Youth populations worldwide and in sub-Saharan Africa are heavily impacted by the HIV/AIDS epidemic. Of the 1.5 million adolescents between the ages of 10 and 19 living with HIV in 2020, more than 90% lived in sub-Saharan Africa (UNICEF, 2021b). Although antiretroviral treatment coverage among adolescents and young people (AYP) has increased over the years in sub-Saharan Africa (UNICEF, 2021a, 2021b), historically, it has been significantly lower than coverage rates among adults. Results from a systematic review suggest that more than half of the countries in sub-Saharan Africa have adolescent adherence rates less than 90% (UNICEF, 2021a, 2021b). In order to reach the UNAIDS 95–95-95 target goals for HIV testing, treatment, and viral suppression among these populations, there is an urgent need for a tailored approach to address the unique challenges faced by adolescents living with HIV (ALHIV) (Kim et al., 2014; World Health Organization [WHO], 2019).

Numerous circumstances and challenges collectively can contribute to low access to HIV treatment and poor treatment adherence among adolescents and young people (10–24 years of age) living with HIV (AYPLHIV) (Archary et al., 2020; Nasuuna et al., 2018; Office of the Global AIDS Coordinator, 2018; UNAIDS, 2016). First, adolescents are in a period where peer pressure is high, particularly pressure to initiate and engage in sexual relationships (Brown et al., 2018; Groves et al., 2018; Hosek & Henry-Reid, 2020). Second, once adolescents reach age 15, they transition from pediatric to adult HIV care, which may lead to poor support for health-care continuity for perinatally infected youth (Abaka & Nutor, 2021; Sander et al., 2020). Third, adolescents may not be receiving HIV care and services that best fit their needs, because national HIV/AIDS programs have historically focused on either younger children or adults (Hodgson et al., 2012). This is reflected in the suboptimal declines of AIDS-related mortality among youth, despite significant declines among adults (Archary et al., 2020; Nasuuna et al., 2018; Office of the Global AIDS Coordinator, 2018; UNAIDS, 2016).

Sexual risk behaviors (e.g., intercourse without condom, multiple sexual partnerships, and early sexual debut) among youth can result in negative long-term consequences and increased risk of HIV acquisition (Faini et al., 2020; Kayibanda et al., 2012; VanderEnde et al., 2018; Woldeyohannes et al., 2017). Furthermore, violence can impact HIV transmission and acquisition directly (through forced sex by an infected person) and indirectly (through increased sexual risk-taking behaviors) (Dunkle et al., 2004; Gibbs et al., 2018; Jewkes et al., 2010). Several studies have elucidated the links between youth sexual risk-taking behaviors, violence, and HIV transmission (Christofides et al., 2014; Dunkle et al., 2004; Jewkes et al., 2010). Sexual violence in particular has been associated with increased risk of HIV transmission (Chiang et al., 2015; Decker et al., 2005; Sabri et al., 2019; Swedo et al., 2018). In addition, sub-Saharan Africa reports some of the highest rates of sexual violence, particularly among adolescent girls and young women aged 10–24, a group that also has the highest incidence of HIV (Hillis et al., 2016; UN Women, 2017, 2020; WHO, 2021). However, less has been written about the role that faith-based organizations (FBOs) play in communicating healthy messaging on topics such as HIV and sexual violence among young people in sub-Saharan Africa.

In sub-Saharan Africa, religion plays a significant role in people’s lives, often positively influencing health-related behaviors and attitudes (Green, 2003; UNICEF, 2021a). Given both their reach and influence, faith leaders are one potential resource for HIV-related information, including HIV counseling, testing, linkage to care services, and knowledge about child sexual abuse (Olowu, 2015). Faith-based organizations promote healthy sexual behaviors, increase self-efficacy and social control, and establish groups (e.g., Bible study or prayer groups) where members encourage and hold each other accountable for their actions (Blevins et al., 2019; Green, 2003). A national survey in Zambia among 5,534 youth between the ages of 13 to 24 found that being part of a religious affiliation or Christian denomination that opposed premarital sex was associated with delayed sexual debut (Agha et al., 2006).

