The conceptual frameworks for HIV prevention held by Pentecostal church youths clustered into five groupings by priority: Biblical teachings, Future focus, Community Norms, Facts about HIV and AIDS and Prevention education. A unique finding from this study is the mapping of the ways church youth understood HIV prevention in the context of their religion and secular influences. This study yielded both the conceptual structure and content for a prospective HIV prevention intervention with church community youths from a developing country.
Although the youths conceptually framed their HIV prevention concepts to include both faith and secular-oriented concepts, they prioritized faith-oriented concepts relatively more than they did secular-oriented concepts. The finding is consistent with the view that the church as a knowledge environment implicitly essentializes faith-informed framing of health concepts [29, 31]. Related studies have documented faith-oriented essentialization in response to the HIV pandemic by Pentecostal family type of churches in Botswana [21, 24, 29], and in Zimbabwe [15, 16] and Mozambique ; -countries which share the same cultural outlook with Botswana. Thus, there appears to be an implicit understanding among the church youths that observance of the church’s core teachings about HIV prevention (e.g., sexual abstinence for unmarried youths) would provide robust protection against a cross-generational pandemic like HIV. However, this perspective might put at higher HIV risk those youths for which adoption of comprehensive secular HIV prevention intervention might be appropriate (e.g., the sexually active) .
Among the secular-oriented HIV prevention strategies, Future focus was the most highly prioritized for HIV risk prevention strategies. It could be regarded as both a faith and secular health protection strategy. For instance, church members would perceive a future willed by a higher spiritual authority, including their prospective health . Future focus for church youths would also mean living church institutionally supported sexual health norms (e.g., abstinence only- until-marriage) and which in this case would reduce risk for HIV infection. As a secular health promotion concept, Future focus is tied to identifying and pursuing goals important to good health and the means to attain them . This would include healthy use of leisure time, use of contraception, and avoiding situations that would expose one to risk for contracting HIV . Future studies should examine the education processes to support choice of healthy futures by the Botswana Pentecostal church youths in a country with high HIV prevalence.
The salience of secular-oriented framing of HIV prevention by the church youths was moderated by sexual experience so that those with first sex considered Facts about HIV and AIDS as relatively less important to their HIV prevention as peers with no first sex. On the one hand, the seeming relative discounting of proven secular HIV prevention concepts like Facts about HIV and AIDS would suggest a higher risk for contracting HIV among the church youths with first sex. On the other hand, with adherence to the church’s framing of HIV prevention (e.g., abstinence for unmarried youths), church youths may perceive to achieve robust health protection with less ego resource depletion [45, 46] than would be with multi-concept secular-oriented interventions (which would lower their risk for contracting HIV). Ego-depletion theory proposes that people seek to conserve their personal (ego) energy resource in their health maintenance by doing the minimum necessary to achieve desired health outcomes [45, 47]. In transacting contrasting knowledge systems (faith versus secular), Pentecostal teenagers in their framing of HIV prevention concepts may align with church teachings, conserving their health protection energies and resulting in lower risk for contracting HIV. Future research should examine the relative explanatory value of ego-resource conservation and dissonance reduction as constructs for the framing of HIV prevention with the Pentecostal church youths.
The female church youths perceived secular-oriented HIV prevention concepts of Prevention Education and Future focus to be relatively less salient to their HIV prevention that did the male youths. This may reflect a cultural imbalance in how females and males perceive to be in control of their futures in Batswana culture. For instance, females in the patriarchal Botswana cultural context may perceive to hold less decisional powers about their futures, including their sexual and reproductive health . This effect may persist even in the context of church, which also is mostly patriarchal in culture . Thus, female Botswana Pentecostal teenagers are at elevated risk for HIV infection, partly from the socio-cultural inequities that constrain choices by females to direct their futures. Future studies could use qualitative inquiry approaches to explore the futures that Botswana female teenagers perceive to control or wish for and the ways by which these could be enabled for health promotion with them.
The older teenagers were more differentiating in their rating of the comparative worth of the secular-oriented HIV prevention concepts suggesting greater exposure to secular HIV prevention education with increases in age. This finding might be variously explained by exposure to the country’s formal education system. HIV prevention education is mandatory in Botswana schools , and the church teenagers would have been exposed to secular HIV prevention education formally through the school curriculum and also through community oriented public health education . The older youths having progressed higher or further in the education system would likely perceive secular influences on their HIV prevention than would the younger peers with relatively less formal education. The church youths may have sexual partners who are from the secular community or with different sexual health attitudes different from those of their FBO, inclining them to privately frame their HIV prevention to align with their romantic or sexual partners. Church youths are part of the secular community, and HIV is mostly acquired from social networks. Future studies should examine social networks by church youths as conduits for HIV prevention information and education.
