Response of religious groups to HIV/AIDS as a
sexually transmitted infection in Trinidad
Gillian L Genrich 1,2 and Brader A Brathwaite3
1Fulbright Fellowship Program for U.S. Students, Port of Spain,
Trinidad, West Indies
2NCID/DVRD/IDPA, Centers for Disease Control and Prevention,
Atlanta, GA, 30333, USA
3Center for Medical Sciences Education, Faculty of Medical
Sciences, UWI, St. Augustine, Trinidad, West Indies
Gillian L Genrich: firstname.lastname@example.org ; Brader A Brathwaite:
Received December 17, 2004; Accepted November 16, 2005.
This is an Open Access article distributed under the terms of
the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
HIV/AIDS-related stigma and discrimination are significant
determinants of HIV transmission in the Caribbean island nation
of Trinidad and Tobago (T&T), where the adult HIV/AIDS
prevalence is 2.5%. T&T is a spiritually-aware society and over
104 religious groups are represented. This religious diversity
creates a complex social environment for the transmission of a
sexually transmitted infection like HIV/AIDS. Religious leaders
are esteemed in T&T's society and may use their position and
frequent interactions with the public to promote HIV/AIDS
awareness, fight stigma and discrimination, and exercise
compassion for people living with HIV/AIDS (PWHA). Some
religious groups have initiated HIV/AIDS education programs
within their membership, but previous studies suggest that
HIV/AIDS remains a stigmatized infection in many religious
organizations. The present study investigates how the perception
of HIV/AIDS as a sexually transmitted infection impacts
religious representatives' incentives to respond to HIV/AIDS in
their congregations and communities. In correlation, the study
explores how the experiences of PWHA in religious gatherings
impact healing and coping with HIV/AIDS.
Between November 2002 and April 2003, in-depth interviews were
conducted with 11 religious representatives from 10 Christian,
Hindu and Muslim denominations. The majority of respondents were
leaders of religious services, while two were active
congregation members. Religious groups were selected based upon
the methods of Brathwaite. Briefly, 26 religious groups with the
largest followings according to 2000 census data were identified
in Trinidad and Tobago. From this original list, 10 religious
groups in Northwest Trinidad were selected to comprise a
representative sample of the island's main denominations.
In-depth interviews with PWHA were conducted during the same
study period, 2002–2003. Four individuals were selected from a
care and support group located in Port of Spain based upon their
perceived willingness to discuss religious affiliation and
describe how living with a terminal infection has affected their
spiritual lives. The interviewer, a United States Fulbright
Scholar, explained the nature and purpose of the study to all
participants. Relevant ethical procedures associated with the
collection of interview data were adopted: interviews were
conducted in a non-coercive manner and confidentiality was
assured. All participants provided verbal consent, and agreed to
be interviewed without financial or other incentive. Ethics
approval was granted on behalf of the Caribbean Conference of
Churches Ethics Committee. Interview questions followed a
guideline, and employed an open-ended format to facilitate
discussion. All interviews were recorded and transcribed by the
Religious representatives' opinions were grouped into the
following categories: rationale for the spread of HIV/AIDS,
abstinence, condom use, sexuality and homosexuality, compassion,
experiences with PWHA, recommendations and current approach to
addressing HIV/AIDS in congregations. Religious representatives
expressed a measure of acceptance of HIV/AIDS and overwhelmingly
upheld compassion for PWHA. Some statements, however, suggested
that HIV/AIDS stigma pervades Trinidad's religious
organizations. For many representatives, HIV/AIDS was associated
with a promiscuous lifestyle and/or homosexuality.
Representatives had varying levels of interaction with PWHA, but
personal experiences were positively associated with current
involvement in HIV/AIDS initiatives. All 4 PWHA interviewed
identified themselves as belonging to Christian denominations.
Three out of the 4 PWHA described discriminatory experiences
with pastors or congregation members during gatherings for
religious services. Nonetheless, PWHA expressed an important
role for faith and religion in coping with HIV.
Religious groups in Trinidad are being challenged to promote a
clear and consistent response to the HIV/AIDS epidemic; a
response that may reflect personal experiences and respect
religious doctrine in the context of sex and sexuality. The
study suggests that (1) religious leaders could improve their
role in the fight against HIV/AIDS with education and
sensitization-specifically aimed at dismantling the myths about
HIV transmission, and the stereotyping of susceptible
sub-populations, and (2) a consultative dialogue between PWHAs
and religious leaders is pivotal to a successful faith-based HIV
intervention in Trinidad.
The HIV/AIDS epidemic in the Caribbean region is fuelled by
stigma and discrimination, which are the most significant
determinants of HIV infection and death from AIDS-related
complications . Trinidad and Tobago (T&T), an island nation
situated off the coast of Venezuela and home to 1.3 million
citizens,  shares with region members an incidence of
HIV/AIDS second only to sub-Saharan Africa . Since the first
case of HIV was identified in Trinidad in 1983 in a homosexual
male,  the prevalence of HIV/AIDS in adults (15–49 years old)
has grown to 2.5%, with half of all new infections occurring in
young people between 15–24 years . HIV is primarily
transmitted through unprotected sexual intercourse,  and is
fueled by multiple sexual partnerships, substance abuse, and
migration and gender inequalities . The Trinidad and Tobago
Ministry of Health suspects the infection is underreported and
the actual number of cases is twice as high .