Faith and community leaders can be drivers of change within the faith and overarching community (Green, 2003; Karam, 2015);, thus an HIV educational intervention targeting these leaders may support positive changes within a community. In Zambia, a predominantly Christian nation (75%–95%), faith-based organizations and religious institutions have made significant strides in changing social norms/laws around child sexual abuse and have substantially contributed to HIV case-finding efforts for hard-to-reach populations such as men and children via direct service delivery and community engagement (Karam, 2015; Mash & Mash, 2013; Morgan et al., 2014).

However, despite demonstrated positive outcomes, some religious belief systems may also have a negative impact. First, studies suggest that faith leaders and communities of faith can perpetuate HIV/AIDS stigma and discrimination, particularly when engaging with ALHIV, given the moral standards and religious rules that govern sexual engagement at a young age (Haddad et al., 2008; Idele et al., 2014; Morgan et al., 2014). Second, although the faith-based community has engaged in HIV/AIDS initiatives, these efforts have predominantly focused on adult populations, with adolescents’ needs inadvertently being overlooked. These observations imply that the faith-based community could benefit from greater awareness, education, information, and skills to positively impact, support, and guide adolescents and ALHIV.

To assess the impact of the 2-day training, a one-group pretest-posttest-follow-up design was adopted to evaluate Faith Matters! conducted in Lusaka, Zambia, in 2021.

A total of 66 faith leaders participated in the Faith Matters! evaluation. All 66 participants completed the first evaluation (baseline); 64 faith leaders completed the posttraining evaluation (immediately after the training); and 59 completed the evaluation at the 3-month follow-up point. Over the course of the three time points, seven participants dropped out of the study.

The findings from the evaluation of the Faith Matters! 2-day training workshop led to improved knowledge, greater comfort with communication, and changes in beliefs related to sensitive topics, including sexual abuse and HIV misconceptions. Historically, faith leaders have played an integral part in responding to public health issues, even dating back to the 1854 cholera outbreak when the Reverend Henry Whitehead worked with Dr. John Snow to communicate critical public health messages to the public (Chave, 1958). In the 2014–2016 Ebola epidemic in West Africa, faith leaders played a critical role in communicating safe burial practices to communities as part of an effective public health response (Blevins et al., 2019). Research in the United States has shown the important role that faith leaders have had in shaping the conversation around a disease, social norms, and sexual health (Coleman et al., 2016; Derose et al., 2019; Maliski et al., 2010; Moore et al., 2015; Nunn et al., 2013; Obong’o et al., 2016; Pichon et al., 2016; Williams et al., 2014). In like fashion, our findings demonstrate the potential important role that faith leaders may play in HIV prevention programs by normalizing and destigmatizing HIV through open discussions with their congregants, which include AYP. While several studies have explored the use of FBOs and faith communities to tackle HIV/AIDS (Kagimu et al., 2012; Mpofu et al., 2014; Otolok-Tanga et al., 2007; USA-PEPFAR, 2021), this is the first evaluation from the PEPFAR-supported Faith Matters! that is part of the broader Faith Communities Initiative.

Participants’ knowledge of HIV/AIDS did not significantly change, which is similar to findings reported in other studies conducted in eastern and southern Africa (CDC, n.d.; Karam, 2015; Mash & Mash, 2013; Morgan et al., 2014; Pusateri, 2010). The lack of a statistically significant increase in HIV/AIDS knowledge between baseline and postintervention assessment may be explained by long-term investments in HIV/AIDS awareness campaigns. However, the lower percentages of respondent knowledge about condoms, viral load, and voluntary medical male circumcision leaves room for further exploration and training. Pusateri (2010) noted that while increases in knowledge were observed early in the HIV epidemic, recent gains have been more marginal. In a survey conducted in Kumasi, Ghana, among 1,200 members of six religious congregations, one fifth of the congregation’s members reported providing some support to people with HIV/AIDS in the past 6 months, mostly through prayer, financial support, and counseling (Bazant & Boulay, 2007; Campbell et al., 2011). Because of their social capital and platform, faith leaders and faith settings are poised to disseminate information that can increase awareness, change attitudes and behaviors, and reduce stigma and discrimination against PLHIV.

