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By Katherine
E. Beal
This research study is part of a larger
and on-going project that aims to contribute to the
knowledge of sexual risk behaviour among youth1 in
Ghana. Specifically, the focus is on the relationship
between religion and sexual behaviours that put youth
at risk of HIV and other sexually transmitted infections.
"When a guy goes out with a girl and
he gets to a time where he would feel like having
intercourse with her, it's his church, or his religious
background that will push him back [from doing it]."
- Male respondent, 18 years
Introduction
While sub-Saharan Africa has been the region hit hardest
by the HIV/AIDS epidemic, the differential rates of
infection observed have been poorly understood. Adult
prevalence rates of HIV range from 0.8% in Senegal
to 38.8% in Swaziland. Rates have been consistently
higher in Eastern and Southern Africa, as compared
to West Africa, but there is still great diversity
within this sub-region as well. For example, the rate
in Ghana is 3.1%, while its neighbours have rates
ranging from 4.1 % to 7.0%, in Togo and Cote d'Ivoire,
respectively [1]. Not only are biological factors,
such as male circumcision and the presence of sexually
transmitted infections, given as possible reasons
for these differences, but various social and cultural
factors have also been postulated. Religion may well
be one of these factors.
According to a worldwide study, West Africa is the
most highly religious region, with 99% of people belonging
to a religious denomination, 82% attending religious
services regularly, 97% giving God high importance
in their lives, and 95% believing that there is a
personal god or some sort of spirit or life force
[2]. So, the question arises, "How does religion
affect the health of West Africans?" Few studies
to date have explored the impact that this religious
involvement may have on the spread of HIV.
Recent studies have found that religion may indeed
affect the spread of HIV in adults in Ghana. Religious
affiliation was shown to have an impact on the knowledge
of HIV/AIDS, but not on specific protective behaviours
of women [3]. Being actively involved in one's religious
organization and worshipping at the same location
for more that 20 years were both associated with reduced
risk of HIV infection among blood donors [4]. We do
not know if these relationships hold true for younger
Ghanaians. There is some evidence to suggest that
being highly religious protects young people against
the risks associated with alcohol, tobacco and other
drug use, suicide and sexual behaviours [5,6,7,8,9,10].
However, many of these relationships have not been
tested in African contexts. This study attempts to
understand what role religion plays in the risk behaviours
of adolescents in Ghana.
Research Objectives
The main question that frames this research is, "To
what extent is religion shaping the sexual and reproductive
lives of young people today?" Some of the questions
being explored in the overall project are the following:
(a) What effect does religion have on the sexual attitudes
and behaviours of Ghanaian youth (with a specific
focus on STI/HIV prevention)? (b) Are there differences
in youth's HIV/AIDS knowledge, attitudes, perceptions
of risk, sources of information and behaviours based
on their denominational affiliations? (c) What is
the relationship between religiosity and STI/HIV risk?
(d) Are there gender differences in the relationship
between religion and sexuality? Both quantitative
and qualitative methods of data collection and analysis
are being used to answer these questions.
Religiosity
Most studies that examine the effect of religion on
health do not offer an explicit definition of religiosity
per se, but base their measurement of religiosity
on several factors, for example: denominational affiliation,
importance of religion in one's life, frequency of
attendance at religious services, or frequency of
prayer. For the purposes of the present study, the
following definition of religiosity is being used:
Religiosity is a term used to describe how religious
someone is and usually falls along a continuum from
"not at all" to "very." People
are categorized as having either "high"
or "low" religiosity relative to some reference.
Several studies have shown that the strength of religious
practice and belief is more important than belonging
to any particular religious group [11,12]. Therefore,
while possible denominational differences will be
explored in the analyses, we are more interested in
what effect being (or not being) very religious has
on the health of young people.
Significance of Study
The data from this study will complement findings
from quantitative analyses and enable us to have deeper
insights into the factors that influence youth health
behaviour. Recent literature reviews on the connection
between religion and health have suggested that large-scale
epidemiological studies could be complemented by qualitative
studies on the same subject and in the same population
[13,14].
In light of the HIV/AIDS epidemic, it is important
to elucidate what mechanisms are acting to maintain
the relatively low levels of infection that have been
observed to date in Ghanaian young people.
