Religion Networks and Hiv/Aids in Rural Malawi
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RELIGION NETWORKS AND HIV/AIDS IN RURAL MALAWI DISSERTATION Presented in Partial Fulfillment of the Requirements for The Degree of Doctor of Philosophy in the Graduate School of Ohio State University By jimi adams * * * * * Ohio State University 2007 Dissertation Committee: Approved by Professor Kazimierz M. Slomczynski, Advisor Professor James W. Moody, Outside Member _______________________ Professor Korie Edwards Advisor Sociology Graduate Program Professor Steven H. Lopez Copyright by jimi adams 2007 ABSTRACT Sub-Saharan Africa’s residents represent approximately two-thirds of the nearly 40 million global HIV/AIDS cases, while comprising only about one-tenth of the world’s population. In the rural settings where most inhabitants of SSA live, religious organizations are the only formal organizations present, and virtually all residents of SSA participate in a religious organization. Many have theorized a relationship between religion and HIV/AIDS, suggesting alternately its helpful and harmful potential in this crisis. The existing research conceptualizes religion, HIV risk and the connection between them by studying individuals, organizations, or aggregations of individuals and organizations. In this dissertation, I demonstrate the adjustments a network perspective contributes to researchers’ ability to understand religious organizational responses to this epidemic, the nature of HIV-risk and, perhaps most importantly, how these are linked. The resulting conceptualization suggests some of the first mechanisms that demonstrate how beneficial and harmful HIV-related outcomes can arise simultaneously from religious structure or corresponding individual behaviors. The first section describes religious organizational networks to demonstrate how social network structural factors shape the HIV-related messages conveyed within religious organizations. While many intended models of prevention and intervention rely on implicit formal organizational hierarchies, little is known about ii how this contributes to the content and effectiveness of subsequent prevention messages. Therefore, I first provide comparative description of the networks within which local religious leaders develop the HIV-related messages conveyed in their congregations. I then compare the HIV-related messages of religious leaders at the national-denominational and local-congregational levels, to demonstrate the existing gaps between the intended model and the functional reality of these efforts. I explain how local clustering of these networks drives the discordant messages. For the analyses in this section, I draw on a social network perspective as a story-telling device that provides a better understanding of how religious organizations develop their responses to the HIV-epidemic. Conceptualizations of individuals’ HIV-risk also benefit from adopting a network perspective to more readily capture the epidemiology of HIV. While individuals’ religious involvement may reduce risk behaviors; HIV risk cannot be fully understood in these terms. Potential infection is dependent, not only the frequency of risk behaviors, but also on characteristics of ones’ partners (e.g., probability of their infection). With the final analysis in this dissertation, I generate a series of simulated networks to demonstrate that the differences observed in risk behaviors associated with religious affiliation do not necessarily translate into corresponding differences in network-oriented risk properties. I draw on data from the Malawi Religion Project and the Malawi Diffusion and Ideational Change Project to investigate these questions. iii ACKNOWLEDGMENTS This project has been a long process of which I have played but one part. Ultimately, the ideas are mine, so only I can be blamed for what’s here, however the contributions of quite a few people substantially strengthened the work. I particularly would like to thank my advisors in this project. While a dissertation typically progresses under the guidance of one person, mine has included the tutelage (officially and unofficially) of three. Their willingness to work with and defer to one another during this process has allowed the work to continue, and not get bogged down in administrative limbo. James Moody has provided invaluable guidance in framing the project as a whole, and providing continual support – theoretical, technical and mental, at stages when each were nearing complete breakdowns. Kazimierz Slomczynski took me on as a student at a relatively advanced stage of the project, and provided helpful pushes forward, without which the project, and my career, probably would have stalled out several times. Susan Cotts Watkins invited me to join the projects that provide