The increase from baseline to 3-month follow-up in awareness and acknowledgment that sexual violence can occur in churches, and that the definition of child sexual abuse includes inappropriate exposure, implies that prior to the training workshop, participants had a blind spot in the areas of sexual violence against children. Historically, religious institutions have typically been considered safe havens where people seek spiritual guidance and support from faith leaders on various aspects of their lives. As a result, faith communities have been found to avoid scrutiny and critical reflection on child sexual abuse (Nweneka, 2007). Similar to other studies that highlight the role that FBOs can play in preventing and responding to sexual and gender-based violence (Anugwom & Anugwom, 2018; Magner et al., 2015), our findings underscore the importance of informing faith leaders about sexual violence against children, especially regarding recognizing, responding to, and preventing sexual violence against children. As gatekeepers, faith leaders can also play a vital role in safeguarding children, including preventing violence victimization, dispelling myths and victim blaming, creating a safe space for survivors to disclose violence, and ensuring that policies are in place to screen all persons who interact with children, and to hold perpetrators accountable (USA-PEPFAR, 2021). Furthermore, while not statistically significant, from a practical standpoint, faith leaders could use their platforms to shift cultural norms, especially those related to child marriage (Karam, 2015).

The ability of faith leaders to be able to appropriately communicate with young people about topics such as HIV/AIDS stigma, misconceptions, prevention, and treatment adherence is one crucial way they can contribute to ending the HIV epidemic. While our study noted changes in the comfort level of faith leaders’ communication on topics related to HIV and sexual violence, these changes were not statistically significant. This is most likely due in part to the study being underpowered and not having a large enough sample size to detect differences between time points (Button et al., 2013). Similar studies have noted that increased knowledge and investments in educating and engaging FBOs has led to stigma reduction (Mpofu et al., 2014; Otolok-Tanga et al., 2007). Of interest was the decrease in comfort levels of faith leaders in discussing sensitive issues reported immediately after the training workshop, with a subsequent increase above baseline at 3-month follow-up. This drop could possibly signify the need for participants to practice more in order to develop the skills required for improved communication. Programmatic implications of this finding could be the need to include more skill-building components into the 2-day training workshop to increase participants’ comfort level in having these sensitive conversations.

Study participants reported increased frequency (1–3 times [baseline: 38.5% v. 3-month follow-up: 49.2%]; 4–7 times [baseline: 7.8% vs. 3-month follow-up 26.7%]) of talking about HIV-related topics with young members of their congregations in the past 3 months (Table 3). This may suggest that faith leaders felt empowered or a sense of responsibility to incorporate topics covered in Faith Matters! more frequently when engaging younger congregants. Although faith leaders’ beliefs about HIV/AIDS did not change significantly between baseline and the 3-month follow-up (Table 3), study participants acknowledged that increased awareness and understanding of the pressures young people experience was one way they could provide support to ALHIV. This reflects the sometimes-contradictory role that faith and religious institutions may play in combating stigma and discrimination (Blevins et al., 2019; Nweneka, 2007). Evidence shows that the stigma that some key populations and sexual and gender minorities face are often religiously motivated and the need for engaging FBOs to combat this stigma (Blevins & Corey, 2013; Blevins & Irungu, 2015; Blevins et al., 2019). However, the role that religious and faith leaders play in providing psychosocial support for PLHIV, especially in settings where services for clinical counseling are nonexistent, cannot be overlooked. Moreover, faith leaders can also be instrumental in educating and empowering young members of their congregations by frequently and repeatedly delivering clear messages that target young people.

Faith leaders who have influence and access to community members, particularly adolescents who continue to be at the highest risk for HIV/AIDS, can be trained to effectively address health issues. A Faith Matters! 2-day workshop holds promise as a low-cost HIV-prevention intervention well suited for faith leaders. The evidence demonstrates that Faith Matters! can increase faith leaders’ knowledge about sexual violence and their comfort in communication to better support and guide ALHIV on issues such as sexuality, peer pressure, child sexual abuse, HIV stigma, and HIV treatment and care. Moreover, the evidence can inform future HIV/AIDS public health initiatives that further increase the capacity and empathy among the faith-based community. As more faith communities are leveraged in the fight against HIV/AIDS, engaging a broad cross-section of faith leaders with varying perspectives will be essential to assure wider impact.