Human immunodeficiency virus (HIV) continues to be a major public health issue, with high infection rates and significant mortality. The role of churches in HIV prevention has been largely debated, particularly concerning the use of condoms.
Aim
The model’s objective was to assist pastors in enhancing support and care for individuals living with HIV, ultimately improving their quality of life.
Setting
This study, using a qualitative phenomenological approach, explored Christian practices that can aid in combating HIV and/or acquired immunodeficiency syndrome (AIDS) and proposed a model aimed at addressing HIV and/or AIDS among Christians in Thulamela churches.
Methods
Data were collected using a semi-structured interview guide. Thematic analysis revealed four major themes: pastors’ experiences regarding HIV and/or AIDS, pastors’ knowledge of HIV and/or AIDS, pastors’ attitudes towards HIV and/or AIDS and pastors’ practices concerning HIV and/or AIDS.
Results
The findings highlighted challenges in pastoral care because of a lack of knowledge and training, alongside negative attitudes and practices towards people living with HIV. A model was developed to combat HIV and/or AIDS, improve pastoral care and counselling, enhance the quality of life for people living with HIV and reduce new HIV infections among church members. The model’s development was guided by the Context, Input, Process and Output (CIPO) theory system.
Conclusion
The research findings underscore the importance of integrating people living with HIV in HIV and/or AIDS prevention efforts within church settings and enhancing pastoral care and counselling.
Contribution
These findings may be applicable to similar settings in sub-Saharan Africa and other developing regions.
AIDSChristianscombatcongregantsHIVmodelPastorFunding information This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.Introduction
Despite national efforts to meet the United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 goals,1,2 South Africa continues to experience high human immunodeficiency virus (HIV) prevalence and gaps in treatment and suppression rates.3 Churches, while offering support, have also presented obstacles to prevention efforts because of doctrinal limitations and persistent stigma.4
Churches have played a vital role in providing care and support but have also posed challenges to HIV prevention because of opposition to condom use.5 Religious beliefs significantly influence individual health choices, yet strict anti-condom stances hinder prevention efforts.6,7 Stigma within religious communities further complicates engagement in HIV-related initiatives.8 This study, therefore, aimed to develop a model to enhance pastoral support and care for people living with HIV in Thulamela churches, ultimately contributing to the fight against HIV and/or acquired immunodeficiency syndrome (AIDS).
Research methods and designResearch design and setting
This qualitative study employed a phenomenological design to explore lived experiences related to HIV and/or AIDS within church communities in Thulamela Municipality, Limpopo, South Africa.9 The study focused on pastors from various denominations, purposefully selected based on their leadership roles and interactions with people living with HIV. A total of 15 pastors were interviewed, representing major denominations including Apostolic, Pentecostal and Zionist churches. Participants were both male and female, aged between 35 years and 65 years, with varying years of pastoral experience (ranging from 5 years to over 20 years).
Sampling techniques
Snowball sampling was used to identify 10 individuals living with HIV, who were congregants or individuals known to the church communities. These participants were also diverse in gender and age (between 30 years and 60 years) and shared insights into their interactions with pastoral care. All interviews were conducted in private, participant-chosen locations to ensure confidentiality and comfort. Data collection involved in-depth interviews conducted in private, participant-chosen locations. Written informed consent was obtained, and confidentiality was ensured.
Data analysis
Interviews were transcribed verbatim and manually analysed using interpretative phenomenological analysis.10 This involved repeated transcript readings, note-taking, theme identification and categorisation into a master theme table. Emergent themes were compared across transcripts to develop a unified theme structure.
Trustworthiness
To ensure credibility, Lincoln and Guba’s model of trustworthiness was applied.11 Prolonged engagement, field notes and peer discussions enhanced data validity. An independent co-coder was involved in data analysis to ensure consistency. The study’s detailed methodology ensured that its replicability and reflexivity were maintained throughout.
Ethical considerations
Ethical clearance to conduct this study was obtained from the University of South Africa (UNISA), UNISA Health Studies Higher Degrees Ethics Review Committee (HSHDC/976/2020).
Results
This section presents the empirical findings derived from the qualitative study, organised around four major themes identified through thematic analysis: pastors’ experiences, knowledge, attitudes and practices concerning HIV and/or AIDS. Rich, verbatim quotes from participants are included to illustrate key points and provide depth to the analysis.
Pastors expressed varied experiences when engaging with congregants living with HIV and/or AIDS. Many felt emotionally burdened and underprepared:
‘Sometimes, I don’t know what to say. I see their pain, but I feel helpless,’ (Participant 3, Male, 52 years)
Some pastors shared that they encountered HIV-positive members who feared judgement or gossip:
‘Most won’t tell anyone. They only talk to me in private and ask me not to tell anyone,’ (Participant 6, Female, 41 years)
These experiences revealed a need for structured emotional and professional support for pastors as frontline caregivers.
