Religiosity and sexual behavior among individuals living with HIV in America's “Bible Belt”

BACKGROUND: Religious practice is associated with improved quality of life and reduced risk-taking in multiple populations. People living with HIV (PLWHIV) report high levels of religiosity or spirituality, but often engage in private religious behavior due to stigma. Understanding the relationship between religious practices and sexual risk in PLWHIV could support innovative approaches for risk reduction and overall health. METHOD: Interview data from 411 diverse PLWHIV in Alabama was analyzed to assess relationships among religious practice, sexual risk, and mediating variables (social support, substance use, physical/mental health status). Interviews were conducted privately by trained interviewers; all procedures were IRB-approved. RESULTS: Univariate comparisons showed high religious practice across the sample but weak association with sexual risk or other mediators. Substance use and sexual risk were strongly associated (p<0.001), but only church attendance was associated with substance use (p=0.0107). Nested logistic regression models explored the relationship of religious practice and mediating variables to sexual risk. These supported the association of substance use and sexual risk. However, religious practice variables were not significant in the models, except for “speaking with a religious leader.” (p=0.0015). CONCLUSIONS: Religious practice and sexual risk were not associated in our sample, perhaps due to ceiling effects. The strong association between substance use and sexual risk supports previous findings. The relationship between substance use and risky sexual behavior was not affected by religious practices. Additional measures of religious practice accounting for high levels of cultural religiosity in subgroups of PLWHIV should be developed to further explore these important issues.