARIBBEAN HIV&AIDS ALLIANCE 75


UCSF/CHAA FBO Study

Name:

Location:

More Detailed Responses:

Youth

Retention of youth in FBO

Current Programmes Future Programmes

FBO Messages

HIV testing

HIV awareness and prevention

Sex work

Homosexuality

Treating PLHIV within FBO

FBO Views

HIV testing

HIV awareness and prevention

Sex work

Homosexuality

Treating PLHIV within FBO

Views outside of the FBO

HIV testing

HIV awareness and prevention

Sex work

Homosexuality

Knowledge and Priority

Level of knowledge about HIV & other STDs in FBO

Priority of HIV/AIDS in the FBO

Priority of HIV/AIDS outside of the FBO

Barriers

HIV prevention programmes in the FBO HIV prevention programmes in other FBOs

HIV prevention programmes in Antigua and Barbuda

Stigma and Discrimination

Levels of stigma and discrimination in the FBO

Levels of stigma and discrimination on Antigua and Barbuda

Ways to combat stigma

Leadership and Inclusion

Possibility of PLHIV leader in FBO

Possibility of GLBT leader in FBO

Influential members

Other Notes

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CARIBBEAN HIV&AIDS ALLIANCE


References

1. Tanzania Stigma-Indicators Field Test Group. Working Report. Measuring HIV

2. stigma: results of a field test in Tanzania. Wasington: USAID; 2005. UNAIDS Caribbean Regional Support Team. Keeping Score

2: a Progress Report Towards Universal Access to HIV Prevention, Treatment, Care and Support in the Caribbean. Geneva:

Joint United Nations Programme on HIV/AIDS (UNAIDS); 2008.

3. UNAIDS. AIDS epidemic update. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health

Organization (WHO); 2009.

4. Central Intelligence Agency. CIA World Factbook 2010.; 2011 [updated 2011; cited 2011 20 April]; Available from:

http://www.indexmundi.com/barbados/demographics_profile.html.

5. Barbados Ministry of Health. HIV surveillance report, 2008. Bridgetown, Barbados: Surveillance Unit, Ministry of Health;

2010.

6. Barbados Statistical Service. Population Distribution by Sex & Religion.; 2011 [updated 2011; cited 2011 20 April]; Available

from: http://www.barstats.gov.bb/census/redatam-1/

7. Caribbean Conference of Churches. Guidelines for Caribbean Faith Based Organisations in Developing Policies and Action

Plans to Deal with HIV/ AIDS. Canadian International Development Agency, editor. St. Augustine, Trinidad and Tobago:

Caribbean Conference of Churches; 2004.

8. Pan Caribbean Partnership Against HIV/ AIDS, Caribbean Community, Department for International Development. Champions

for Change: Reducing HIV/AIDS Stigma and Discrimination. Georgetown, Guyana: Caribbean Community Secretariat/ Pan

Caribbean Partnership Against HIV/ AIDS; 2005.

9. Pan Caribbean Partnership Against HIV/ AIDS. Declaration of Commitment: Champions for Change II. . Georgetown, Guyana:

PANCAP; 2005 [updated 2005; cited 2011 20 April]; Available from: http://www.pancap.org/index.phpoption=com_content&view

=article&id=282:world-aids-day-2009-message-the-hon-denzil-douglas-chair-of-pancap&catid=70:regional-meeting.

10. Balm in Gilead. Feasibility study for implementing faith-based HIV/AIDS voluntary counseling and testing centers in Tanzania

New York: Balm in Gilead; 2006.

11. Steward W, Herek G, Ramakrishna J, Bharat S, Chandy S, Wrubel J, et al. HIV-related stigma: adapting a theoretical framework

for use in India. Social Science and Medcine. 2008 Oct;67(8):1225-35.

12. Bombereau G, Allen C. Social and cultural factors driving the HIV epidemic in the Caribbean: a literature review.

St. Augustine, Trinidad and Tobago: Caribbean Health Research Council. ; 2008 [cited 23rd July, 2010]. Available from:

http://www.chrc-caribbean.org/LiteratureReviews.php.

13. Caribbean HIV&AIDS Alliance, University of California San Francisco. Investigating the feasibility and acceptability of

implementing evidence-based HIV prevention interventions for women working in industrial estates in St. Kitts. Port of Spain:

Caribbean HIV&AIDS Alliance; 2010.

CARIBBEAN HIV&AIDS ALLIANCE 77


Notes


Notes


Notes


Notes


Notes


CHAA Country Offices

Antigua and Barbuda

Newgate Street, St John’s, Antigua

Phone: (268) 562 7327/8

Barbados

Flint Hall, St Michaels, Barbados

Phone: (246) 228 4306

Dominica

Federation Drive, Goodwill, Commonwealth of Dominica

Grenada

Gran Anse, St George, Grenada

Jamaica

24 Haining Road, Kingston 5, Jamaica

Phone: (876) 631 2279

St Kitts and Nevis

11 Rose Lane, Greenlands, St Kitts

Phone: (869) 466 3909 / 465 0496

St Lucia

San Souci, Castries, St Lucia

St Vincent and the Grenadines

North River Road, Kingstown, St Vincent

Phone: (784) 451 2044


CHAA’S VISION

A region where people do not experience discrimination or die of AIDS.

CHAA’S MISSION

To facilitate effective and collective community action to reduce the impact of

HIV and AIDS across the Caribbean.

CHAA’S CONTACT INFORMATION

Caribbean HIV&AIDS Alliance

Regional Office

122 Eastern Main Road

Tunapuna

Trinidad and Tobago

Phone: (868) 223 7059/7209

223 8522/9714

Fax: (868) 223 6994

Email: info@alliancecarib.org.tt

Website: www.caribbeanhivaidsalliance.org

CARIBBEAN HIV&AIDS ALLIANCE 2012

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