Stigma and discrimination create barriers to HIV testing and
treatment, care and support networks for people living with and
affected by HIV/AIDS [8,9]. In Trinidad, few cases of HIV
infection are diagnosed early in the course of infection and the
average time from HIV diagnosis to death is only 13 months .
Of all confirmed AIDS cases reported in 1999, 75% were
identified as HIV positive within the same year as the AIDS
diagnosis . The statistics suggest that individuals may fear
testing, perhaps as a result of the stigmatization of HIV
throughout Trinidad and Tobago's society.
T&T is a spiritually-aware society where the majority of the
population belongs to at least 1 of over 104 religious groups
 that coexist peacefully, often participating in public
celebrations of other faiths . When the last census was
taken, approximately 30% of the population was Roman Catholic,
24% Hindu, 11% Anglican, 6% Muslim, 3% Presbyterianism and 26%
"other" . Religious groups are geographically evenly
distributed throughout the nation; active amongst the poorest
communities and within areas of high HIV/AIDS prevalence .
The pervasiveness of diverse religious ideologies thus creates a
complex environment for the transmission of a sexually
Religious leaders are esteemed, frequently exchange with the
public and maintain an influential role in policy-making in
Trinidad . They may use their position to promote HIV/AIDS
awareness, fight stigma and discrimination in communities, and
exercise compassion to facilitate healing for people living with
HIV/AIDS (PWHA). Some religious groups are involved in such
efforts. In 2001, the Caribbean Conference of Churches (CCC),
the Regional Ecumenical Organization of the Caribbean, brought
120 church leaders and church workers from across the region
together in a consultation on "Human Sexuality and HIV/AIDS in
the Caribbean – A Theological Approach" . The consultation
raised awareness about the discrimination, fear, rejection,
poverty and pain that PWHA may face in Trinidad's society.
Yet there are barriers to more active and widespread involvement
in HIV/AIDS initiatives among religious groups in Trinidad.
Debate over condom sales, for example, has hindered
collaboration with public health organizations  and
religious groups have not been optimally integrated into the
HIV/AIDS care and support network. Further, there are few local
research studies that explore religious leaders' incentives to
promote and gain involvement in faith-based HIV/AIDS
initiatives. One investigation of the potential to inspire a
faith-based response to HIV/AIDS in T&T  found that
HIV/AIDS-related stigma and discrimination inhibited active
involvement. The present research expands upon previous work by
sampling both diverse religious groups in Trinidad, and
individuals who are living with HIV/AIDS. Accordingly, this
study investigates how the perception of HIV/AIDS as a sexually
transmitted infection impacts religious leaders' incentives to
become involved in HIV/AIDS initiatives, and how the experiences
of PWHA in religious gatherings have impacted their healing and
coping with HIV/AIDS.
All relevant ethical procedures associated with collection of
interview data were adopted, and the methods approved on behalf
of the Caribbean Conference of Churches Ethics Committee. The
interviewer explained the nature and purpose of the study to the
participants and conducted the interviews in a non-coercive
manner, with the assurance of confidentiality. All respondents
provided verbal consent, and agreed to be interviewed without
financial or other incentive.
Selection of religious representatives
Between November 2002 through April 2003, in-depth interviews
were conducted with 11 consenting representatives from 10
religious organizations in Trinidad, including: Anglican, Open
Bible, Pentecostal, Salvation Army, Unity School of
Christianity, Seventh Day Adventists, Hindu, Jamaat al Muslimeen,
Nation of Islam, and Roman Catholic (2 representatives).
Selection of religious groups was based upon the methodology of
Brathwaite . Briefly, 26 religious groups with the largest
followings according to 2000 census data were identified in
Trinidad and Tobago. Groups were categorized into Christian,
Hindu, Muslim, and 'native' (Bahai, Orisha). From this original
list, 10 representative groups from Christian, Hindu and Muslim
denominations with large and small congregations, and located in
Northwest Trinidad were selected. Potential participants were
contacted by phone, the research plan described, and interviews
arranged with willing participants. Religious respondents were
generally leaders of religious services (pastors, priests,
pundits), while 2 were active congregation members. The majority
of interviews with Christian representatives were conducted in
offices adjacent to churches. Other interviews were held in an
agreed location such as the interviewee's home. Interviews
ranged from 1–2.5 hours. Interview questions followed a
guideline (see Figure 1), but employed an open-ended question
format to invite discussion of sensitive HIV/AIDS-related
themes. Those themes were previously identified in a survey of
26 religious organizations,  and included: rationale for the
spread of HIV/AIDS, abstinence, condom use, sexuality and
homosexuality, compassion, experiences with PWHA, and
recommendations and current approach to addressing HIV/AIDS in
Interview Questions for Religious Representatives.
People living with HIV/AIDS (PWHA)
In-depth interviews with PWHA were conducted during the same
study period, 2002–2003. Four PWHA (P1–P4) were selected from an
established HIV/AIDS support group in Port of Spain, Trinidad,
based upon their perceived willingness to discuss sensitive
issues and religious affiliation. Interview questions were
open-ended, but followed a structured guideline (see Figure 2).
Belief Systems Questionnaire for People Living with HIV/AIDS.
The interviewer was a United States Fulbright Scholar who had
studied HIV/AIDS and other public health issues, and intended to
use the research on religious groups to stimulate faith-based
contributions to ongoing HIV/AIDS initiatives in Trinidad. The
interviewer was associated with the HIV/AIDS support group from
which the 4 PWHA were selected, and had spent several hours each
week interacting with the participants prior to the interviews.
