HIV This Week

Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N. Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC Public Health. 2009;9(1):75.

Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes toward antiretroviral treatment. A self-administered survey was distributed to a convenience sample of parishioners (n=438) attending Catholic, Lutheran, and Pentecostal churches in both urban and rural areas. The survey included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about antiretroviral treatment. Multivariate logistic regression analysis was performed to assess how religion was associated with perceptions about HIV, HIV treatment, and people living with HIV. Results indicate that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God (p<0.01) or that people living with HIV have not followed the Word of God (p<0.001). Most participants (84.2%) said that they would disclose their HIV status to their pastor or congregation if they became infected. Although the majority of respondents (80.8%) believed that prayer could cure HIV, almost all (93.7%) said that they would begin antiretroviral treatment if they became HIV-infected. The multivariate analysis found that respondents’ hypothetical willingness to begin antiretroviral treatment was not significantly associated with the belief that prayer could cure HIV or with other religious factors. Refusal of antiretroviral treatment was instead correlated with lack of secondary schooling and lack of knowledge about antiretroviral treatment. The decision to start antiretroviral treatment hinged primarily on education-level and knowledge about antiretroviral treatment rather than on religious factors. Research results highlight the influence of religious beliefs on HIV-related stigma and willingness to disclose, and should help to inform HIV-education outreach for religious groups.

Editors' note: Christians make up about 30% of the population in Tanzania, with churches being influential social networks with the power to support or stigmatize people living with HIV, promote or impede HIV education, and endorse or reject HIV medical treatment. Only 42.7% of respondents had been tested for HIV and, interestingly, Catholics were least likely (42.7%) and Pentecostals were most likely (69.7%) to report never having used condoms. Despite the study’s limitations, including data collection in the presence of pastors after church services, the findings are relevant for the design of outreach campaigns and theological discussions in faith-based communities to reduce shame-related stigma, enhance disclosure, and contribute to improved social support for people living with HIV.