Margaret Morris Doctor of Philosophy

363 Pages·2016·15.79 MB·English

UNIVERSITY OF DERBY
COMPETING REALITIES,
DIVERSE NEEDS:
AN INTER-DISCIPLINARY APPROACH TO
RELIGIOUS ENGAGEMENT WITH HIV
PREVENTION AND CARE
Margaret Morris
Doctor of Philosophy 2012
IMAGING SERVICES NORTH
Boston Spa, Wetherby
West Yorkshire, lS23 7BQ
www.bl,uk
TEXT BOUND CLOSE TO
THE SPINE IN THE
ORIGINAL THESIS
ORIGINAL COpy TIGHTLY
BOUND
CONTENTS
Table of Contents
List of Tables vi
List of Figures Vlll
Glossary IX
Abstract Xl
Acknowledgements Xlll
CHAPTER ONE 1
Introduction 1
Competing realities, diverse needs 1
Framing the question 1
Introducing practical theology 4
Introducing public health theory and practice 6
Towards shared praxis 8
Background 9
HIV - Epidemiological contexts and contestations 14
An emerging phenomenon 14
Disputed relationship between HIV and AIDS 16
An epidemiological map 17
Global HIV 17
United Kingdom HIV 20
Prevention and care strategies 26
Conceptual tensions 26
Strategic conflicts 28
Developing the research proposal 30
CHAPTER TWO 37
Literature Review 37
Search strategy 37
Globalisation, religion and HIV 39
1
Inequalities, religion and HIV 50
Identity, religion and HIV 56
Religion and people living with HIV 60
Conclusion 69
CHAPTER THREE 72
Methodology 72
Introduction 72
Preliminary model 72
Formulating a research strategy - paradigms and philosophies 74
Qualitative, Quantitative 74
Narrativist, Positivist 76
Interdisciplinarity - making epistemological and
practical theological connections 77
Emerging typology 81
Training 81
Funding 81
A methodological case study - strategies and outcomes 81
Sensitivity 85
Ethnicity and diversity 87
Localising data collection 90
Context - Leicester's ethnic, religious and HIV prevalence profiles 90
Context - perspectives on a city's HIV history 97
Method 100
Introduction 100
Triangulation 100
Recruitment, ethics and research governance 101
Gatekeepers to research popUlations 104
Researcher bias and reflexivity 106
ii
Gender 107
Terminology 108
Health and healing 109
Faith, religion and belief 109
Multi-, inter-, plural III
Additional primary research 113
Secondary research 114
Towards a questionnaire 114
Towards data collection, organisation and analysis 114
Conclusion 115
CHAPTER FOUR 117
Recruitment, Data Collection and Anatysis 117
Characterising the study's collection of local data 117
Questionnaire 118
Design 118
Distribution and recruitment 119
Interviews 123
Groups 123
Numerical data 127
Questionnai re 127
Frequencies 128
Measures of association and
statistical significance 132
CHAPTER FIVE 135
Local field data: reports and preliminary analysis 135
Introduction 135
Themes and narratives 136
HIV knowledge and beliefs 136
Sources of HIV information 141
Beliefs about transmission 145
Prevention and care messages 152
Sexual Health Education for children
III
and young people 157
Teachings on intimate relationships 157
Talking about HIV 164
Faith group talking about HIV
Faith leaders talking about HIV
Initiating discussion
Talking to health professionals
Talking to religious leader
Knowing people with HIV 179
Knows person with HIV
Who knows? Telling someone you have HIV
Knowing person with HIV in faith group
Support for people with HIV 184
Responding to people with HIV
Support off aith group
Support of other agencies
and wider community
Appropriations of beliefs and teachings 199
Making meaning 211
Disclosure 217
Religious teachings 223
Stigma 228
Synthesis 231
CHAPTER SIX 233
Discussion and further analysis 233
Emergent themes 233
Diversity 235
Power 240
Religious authority 243
HIV prevention and care services 248
Stigma 252
CHAPTER SEVEN 257
Conclusion 257
Study's weaknessesllimitations 257
Introduction 257
Non-replicability, validity and reliability 257
Researcher's perspectives and realities 258
Naming the research location
and issues ofp articipant identification 259
Towards a new practical theology 259
iv
Suggestions for further research 273
Looking to the future 276
BffiLIOGRAPHY 279
Cited works 279
Resources consulted but not cited 310
APPENDICES Volume II
v
List of tables
Table 1: Global estimates of HIV infections at end of 2009 (UNAIDS
Report on the Global AIDS Epidemic 2010) 17
Table 2: Regional estimates of HIV infections at end of 2009 (UNAIDS
Report on the Global AIDS Epidemic 2010) 18
Table 3: HN in the UK end of 2009 (Health Protection Agency. HIV
in the United Kingdom: 2010 Report) 21
Table 4: Estimated number of adults (15-59 years) living with HIV (both
diagnosed and undiagnosed in the UK: 2009). Health Protection
Agency 20 lOb, HIV in the United Kingdom 2010 Slideset 1 23
Table 5: New HIV and AIDS diagnoses in the UK and deaths among
HIV infected individuals: 2000-2009. Health Protection
Agency 201Ob, HIV in the United Kingdom 2010 Slideset 2 24
Table 6: Number of new HIV diagnoses by prevention group, UK:
2000-2009. Health Protection Agency 201Ob, HN in the
United Kingdom 2010 Slideset 3 25
Table 7: Towards a research proposal 35
Table 8: Identifying the realities of living with HIV: a thematic map 71
Table 9: Census 2001: Ethnic composition. Area Profile for the City
of Leicester 91
Table 10: Census 2001: Religion. Area Profile for the City of Leicester:
Demographic and Cultural 92
Table 11: Estimated resident population by ethnicity (Experimental
popUlation estimates by ethnicity 2011) 93
Table 12: HIV -diagnosed persons seen for HIV care resident in
East Midlands Strategic Health Authority (SHA) by ethnic
group: 2010. Survey of Prevalent HIV Infections Diagnosed
(SOPHID) East Midlands data tables. (Health Protection
Agency (2011d) 95
Table 13: HIV -diagnosed persons seen for HIV care resident in East
Midlands SHA by exposure category: 2010. Survey of
Prevalent HIV Infections Diagnosed (SOPHID) East Midlands
data tables. (Health Protection Agency (2011d) 96
Table 14: Questionnaire design - anticipated themes for analysis 120
VI
Table 15: Biographical information: questionnaire respondents (N = 50) 124
Table 16: Biographical information: interviewees with HIV (N = 13) 125
Table 17: Biographical information: group participants (N = 45) 126
Table 18: Distribution of questionnaires and returns by religion 127
Table 19: Early theoretical outline 136
Table 20: SOPHID Table 2: Numbers of HIV -diagnosed persons seen
for HIV care in the UK by country, SHA of residence and
exposure category: 2010. Survey of Prevalent HIV Infections
Diagnosed (SOPHID) Data tables 2010. [Survey of Prevalent
HIV Infections Diagnosed (SOPHID) Data tables 2010] 137
Table 21: Theoretical clusters; streams of interest 234/235
Vll