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. Author manuscript; available in PMC: 2020 Dec 1.
Published in final edited form as: Glob Public Health. 2019 Aug 7;14(12):1744–1756. doi: 10.1080/17441692.2019.1647263

Faith and Healthcare Providers’ Perspectives about Enhancing HIV Biomedical Interventions in Western Kenya

Eunice Kamaara 1, Dismas Oketch 2, Irene Chesire 3, Cassandra Sutten Coats 4, Gladys Thomas 5, Yusuf Ransome 6, Tiara C Willie 7, Amy Nunn 4,5
PMCID: PMC6779517  NIHMSID: NIHMS1536641  PMID: 31390958

Abstract

Adult HIV prevalence in Kenya was 5.9% in 2017. However, in the counties of Kisumu, Siaya, and Homa Bay, HIV prevalence was over 15%. Biomedical interventions, including home-based testing and counselling (HBTC), HIV treatment and pre-exposure prophylaxis (PrEP) provide opportunities to reduce HIV transmission, particularly in rural communities with limited access to health services. Faith-based institutions play an important role in the Kenyan social fabric, providing over 40% of all health care services in Kenya, but have played limited roles in promoting HIV prevention interventions. We conducted qualitative interviews with 45 medical professionals and focus groups with 93 faith leaders in Kisumu and Busia Counties, Kenya. We explored their knowledge, opinions, and experiences in promoting biomedical HIV prevention modalities, including HBTC and PrEP. Knowledge about and engagement in efforts to promote HIV prevention modalities varied; few health providers had partnered with faith leaders on HIV prevention programs. Faith leaders and health providers agreed about the importance of increasing faith leaders’ participation in HIV prevention and were positive about increasing their HIV prevention partnerships. Most faith leaders requested capacity building to better understand biomedical HIV prevention modalities and expressed interest in collaborating with clinical partners to spread awareness about HIV prevention modalities.

Keywords: HIV, HBTC, intervention, faith leaders, beliefs, knowledge

Introduction

In the past decade, estimated HIV prevalence among Kenyan adults aged 15–49 has decreased from 10.6% to 5.9% (National AIDS Control Council, 2014a). Intensified outreach from the Kenyan Ministry of Health and foreign support has resulted in more Kenyans receiving counseling and testing services and improved outcomes regarding antiretroviral treatment (ART) initiation and retention in care, viral suppression, and AIDS-related deaths (National AIDS & STI Control Programme, 2016; National AIDS Control Council, 2014a, 2016a; United Nations Joint Programme on HIV/AIDS, 2016). In western Kenya, where the HIV epidemic is generalized, these improvements have been facilitated by the ongoing HIV prevention efforts by the Academic Model Providing Access to Healthcare (AMPATH), a partner consortium of Kenyan, Canadian, and American universities (Mamlin, Kimaiyo, Nyandiko, & Tierney, 2004). Located within 25 Ministry of Health Centers and 46 satellite clinics in Western Kenya, AMPATH provides on-site HIV prevention and treatment services, and home-based counselling and testing (HBTC) (Genberg et al., 2015; McIntosh & Kamaara, 2016; Tierney et al., 2013).

Home-based HIV screening supported by AMPATH has been well-received by individuals and communities in western Kenya (Genberg et al., 2015; McIntosh & Kamaara, 2016). Between 2009 and 2014, more than 1 million western Kenyans were enrolled in AMPATH services through HBCT outreach (Genberg et al., 2015; Miller, 2014). Home-based HIV testing services provide important opportunities to reach populations at high risk for HIV who may experience stigma or who prefer to screen in the privacy of their homes (Low et al., 2013; Nuwaha, Kasasa, Wana, Muganzi, & Tumwesigye, 2012; World Health Organization, 2012).

