The following examples of organisations have been chosen to show how FBOs can successfully create change, working within their own religious contexts, to increase access to SRHR. One example is taken from South Africa of an FBO working in Muslim communities; the second example is taken from Nigeria of an FBO working in Christian communities.

Positive Muslims

Positive Muslims is a South African (Cape Town) based FBO for Muslim people living with HIV/AIDS founded in 2000. The majority of the Muslim community, including some of its leadership, perceive HIV/AIDS to be a punishment from God for having immoral lifestyles and having sinned. Positive Muslims challenges the Muslim leaders and Islamic policies towards those infected with HIV through direct community action and research with such groups in the community. One of their members has also spoken publicly about her positive status and the issues she faces as being part of the Muslim community.

Positive Muslims offers individual counselling, home visits and hospital visits. They also run a fortnightly support group for male and female Muslims living with or affected by HIV/AIDS. Some issues that are discussed within the support group include the wish to have children, loss of a child either through AIDS or due to complications during pregnancy, and relationships and HIV. Some women have difficulties discussing such issues in the presence of men and even their partners. Women also face problems when seeking advice from the Muslim clergy as they feel "judged" by them, firstly for being HIV positive and secondly for talking about sex-related matters while the Muslim clergy tends to be male.

The support group aims to overcome some of these barriers by encouraging open discussions between men and women in the group. There are also three Muslim religious leaders who regularly participate in discussions. Through this process they now openly address HIV/AIDS issues in their mosques. This is a significant change, as it was previously forbidden to talk about these issues in mosques. The women and men participating in the support group have emphasised the need and usefulness of such a service, as well as the fact that they feel more accepted, respected and recognised as Muslims who are living with HIV/AIDS.

Another example of the influence Positive Muslims has had on religious hierarchies concerns the issue of condom use before marriage. This is traditionally forbidden, as in Islam sex before marriage is not allowed. However, the Muslim religious leaders involved in the discussions have drastically changed their views on this issue through continual dialogue with Positive Muslims and involvement in other awareness raising activities. Many Muslim leaders will now discuss these issues in the mosque as well.

ECWA – Evangelical Churches of West Africa

ECWA is a faith-based organisation involved in community programmes in Northern Nigeria. Programme activities include: theological education, media and information, work within hospitals, with Challenge bookshops and Challenge cinema. They also run a pharmacy, printing press and radio station amongst others. They address a variety of sexual and reproductive health issues in the communities where they work through the involvement of church leaders. One SRH issue that is being addressed in the Christian communities is that Christians would much rather talk about reproduction than the accompanying issues of sexuality and the problems around it, e.g. frigidity, erection problems and premature ejaculation. Many Christians in Nigeria feel that sex between couples is strictly for procreation and nothing more. If procreation is not affected, then there are no problems, they argue. However, the reality faced by many Pastors and Counsellors in the church is that sexual problems are fundamental to a lot of the marital dysfunction they see among their members, but that no one was willing to talk about it.

The challenge was how to get Church members to discuss their sexuality problems and get appropriate help. ECWA approached respected theologians who were specialized in teaching and writing on the biblical reasons for marriage, to find ways of working on issues around SRHR. As a result, books, bible study materials and other pamphlets were prepared indicating the appropriate place of sexuality in marriage. The curriculum for the seminaries and theological colleges was also modified to include material on sexuality and possible problems. Local churches were stimulated to have a retreat for couples, where members are encouraged to share and seek help concerning their sexuality problems. The church also made sexuality a required section of counselling for couples intending to marry.

Out of this has grown a willingness by couples to contact their Pastor or Counsellor concerning sexual health problems they would hitherto have kept to themselves. There are also a growing number of experienced counsellors who are able and willing to help couples with these problems.

Conclusion

The work of FBOs is very challenging and it is important that they have the opportunity to share their experiences and strategies for working within their different environments. In this light International Family Health created the "African Forum of Faith-Based Organisations in Reproductive Health and HIV/AIDS"; an alliance of FBOs in Africa working in the field of sexual and reproductive health in 1999.  The Forum provides an effective mechanism for FBOs to increase their capacity to become agents for change; to have a stronger voice at local, national and international levels; and to advocate for increased recognition of women's and men's rights to modern, safe, integrated and affordable sexual and reproductive health care services.

The Forum has 15 partners from 8 African countries (Nigeria, Ethiopia, Tanzania, Kenya, Uganda, Zambia, Namibia, and South Africa), including ECWA and Positive Muslims. Members receive financial support to implement a range of activities to promote the aims of the Forum. This includes leadership development training for religious leaders and FBO leaders, exchange visits, action research and technical assistance from International Family Health.