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Middlesex University Research Repository an Open Access Repository Of Middlesex University Research Repository An open access repository of Middlesex University research http://eprints.mdx.ac.uk Banda, Joshua H.K. (2017) Impacts of congregation-based HIV/AIDS programmes In Lusaka, Zambia: how abstinence and marital fidelity efforts function in overall strategies addressing HIV/AIDS. PhD thesis, Middlesex University. [Thesis] Final accepted version (with author’s formatting) This version is available at: https://eprints.mdx.ac.uk/21800/ Copyright: Middlesex University Research Repository makes the University’s research available electronically. Copyright and moral rights to this work are retained by the author and/or other copyright owners unless otherwise stated. The work is supplied on the understanding that any use for commercial gain is strictly forbidden. A copy may be downloaded for personal, non-commercial, research or study without prior permission and without charge. Works, including theses and research projects, may not be reproduced in any format or medium, or extensive quotations taken from them, or their content changed in any way, without first obtaining permission in writing from the copyright holder(s). They may not be sold or exploited commercially in any format or medium without the prior written permission of the copyright holder(s). Full bibliographic details must be given when referring to, or quoting from full items including the author’s name, the title of the work, publication details where relevant (place, publisher, date), pag- ination, and for theses or dissertations the awarding institution, the degree type awarded, and the date of the award. If you believe that any material held in the repository infringes copyright law, please contact the Repository Team at Middlesex University via the following email address: [email protected] The item will be removed from the repository while any claim is being investigated. See also repository copyright: re-use policy: http://eprints.mdx.ac.uk/policies.html#copy Impacts of Congregation-based HIV/AIDS Programmes In Lusaka, Zambia: How Abstinence and Marital Fidelity Efforts Function In Overall Strategies Addressing HIV/AIDS Joshua HK Banda PhD 2017 Abstract The 2013-2014 Zambia Demographic and Health Survey (ZDHS) reported HIV prevalence rate among adults aged 15-49 at 13.3%, ranking Zambia 7th among countries experiencing devastating effects of a mature and generalised epidemic. This report is particularly noted as the first to measure HIV incidence1. Chanda Kapata2 et al. posting results from Zambia’s largest population-based mobile testing survey (2013–2014) placed the HIV prevalence rate generally lower. In 2002, the National AIDS Council (NAC) was established to lead a multi- sectoral national response to stem the tide. Government Agencies and the United Nations led the responses. In 1992, The World Health Organisation (WHO) observed that abstinence and marital fidelity might constitute strategies capable of completely eliminating the risk of infection from HIV and other sexually transmitted diseases (STDs). Yet funding for applicable initiatives has seldom been prioritised in this respect. On one hand, from the onset of global interventions, condoms were seen primarily as most potent towards reducing the risk of infection. On the other hand, in due course, the implementation of Abstinence and Being Faithful (AB) initiatives by Churches among others, has since been seen as holding massive comparative advantage in facilitating sustainable interventions for prevention and mitigation of AIDS impact. However, church-congregation engagement in AIDS work, for a while, remained under-researched, and applicable interventions were often undocumented and unmeasured in relation to impact. This study investigated (1) how interventions affect impacts in congregation-based HIV/AIDS programmes, and (2) how abstinence and marital fidelity function within the larger picture of overall strategies to combat AIDS. It examined the community work of the Circle of Hope Family Care Centre, a congregation-based HIV/AIDS support group initiative undertaken by the Northmead Assembly of God Church 1 Central Statistical Office (CSO) Zambia, Ministry of Health (MOH) Zambia and ICF International. Zambia Demographic Health Survey 2013/2014. Rockville, Maryland, USA: Central Statistical Office, Ministry of Heath, and ICF International. 2014. 