Theme 2: Pastors’ knowledge of human immunodeficiency virus and/or acquired immunodeficiency syndrome
A prominent challenge was insufficient knowledge about HIV and/or AIDS. Many participants admitted to relying on outdated or anecdotal information:
‘I learned about HIV from TV and stories. I never had proper training,’ (Participant 1, Male, 38 years)
This lack of knowledge sometimes led to misinformation being shared during sermons or counselling. The absence of collaboration with health professionals further widened the knowledge gap.
Theme 3: Pastors’ attitudes towards human immunodeficiency virus and/or acquired immunodeficiency syndrome
Some pastors held judgemental or theologically influenced views:
‘I used to think HIV was a punishment from God for sinful living,’ (Participant 5, Female, 47 years)
Others had more compassionate attitudes, often influenced by personal encounters with people living with HIV:
‘One of our choir members died from AIDS. Since then, I speak about it more openly,’ (Participant 8, Male, 60 years)
Such divergent attitudes significantly influenced how HIV and/or AIDS was addressed in church settings.
The majority lacked structured practices for HIV and/or AIDS prevention and care. Very few churches had organised support groups or HIV-related programmes:
‘We pray and give comfort, but we don’t have anything formal like workshops or counselling,’ (Participant 2, Female, 55 years)
Some expressed willingness to engage more proactively if trained:
‘I would like to do more, but I need help to know how to help,’ (Participant 4, Male, 49 years)
Integration with the context input process output model
These findings formed the empirical foundation of the Context, Input, Process and Output (CIPO)-based model.12 The challenges of insufficient knowledge and training (Themes 2 and 4) directly informed the model’s Input and Process components:
Input: Inclusion of ‘Knowledgeable Pastors’ and collaboration with healthcare workers as essential resources.
Process: Implementation of targeted training and pastoral counselling sessions.
Negative attitudes and inconsistent practices (Themes 3 and 4) informed the need for attitude transformation and awareness campaigns:
Process: Awareness campaigns and active involvement of people living with HIV aim to combat stigma.
Pastors’ emotional burden and fear of inadequacy (Theme 1) validated the need for structured pastoral care:
Output: Improved quality of life for people living with HIV and better pastoral care are key anticipated outcomes.
Model evaluation and refinement
To ensure the rigour and relevance of the model, a modified Delphi technique was used for expert review and refinement.13 The Delphi method involved three iterative rounds of consultation with a panel of six experts drawn from fields including public health, pastoral care, HIV and/or AIDS intervention and theology.
The expert panel included:
Two university-based public health researchers with doctoral qualifications in community health.
One senior pastor with over 15 years of pastoral experience and a Master’s degree in practical theology.
One HIV and/or AIDS programme coordinator from a non-government organisation (NGO).
One psychologist specialising in counselling for people living with HIV.
One academic specialist in theological ethics and health policy.
Round 1
Experts received the initial model draft and a structured feedback guide. Their feedback highlighted the need for greater clarity in the roles of healthcare workers in church settings and recommended specifying monitoring indicators.
Round 2
After incorporating initial feedback, the revised model was resubmitted. Experts suggested emphasising the importance of confidentiality in pastoral counselling and clearer inclusion of people living with HIV in decision-making bodies within churches.
Round 3
Final round focused on validating the language, structure and feasibility of implementation. Minor adjustments were made to align terminology with standard HIV care frameworks.
Examples of refinements made
The ‘Training’ process component was expanded to include confidentiality training for pastors.
‘Involvement of people living with HIV’ was elevated from a supporting strategy to a core process component.
A monitoring and evaluation matrix was added as a supplementary tool, based on expert recommendation.
The development of the model
The model for improving pastoral support and care for people living with HIV was informed by research findings and guided by the CIPO systems theory framework.12 The model development followed established theory development methodologies, including concept analysis, synthesis and derivation.14,15,16
Concept analysis
Concept analysis identified key components required to develop a holistic approach to HIV and/or AIDS prevention within churches.12 The research focused on integrating HIV and/or AIDS programmes within church settings, incorporating inputs, processes and outputs.
Synthesis
Concept synthesis involved analysing data to develop new perspectives on HIV and/or AIDS prevention in religious settings.12 Insights from literature and participant responses informed the model’s structure.
Derivation
The lack of existing models tailored to church-based HIV and/or AIDS interventions necessitated concept derivation. Theory derivation allowed the researcher to adapt relevant health concepts to the church setting. The modified Delphi technique was employed for peer evaluation and refinement of the model.13
Description of the model
Figure 1 visualises the dynamic interplay between the four components of the model – context, input, process and output.12,17 The outer rectangles in the figure represent the broader global and national contexts that influence local church policies and attitudes towards HIV and/or AIDS.18 Inputs such as knowledgeable pastors, committed congregants, inclusive forums and healthcare worker involvement feed directly into processes that include targeted training, counselling, awareness campaigns, involvement of people living with HIV and robust monitoring and evaluation mechanisms.19
Context, input, process and output-based model for improving pastoral care and support for people living with HIV in church settings in Thulamela. The model illustrates the systemic flow from global and national influences to contextual church realities, including inputs, intervention processes and expected outputs.