Implications for HIV prevention education with church youths
Church youths perceived both faith and secular influences important to their HIV prevention. This means that some aspects of existing comprehensive, evidence informed HIV prevention interventions might be of service with Pentecostal church youths if tailored to be of value-add to church institutionally endorsed concepts [34, 49]. An implication of the findings from this study is that while HIV prevention interventions with church community youths could be customized to the church knowledge environment, the church teenagers recognize and value heath protective secular oriented teachings. For instance, sexually active teenagers in this Pentecostal faith community for abstinence outside marriage (A) would likely look to secular concepts (possibly condom use: C) for their health protection than to church/faith concepts only, even with a higher regard for faith-oriented framing of HIV prevention. If church youths engaged in premarital sex from privately framing of their sexual decisions contrary to the church “A” teachings, while also undervaluing secular-oriented prevention concepts (e.g., knowledge about HIV and AIDS, use of condoms), then their HIV risk would increase.
Although the relative openness to secular-oriented framing of HIV prevention by the church youths represents an exciting opportunity for public health, an effective collaboration with the faith sector will require a better understanding of their specific faith traditions; - to better align HIV prevention messages and identify resources for sexual health education. For instance, while church communities may share a preference for faith-oriented framing of HIV prevention, there may be shades of differences in perceived importance of the specific practices underpinned by the same generic HIV prevention concept (e.g., Biblical perspective). For instance, churches for abstinence only-until-marriage impose a more restrictive sexual health norm standard on their youths congregates that those prioritizing abstinence but with valuing of secondary abstinence for those who may have indulged while unmarried . These differences in faith-oriented concepts emphasis may arise from the cultural-historical traditions of specific faith traditions as interpreted by the church leadership in the context of current health issues [15, 40]. Thus, faith traditions may have diversity in the content of their specific HIV prevention concepts and which would be important for health promotion partnerships with them.
Limitations of the study
First, the study investigated the conceptual framing of HIV prevention by youth members of a prosperity oriented Pentecostal church, and their priority concepts may be different from those of faith communities with a different ideology. For instance, youth members of a faith community with a vengeful view of God (33, 34) may be less accepting of secular-oriented HIV prevention. In this regard, a study on the constructions of HIV prevention concepts by the church leadership would clarify the likely influences of church ideology on the ways in which the Pentecostal church youths framed their HIV prevention. A substantial overlap between the conceptual framing of HIV prevention between the church youths and leadership would suggest higher prospects for the adoption implementation of a prevention intervention to result.
Second, perceptions of HIV prevention concepts rather than the actual HIV prevention behaviors the church youths engaged were studied. Evidence is needed on context and types of sexual decisions the church youths engage to protect themselves from contracting HIV. Some of the church youths may see no disconnect between their being sexually active while in a church officially endorsing abstinence, and if they privately framed their sexual decisions to be consistent with the church’s compassionate view of God.
Third, the relatively higher representation of female youths congregates compared to males may have biased in unknown ways the structure and salience of HIV prevention concept map observed. Future studies could use a larger enrollment of the male youths with confirmatory tests  to check on the comparability of HIV prevention concept maps by gender.
Fourth, the study did not seek to explore the framing of HIV prevention by church youths already infected from any cause. The incidence of new infections in the church membership will continue to increase in the absence of a cure as is the case in the general population. Infected church members will need FBO pastoral and treatment care support, among others socially networked resources, to prevent secondary infection and transmitting the HIV to others . Future studies should consider the framing of HIV prevention by FBOs with youth members living with HIV and AIDS.
Fifth, despite privacy protections for the data reporting, some of the youths may have underreported on their sexual debut for social desirability effects, and particularly since the data were collected at the congregation or church sites rather a neutral community center. Social desirability effects to not disclose own sexual activity may have resulted in the relatively lower numbers of youths self-identifying as with first sex experience, which would under-power the related analysis. Future studies should engage church youths for study in neutral venues such as community centers where the youths may feel less constrained in expressing their views by the context of study.