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Response of religious groups to
HIV/AIDS as a sexually transmitted infection in Trinidad
Gillian L Genrich1,2 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
Corresponding author.
Gillian L Genrich: glgenrich@yahoo.com ; Brader A Brathwaite: brada@wow.net
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.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1310629
Abstract
Background
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.
Methods
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, 20022003. 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 interviewer.
Results
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.
Conclusion
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.
Background
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 [1]. Trinidad and
Tobago (T&T), an island nation situated off the coast of Venezuela and
home to 1.3 million citizens, [2] shares with region members an
incidence of HIV/AIDS second only to sub-Saharan Africa [3]. Since the
first case of HIV was identified in Trinidad in 1983 in a homosexual
male, [4] the prevalence of HIV/AIDS in adults (1549 years old) has
grown to 2.5%, with half of all new infections occurring in young people
between 1524 years [5]. HIV is primarily transmitted through
unprotected sexual intercourse, [6] and is fueled by multiple sexual
partnerships, substance abuse, and migration and gender inequalities
[7]. The Trinidad and Tobago Ministry of Health suspects the infection
is underreported and the actual number of cases is twice as high [5].
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 [4]. Of all confirmed AIDS cases reported in
1999, 75% were identified as HIV positive within the same year as the
AIDS diagnosis [4]. 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 [10] that
coexist peacefully, often participating in public celebrations of other
faiths [11]. 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" [12]. Religious groups are
geographically evenly distributed throughout the nation; active amongst
the poorest communities and within areas of high HIV/AIDS prevalence
[13]. The pervasiveness of diverse religious ideologies thus creates a
complex environment for the transmission of a sexually transmitted
infection.
Religious leaders are esteemed, frequently exchange with the public
and maintain an influential role in policy-making in Trinidad [11]. 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" [14]. 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 [15] 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 [13] 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.
Methods
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 [13]. 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 12.5 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, [13] 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
congregations.
Figure 1
Interview Questions for Religious Representatives.
People living with HIV/AIDS (PWHA)
In-depth interviews with PWHA were conducted during the same study
period, 20022003. Four PWHA (P1P4) 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).
Figure 2
Belief Systems Questionnaire for People Living with HIV/AIDS.
The interviewer
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 interviewer.
Results
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...."
Open Bible
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.
Pentecostal
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 behavior.
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 Caritas.
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 the virus.
Unity School
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."
Hindu
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 reap."
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...."
Abstinence
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
Christian Church."
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 stand."
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."
Condom use
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 people involved."
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 organization:
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, entertain it...."
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 be compassion...."
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 concrete...."
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 PWHA:
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 fact...."
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 with themselves."
Recommendations and approach to addressing HIV/AIDS in congregations
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 it."
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, of bargaining."
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 explore spirituality.
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 PWHA.
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 outreach programs.
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 trust him."
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 a lot."
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."
Conclusion
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
abstinence.
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 transmission.
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 [16]. A 2001 report revealed that religious
groups desired to improve their capacity to contribute to care and
support [13].
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" [17]. 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 [18].
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.
Abbreviations
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
Competing interests
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 publication.
Authors' contributions
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.
Pre-publication history
The pre-publication history for this paper can be accessed here:
http://www.biomedcentral.com/1471-2458/5/121/prepub
Acknowledgements
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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