the data for this project. Her continual offering of suggestions, and unmatched knowledge of what has already been done have been invaluable resources in this process. She willingly let graduate students, not only run the data collection projects, but also shape their content, which is beyond what I could have asked for. This gave me the chance to iv examine questions that interested me in ways that otherwise would have not been possible. For that opportunity, I am immensely grateful. I would also like to thank the other members of my committee, Korie Edwards and Steven Lopez for adding their helpful insights into areas of this project where their expertise was especially salient, and filled what otherwise would have been substantial gaps. Two fellow graduate students have been particularly helpful in my making it through this process. Jenny Trinitapoli willingly accepted me into what was, in essence, her project. I thank her for not seeing me as infringing on her territory, but instead being an incredible sounding-board. The ideas here were often little more than half-baked before our discussions formed them into something cogent. Joshua Dubrow has read drafts of, and provided helpful feedback on, virtually everything I have written over the past five years, and has not laughed at me once. That I know of. There are numerous others who read drafts of this work, chatted online or over coffee about the ideas, or simply offered a listening ear when needed. Among those, I would especially like to acknowledge the feedback and support I received from Sara Bradley, Agnes Chimbiri, Peter Fleming, Stephane Helleringer, Hans-Peter Kohler, Ryan Light, Michelle Poulin, Mark Regnerus, Georges Reniers, Irina Tomescu- Dubrow, Alexander Weinreb and Sara Yeatman. I would also like to note the MDICP/MRP field teams for their invaluable contributions, not only to the collection of excellent data, but also to shaping the projects that come out of them. In particular, my work has especially benefited from the input of Sydney Lungu, James Mwera, Julius Nyambo and Joel Phiri. v During this project, I have received financial support from several sources, without which the work would not have been possible. I am grateful for this support from the National Institutes of Health (grants 1R01-HD050142 and 5R01-HD041713, Susan Watkins, PI; 7R01-DA012831 and 1R01-HD041877, Martina Morris, PI), the Society for the Scientific Study of Religion, the Office of International Affairs and the Initiative in Population Research at Ohio State University, and the Population Studies Center at the University of Pennsylvania. My parents long ago taught me (or allowed me) to ask questions in ways that inevitably paved my path to grad school. For that and the support they provided along the way, I am thankful. Several friends of mine who have pastored the various churches I’ve attended over the past decade have pushed (or pulled against) me when necessary. I want to thank for that: Matt Bartley, Mike Borst, Brian Brooks, Chris Martin, JR Woodward and Jim Zippay. Each of you helped me to recognize that my faith and my work do not have to be, and in fact should not be, separate. The places I have lived while writing this have been an incredible support, and for being there through it, I am grateful to all of you with whom I’ve shared those spaces, and considerable chunks of our lives: Kyle Bush, Jed Dearing, Tim & Jenny Evans, Tim Poindexter, Cisco Sanchez, John & Karen Thomas and Jenny Trinitapoli & Gregory Collins (and Cassia). And most of all, I want to thank God for never giving up on me no matter how many times I try to on Him. vi VITA October 21, 1976…………………….. Born – Lexington, KY 2004…………………………………...M.A. Sociology, Ohio State University 2001 – 2006 ………………….……… Graduate Teaching and Research Associate, Ohio State University PUBLICATIONS 1. adams, jimi. 2007 “Stained Glass Makes the Ceiling Visible: Organizational Opposition to Women’s Congregational Leadership.” Gender and Society, 21(1): 80-105. 2. adams, jimi and James Moody. 2007. “To Tell the Truth?: Concordance in Multiply Reported Network Data.” Social Networks, 29(1): 44-58. FIELD OF STUDY Major Field: Sociology vii TABLE OF CONTENTS Page Abstract …………………………………………….…………………………...….....ii Acknowledgments …………………………………………………………...…...…...v Vita ……………………………………………………………….………..………..vii List of Tables …………………………….…………………………………..……….x List of Figures ………………………….……………………………………..….....xii Chapters: 1. Introduction: A Relational Approach for a Relational Problem ...….………...1 2. Theoretical Orientation: Moving from People and Variables to Relations and Networks …………………………………………………..20 3. Data: The Malawi Religion Project and The Malawi Diffusion and Ideational Change Project ..…………………….44 4. Examining Policy Location (not Locution): Congregation Leaders’