Religion is a powerful force in southern Africa, affecting all aspects of daily life and health (Anderson 2001, Chitando 2007a), particularly among rural women (Agadjanian 2005). Rural churches are a center for informal social interaction, shaping attitudes and behaviors of its members (Agadjanian and Menjivar 2008). Yet, the role of religion in the sub-Saharan HIV epidemic has received limited attention in the literature. Few studies (e.g., Gregson et al. 1999, Garner 2000, Agadjanian and Menjivar 2008, Mpofu et al. 2011) have probed the mechanisms through which religious affiliation might affect HIV-related risk factors in subSaharan Africa. At the same time, there is a growing scientific consensus about the importance of structural and social contextual factors that shape HIV-related attitudes, behaviors, and outcomes (Gupta et al. 2008, Amon and Kasambala 2009).

The purpose of this paper is to examine the influence of religion on HIV-related behaviors and attitudes among orphan adolescent girls participating in a randomized controlled prevention trial (RCT) in rural Zimbabwe. The RCT sought to test the notion that a structural intervention providing school fees and other support for orphan girls to stay in school can help reduce HIV risk behaviors and attitudes. After two years, the intervention reduced school dropout by 82% and early marriage by 63% compared to controls, and showed a trend toward more equitable gender attitudes and more protective attitudes about future expectations and delayed sex (Hallfors et al. 2011). In the present study, we examine the influence of religion, controlling for intervention effects.

Early in the study, we observed that the influence of the Apostolic Church was widespread and increased the likelihood of girls dropping out of school to marry. Despite a strong and growing presence in southern Africa, we found very little in the published peer-reviewed literature about the Apostolic Church, and no studies comparing HIV biomarker data between Apostolics and other religious denominations. Because our study did not include HIV biomarker data, we used population based data from the latest Zimbabwe Demographic and Health Survey (2006 ZDHS) as a supplementary source to further examine the relationship between religion, marriage, and HIV infection among young rural women.