All interviews were audio recorded and transcribed by the
Verbatim statements with religious representatives were
extracted from raw interview text and were categorized according
to the following themes: rationale for the spread of HIV/AIDS,
issues related to abstinence, condom use, sexuality,
homosexuality, personal compassion and personal experiences with
PWHAs. Similarly, the responses of PWHA were grouped into three
main themes: response to HIV diagnosis, experiences in church,
and current attitude toward religion.
Introduction to religious groups
Anglican Church (AC)
In keeping with "a more collegial approach to ministry," the
Anglican community was engaged in educational programs, such as
peer counseling, to sensitize and educate the clergy on issues
surrounding HIV/AIDS. According to the AC representative, "AIDS
is one of our chief priorities: our thesis that the faith based
communities must be part of the solution than a problem by being
negative and adversarial versus pastoral...."
The respondent felt that because HIV/AIDS prevalence in T&T had
not reached critical proportions like in Africa, it was not an
urgent problem. There was no written policy on HIV/AIDS because
"we have not had a lot of cases to deal with. I guess if we had
that amount we would. We have treated every case on an
individual basis." It was felt that if the problem were
addressed on a national level, churches would necessarily unite
to develop a joint initiative.
The representative upheld compassion for all individuals,
recognizing the dignity of every human life. The organization
would assist PWHA in order to help to facilitate conversion and
lifestyle changes that would lead to an improved contribution to
the community. HIV/AIDS has caused a devastation that requires
communities and individuals to reexamine and change their
Roman Catholic (RCI, and RCII)
RCI believed the degradation of the traditional family unit, the
erosion of traditional cultural values and undefined rites of
passage have contributed to the spread of HIV/AIDS. Religious
instruction in the Church has failed to meet the present day
needs and concerns of the congregation. RCII felt that HIV/AIDS
must evoke a discussion of sexuality and of how individuals
could prepare themselves to make informed, meaningful and
healthy choices that reflect who they are and not simply what
they want. To date, the Roman Catholic Church has very
effectively delivered home health care to individuals suffering
from AIDS-related complications through ministries such as
Salvation Army (SA)
The Salvation Army was founded in 1878 by William Boothe, a
Methodist minister in England, who wanted to help the poor of
England receive food, shelter and clothing. Thus, the
organization is based on a philosophy of outreach, serving
community needs, helping the sick and the poor. SA "does not
condone sin...but we love the sinner," and would work with
individuals to build a better lifestyle. SA advocated chastity,
but condom use was preferred to acquiring HIV for individuals
who choose to engage in sexual intercourse before marriage.
Seventh Day Adventist (SDA)
There was a written policy on HIV/AIDS, but the interviewee was
not familiar with the text in the policies. The interviewee was
disappointed in the rate at which the SDA organization had
responded to the HIV/AIDS epidemic in Trinidad and acknowledged
that there was the need for further education of clergymen
within the church. Increasing education in society and among the
clergy was the most critical component of reducing the spread of
Unity was a small congregation of mostly women, who were
described as traditional and conformist. HIV/AIDS did not affect
the congregation and the representative did not have personal
relationships or experiences with PWHA. The organization was not
involved in outreach. Unity is based upon the philosophy that
"human beings create their experiences by the activity of their
thinking." Therefore prayer is "creative thinking that heightens
the connection with God."
The Hindu representative felt that HIV/AIDS occurred primarily
among homosexuals and did not pose a significant problem for the
Hindu organization. Furthermore, it was assumed that Hindus were
less likely to acquire HIV due to high social and spiritual
obligations to obey religious doctrine. According to the
interviewee, HIV/AIDS was a medical problem. Although prayers
and mantras are effective treatments and cures for disease, the
organization was less concerned about bodily ailments than it is
about eternal life. The interviewee felt that individuals living
with HIV/AIDS in the Hindu community may feel discriminated
against and ostracized because disease is an "unhygienic
situation;" individuals living with HIV/AIDS are unclean and
would be expected to stay away from organized worship.
Compassion is inherent in Hinduism, but the religion does not
provide the opportunity for confession and reconciliation.
Nation of Islam (NOI)
NOI supported a theory that HIV was man-made in a United States
laboratory in a plan to control population growth. The NOI
representative was skeptical of scientific literature and
research on the efficacy of condoms and boldly supported
abstinence as the only effective prevention of HIV and other
STDs. NOI valued the individual, and is particularly protective
of women. The organization fulfills the obligation to help
anyone in need.
Jamaat al Muslimeen
This representative was highly active in HIV/AIDS education for
the neediest urban communities. Jamaat al Muslimeen traveled on
foot to reach individuals and families who demonstrated serious
health risks, and provided education and condoms. However, the
representative's activism, particularly in condom distribution,
was not supported by the Jamaat al Muslimeen organization.
According to the interviewee, the organization believed HIV/AIDS
was a "sin from God."
Rationale for the spread of HIV/AIDS
Religious representatives described cultural, spiritual, and
social factors that contributed to the spread of HIV/AIDS. RCI
believed that new opportunities for HIV transmission were born
in the fragmentation of traditional family structure and the
erosion of the influence of religious doctrine in society.
