Bringing Faith and Science Together to Fight HIV in Africa
An enterprising science-based education program enlists clergy to help spread the word about HIV prevention and treatment.
While most biomedical researchers want to make discoveries that will improve health for humankind, their intense, lab-based work — replete with cells, molecules and microscopes — can feel somewhat detached from the people who are affected by the diseases and conditions they are studying.
A group of U-M researchers who are dedicated to bridging this divide recently published a paper in the journal Global Public Health detailing a simple, yet effective program designed to bring scientific knowledge to the people.
The program is the brainchild of A. Oveta Fuller, Ph.D., a professor of microbiology and immunology and senior author on the paper. Fuller spent 20 years as a self-described “hardcore virologist lab scientist” before turning to community engagement.
While on sabbatical in 2006, Fuller, a member of the African Methodist Episcopal (AME) church, was invited by representatives of the global church to assist with addressing HIV/AIDS in several African countries, including Botswana, South Africa and Zambia.
“I was asked to do these things and the more I did them, the more I realized no matter how much we discover, if it doesn’t get to the people in a way they can use it, it’s not having its full impact,” she says.
In Zambia, in southern Africa, she worked with AME bishops as the highest official on an approach designed to move science discoveries into community implementation. Zambia was hit hard by the AIDS epidemic, with an almost 15 percent prevalence rate in 2006.
Their request: help church clergy to understand the science behind HIV and AIDS and how to counter the high AIDS impacts in their communities.
Spreading the word
This seemingly unorthodox request made sense to Fuller.
“Religious leaders are in every community already dealing with HIV,” says Fuller. “They bury people who die, they console families who lose sons and daughters, they help find homes for vulnerable children, and help parents and grandparents provide for younger children through family and community — the human capital that serves as a major social security.”
After attending a U-M workshop in 2015 on use of mixed methods in research, Fuller approached workshop presenter Elizabeth King, Ph.D., MPH, who also studied HIV and taught a qualitative methods course at the U-M School of Public Health.
A master’s student in one of King’s classes, lead author John Mark Wiginton, MPH, assisted Fuller to help measure the impact of her work in Zambia.
“I jumped at the opportunity, as it involved many of my interests — global public health; HIV/AIDS; interventions; and qualitative methods,” Wiginton says.
In the 10-year span from the initial invitation, Fuller and U-M student teams and occasional professor assistants partnered with leaders of the Council of Churches of Zambia to implement and rigorously measure results of the intervention, which they called Trusted Messenger.
To prepare, pastors, officers and their spouses attend a two-day workshop.
Fuller explains, “During the highly interactive sessions, participants learn the science behind HIV/AIDS and how they can control it instead of it controlling them. They also bring insights into unique issues and factors that affect virus spread and illness in their communities.”
Outreach offers insight, relief
The crux of the program is designed to dispel prevalent myths and moral judgments around HIV infection.
“HIV doesn’t care who you are — it’s just a virus trying to find a body in which it can replicate,” says Fuller. “When clergy and leaders understand this, it changes their view and their actions.”
The workshop includes details about how HIV is transmitted through blood, semen, vaginal fluid or breastmilk.
“We explain that if you always avoid contact with those four fluids, you will never get HIV, ever. They are amazed. It’s fact, not something that one can only hope for or pray about,” Fuller says.
The participants also learn how antiviral therapies work and how the virus’ fragile structure makes transmission via fluids such as saliva and tears impossible.
They learn how infections with HIV, as a retrovirus, mean that once a person becomes infected, the virus inserts a copy of its DNA inside their cells. Because of this, people living with HIV must remain under medical care and always take antiviral medication.
“They understand that one can’t pray for healing and throw away the HIV medicines,” Fuller says. “It’s a lifetime commitment that allows control of a chronic disease.”
A vital element of the Trusted Messenger workshops is the opportunity for each participant to complete an HIV screening test.
“As a leader, you are no greater than what you do,” Fuller says. “You and your family must get tested to model one desired behavior. It’s a powerful first step for a trusted community leader.”
The religious leaders pick up the mantle in the last sessions, brainstorming how to use their new knowledge coupled with existing community resources to encourage people to get tested and to connect to medical care if they are infected.
Looking to the future
Charles Michelo, M.D., Ph.D., dean of the School of Public Health at the University of Zambia, says that Trusted Messenger’s effectiveness is due in large part to its ability to capitalize on a key societal network.
“Religious leaders in these communities serve as community leaders with a mandate to serve the spiritual needs of those communities,” he says. “They are thus the default gatekeepers in such a society like we have in Zambia.”
Michelo hopes the program can reach sustainability by having the Zambian Ministry of Health use it with community leaders.
Already, the incidence of HIV in adults in Zambia has declined to 11.5 percent. This is due to many factors, including sustained effective efforts like Trusted Messenger and others.
In fact, the World Health Organization has set an ambitious goal to end the global AIDS epidemic by 2030.
“The modeling data show that we could get rid of HIV by then,” says Fuller. “So what’s the holdup?” she asks. “It’s that the people who needed to consistently use what has been discovered don’t know what the scientists know.
“The goal is to take some of the same info we give our medical students and undergrads and move it into the community to dispel misconceptions that paralyze people from doing what works and is already available to them. They then move forward in amazing ways to take control of HIV and AIDS.”