There are important disparities between how HIV transmission, prevention, and mitigation are addressed within sub-Saharan Africa (SSA) and how they are understood by the international aid agencies that design and implement interventions to combat AIDS in this region. Contending that local responses to the AIDS epidemic hinge on a religious framework, this dissertation examines the relationship between religion and HIV risk at both the individual and collective levels in the setting of rural Malawi - a religiously diverse country with high levels of both religious participation and HIV prevalence. This dissertation advances the Durkheimian idea that participation in harmful behaviors is reduced in places where particular religions or religious rituals are widely practiced. Specifically, it addresses the associations between religion and (1) HIV prevention, (2) actual HIV status, and (3) perceived obligations to support families affected by AIDS. The relationships are assessed by employing multiple methodologies and data sources including participant observation data from religious services, in-depth interviews with religious leaders and lay people, and large-scale survey data. This dissertation provides the first empirical assessment of what religious leaders in SSA say and do about HIV in their communities and shows that many have assumed an activist role in combating the epidemic. The relevant practices religious leaders engage in include: preaching explicitly about AIDS on a regular basis, privately advising members to use condoms, actively policing the sexual behavior of their members -- visiting those suspected to be at risk of contracting the disease and to confront them about their sexual behavior, and advising divorce as a strategy for HIV prevention in cases where a member is likely to be infected by an unfaithful spouse. By synthesizing insights from demographic studies of contextual effects on sexual behavior with the notion of "moral communities" from the sociology of religion, this dissertation emphasizes the importance of conceptualizing religion as a supra-individual phenomenon with important implications for the health of populations.

The study examined correlates of HIV perceived risks and protective strategies among adolescents in rural Malawi i.e. whether there was an association between socio demographic characteristics of adolescents and subsequent HIV perceived risks and protective strategies. Age at sexual debut is a variable of interest in this study. The objectives were to investigate whether age at first sexual intercourse does influence adolescents’ individual’s risk perceptions of HIV and protective strategies, i.e. does age at first sex set a precedence in the thinking of adolescentswith regards HIV risks and protective strategies such as condom use. Data: This study uses cross sectional data from Wave 3 of a wider study, the Malawi Diffusion and Ideational Change Project (MDICP).The MDICP is a joint collaboration between researchers from the Population Studies Centre at the University of Pennsylvania and the University of Malawi‘s College of Medicine and Chancellor College. In this study, a multiple regression analysis on the cross sectional data from the 2004 wave 3of the Malawi Diffusion and Ideational Change Project was done. The focus of this study is on the relationship between age at first sexual intercourse and the individual‘s perception of risk of HIV/AIDS and protective strategies, it examines if there is an association between the two factors. Descriptive analysis: Descriptive statistics to obtain the frequencies of the main variables of interest such as the background characteristics of respondents (gender, marital status, mean age at sexual debut, education, economic status of household) were computed in order to better understand the population under study. Multivariate Analysis: Three separate models were employed; two multinomial regression analysis measuring worry and likelihood of infection against socio demographic variables and a binary logistic regression measuring condom use and the socio demographic variables. Relative Risk Ratios were used to interpret the multinomial logistic regression output while odds ratios were used to interpret the logistic output. Results: Consistent with existing literature, results indicate that early age at first sex is a predictor of HIV risk perceptions and protective strategies. Age at first sex does set a precedence in the future thinking of adolescents with regards to how they perceive HIV risks, as well as how they perceive protective strategies against HIV-particularly condom use. This study confirms that age at first sex alongside with other socio demographic variables are significantly associated with HIV risk perceptions HIV and condom use, while other factors may matter, such as gender, region, HIV knowledge, religion or educational level. Limitations: The information on age at first sexual encounter was based exclusively on respondent’s self–reports. This data collection method often has limitations that are attributed to the tendency for people to under-report socially unacceptable behaviours (e.g. having multiple sex partners) and to over-report socially acceptable behavior. The other limitation is that the study lacks longitudinal data to allow a more in-depth analysis of trends in HIV/AIDS-related indicators. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)