Despite increased access to and uptake of HIV prevention and treatment interventions, significant disparities in HIV prevalence persist in Kenya. Some individual counties report an average HIV prevalence five times the national prevalence for Kenyan adults. In particular, counties in the Lake Victoria region of western Kenya report the greatest prevalence of HIV (National AIDS Control Council, 2016b). For example, in 2015, Kisumu county reported an HIV prevalence of 19.9%, which resulted in 8,500 new infections among Kenyan adults (National AIDS Control Council, 2016b).

High HIV prevalence suggests that bolstered efforts are required to reduce HIV transmission in Kenya and meet the strategic goals of the Kenyan Ministry of Health. Those goals include: reducing HIV infections, expanding biomedical HIV prevention modalities, and increasing access to HIV treatment (National AIDS Control Council, 2014b). HBCT for HIV presents an opportunity to expand access to HIV screening, and it has been associated with earlier ART initiation and enhanced HIV outcomes (Cohen et al., 2011; Gardner, McLees, Steiner, Del Rio, & Burman, 2011; McNairy & El-Sadr, 2012; Mills & Ford, 2012; Thrun, Gardner, & Rietmeijer, 2013; Wachira, Kimaiyo, Ndege, Mamlin, & Braitstein, 2012). Pre-exposure prophylaxis (PrEP), is one pill taken once a day that can reduce HIV transmission (Choopanya et al., 2013; Grant et al., 2010; Spinner et al., 2016; Thigpen et al., 2012). Recent guidelines identify protocols for PrEP use in Kenya (National AIDS & STI Control Programme, 2016, 2017). Though knowledge of PrEP is somewhat low, implementation programs have demonstrated high acceptability among populations at high risk for HIV acquisition (Baeten et al., 2016; Karuga et al., 2016; Van der Elst et al., 2013).

Working with faith-based organizations (FBOs) provides an important public health opportunity to enhance community involvement to address the HIV epidemic. Over 97% of Kenyans report that they are affiliated with an organized religion (Kenya National Bureau of Statistics, 2015). Among those affiliated with an organized religion, the most common religions are Christianity (82%) and Islam (11.2%) (Berkley Center for Religion, Peace & World Affairs, 2017). FBOs play a critical role in the social fabric of Kenyan society. In particular, FBOs oversee the administration of one-third of all health and education institutions in Kenya (Christian Aid, 2012; Green, 2015; Kenya National Bureau of Statistics, 2015; Lazzarini, 1998).

Despite the important role of religious institutions in Kenyan society, the faith-based response to the HIV epidemic has not been commensurate with the scope of the epidemic. This may be due to stigma and limited understanding of technical issues about HIV/AIDS, particularly in regard to new biomedical HIV prevention modalities (National AIDS Control Council, 2015). While FBOs finance much of the privately-delivered HIV care in Kenya, few efforts have attempted to engage faith leaders and FBOs in HIV prevention programs, particularly in biomedical HIV prevention modalities (National AIDS & STI Control Programme, 2017; National AIDS Control Council, 2015).

The goal of this study was to explore whether and how faith leaders and medical providers in Western Kenya could promote biomedical HIV prevention modalities, subsequent linkage to HIV care, and PrEP use in Western Kenya.

Methods

Ethical Considerations

This study protocol was approved by the Moi University College of Health Sciences/Moi Teaching and Referral Hospital’s Institutional Research and Ethics Committee (IREC) as well as by the Lifespan-Miriam Hospital’s Institutional Review Board (IRB). Participants were informed of all study details and had the opportunity to decline to participate. Participants provided written informed consent.

Sampling area & population

The study was conducted in partnership with AMPATH clinical sites in Busia and Kisumu counties in Western Kenya between April 2014 and September 2017 (Figure 1). Providers were recruited at the following AMPATH sites: Mukhobola Health Centre, Port Victoria Sub-District Hospital, and Chulaimbo Sub-District Hospital and its satellite clinics: Riat Dispensary, Siriba Dispensary, and Sunga Dispensary.

Figure 1.

Figure 1

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AMPATH infrastructure in Western Kenya.