According to the Pentecostal representative, "if you follow the
pattern that is established here in the Word, that you are not
going to get into trouble, or there will be no involvement in
sexual accounts...like HIV...or any of the other kinds...." The
Open Bible representative "really believe that this started with
homosexuality. They can't find a cure for it...what you sow, you
The "Carnival mentality," was also felt to fuel the epidemic.
Group representatives generally described how Carnival
encouraged individuals to abandon their moral framework. The
Hindu representative did not feel that Hindus would engage in
this behavior, however.
Pentecostal: "It's what people are making of the Carnival
mentality. If people would enjoy themselves and see Carnival as
functional in terms of your socioeconomic...we will not have
this kind of [situation]... [People] let their standards
down...to do what they would not normally do. And this to me is
prostituting Carnival...To go around and have sex, as if, you
know, you have no control."
Open Bible: "Carnival is one of the greatest contributors to
AIDS...there is no limits, there is no restrictions. People just
let down all there guards that they will have had all year...And
only afterwards they realize they make mistakes...too late."
Hindu: "You find too that around Carnival time...this is
highlighted most of all, and you would find that many Hindus
would not be seen in the streets taking part in Carnival. You
may see [East] Indians, people of Indian descent, many of them
would have already crossed over to other religions. And so the
guard is already dropped...promiscuity, and licentiousness...."
There was little variability among religious groups in response
to the organization's position on abstinence.
Pentecostal: "We are not going to tolerate at all any sexual
activity outside of the bonds of marriage. We go in accordance
with what the Word says that marriage is honorable in all, and
the bed undefiled-the only time the bed is undefiled is when
there is marriage."
Salvation Army: "Sex before marriage is not acceptable in the
SDA: "I believe that we are aware of the reality, of not
everybody will abstain, but we would emphasize abstinence, from
a doctrinal point of view, and because we believe that it is the
safest... Our thing of abstinence is not strictly about avoiding
HIV; abstinence is also about...pregnancy, it's about...sexual
relationships, where you have amount of responsibility...If it's
with somebody you are very interested in...not just a one night
NOI: "...the sole objective is to promote abstinence-not the
fact that you can get an STD. I don't relate to that at all. And
we don't go around, you know, promoting condom use, we promote
abstinence because there is a much greater value attached to the
individual, particularly the female that if she was sensitized
and made aware of that and I think that would be much more
effective for her than the condom."
Within Christian denominations and across religious groups,
positions on condom use differed, ranging from an acceptance of
condoms in lieu of the "reality" of HIV/AIDS, to a general
contempt for their use as a substitute for self-control.
SDA: "From my personal point of view, you cannot promote the use
of condoms, because in promoting the use of condoms, what you're
actually doing is telling the person you cannot control your
sexual urge. So because you cannot control your sexual urge,
here is something to use when the urge comes...And you find that
as a country growing, so many young people are contracting HIV
in spite of the availability of condoms."
RCII: "What I was very clear about myself was that...we are not
talking about condoms as contraceptives when you talk HIV. That
the church's condemnation of condoms is about contraception; you
are talking about a contra-abortive, which is people dying."
Pentecostal: "We don't think that it is fair or right to
distribute condoms to... like young people who are not married.
You are not supposed to be actively involved with sex outside of
marriage, so any person or persons outside of marriage, we feel,
should not really have the use of any condom. Condoms within the
marriage we feel, should, in our view, be a matter for the
Salvation Army: "Sex before marriage is not acceptable in the
Christian Church, but being practical in this day and age,
better use a condom than get a disease."
Open Bible: "...teaching the people the importance of not being
promiscuous...providing condoms...that doesn't fix the
problem...the problem is the individual...so start from
small...there is a whole lifestyle that starts from a little
child, and you have to start there."
NOI: "I read one interesting quotation from a medical
professional that has stayed with me. And it says that the AIDS
virus passes through...the membrane of a condom like a golfball
passes through a basketball hoop...."
The Jamaat al Muslimeen organization forbids condom use.
However, the interviewee's position was in marked contrast to
that held by the organization. The Jamaat al Muslimeen
representative carried condoms on foot to the poorest of
Trinidad's communities in opposition to the philosophy of the
Jamaat al Muslimeen: "And what I do also is that I distribute
condoms. And a lot of people that I have spoken to in the
underdeveloped community, most of them use condoms sometimes,
and sometimes they don't use condoms... we try to educate them
towards the disease...."
Sexuality and homosexuality
Adherence to religious doctrine and the fear of shame are
thought of as protective factors that insulate the Hindu group
from a promiscuous lifestyle. The Unity group felt that Trinidad
and Tobago was "probably the most promiscuous little country in
the world." Roman Catholic representatives were concerned about
the growing number of young children voluntarily initiating
sexual activity, and believed that sex among the youth was
becoming a defining characteristic of the culture. The RCII
representative explained that gender equality provides enormous
potential for mutuality, and needs to be explored by society.
RCII: "Sex is a powerful potent force in human society.... For
me the one thing that is difficult in Caribbean society that is
distinct from some more traditional societies, is that the kind
of rituals of initiation which have allowed people to claim
manhood, womanhood without become sexually active in the open
sense, those rituals don't exist.... Sexuality is extremely
fragile...we talk about it simply as something that we do when
in fact it is something that you are...."
