{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:29:31Z","timestamp":1754162971126,"version":"3.41.2"},"reference-count":76,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Heidelberg Graduate School of Global Health","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Olympia-Morata-Programm","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100003042","name":"Else Kr\u00f6ner-Fresenius-Stiftung","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100003042","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,4,4]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Religious leaders (RLs) form an influential group in Eswatini. This study explores their understanding and acceptance of pre-exposure prophylaxis (PrEP), with a view to improve PrEP service delivery for those who would benefit from PrEP the most.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted online and in-person in-depth interviews with (n=26) purposefully selected RLs (n=12 female and n=14\u2009male) from Eswatini. Data were managed using NVivo V.12 and coded inductively. We used thematic analysis to analyse our data and structure our findings across the individual, interpersonal, community and institutional levels of an ecological framework.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>RLs have the willingness, potential and influence to promote PrEP in their church communities. They are aware of the community need for HIV prevention, but describe a conflict between their professional role as a pastor and their personal commitment to the well-being of their church community. Participants expressed a dilemma between their pastoral ethics\u2014 which oppose sex outside of marriage\u2014and the conflicting challenges of HIV stigma and evidence-based health promotion among church members. Discussing PrEP could compromise their credibility and expose them to potential censure from religious authorities and the church community.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>RLs can play an important role in the community acceptance and implementation of PrEP but are conflicted between community health and their professional role. Addressing the sources of this conflict and offering tailored training about HIV prevention and PrEP is essential to reduce stigma and benefit from RLs\u2019 influence in the church community.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018174","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T23:23:52Z","timestamp":1746055432000},"page":"e018174","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cIf I wasn\u2019t a pastor, I would be telling them about condoms, contraceptives and PrEP\u201d\u2014conflicts, dilemmas and credibility: qualitative insights from religious leaders and the promotion of pre-exposure prophylaxis (PrEP) in Eswatini"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1290-1220","authenticated-orcid":false,"given":"Hannah","family":"Goymann","sequence":"first","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5484-890X","authenticated-orcid":false,"given":"Astrid","family":"Berner-Rodoreda","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mxolisi","family":"Mavuso","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative (CHAI), Mbabane, Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8634-9283","authenticated-orcid":false,"given":"Shannon","family":"McMahon","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sindy","family":"Matse","sequence":"additional","affiliation":[{"name":"Eswatini Ministry of Health, Mbabane, Eswatini"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albrecht","family":"Jahn","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany"},{"name":"School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"2025073014472486000_10.4.e018174.1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2018.3048701"},{"key":"2025073014472486000_10.4.e018174.2","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1177\/10497323231181207","article-title":"\u201cWe Should Not Be Quiet but We Should Talk\u201d: Qualitative Accounts of Community-Based Communication of HIV Pre-Exposure Prophylaxis","volume":"33","author":"Goymann","year":"2023","journal-title":"Qual Health Res"},{"key":"2025073014472486000_10.4.e018174.3","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1080\/17441692.2019.1647263","article-title":"Faith and healthcare providers\u2019 perspectives about enhancing HIV biomedical interventions in Western Kenya","volume":"14","author":"Kamaara","year":"2019","journal-title":"Glob Public Health"},{"key":"2025073014472486000_10.4.e018174.4","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1007\/s10943-022-01632-3","article-title":"Exploring the Contextual Factors of Religious Leader Participation in Health Communication: Evidence from a Qualitative Study in Sierra Leone","volume":"62","author":"Luetke Lanfer","year":"2023","journal-title":"J Relig Health"},{"key":"2025073014472486000_10.4.e018174.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276801","article-title":"The role of religious leaders on the use of HIV\/AIDS prevention strategies among young people (15-24) in Lira district, Uganda","volume":"17","author":"Murungi","year":"2022","journal-title":"PLoS One"},{"key":"2025073014472486000_10.4.e018174.6","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1080\/13691058.2021.1874054","article-title":"Religious leaders\u2019 role in pregnant and breastfeeding women\u2019s decision making and willingness to use biomedical HIV prevention strategies: a multi-country analysis","volume":"24","author":"Young","year":"2022","journal-title":"Cult Health Sex"},{"key":"2025073014472486000_10.4.e018174.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.04.018"},{"key":"2025073014472486000_10.4.e018174.8","unstructured":"UNAIDS . 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