AMPATH medical providers were recruited to participate in focus groups using purposive sampling at the AMPATH program sites. Faith leaders were recruited through snowball sampling; the initial faith leaders were recruited from the research team’s existing network of clergy in the geographic catchment area. The same sample of faith leaders was convened at the study’s onset as well as in mid-2017 to solicit further input about biomedical HIV prevention modalities. A final sample of 19 health outreach workers, 26 medical providers, and 93 faith leaders were enrolled.

Focus Groups and Interviews

Focus groups and interviews were conducted in English and Kiswahili, and each discussion lasted 1–2 hours. A trained moderator conducted all the focus groups using a semi-structured interview guide. Initial discussions held with faith leaders between April 2014 and September 2015 included questions about how to discuss health behaviours with members; faith leaders’ attitudes, knowledge, and beliefs of HIV/AIDS and the Kenyan epidemic; willingness to discuss HIV testing and treatment; and acceptability of promoting HBCT in a faith-based setting. Follow-up focus groups in July 2017 discussed knowledge and acceptability of PrEP. Focus group guides at each round of data collection also included normative questions about what faith leaders believe the role of their institution should be in the response to HIV/AIDS, and what barriers may exist in promoting and normalizing HBCT as well as more widespread PrEP use. All focus group discussions and interviews were digitally recorded and professionally transcribed and translated. Transcripts were reviewed for accuracy, and identifying information was removed.

Interviews with medical providers and AMPATH outreach workers involved in the HIV care continuum (i.e., diagnosed, engaged in care, prescribed ART, and virally suppressed) focused on the potential for: 1) advocacy of HBCT by faith leaders; and 2) partnership between medical providers and faith leaders to promote HIV/AIDS awareness, testing and treatment. Interviews were conducted by a trained interviewer using a semi-structured interview guide, which solicited recommendations from medical providers about how faith leaders could contribute to improving outcomes in the HIV and PrEP care continua.

Data Analysis

All focus groups and interviews were analysed using Grounded Theory. In grounded theory, theory and data analysis interact to inform interpretation of findings (Glaser & Strauss, 1967; Morse, 2009). Following Grounded Theory, the process of data collection and theory development was iterative, whereby data collection informed theory development, and theories informed data analysis (Glaser & Strauss, 1967). The coding scheme for data analysis was developed over several stages: (1) coders read discussion transcripts to broadly understand participant answers and thoughts on each question; (2) coders identified recurring themes in the transcripts to inform the developing coding scheme; (3) the scheme was discussed amongst all collaborators, and emergent themes from ongoing interviews were integrated; (4) three analysts coded the transcripts in accordance with the final coding scheme, and any discrepancies were discussed and resolved between analysts; and (5) primary findings were synthesized. We used “member checks” to share our interpretations of primary findings with focus group participants to ensure that our interpretations captured their intent.

Results

Ninety-three faith leaders participated in the focus groups. We conducted 11 focus groups with 8–11 participants in each group. Faith leaders served a diversity of community settings and represented a variety of religious groups in Kisumu and Busia counties (Figure 2).

Figure 2.

Figure 2

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Faith Leaders in Western Kenya.

Table 1 provides demographic and religious affiliations. Religious affiliations were grouped according to membership. Most participants were affiliated with major branches of Christianity (Mainline) or Pentecostal Christian churches. Several participants were affiliated with Muslim mosques or Indigenous Churches, and a small percentage of participants were affiliated with non-denominational organizations (ecumenical groups). Faith leaders represented a variety of roles within their organizations. Most (90%) were not officially ordained and included Christian Pastors, Christian lay leaders, religious community members, and Muslim Sheikhs. Ten percent were ordained Pastors, Imams or Bishops.

Table 1.