According to many representatives, education on sexuality in the
context of religious doctrine was unnecessary, because religious
tenets sufficiently define appropriate behavior: if one upheld
the teachings in the sacred texts, HIV/AIDS would not be
transmitted or acquired. The opinion on homosexuality was
generally uniform across religious denominations, although
personal attitudes varied in their degree of outrage; some
groups called it "abominable," or "sickening". Some
interviewees, however, expressed the potential for homosexuals
to be converted, and adopt an acceptable form of behavior.
Open Bible: "We are not against homosexuals but we don't promote
homosexuality...we strongly disagree with it. We believe that
God never intended for people to live in a homosexual
relationship and so certainly we don't in any form or fashion,
Unity: "AIDS is not new. I don't think AIDS comes from any
homosexual behavior. I think people are capable of loving."
SDA: "From my personal observation I don't think that
homosexuality is something that our ministers have a lot to do
with...they have not done a lot of interacting."
Hindu: "In all religions, sex is looked at as very sacred.
Whereas you would not find the Hindu woman covered all over like
the Muslim, they ought to be quite protected, and I think from
the woman folk point of view, it is even less a threat. You
would find that homosexuals mainly from the male contingency,
and...he would be out there in the world, and he may encounter
certain situations, and he may get into...this promiscuous
activity and may become homosexual...."
Compassion and religious representatives' experiences with PWHA
Personal interactions between group representatives and PWHA
varied widely. Some representatives had buried individuals who
had died from AIDS-related complications. The Jamaat al
Muslimeen representative personally contacted individuals and
communities in Port of Spain affected by HIV/AIDS to provide
them with condoms, support and education. In contrast, other
representatives, including Open Bible, Unity, and Hindu,
reported little to no personal interaction with PWHA.
Nonetheless, religious groups unanimously supported compassion
for people living with and affected by HIV/AIDS. The expression
of compassion was often associated with conversion and a desire
to "help the person change."
RCII: "The point of breakthrough was to equate HIV positive
persons with lepers in the Gospel story, so Jesus came for the
lepers, he's come for them. Which is so horrible...but it was a
way for the churches to open up to it...
"There was a conversion process involved in many people... from
AIDS as punishment from God to AIDS as a sad event in human
history which now demands a response from those who say they
believe in the name of God, but that that response must always
Anglican: "Last month I buried at least two persons with AIDS. A
twenty-five year old male, thirty-eight year old female-she sold
drugs and she also sold herself-her body. A sad, sad, sad
moment...AIDS is not an academic thing here...it is very
Pentecostal: "So we feel we need to relate with them treat with
them as members like anyone else and we ought to show that the
same kind of love, the same kind of respect...and we do that."
The Pentecostal representative also articulated how myths about
HIV transmission were dispelled in personal interactions with
Pentecostal: "Many of the myths are...HIV can be spread with the
use of utensils-many believe in those myths even within the
church...The fallacies...or the myths have been put to rest for
us...because of the experiences we have had dealing with people
who have had HIV...."
Salvation Army: "We actually had an HIV/AIDS person who was very
close to us in our formal apartment...he was bold enough to tell
us he had the problem, and so we helped him a great lot...we
knew that he needed extra food...he was rejected from his own
house, and we had to help him get settled...so we sort of have
an idea...it is a problem that needs help. If you come to me and
say I have HIV/AIDS, I am not going to say that you did
something wrong... We have reached out into many areas of social
work because we have a heart for people."
SDA: "The churches responsibility is to show compassion. And not
to check and find out how this person managed to get it. I think
most Adventist churches are moving away from the medical
Hindu: "This religion is based upon compassion, if you do not
have compassion, you are lacking in one of the major ingredients
to be a Hindu. So we do not go about branding anybody, saying
okay, you are a sinner. It is more understanding, it is also a
recognition of the unhygienic situation that arises."
Jamaat al Muslimeen: "I have a twenty-one year old girl, she's
HIV positive...I was even trying to get her to get public
assistance because she and the two children are HIV positive.
And I really thought that she was trying to turn around her
life. But she just kept going with men without condoms."
According to some religious representatives, coping with
HIV/AIDS was different than coping with other terminal diseases
that are not sexually transmitted, such as cancer: people living
with HIV/AIDS come to church requesting confession, whereas
people fighting cancer want to be healed. The RCII represented
expressed the contrast this way:
RCII: "What she was showing was a different form from someone
who has cancer. But the fear that I saw in her was different
from the fear I saw in cancer patients. It was fear coupled with
guilt, and of course she came asking me to pray plenty... you
hear the AIDS people telling you that there's a certain anger
Recommendations and approach to addressing HIV/AIDS in
Religious organizations differed on how to confront the HIV/AIDS
epidemic in Trinidad, if at all. Some representatives, like
RCII, began their involvement in HIV/AIDS care and support
networks early in the epidemic, while others remained insulated.
RCII: "But what they did very well was to train a number of
people would could go into homes and provide home care for
people who had nobody else to care for them...More recently, the
schools have been involved in education and the Catholic Church
is in the process of providing, producing a video about HIV."
Open Bible: "I don't think there is a need to have something
structured in place. I guess in Trinidad it is still a very
private matter...I don't think that this can be addressed by any
one local church, I think this is something that is more a
national issue...and if it has to be dealt with then churches
have to get together to deal with it because of the scope of
Anglican: "If you don't arrest this AIDS thing...what will
happen is that so much money will be spent on AIDS and people
infected with the virus, you have little or no money to spend on
cancer, and diabetes, and all the other things."
Pentecostal: "Obey the word, abstain from sex, and avoid HIV."
