Religious Leader’s Knowledge, Stigma, and Support for People Living with HIV and AIDS (PLHIV) in Kupang

IAKMI IPHJI use only: Received date : 3 April 2020 Revised date : 23 April 2020 Accepted date : 25 May 2020


INTRODUCTION 
Indonesia is one of the 20 countries with the highest HIV cases in the world. In 2018, cases of HIV and AIDS in the world reached 37.9 million. In addition, Indonesia has the fastest growth rate of HIV cases in the Asia Pacific after India and China. On average, 46.000 new cases are found in Indonesia every year 1. In 2018, 441.347 cases of HIV and AIDS were reported 2. The number of cases of HIV and AIDS in East Nusa Tenggara (ENT) in 2018 reached 6.192 with 887 new cases. Kupang is the district/city with the most HIV cases in ENT. Based on occupation, the distribution of HIV and AIDS cases was found the most in housewives. Likewise, there has also been an increase in HIV cases in children under the age of four 3. These facts show that HIV and AIDS has become an issue at the household level. Therefore, the empowerment  Corresponding author. E-mail address: imelda.manurung@staf.undana.ac.id of all levels of society to actively participate in efforts to treat HIV and AIDS must continue to be driven. Community-based HIV treatment puts the community as agents to achieve the expected goals. The results achieved are more effective because they can overcome overall social and structural barriers to health and human rights 4. Community mobilization for HIV and AIDS treatment is powerful because leaders, agents and targets are in the community 5. The influence of community leaders is very effective in delivering the message of HIV and AIDS and supporting good behavior change 6. Religious leader is among influential leaders in society. Religious leader (RL) is proven to be able to deliver messages and support good behavior change in the community to treat HIV and AIDS 7. Religious leader's support to campaign for the elimination of stigma in people living with HIV is obeyed by the community 8. This is because RL has the power and charisma to influence followers' mind and behavior 9.
Many people in East Nusa Tenggara (ENT) rely on RL's ability to heal the sick. They believe that RL has a gift from God to cure all kinds of diseases including AIDS 10. The community is very obedient to RL's commands for recovery 11.
The results of preliminary survey showed that that most of the times, advice given by RLs are contrary to the advice given by medical personnel. The advice given by RL to PLHIV include: taking medicine is unnecessary because the disease has been cured by God. The stigma against PLHIV is one of the factors that influence the success of HIV and AIDS treatment 12. Stigma may reduce PLHIV's quality of life in an attempt to maintain their health. In addition, stigma also affects social interaction in the community 13. RL as a respected person in the community has the potential to facilitate the elimination of stigma in PLHIV. Therefore, this study aims to examine RL's knowledge, stigma and support for PLHIV.

METHOD
This study is a quantitative descriptive study 14. The population and samples of the study are 51 religious leaders representing each village in Kupang. The RL criterion in this study is recognized by the community as having the gift of healing from God. The variables of the study are knowledge, stigma and support. Questionnaire was used as the instrument of the study. The knowledge variable consists of 6 statements to be responded with True or False. The stigma and support variables consist of 4 statements each to be responded with Yes or No. Score 1 is given for each correct respond, otherwise score 0 is given. For the knowledge and support variables, a total score of more than 70 percent is classified as good. Score less than 70 percent is classified as poor. As for the stigma variable, a total score of more than 70 is classified as low and less than 70 is classified as high. Data were analyzed descriptively and presented in a frequency table.

RESULTS AND DISCUSSION
The results showed that most RL are female aged over 40 years old.
Based on table 1, in the knowledge variable, the most correctly responded statement was 'HIV is a preventable disease', responded correctly by 35 (68.6%) RLs. HIV and AIDS treatment by empowering religious leader has been proven to be effective based on many studies in various parts of the world 15. The results of this study showed that most RLs had a poor knowledge. This may be because RLs had never obtained information about HIV and AIDS 16. One has a poor knowledge due to their low awareness to access information and the lack of exposure to information from the government to campaign on HIV and AIDS treatment 17. Knowledge is essential in supporting behavior formation. The better a person's knowledge, the better their behavior to support HIV prevention 18. Study on teenagers in Yogyakarta shows that knowledge is related to HIV prevention behavior 19. If RLs had a poor knowledge about HIV, the behavior to carry out HIV treatment would be hard to realize. Stigma is the act of giving a social label that aims to exclude someone with a bad image. Stigma results in acts of discrimination that ignore one's basic rights and dignity 12. Most RLs gave stigma to PLHIV. The stigma given includes HIV is a disease of punishment and a result of immoral behavior. In addition, RLs also gave the stigma that PLHIV must be ostracized. Giving stigma to PLHIV was affected by lack of knowledge. RLs did not know how HIV was transmitted so that they gave a bad image on PLHIV. A study conducted in Nigeria to nursing students shows that good knowledge reduces the stigma to people living with HIV 20. The results of this study indicated that although RLs had poor knowledge and high stigma, most RLs provided a great support for PLHIV. This is because RLs can accept anyone and have the motivation to serve everyone. RLs love everyone who needs help. They are even ready to provide support for PLHIV who experience stigma from the community. The study conducted in South Africa shows that RL is able to motivate congregations to take HIV tests 21. Church leaders and congregational groups have the strength in the form of love, attention, and mental recovery by using their faith to support PLHIV . RL is trusted as having high integrity and strong faith 22. RL also has the power to influence and mobilize people for an ultimate goal, namely to repent, to make peace, and to make a better life 23.

CONCLUSION
This study concluded that although RLs had a poor knowledge and high stigma for PLHIV, they provided a great support for PLHIV. Therefore, efforts to improve knowledge and eliminate stigma are necessary so that RLs can provide support that is in line with treatment for PLHIV.

ACKNOWLEDGMENT
The authors gratefully thank all the religious leaders who have been involved in this research, GMIT Church that assisted in providing data of praying fellowship, AIDS Commission of ENT Province that took the time to complete the survey.