Demographic characteristics of religious leaders (n = 93)

Variable N = 93 %
Age
 <25 years old 5 6.0
 25–50 years old 71 76
 >50 years old 17 18
Sex
 Male 81 87
 Female 12 13
Religious Affiliation
 Ecumenical 2 2.0
 Indigenous 8 9.0
 Mainstream Christian 19 20
 Muslim 8 9.0
 Pentecostal 56 60
Role
 Islamic elder (Sheikh) 2 2.0
 Imam 4 4.0
 Ordained minister 6 6.0
 Non-ordained minister 44 47
 Community leader 31 34
 Secretary or church administrator 4 4.0
 No response 2 2.0
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Note:

Ecumenical = nondenominational religious

Indigenous = Traditional African

Mainline = Roman Catholic, Anglican, Presbyterian, Seventh Day Adventist

Forty-five medical professionals (i.e. medical providers and outreach workers) participated in individual in-depth interviews. Table 2 provides demographic information for all medical professionals.

Table 2.

Demographic characteristics of healthcare professionals (N = 45)

Variable N (%) Male (%)
n=29 (60) 		Female (%)
n=16 (40)
Age
 <25 years old 0 (0.0) 0 (0.0) 0 (0.0)
 25–50 years old 37 (82) 21 (78) 16 (89)
 >50 years old 8 (18) 8 (18) 0(0.0)
Profession
 Medical Officer 4 (9.0) 4 (14) 0 (0.0)
 Clinical Officer 9 (20) 8 (28) 1 (6.0)
 Nurse 11 (24) 2 (7.0) 9 (56)
 Outreach Worker 19 (42) 13 (45) 6 (38)
 Public Health Officer 2 (4.0) 2 (7.0) 0 (0.0)
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Three key themes were identified from the focus groups and individual in-depth interviews. These themes included: 1) faith leaders’ knowledge, attitudes, and beliefs about HIV transmission and biomedical HIV prevention modalities; 2) the role and capacity of faith leaders to use and/or promote biomedical HIV prevention modalities; and 3) normative recommendations for engaging faith leaders in biomedical HIV prevention modalities. Table 3 illustrates conceptual understandings of these themes and examples of these themes from the perspectives of both the faith leaders and medical providers.

Table 3.

Emerging themes from focus group discussions and individual interviews.

Theme Examples from Faith Leaders Examples from Health Providers
Knowledge, Attitudes, & Beliefs about HIV Transmission & Biomedical HIV Prevention Modalities Faith leaders have limited knowledge about the HIV epidemic. • HIV is highly stigmatized among some faith leaders.
• HIV/AIDS may be viewed as punishment from God for sexual immorality.
• Community members seek support from leaders when they are sick, but leaders may be unable to help due to limited understanding of biomedical interventions.		 • Providers were not confident faith leaders had enough information to provide HIV care in their communities.
• Providers were aware of some faith leaders in the community who were more knowledgeable and more active in promoting HIV testing and treatment than others.
• Providers were concerned about some faith leaders who believe HIV is a curse that can be cured through prayer.
Role & Capacity of Faith Leaders to Promote Biomedical HIV Prevention Modalities Faith leaders influence community thought and are in a unique position to promote HIV prevention & treatment strategies. • Leaders acknowledged their trusted and respected role within the community.
• Leaders reported their ability to integrate messages on HIV into religious teachings to combat stigma.		 • Providers suggested that faith leaders can link their congregants to biomedical services due to their trusted leadership roles.
• Providers noted leaders’ capacity for mobilizing their communities to embrace biomedical interventions.
Normative Recommendations for Engaging Faith Leaders in Biomedical HIV Prevention Modalities Greater collaboration must exist between researchers, health providers, and faith leaders to best address the HIV epidemic. • Leaders indicated reliance on outside experts for information, stating they were often left uninformed.
• Leaders discussed working as a coalition for HIV prevention.
• Leaders wanted more conversation and education on public health topics such as biomedical interventions.		 • Providers believed that Kenya could not meet its strategic goals for HIV without engaging faith leaders.
• Providers suggested that faith leaders receive education about HIV as the first step towards educating the community.
The context in which faith leaders engage their followers in discussions about HIV is crucial for community engagement. • Leaders indicated that their approach to discussing HIV and biomedical interventions was key to normalizing uptake of biomedical services.
• Some leaders identified using the pulpit as a platform for HIV education would be acceptable; others preferred alternative means of community education and outreach.		 • Providers were willing to collaborate with faith leaders.
• Providers believed they could help faith leaders develop prevention messages for their congregations.
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Knowledge, Attitudes, & Beliefs about HIV Transmission & Biomedical HIV Prevention Modalities

Faith leaders and health providers indicated that faith leaders have limited knowledge about the HIV epidemic. Both faith leaders and health providers discussed HIV-related stigma and limited awareness among faith leaders as barriers to promoting effective HIV treatment and prevention strategies.