SDA: "We have been more or less targeting young people. A lot of
workshops going on as well. We run a home care training
workshop, we also do a sensitizing program for our young
people...we try to bring across in as many of our programs as we
can...activities that relate to HIV and AIDS, so that we are
educating our young people. In terms of our ministerial
staf...there are courses that they must necessarily do in the
program... there is a health course that ministers must do while
they are there in their training, and that of course exposes
them to the myths and realities of HIV and AIDS...."
Hindu: "When I started thinking more deeply, I thought to
myself, this is not so much of a Hindu perspective, or a
Christian perspective, or a religious perspective, but a medical
issue...I think that the avenue provided for help, is one of a
spiritual environment. But it is not through religious bodies."
Religion in the lives of PWHA
Both Roman Catholic representatives provided a rationale for
seeking God to facilitate coping with an HIV diagnosis:
RCI: "Well, they're in a hopeless situation! They're beyond
human help and so the next thing you turn toward God."
RCII: "Because this is fundamentally a religious society. If you
say you don't believe in God, doors close in your face. If you
say you believe in God you stand a much better chance of getting
help from certain quarters. Plus the psychology of HIV, you come
face to face with your own mortality. Turning to God is probably
the most natural thing to do...Once you enter into a mode where
you think you're dying you go through a whole process of anger,
Four PWHA described their experiences in church and their
spiritual journey subsequent to receiving an HIV diagnosis. One
respondent agreed with religious representative, RC1, in that
HIV was a "crisis" situation. Managing feelings of guilt were an
important part of the initial coping process. When 1 of the
interviewees was diagnosed with HIV, she felt she was being
punished for committing a sin, and her pastor confirmed those
feelings. All 4 individuals described discriminatory experiences
by clergy or congregation members, but for 3 of the 4 PWHA,
negative experiences did not affect attendance nor diminish a
spiritual journey. HIV diagnosis generally inspired a desire to
The first interviewee, P1, went to church irregularly growing
up. When she was diagnosed with HIV in her early twenties, the
church provided peace and solitude during her "crisis." However,
she stopped attending when she suspected her pastor ostracized
Response to HIV diagnosis
P1: "With HIV that I went. Before I never really had any kind of
crisis. If a boyfriend and I split up, that wasn't a crisis;
they had other guys out there. It was really when I found out
about my status...I would go to church and people would see me
crying...crying down the place...just tears. Letting my heart
pour out and talking to God."
Experiences in church
P1: "I went to the church for solitude to get some sense of
peace some kind of understanding as to why this is happening to
me...we decided that I could speak to the pastor's wife. And she
sat down with me and she said, you know she had a son who also
died from it. I mean nobody would have expected a pastor's son
to get HIV because they're not supposed to be living a
promiscuous life...She comforted me and she told me you know I'm
welcomed in this church at anytime.
I came and I told [my friend] about it. She knew the guy who
died, her son. His family was not nice to him. His mother his
father was not nice to him. For her to be giving me another
story. It was unbelievable to think that they were not nice... I
think that is one of the reasons too that I did not go back."
Current attitude towards religion
P1: "I kind of gave up on myself and I started going to a lot of
parties. So when Sunday came, I would go party Saturday night
and when Sunday came I can't get up in the morning to go to
church. And that kind of threw me off from going, from attending
that. But I want to start back going."
P2 grew up attending church daily with his mom, who was Roman
Catholic. Later in life he experimented with drugs and sex.
Near-death experiences were the impetus to reach out to a
spiritual counselor, and he later became active in community
Response to HIV diagnosis
P2: "I was thinking about dying all the time. The addicts felt
sorry for me.
But I don't feel like dying anymore. It is only by the grace of
God that I am not depressed. What I care about doing the right
thing, taking my medication and learning more about it. I would
like to carry the message to schools ...I don't feel any less
than anybody because I know that Jesus Christ loves me and I
Experiences in church
P2: "I talked to the pastor and a few of the deacons high in the
Church and when I was sick they didn't come by. I felt they
didn't respond as they should have. Last Saturday my pastor
shook my hand."
Current attitude towards religion
P2: "God is my armor, my weapon has made me overcome a lot of
hurdles and a lot of hang-ups...it has played a very important
part...even with my addiction my spirituality has changed a lot.
I choose God."
P3 was active in an SDA church, but before her HIV diagnosis was
a member of an Islamic organization.
Response to HIV diagnosis
P3: "It happened in 1995...and I couldn't believe that I was HIV
positive, because at that time I was not educated about living
healthy with HIV. So I thought to myself that it would be the
end of the world for me.
...I decided, listen if I have to die I need to make peace with
my God, whoever the creator is...I also had a friend, who was a
Christian...and he said to me Christ could help you, Christ can
heal you...I started reading the Bible, with a longing in my
heart to find out...if the creator was hearing me or not. I used
to pray like five times a day because my body was diminishing,
my hair was falling off, I had sores all over my body...things
just started getting clearer and clearer to me, and my eyes were
just opened, slowly but continually being opened to what is
real, what is the reality of life."
Experiences in church
P3: "I was impressed to let the church know of the power of God,
because I know it was a miracle, and I wanted them to know that
the God that they serve is still in the business of doing
miracles...But they did not respond to it very well, therefore I
was faced with plenty stigma, and word got around...and I just
saw everybody start whispering...Now I'm faced with a
reality...if I get involved with anybody, everybody...scorn me,
and any young man within the church comes around me, bet your
bottom dollar someone's going to tell them, she's HIV positive."
