A total of 422 participants were interviewed using an interviewer administered questionnaire with a 100% response rate. The mean age of the respondents was 19.18 (SD = ± 2.6) with 56.9 % (240/422) in the age category of less than 20 years. About 71.8% (303/422) of the respondents were singles and 57.1% (241/422) were females. The majority of respondents, 45% (190/422), had completed an ordinary level of education. (Table 1)
HIV prevention strategies provided by religious leaders
The majority of participants, 85% (362/422), reported that their religious leaders advocate for abstinence. In addition, the majority, 95% (401/422) of the participants, reported that their religious leaders advocated for faithfulness (Table 2). Participants in the qualitative interviews strongly supported or advocated for abstinence, particularly among unmarried young people, and for being faithful to one partner among married people. One respondent reported that:
"Abstinence is the best. We discourage premarital sex for two reasons: one, you don't go when there isn't time, and there is time for everything. Sex is good, but in a marriage setting, it's inappropriate. "So, according to Galatians 5:19, we reject and condemn fornication among young people, and we discourage and condemn adultery. “The only good way is abstinence and patience. "Male, SDA, R16, 38 years, March 2021.
As far as condom use is concerned, religious leaders have varying opinions concerning their support for condom use. Therefore, the message regarding condom use as one of the HIV prevention strategies by religious leaders cannot be ignored. A significant proportion, 71.8% (303/422) of the respondents, reported that their religious leaders discouraged condom use (Table 2). This result was further supported by a section of religious leaders who reported discouraging condom use among young people. Those who don’t support condom use argue that it promotes fornication and adultery among the youth. Some of the key informants remarked:
"Using condoms is not good for them because it allows them to engage in sexual relationships, which can easily lead to the spread of HIV/AIDS among young people” When you read Exodus 20 in the Bible, it talks about avoiding fornication, and the church teaches the youth not to engage in sexual relationships”. Male, SDA, R12, 50 years, March 2021.
According to another key informant:
"... Because of respecting the law, just like I swore, it makes me accept what the church has accepted. But what the church has refused, I will also refuse" Male, Catholic, R5, 30 years, March 2021.
A level of ambivalence was articulated by one of the key informants who was able to detach himself from his religion and reported he would encourage young people to use condoms because it would prevent them from contracting the virus, as quoted below:
".... "Leaving aside the issue of being a catechist, it is to advise a child to go to the hospital and get a condom in order to prevent a child from contracting the virus" Male, Catholic, R6, 42 years, March 2021.
About 51.2% (216/422) reported that their religious leaders have never advocated for voluntary medical male circumcision (Table 2). According to some qualitative interview participants, male circumcision is not a safer method of HIV prevention among young people, as one can still contract the disease and it encourages sexual relationships. One religious leader said:
"It makes one have uncontrollable sexual behavior." Male, Anglican, R11, 46 years, March 2021.
A significant proportion of participants, 65.2% (275/422), reported that their religious leaders preach about HIV prevention. The same message was echoed by participants in the key informant's interviews. One participant reported:
"We preach to them and we encourage them to carry out tests to know their status as well. For those that already know their status, we always give them words of hope that that’s not the end of life" Male, Anglican, R19, 39 years.
About 61.9% (261/422) of the respondents reported that their religious leaders are involved in awareness creation programs among young people (Table 2). A section of the religious leaders reported not having posters/charts with HIV prevention messages in their various places of worship. If they are available, some people prefer to hang them in their places of worship. One participant was quoted as saying;
"...So my opinion is that it should not be hung against the wall in the church because it’s the house of the Lord, but it can be hung outside the church in the compound." Female, Pentecostal, R4, 50 years, March 2021.
The majority, 47.4% (200/422) of young people, reported that religious leaders have a strong influence on their use of HIV prevention strategies. A significant number, 47.9% (202/422) reported that religious leaders’ preaching influences their choice of HIV prevention strategy. Moreover, most 61.9% (261/422) of the participants reported that their religious leaders are involved in HIV/AIDS awareness campaigns (Table 2). This result is consistent with the results of the key informant's interviews. One participant reported:
They have training most of the time during camp meetings, in the 13th week,........... and the church also organizes youth meetings once a month. We also have an Adventist Youth group that we teach about the dangers and prevention of HIV/AIDS, and we have books like 'Free from Addiction' that we give people to read about HIV/AIDS." All of these programs are aimed at youths as well. "Male, SDA, R12, 50 years.
About 47.4% (200/422) of the respondents reported that religious leaders have a strong influence on their choice of HIV prevention strategies.
Bivariate and multivariable logistic regression of factors associated with use of HIV prevention strategies among young people.
Factors significantly associated with the use of HIV prevention include completion of the primary level (aOR 4.95, p < 0.05), completion of at least A level (aOR 8.85, p < 0.05), awareness of HIV prevention strategies by religious leaders (aOR 0.02, p < 0.001), provision of HIV prevention messages from religious leaders (aOR 2.53, p < 0.01), Advocacy for being faithful (aOR 35.6, p < 0.01), Religious leaders preaching about HIV prevention (aOR 4.88, p < 0.001). (Table 3)