Faith leaders’ perspectives

Knowledge, attitudes, and beliefs varied widely among faith leaders. Though some leaders reported that they were involved in HIV prevention campaigns through their churches, all participants agreed that discussing HIV within the context of church could be challenging due to stigma around HIV:

How do you talk about sex in church? How do you talk about HIV/AIDS? People will run away…You cannot mention a condom in the mosque.

We realized that the issue of HIV is not discussed in the church, and this is what is killing people in the church just because of ignorance.

Though some leaders demonstrated knowledge of HIV and how it impacted their communities, many leaders maintained the belief that HIV was a punishment from God for sexual immorality. One faith leader remarked:

The almighty God rejected people who sin and asked them to instead get married. People do not listen but continue to commit adultery and even in marriage… AIDS is God’s punishment to warn us against behaviours that do not please Allah.

Leaders acknowledged the impact of stigmatizing beliefs and indicated that inaccurate information was detrimental to their communities. Religious stigma was cited as a rationale for leaders’ hesitance to discuss HIV and to advocate for screening and HIV prevention with their congregations. They agreed that limited conversation about HIV prevention was harming their communities. One pastor quoted a biblical verse, remarking:

My people are perishing for lack of knowledge.

Some leaders indicated that their congregants sought their support for HIV, but they discussed they had insufficient knowledge to help their congregations. Leaders emphasized that the education about HIV must be comprehensive and ongoing:

I think people’s perception about someone’s HIV status is something people have used to judge...so many people are using their perceptions to measure whether somebody is HIV positive or negative. But I don’t think that is the best way to know whether somebody is positive or negative. The only way is through testing.

It takes time to unlearn all the biomedical information we’ve given people. It’s changing all the time! Now we’re telling them that with treatment as prevention they may not even get infected. This takes time.

Health provider perspectives

Medical professionals reported varying degrees of knowledge among faith leaders. Providers were concerned about faith leaders’ limited knowledge about biomedical preventions and several criticized the common practice of engaging in faith healing with no biomedical interventions:

If he hasn’t been tested, he will not test because he is told, ‘once you believe in God, you will never be infected’…There is a church that discourages people from testing. That church discourages people from even taking HIV medicines, and those who were on drugs are discouraged from taking them…I know a number of people who have died.

However, providers noted that with education, faith leaders could be key to promoting and providing biomedical HIV prevention modalities. Some knowledgeable pastors actively promoted testing and treatment:

The pastor has made it a routine that on some specific Sundays, he makes an invitation to a medic to come and talk to people about HIV and ask people to come conduct testing or refer people to care.

Role & Capacity of Faith Leaders to Promote Biomedical HIV Prevention Modalities

Faith leaders and health providers acknowledged the role and capacity of faith leaders to influence community norms because of their unique leadership roles.

Faith leaders’ perspectives

Faith leaders recognized their role in the community and understood that they had the power to advocate for testing and treatment. Some faith leaders expressed support for HIV screening in churches and encouraged their congregants to feel comfortable disclosing their HIV status in order to facilitate linkage to care:

I might guide you to privately suggest to somebody to seek health care… it can give you an indication to approach and walk somebody through and link them to care.

Leaders expressed willingness to become more involved in addressing the HIV epidemic. Some discussed how they could use religious messaging as a platform for HIV education that would be congruent with local culture. One faith leader leader provided an example:

We had to adjust our teachings in the mosques because originally when the HIV appeared on earth, people thought it was just a curse from God... One person believed he was supposed to be neglected and stigmatized and even chased out of the crowd. We had to go back to the Koran and see whether there were any verses that can support such a person, so as to give him hope and accept him in the community and help him?