Current attitude towards religion
P3: "It's all well and fine that governments are looking into
HIV care and treatment, but why isn't the religious sector
taking part in a more meaningful way? Presently I am trying to
get the Adventist, we already we have an AIDS ministry, but they
are not involved in a holistic view in terms of educating even
their own people, far less the general public.
The church has to play a very important role in the fight
against HIV and AIDS... The reason that I think that the virus
has mushroomed, is because of moral standards...moral standards
have gone down."
P4 regularly attended and was active in a Pentecostal church.
The HIV diagnosis was confirmed at 18 years old.
Response to HIV diagnosis
P4: "I thought I was being punished for my sins. That's what he
said too. I am being punished. And I caused it on myself, and on
and on and on he went. But I don't think that is true...The
first camp I went to after I was diagnosed, I talked to a social
worker. She used to really encourage me. The first time I went
to her I was really depressed, and asked her if she thought God
was punishing me for my sins. She said, is God evil? What about
all the children born with HIV, are they being punished? Bad
things happen to everybody."
Experiences in church
P4: "I talk to my pastor. But I come to find out that he was not
so trustworthy...I went to my pastor and I was talking to him
about it and I find out that he was telling everybody...He said
they needed to know so that they could pray, so the church could
pray. But he just said that so he could tell everybody...Once
the board knows-the board is family member leaders. I think
everybody probably knew or was told by someone else. I still see
him. I'll say hi. That was about a year and a half ago.
The last time I went to church I was talking to this little boy,
and this woman told me not to touch him, if you touch him you
will give him your germs. The boy was six months old. I learned
Current attitude towards religion
P4: "Despite all the real bad things, I believe in my religion.
I guess in every organization you'll find good people and bad
people...I'm always really love my religion, love church and
love God. To myself I feel comfortable, so I don't think people
should influence my relationship with God, I'm really, really,
really trying to work on it."
Christian, Hindu and Muslim religious representatives differed
in their attitudes and opinions on the following themes:
rationale for the spread of the HIV/AIDS epidemic in Trinidad,
sexuality and homosexuality, condom use, processes for healing,
and the impetus to become involved in faith-based initiatives.
Levels of awareness about the prevalence of HIV/AIDS in
Trinidad, susceptible sub-populations, and knowledge of the
mechanisms of HIV transmission also varied. Religious
representatives isolated subgroups who were believed to be
particularly susceptible to HIV infection, and in so doing,
implicitly articulated HIV/AIDS stigma in different ways. For
example, the Hindu representative believed that HIV infection
was generally limited to homosexuals and promiscuous non-Hindus.
For the SDA and Pentecostal representatives, HIV was synonymous
with a promiscuous lifestyle and the transgression of
Representatives were generally in agreement in their advocacy
for the sanctity of marriage prior to engaging in sexual
intercourse. In correlation, the SDA representative felt that
condoms facilitated the transgression of abstinence and the
degradation of self-discipline. The NOI representative felt that
condoms aided and abetted promiscuity in society, but went
further in claiming that condoms were not even an effective
barrier against sexually transmitted infections. In contrast,
the "reality" of HIV/AIDS for the SA representative led to a
more accepting attitude toward condom use. The Jamaat al
Muslimeen and RCII representatives had personal experiences with
PWHA, and it was their understanding that condoms were
life-saving tools. Thus, the present research also suggested
that personal experiences and interactions among religious
representatives and PWHA dispelled myths surrounding HIV/AIDS
transmission, and sensitized individuals to the HIV/AIDS
"reality." The SDA interviewee believed that personal
experiences with PWHA were critical to the HIV/AIDS
sensitization process, and for dismantling myths about
The full potential for religious groups to contribute to
HIV/AIDS awareness efforts is currently untapped. While the
majority of representatives admit that HIV/AIDS is a serious
problem that is affecting the country and the world, there was
wide disparity in the impetus for implementing a faith-based
initiative targeting HIV/AIDS-related issues. The Anglican
interviewee supported a proactive initiative and HIV/AIDS was
among the Church's 5 priorities; however for the Pentecostal,
SDA, Open Bible and Hindu groups, HIV/AIDS was not a priority
that needed immediate attention and warranted discussion among
congregations. According to the Pentecostal representative, HIV
could simply be avoided by adhering to the behavioral conduct
outlined by Christian tenets. Despite the Jamaat al Muslimeen
representative's personal efforts in raising awareness about
HIV/AIDS in rural communities, she felt that the "mix" of
HIV/AIDS initiatives and faith-based communities invited
stigmatization of PWHA.
Whether it was called "divine purpose" according to the Hindu
representative, "openness to the transcendent," by the RCII
interviewee, or the "God conscious part" by the Open Bible
representative, it was agreed that humankind are inherently
spiritual beings; and that Trinidad is indeed a
spiritually-aware society. For the 4 participants living with
HIV/AIDS, all of whom identified themselves as Christians, an
HIV diagnosis inspired an exploration of spirituality, and led
to a deeper connection with God-despite experiences of isolation
and discrimination in church. One PWHA was identified as HIV
positive by her pastor during a worship service, so that he
could exemplify deserving consequences of sexual behavior. The
attitude of this pastor seems to reflect the opinion of the Open
Bible and Pentecostal representatives: by abstaining from sex
one avoids HIV. Other PWHA were also discriminated against by
members of the congregation. Nonetheless, for 3 of the 4
individuals, negative and discriminatory experiences did not
affect attendance in church nor attenuate a spiritual journey.
