is associated with late HIV diagnosis among men who have sex with men (MSM), according
to US research published in the online edition of Clinical Infectious Diseases. The study was conducted in Alabama
and showed that church-attending MSM were more than twice as likely to have a
CD4 cell count below 200 cells/mm3 at the time of HIV diagnosis than
MSM who did not attend church. There was also some evidence that church
attendance was associated with less frequent HIV testing among MSM.
“We report an
independent association between church attendance and sexual behaviour on
timing of HIV diagnosis…and patterns of HIV testing,” write the authors.
“HIV-infected MSM who reported current church attendance were more likely to
present with advanced disease and less likely to report a history of HIV screening
than non-church attending MSM.”
describe their findings as “provocative” and urge caution in their
have shown a positive association between religious belief and practice and
health outcomes. However, this research has focused on non-stigmatised
illnesses. Much less is known about the relationship between participation in
organised religion and outcomes among people with stigmatised health
conditions, such as HIV.
the 1917 Clinic in Birmingham, Alabama, therefore designed a cross-sectional
study involving people newly diagnosed with HIV after 2007.
a questionnaire about their HIV testing history and sexual behaviour. They were
categorised as MSM, men who have sex with women (MSW) and women who have sex with
men (WSM). Participants were also asked if they attended church.
A total of 508
patients were included in the investigators’ analyses. Approximately two thirds
(62%) were African American. The authors note that religious belief and church
attendance is especially important among this group.
The majority of
participants (60%) were categorised as MSM, 21% as MSW and 18% as WSM. Church
attendance was reported by most patients, including 53% of MSM, 59% of MSW and
64% of WSM.
A third (32%) of
patients had a CD4 cell count below 200 cells/mm3 at the time of
entry to HIV care and were therefore considered to have been diagnosed 'late'. There was a
significant interaction between church attendance and late presentation to care
(p = 0.02).
MSM were significantly more likely to have a CD4 cell count below 200 cells/mm3
at the time of their diagnosis than non-church-attending MSM (32 vs 20%).
After adjusting for other factors known to be associated with late
presentation, the investigators found that church attendance was associated
with a more than two-fold increase in the risk of late diagnosis among MSM (OR
= 2.2; 95% CI, 1.2-4.0; p = 0.01).
For both MSW and
WSM, there was no association between church attendance and late diagnosis.
Just under a third
(29%) of participants reported never having had a previous HIV test before their
diagnosis. There was a significant interaction between church attendance and
sexual behaviour and testing history (p = 0.012).
Women who did not
attend church were more likely to report no previous HIV test compared to women
who were church attenders (59 vs 32%; OR = 0.3; 95% CI, 0.1-0.8; p = 0.01).
In their initial analysis, the investigators also found that church-attending
MSM were more likely to report no previous test compared to MSM who did not
attend church (21 vs 12%; p = 0.041). But there was no significant
association after controlling for potential confounders.
offer three possible explanations for the relationship between church
attendance and late diagnosis among MSM:
- Stigmatising attitudes of some
churches towards sex between men.
- Denial about HIV risk among
- Turning to organised religion
because of illness.
attempted to adjust for potential confounders, we acknowledge that church
attendance may merely associate with the actual causal factor(s), and work is
underway to understand predictors of church attendance in our population,”
comment the investigators.
conclude: “The modifying role of church attendance on late presentation for
care in MSM is a novel and potentially important finding…some religious
communities may need to explore reasons why their HIV-infected MSM members
might present with more advanced disease than non-church-attending MSM.”