Theoretical Issues
It would be impossible to study youth risk behaviour
without reference to the multiple influences that
exert force upon young people's lives. Research on
adolescent drug use and sexual activity has suggested
that religion may play a key role in determining why
some youth engage in these behaviours and others do
not. In an attempt to provide conceptual and theoretical
clarity as to the circumstances in which religion
is expected to relate to health outcomes, Wallace
and Williams [15] proposed the socialization influence
framework (see Figure 1 which has been adapted to
the Ghanaian context by adding "work" as
a secondary socialization influence).
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1: Socialization influence framework |
The framework recognizes that the family plays a
primary role in the early socialization of a young
person and that this also has an effect on the secondary
socialization influences (religion, peers, school,
work). Each of these socialization influences is thought
to exert influence both on the socialization mechanisms
(i.e. social support, social control, and values and
identity) as well as on the family itself, as shown
by the bi-directional arrows in the diagram. These
socialization mechanisms in turn affect the health
outcomes of adolescents. What should be kept in mind
about this framework is the dynamic nature of it and
the fact that different factors affect each other
in ways that are not necessarily linear or in one
direction. For example, young peoples' behaviours
may well be influenced by social control but the way
that they behave may also have an effect on the social
control that they experience.
Methodology
We have conducted in-depth interviews (IDIs) with
forty-eight adolescents resident in the Greater Accra
Region of Ghana on the following topics: religion,
dating, sexuality, and HIV prevention. By employing
a qualitative approach, we have been able to probe
individual issues and consequently gain a deeper understanding
of the mechanisms at work in the religiosity-risk
behaviour relationship. The study subjects are 15-19
year olds who participated in a survey of young people
in Ghana in 20042 and at the end of that interview
consented to be revisited for another interview.
Since we are interested in making comparisons between
different categories of religiosity and sex, every
attempt was made to include subjects with "high,"
"medium," and "low" religiosity
and an equal number of males and females.
Preliminary Findings
Since we have just recently finished data collection
and are now beginning the analyses, there are only
a few preliminary observations to share at this time.
First, we have found that Ghanaian young people are
by and large very religious. Indeed, only 0.5% of
those interviewed last year in the Greater Accra Region
were categorized as having "low" religiosity.
However, in terms of the measurement of religiosity,
it appears that the use of one question in a structured
interview survey may not always be the best indicator
of one's religiosity status. Based on the in-depth
interviews, we have found that some adolescents who
were categorized as "high" may in fact be
"medium" or "low" and vice versa.
With the lag time of one year between interviews,
it is also possible that one's religious involvement
has changed over time. It is also apparent from the
IDIs that being involved in religious activities has
complexities that single questions on a quantitative
survey may not uncover. For example, the response
to the question, "How often do you attend religious
services?" will not illustrate that for some
adolescents while they would like to attend church
services on a more regular basis they are constrained
by such issues as having to work during that time.
Religion and Choice
From initial observations, it seems that religion
does influence the choices that some young people
make regarding dating and sexuality. This is well
illustrated by a young woman who describes herself
as very religious, attending weekly services in her
church and going to Bible study at least three times
per week. She says that she feels different from other
young people her age because of what she wears and
how she talks. She claims that before she "found
Jesus and took him into her heart," she was "bad."
Previously, she would not have been home at the evening
time that we came to her house to interview her as
she would have been in a caf‚, hanging out with
friends. She had had a boyfriend for one and a half
years, but when she accepted Jesus as her personal
god, she knew that dating wasn't right, so she broke
up with her boyfriend. He didn't understand her reasons
at the time, but they still remain good friends. When
asked if religion has any effect on one's sexuality,
she remarked, "It will help you to control yourself."
Other young people, however, say that religion does
not have such a strong influence on their lives and
that they rely much more on their parents or peers
when it comes to decision-making about dating and
sexuality.
Dissonance
For many young people, the relationship is not so
easy to disentangle. We are finding that for several
adolescents the messages that they receive from their
religious leaders, which is often 'abstinence before
marriage', does not resonate with their personal experiences.
Some youth have said that while they would like to
be "good" Christians or Muslims, they have
life experiences that are such that they have found
themselves in dating and sexual relationships and
are confused about how to integrate this fact with
their religious life. Whether involvement in these
dating and sexual relationships is motivated by peer
pressure, a search for companionship, or economic
reasons, what results is a cognitive dissonance for
these young people when it comes to reconciling the
conflicting realities and messages in their lives.
