Understanding the gender and religious context of women and HIV in Libya: A mixed-methods study.

Abstract

HIV (Human Immunodeficiency Virus) first became a public concern in Libya after the 1998 El-Fatih Hospital outbreak when over 400 children acquired HIV. Since then, despite the lack of research and a functioning surveillance system, the number of cases is believed to be increasing, particularly among married women. To effectively respond to this challenge, this study presents a better understanding of the intricate interplay of culture, religion, and gender that may obstruct Libyan married women's access to HIV services, awareness and prevention programmes, and management. A sequential mixed-method design was used to explore the levels of: (a) HIV knowledge; (b) risk perception; and (c) prejudice towards people living with HIV (PLHIV), among Libyan women. This was achieved through comprehensive literature reviews and, nationwide anonymous, self-administrated online survey, followed by qualitative interviews with five key HIV stakeholders, the latter offered deeper insights into the quantitative findings. A total of 1,101 questionnaires were completed: 40.9% of women were between 26 to 35 years old, 91.6% were university graduates, with 64.8% in employment. Most lived in the West (66.3%) and the East (24.6%) of Libya. The survey found a mixed level of HIV knowledge, with a relatively balanced spread of low, medium and high. As for the level of HIV risk perception, there was a slight inclination towards higher risk awareness and most women had positive perceptions of PLHIV. Closer examination revealed that across the three levels, ‘getting tested for HIV’ emerged as a significant factor, meaning that women who had been tested demonstrated higher levels of knowledge and HIV risk perception, while also exhibiting lower levels of prejudice. Conversely, the link between education, particularly higher levels of education attainment, and HIV knowledge were not explicit. The HIV stakeholders’ interviews identified limited awareness, widespread misinformation, stigma, a weak healthcare system, and a lack of government funding and interest, as critical barriers. Furthermore, they reiterated that patriarchal social structures and the ongoing conflict exacerbate these challenges. This mixed-methods study integrated secondary findings from reviews with primary quantitative and qualitative data, revealing key vulnerabilities in Libyan women related to HIV. A significant gap in HIV research was highlighted, particularly concerning the impact of gender, religion, and culture. The study stresses the need to address the women’s cultural and social roles, incorporate Islamic perspectives, and consider the potential impact of ongoing and post-conflict conditions on HIV. Worryingly, the lack of awareness, compounded by Libya’s patriarchal structure, seems to play a significant role in limiting women’s ability to protect themselves or seek treatment which was supported by the finding that 60% of women lacked confidence in their ability to prevent HIV. Furthermore, social media emerged as a potential tool, providing privacy and support, enabling Libyan women to access HIV information.