Health provider perspectives

Among medical professionals, faith leaders were recognized as an integral part of the healthcare continuum. Citing their community influence, many providers recognized faith leaders as important partners for promoting HIV prevention and treatment:

Religious leaders have a big role to play in their community as far as promoting testing and linkage to care is concerned. Religious leaders could be our link with communities, sensitizing communities, and giving communities the information, they need to encourage people to test and go for care.

Many providers mentioned the influence of faith leaders on their patients and noted that leaders had influential social networks and the capacity to reach numerous people on a regular basis. Providers noted that leaders could easily use their platforms to mobilize their congregations to embrace biomedical HIV prevention modalities:

They have believers that they talk to every day…They are respectable people, so people will always listen to them…They network! They have churches everywhere, so you know it is easy for them to mobilize for any activity!

Normative Recommendations for Engaging Faith Leaders in Biomedical HIV Prevention Modalities

Faith leaders and health providers each discussed the necessity for increased collaboration between researchers, health providers, and faith leaders to better address the HIV epidemic. Faith leaders and medical providers highlighted the necessity of education and collaboration to intervene in the local HIV epidemic. Several faith leaders believed and expressed dismay that Kenyan government often relied on outside experts rather than investing and partnering with local faith leaders:

Pastors feel neglected and like they are not part of the conversation. We need to invite people to the table. We need to do a lot of capacity building.

Medical professionals stressed that faith leaders’ involvement would be an important part of Kenya reaching its strategic goals related to HIV/ADIS:

We still cannot say we are preventing HIV, because there are religious leaders in our community who are not partnering with us. We need to be speaking in one language if we are going to make a difference.

Members of all focus groups suggested building more collaborative partnerships between faith leaders and medical providers to increase leaders’ ability to educate and link congregants to care. One faith leader said:

It’s time to have a coalition so that we can share information to bring to the pulpit.

Similarly, several medical providers indicated their support for increased education and collaboration with faith leaders:

If we are talking about HIV zero infection, everyone must talk about HIV. We need religious leaders to work with health care providers if we are to reach everyone in our communities.

Faith leaders and medical providers additionally discussed the critical impact of context on faith leaders’ messaging about the HIV epidemic to their followers, citing how location and messaging, and education could be tailored for optimal community engagement. Faith leaders and providers emphasized how sensitization, awareness, education, and empowerment of faith leaders are important for enhancing HIV testing, PrEP, and linkage to care. One leader spoke of the impact of education on his interactions on his congregation:

Once I realized that HIV was a problem, I decided to go and learn these things of testing so that when I preach, I preach as an informed speaker.

Leaders also discussed how capacity building would enhance their ability to promote biomedical HIV prevention modalities. Two medical providers mentioned how faith leaders could be empowered through capacity building:

I think it is time that these religious leaders were empowered to realize that if they do not have a healthy congregation, they do not have anyone to speak to…Religious leaders are trusted…if they are empowered, and they know the right thing, they will help a lot.

If this religious leader could be fully sensitized…then we will be curbing a very big gap that is there…If they can be taught on how they can package their messages, it would be very helpful.

Some leaders appeared comfortable discussing HIV with their congregations. However, other leaders indicated that their followers would not be amenable to HIV-related discussions if it came ‘from the pulpit.’ One pastor summarized:

The church is very receptive. But the approach is key.

Discussion

Many faith leaders were knowledgeable about HIV transmission and biomedical HIV prevention modalities for screening, treatment and care, but others were unfamiliar with biomedical prevention modalities. Nevertheless, the majority of participants indicated their willingness to support efforts to scale-up biomedical HIV prevention modalities in Western Kenya, including home-based testing, HIV screening and care, and PrEP.

