The findings presented here demonstrate that people living with HIV in this setting seek solace and support in their religious faith, which helps them to live positively with the virus. Even though very few respondents were disclosing their HIV status in their religious organizations, respondents' religious beliefs nevertheless gave them hope and provided them with courage to face their condition. The psychological benefits of religious beliefs for PLWHA has been documented in other settings,3,9
and has also been associated with improvements in disease progression.4
Many respondents said that their religious convictions increased after their diagnosis, a phenomenon that has been observed elsewhere and has been attributed to a search for meaning and comfort.8,9
At the same time, however, participation in religious organizations decreased for some because of a fear of involuntary disclosure and resulting stigma.
For the most part, religion played a complementary role with clinical care in respondents' lives. The fact that respondents saw ARVs as a gift from God meant that religious and medical practices and beliefs were not mutually exclusive. In addition, religious beliefs and practices facilitated adherence to medication, as respondents reported anchoring the routine of medication-taking to prayer. It has elsewhere been shown that religious practices (such as regular church attendance) may positively influence adherence,14
and having a consistent daily routine, as one that revolves around regular prayer and religious activity, can make it easier to remember to take medication on time.21–23
The positive influence of religion on people's lives came through an individual relationship with God and prayer, and not through the institutional structures of the church or mosque. In fact, respondents revealed that these institutional structures sometimes exerted negative influences by expressing judgmental attitudes about people living with HIV. Stigmatizing attitudes have been documented in religious settings, in large part because of the associations between HIV and “immoral” sexual behavior.11
Perceptions of stigma, even if stigma is never experienced directly, can make it difficult for patients to disclose their status and participate freely in their religious communities.
Expressed beliefs about the ability to be cured from HIV through prayer is concerning. Although only two respondents believed that spiritual cures were possible, almost all respondents said they had heard of such beliefs. It is unclear to what extent these “cures” may account for dropout from ARV programs,24
but a small investigation in Uganda suggests that it may play an important, but underrecognized, role.25
While religious-based health facilities play an important role in meeting the clinical needs of people living with HIV in Tanzania,15
churches and mosques appear to be falling short in meeting the psychological needs of HIV positives. While many respondents in our study reported hearing HIV prevention messages in their church or mosque, none said they had heard messages about living with HIV. This echoes findings in other parts of Africa that religious organizations are failing as institutions to provide support and care to people living with HIV,26,27
even though people may get individualized support from pastors or congregation members.28,29
The institutionalized programs that do exist30,31
should be examined for their impact and disseminated to other settings.
The study's findings highlight opportunities for the religious communities in this setting to provide spiritual support and guidance for people living with HIV. First, in order to avoid negative influences of religion, leaders should review messages and sermons about HIV to ensure that they do not to stigmatize people living with HIV. Prevention messages that equate immoral behavior with HIV may inadvertently enforce discrimination against PLWHA.11
Instead, religious leaders should take care to create an environment in which PLWHA feel comfortable to disclose, by making it clear that they will be accepted unconditionally and without judgment. This environment may be strengthened by inviting PLWHA to speak at religious meetings, in order to introduce role models for positive living and disclosure. The act of making public the stories of HIV positive people can be an important step for religious organizations to mobilize an appropriate and compassionate response to PLWHA.30
Religious organizations have an important role to play in sharing knowledge and dispelling misconceptions about HIV. Religious leaders should encourage people to seek out testing and care, and provide information about where services might be accessed. They should responsibly address myths about prayer as a cure for HIV, and emphasize that prayer and medical care go hand-in-hand for PLWHA.
Finally, religious organizations should see themselves as an important source of social support for PLWHA. In addition to providing support through their normal ministry, they could organize venues for PLWHA to come together to discuss their situations, pray together, and share information and ideas. By reaching out to governmental or nongovernmental bodies, religious organizations could become a venue for providing financial or food support to PLWHA.
The results presented here must be viewed in light of the study's limitations. The themes reported in this paper are limited to the issues that individual respondents chose to discuss during the interviews. While the interview guide included several broad questions and probes about religion, it was not the only topic explored in the interviews, and the depth of discussion on religion was not standard across the interviews. The lack of a common denominator across the themes made it impossible to provide proportions who agreed with statements or ideas. The small number of respondents, and limited discussion of religious influences among Muslim respondents, made it difficult to compare the experiences of Christians and Muslims. Finally, as applies to any qualitative study, the results are not meant to be statistically generalizable to a larger population, but to illuminate aspects of experience and context that may be shared by others.
Despite the limitations of the study, the results provide some important insight into the influence of religion for PLWHA in this setting. The findings highlight the positive role that religious beliefs play in the lives of PLWHA, and point to specific areas where religious organizations may build on this role to better support PLWHA.