Further analyses will show how common this and other
themes are for the adolescents that we have interviewed
and whether there are gender differences in what we
have observed.
Acknowledgement
The author would like to thank Allan G. Hill and John
K. Anarfi for their guidance, support, and encouragement
on this project.
Notes
1The terms "youth," "adolescent,"
and "young people" will be used interchangeably
throughout the text. It is acknowledged that different
organizations use these terms differently. The generally
accepted WHO definitions include the following age
groups: "youth" are 12-24 year olds; "adolescents"
are 12-19 year olds, and distinctions are often made
between "young adolescents" (12-14 year
olds) and "older adolescents" (15-19 year
olds). The 20-24 year old category is often referred
to as "young adults."
2 The previous study was a national-representative
survey of adolescents 12-19 years old in Ghana that
was conducted to address adolescents' sexual and reproductive
health needs. The 2004 survey is part of a larger,
five-year study of adolescent sexual and reproductive
health issues called Protecting the Next Generation:
Understanding HIV Risk Among Youth (PNG), which is
being carried out in Burkina Faso, Ghana, Malawi and
Uganda with funding by The Bill & Melinda GatesÿFoundation.
References
1. UNAIDS (2004). Report on the Global HIV/AIDS
Epidemic: 4th Global Report. http://www.unaids.org.
2. GIMS (2000). Gallup International Millennium
Survey. http://www.gallup-international.com.
3. Takyi, B. K. (2003). "Religion and women's
health in Ghana: insights into HIV/AIDs preventive
and
protective behavior." Soc Sci Med 56(6):
1221-34.
4. Alain, J. -P., M. Anokwa, et al. (2004) "Sociology
and behaviour of West African blood donors: the impact
of
religion on human immunodeficiency virus infection."
Vox Sanguinis 87: 233-240.
5. Adlaf, E. M. and R. G. Smart (1985). "Drug
use and religious affiliation, feelings and behaviour."
Br J Addict
80(2): 163-71.
6. Burkett, S. and B. Warren (1987). "Religiosity,
peer associations, and adolescent marijuana use: A
panel study of underlying causal structures."
Criminology 25: 109-131.
7. Peltzer, K., D. W. Malaka, et al. (2002). "Sociodemographic
factors, religiosity, academic performance, and
substance use among first-year university students
in South Africa." Psychological Reports.
91: 105-113.
8. Nonnemaker, J. M., C. A. McNeely, et al. (2003).
"Public and private domains of religiosity and
adolescent
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Science &
Medicine. 57(11): 2049-54.
9. Thornton, A. and D. Camburn (1989). "Religious
participation and adolescent sexual behavior and attitudes."
Journal of Marriage and the Family 51: 641-653.
10. DuRant, R. H. and J. M. Sanders, Jr. (1989). "Sexual
behavior and contraceptive risk taking among sexually
active adolescent females." Journal of Adolescent
Health Care. 10(1): 1-9.
11. Santelli J.S., Beilenson P (1992), Risk factors
for adolescent sexual behavior, fertility, and sexually
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12. Sheeran, P., R. Spears, et al. (1996). "Religiosity,
gender, and the double standard." Journal
of Psychology.
130(1): 23-33.
13. Ellison, C. G. and J. S. Levin (1998). "The
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Future
Directions." Health Education and Behavior
25(6): 700-720.
14. Chatters, L. M. (2000). "Religion and health:
public health research and practice." Annu
Rev Public Health
21: 335-67.
15. Wallace, J. M., Jr. and D. Williams (1997). Religion
and Adolescent Health-Compromising Behavior.
Health Risks and Developmental Transitions During
Adolescence. J. Schulenberg, J. Maggs and K.
Hurrelmann. Cambridge, Cambridge University Press.
* Katherine E. Beal is a research affiliate at
the Institute for Statistical, Social, and Economic
Research (ISSER) at the University of Ghana, where
she is conducting several studies to examine the relationship
between religion and HIV risk among youth. She is
also doctoral student in Population and Reproductive
Health at Harvard School of Public Health, USA.
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