2 Chanda-Kapata, P., Kapata, N., Klinkenberg, E., William, N., Mazyanga, L., Musukwa, K., … Mwaba, P. (2016). The adult prevalence of HIV in Zambia: results from a population based mobile testing survey conducted in 2013–2014. AIDS Research and Therapy, 13, 4. http://doi.org/10.1186/s12981-015-0088-1 in Lusaka, Zambia. The main research question was: 1) Is a person’s sexual behaviour influenced by their attitude and behaviour towards God? Two subsidiary questions were: i) what are the factors that affect a person’s sexual lifestyle? ii) Does attendance at the church’s HIV/AIDS programmes cause a change of behaviour in a person’s sexual relationships? A triangulated methodology required the collection of both quantitative and qualitative data. The experimental design included a purposively selected intervention group and a control group. Both groups were studied by employing baseline first, and follow-up measures after three months. Quantitative data analysis was carried out in two stages comprising first, cross tabulations to examine the relationship between safer sexual behaviour and socio-economic variables. For the statistical analysis, chi-square tests of independence were conducted at the bivariate level, and the differences were determined at P < 0.01 and P < 0.05 significant level. Next, major predictors were carried out with the help of logistic regression analysis. The results of the logistic regression models were converted into odds ratios, which represented the effect of a one-unit change in the explanatory variable on the indicator of experiencing safer sexual practices and abstaining from sex. Qualitative data were analysed using Atals.ti software to produce the attendant themes and sub-themes. The results of the logistic regression analysis show that those who participated in the interventions were 4.1 times more likely to report having adopted new behaviour or modified old behaviour, specifically to live positively, than those who did not attend the interventions. Similarly, participants in the faith-based interventions were 2.3 times more likely than those who did not take part to report having adopted safer sexual practices. Further analysis revealed that those participants were more likely to report abstinence from sex than those who did not attend. The conclusion is that church congregations have immense comparative advantage to influence sexual behaviour through increasing captive audiences constituting the churches’ presence in the community. Additionally, their morally based interventions such as abstinence and marital fidelity show significant impact on sexual behaviour change and have potential to turn the tide of HIV/AIDS, as the tested models are replicable, scalable and sustainable. Impacts of Congregation-based HIV/AIDS Programmes In Lusaka, Zambia: How Abstinence and Marital Fidelity Efforts Function In Overall Strategies Addressing HIV/AIDS by Joshua HK Banda Diploma (Trans-Africa Christian University) B.A. (Northwest University) MAMDP Studies (OCMS matriculation) Director of Studies: Dr Chris Sugden Second Supervisor: Professor Emil Chandran House Tutor: Brian Woolnough A thesis submitted in partial fulfilment of the degree of Doctor of Philosophy in Middlesex University 08 September, 2016 Oxford Centre for Mission Studies DECLARATION This work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidature for any degree. Signed Joshua HK Banda (Candidate) Date 08 September, 2016 STATEMENT 1 This thesis is the result of my own investigations, except where otherwise stated. Where correction services have been used, the extent and nature of the correction is clearly marked in a footnote. Other sources are acknowledged by midnotes or footnotes giving explicit references. A bibliography is appended. Signed Joshua HK Banda (Candidate) Date 08 September, 2017 STATEMENT 2 I hereby give consent for my thesis, if approved, to be available for photocopying by the British Library and for Inter-Library Loan, for open access to the Electronic Theses Online Service (EthoS) linked to the British Library, and for the title and summary to be made available to outside organizations. Signed Joshua HK Banda (Candidate) Date 08 September, 2017 i ACKNOWLEDGEMENTS My Lord God: I am forever grateful for his ever-sufficient grace through out this rewarding journey. My wife Gladys: Thank you for your love, care, prayers, encouragement and unflinching support during the many solitary months of writing. Linda, Ryan, Nathan and Lisa: Iam so grateful for your understanding and loving support. All of you are such a special gift, making me a very fulfilled father! Dr Chris Sugden, an astute academic and discerning supervisor. A father, mentor and friend through this process. Thank you. Professor Emil Chandran: Many thanks for your unique wisdom and guidance on the supervisory team. You helped make statistics simpler to grasp. OCMS faculty and staff: Thank you for being family and making Oxford a home. The Northmead Assembly of God leadership and congregation: Thank you for your prayers, encouragement and financial support. You are a blessing! Scholar Leaders International,
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