Both faith leaders and medical professionals agreed about the importance of faith leaders’ participation in biomedical HIV prevention modalities; this is consistent with previous literature exploring the role of faith leaders in Kenyan health service delivery (Christian Aid, 2012; Green, 2015; Lazzarini, 1998). Several medical professionals discussed how FBOs can use their platform to encourage their congregation to engage in biomedical HIV prevention modalities. Faith leaders’ willingness to promote biomedical interventions highlights important public health opportunities in Kenya. Perhaps most importantly, our results challenge a commonly cited belief that faith communities are averse to engaging in discussions about HIV and AIDS (Francis, Lam, Cance, & Hogan, 2009; Tesoriero et al., 2000).

Our results also highlight structural barriers that may limit faith leaders’ ability to address the HIV epidemic in their communities. For example, faith leaders reported being excluded from education and policy discussions, which could have diminished their ability to support their communities and get involved in biomedical interventions. Recognizing the importance of having faith leaders as advocates for public health action (National AIDS Control Council, 2015), the Kenyan government recently recommended building capacity and strengthening engagement with faith leaders in the government’s strategic action framework for HIV/AIDS (National AIDS Control Council, 2014b, 2015). Further, the Kenyan strategic plan for HIV was recently updated to include plans for PrEP implementation (National AIDS & STI Control Programme, 2016, 2017; National AIDS Control Council, 2015). These collaborative initiatives have the potential to increase faith leaders’ access to HIV education and resources (Olivier & Smith, 2016) . Aligning with several discussions from the medical professionals, supporting faith leaders’ involvement in the promotion uptake of biomedical HIV prevention modalities is key for Kenya to meet its strategic HIV goals.

Our findings suggest that faith leaders are willing to undertake this work, including with medical providers, but ongoing training about biomedical HIV prevention modalities, as well as opportunities to partner with clinics and medical providers is needed. These findings are consistent with previous research in the United States (Coleman, Lindley, Annang, Saunders, & Gaddist, 2012; Foster, Cooper, Parton, & Meeks, 2011; Nunn et al., 2012; Nunn et al., 2013; Nunn et al., 2018; Nunn et al., 2015; Payne-Foster et al., 2018). However, many leaders preferred inviting outside experts to speak in church or mosques rather than speaking ‘from the pulpit.’ These recommendations highlight actionable strategies for effectively engaging faith leaders in biomedical interventions.

Notably, leaders residing in urban areas or areas with AMPATH testing sites had more awareness about HBTC and biomedical interventions than leaders from other areas (Odhiambo & Atieno, 2014). This suggests that simply offering services in clinical settings may help normalize conversations about access to biomedical prevention services.

This study is subject to several limitations. We only recruited faith leaders from Kisumu and Busia counties of Western Kenya, and it may not be generalizable to other parts of Kenya or Sub Saharan Africa. Our findings may also not represent the views of faith leaders who were unwilling to participate in discussion related to HIV prevention. However, our findings suggest that many faith leaders are highly influential members of their local communities. These faith leaders were willing and able to collaborate with clinical providers to promote HIV prevention, and requested training towards that end.

Few interventions to date have focused on partnerships with faith leaders to promote biomedical HIV prevention modalities in Kenya (Pintye et al., 2018), particularly those related to HIV screening and PrEP. This study highlights important public health opportunities to engage faith leaders in efforts to promote biomedical HIV prevention modalities in regions of Kenya with high rates of HIV incidence. Many faith leaders are eager to increase engagement in biomedical HIV prevention modalities but may need greater and ongoing capacity building and structural support from clinical partners and the Kenyan government.

Acknowledgements

The authors would like to acknowledge Hellen Atieno Oketch, Lillian Awuor Odhoch, Isdora Akoth Odero, and Washington Ochieng Oito for their administrative and operational support during study set up, mobilization and recruitment of potential participants, and data collection. We would also like to thank the study volunteers for their participation and invaluable contributions during focus groups and individual interviews.

Funding Details

This project was supported with a Center for AIDS Research International Development award, P30A1042853.

Footnotes

Disclosure Statement

No potential conflict of interest was reported by the authors.

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