These processes are interlinked and designed to function systemically, with training equipping pastors to provide scientifically informed counselling, awareness campaigns reducing stigma and people living with HIV involvement fostering inclusivity and community ownership.15 Monitoring ensures sustainability and accountability.20 Collectively, these interconnected processes lead to the model’s intended outputs: improved pastoral care, enhanced quality of life for people living with HIV and a reduction in new HIV infections among church members.14 The systemic approach outlined above forms the foundation for how this model can be applied in real-world pastoral and faith-based health contexts.21
Applications of the model
The model calls for a paradigm shift in HIV and/or AIDS policy and practice by incorporating people living with HIV in decision-making and expanding pastoral training. Following consultations with the Pastors’ Forum and key stakeholders, the model was deemed applicable across multiple settings, including:
Churches within the Thulamela Municipality, regardless of denomination.
Biblical colleges and theological institutions.
Pastors’ forums.
Discussion
The findings of this study provide vital insights into the barriers and opportunities for improving pastoral care for people living with HIV in faith-based communities. A major obstacle identified is the lack of accurate knowledge and scientific training among pastors, which limits their ability to deliver informed and supportive care. This aligns with Tiendrebeogo and Buykx’s6 findings on the importance of health education within religious settings. Additionally, the study highlights the ongoing presence of stigma and moral judgement within churches, echoing previous research on how spiritual interpretations can promote silence and exclusion.8,22
Traditional HIV and/or AIDS interventions, such as those supported by the UNAIDS, primarily rely on behavioural and biomedical approaches. Biomedical strategies include male circumcision, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) and antiretroviral therapy (ART),1,2 while behavioural approaches focus on promoting safer sexual practices such as abstinence, monogamy and condom use.7 However, these approaches often overlook the socio-religious context of health behaviours.
The church-based intervention model developed in this study, structured around the CIPO framework, offers a distinct strategy. It emphasises spiritual and emotional care over clinical or behavioural interventions, particularly within Christian communities. The model recognises the significant influence of religious leaders, especially pastors, on the attitudes and behaviours of their congregants. It seeks to equip them with the knowledge, training and resources needed to provide compassionate, stigma-free support to people living with HIV.
Previous frameworks, such as Mouton’s14 concept of pastoral care as community care and Chemorion’s15 approach, have similarly highlighted the role of the church in offering holistic support that includes theology, counselling and social care. The CIPO-based model builds on this foundation by explicitly integrating these elements into a structured intervention framework tailored to the faith context. It addresses critical gaps in existing biomedical and behavioural models by embedding HIV and/or AIDS care within the spiritual life of faith communities
Conclusion
The model for addressing HIV and/or AIDS and enhancing pastoral support and care among Christians was developed based on this study’s findings and structured using the CIPO framework. The proposed model provides a structured approach to integrating HIV and/or AIDS interventions within church settings, promoting care for people living with HIV and reducing new infections. The model recognises the systemic nature of HIV and/or AIDS interventions at global, national and local levels and underscores the importance of equipping pastors with the knowledge and skills necessary to improve the quality of life of people living with HIV and foster supportive church environments.
Recommendations
The model should be translated into Tshivenda to enhance accessibility for pastors, people living with HIV and congregants. Strong collaboration is needed among pastors, people living with HIV, healthcare professionals, the Department of Cooperative Governance and Traditional Affairs (COGTA) and the Department of Health to reduce new HIV infections and associated deaths. Various communication platforms (e.g. community radio, seminars and municipal meetings) should be leveraged to promote the model. Pastors should actively participate in model implementation to ensure its success. Future research should explore the implementation of this model in broader religious communities to enhance HIV and/or AIDS response efforts in faith-based settings.
Acknowledgements
The authors would like to thank the participants of this study.
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
CRediT authorship contribution
Tshifhiwa S. Netshapapame: Conceptualisation, Data curation, Formal analysis, Investigation, Writing – original draft. Cairo Ntimane: Conceptualisation.
Data availability
Data supporting the findings of this study are available from the corresponding author, Tshifhiwa S. Netshapapame, upon request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.
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How to cite this article: Netshapapame TS, Ntimane C. A model for improving pastoral support and care for church members living with human immunodeficiency virus and/or acquired immunodeficiency syndrome in Limpopo province. J Public Health Africa. 2025;16(1), a1402. https://doi.org/10.4102/jphia.v16i1.1402