Religious representatives were generally willing to participate
in a care-giving capacity for people with HIV/AIDS because these
efforts were built into their existing mission. Religious groups
in the past have publicly acknowledged a responsibility and
desire to be involved in care-giving for people living with and
affected by HIV/AIDS. For example, organizations such as the
Roman Catholic-sponsored Caritas have been successful in home
health care for PWHA and their families. At the 1998 Youth
Summit, religious representatives formulated "support
resolutions," recognizing the need for their involvement in
communities through the provision of information and counseling
services for adolescents in society . A 2001 report revealed
that religious groups desired to improve their capacity to
contribute to care and support .
Regional conferences such as those led by the CCC indicate that
religious groups are beginning to mobilize in confronting the
HIV/AIDS epidemic. Since the completion of this study, in 2005,
the CCC hosted another consultation with Faith Based
Organizations to develop an HIV/AIDS policy and action plan,
entitled, "Guidelines for Caribbean Faith-Based Organizations in
Developing Policies and Action Plans to deal with HIV/AIDS"
. The document is part of a collaborative effort, "Building
a Faith Based Response to HIV/AIDS in the Caribbean" to enhance
the response of faith-based organizations to Trinidad's HIV/AIDS
epidemic. Furthermore, the highest level of government supports
the crucial role religious groups may play in mitigating the
impact of HIV/AIDS stigma and discrimination. National HIV/AIDS
prevention efforts involving faith-based organizations are
mandated by the 5 year HIV/AIDS National Strategic Plan (NSP),
whose goals include the provision of necessary support within a
holistic framework for those persons infected and affected by
HIV/AIDS. These goals are currently undertaken by the
newly-formed National AIDS Coordinating Committee .
Nonetheless, several religious representatives agreed that the
pace of efforts on behalf of religious organizations has been
too slow. The present research raises the following question: if
HIV were not sexually transmitted, would religious organizations
respond to the epidemic in the same way? The HIV/AIDS epidemic
in Trinidad urgently calls upon religious groups to provide a
clear and consistent response to issues of sex and sexuality
that resonates with personal experience and respects religious
doctrine. However, the present research highlights inconsistent
attitudes and opinions on the moral and spiritual issues
surrounding HIV/AIDS; such inconsistencies may serve as a
barrier to a united faith-based initiative in Trinidad.
Religious groups across all faiths and denominations are
challenged to recognize that human beings are sexual beings;
herein lays the dilemma for religious groups. A faith-based
intervention must understand the complexity of preserving the
central tenets of organized religion while embodying compassion
for individuals as sexual beings.
This study was limited by a small sample size and the geographic
location of Northwest Trinidad; this may affect the
generalization of results throughout Trinidad and Tobago. On
average, only one representative from each religious
organization was interviewed, and opinions expressed did not
necessarily reflect those of the religious organization as a
whole. Nonetheless, HIV/AIDS-related stigma and discrimination
will continue to fester throughout Trinidad and Tobago until all
the republic's religious leaders, esteemed in the public eye,
possess accurate information about HIV transmission, which may
then be conveyed to congregations; and until religious leaders
are sensitized to the experiences of PWHA. Prior to involvement
in community-based education, care and HIV/AIDS support
initiatives, religious leaders must possess compassion that is
reinforced by personal experiences with PWHA. PWHA are receptive
to faith-based counseling and support provided by religious
leaders and congregation members. Thus, a consultative dialogue
between PWHA and religious leaders is pivotal to a successful
faith-based HIV/AIDS initiative in Trinidad.
AC: Anglican Church
AIDS: Acquired Immuno-Deficiency Syndrome
CAREC: Caribbean Epidemiology Center
HIV: Human Immunodeficiency Virus
NOI: Nation of Islam
PWHA: People Living with HIV/AIDS
RC: Roman Catholic (group representatives, RCI and RCII)
SA: Salvation Army
SDA: Seventh Day Adventist
STI: Sexually Transmitted Infection
The findings and conclusions in this report are those of Dr.
Brathwaite and Ms. Genrich and do not necessarily represent the
views of the funding agency, the Institute for International
Education and Fulbright Fellowship Program, nor the
organizations where the authors currently work, the University
of the West Indies and the Centers for Disease Control and
Prevention, respectively. There were no competing interests,
financial or otherwise, in the present investigation, and no
incentive on behalf of the Institute for International Education
to obtain the results found. No fees or funding were obtained
from any organization that could gain or lose from the
publication of the manuscript, and no stocks or shares are held
in any organization that stood to gain or lose financially from
Dr. Brathwaite contributed to the design of the research method.
Ms. Genrich carried out the in-depth interviews with the
participants, religious representatives and individuals living
with HIV/AIDS. Both Dr. Brathwaite and Ms. Genrich collaborated
on the final analysis and manuscript preparation. Both authors
read and approved the final manuscript.
The pre-publication history for this paper can be accessed here:
With deep appreciation we thank the Fulbright Fellowship Program
and Institute for International Education for making this
important investigation possible. The authors are sincerely
grateful to all participants for willing to openly share their
opinions and experiences. Special thanks to Dr. Dean Knolly
Clarke for his insight and support.
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