Religious beliefs don't deter HIV testing or use of antiretrovirals among Africans in London

Religious beliefs do not prevent black Africans living in London from accessing HIV testing or starting antiretroviral therapy, according to a study published in HIV Medicine. The research involved 246 patients who were diagnosed with HIV between 2004 and 2006. Almost all (99%) had religious beliefs.

“Strong religious beliefs about faith and healing do not act as a barrier to accessing HIV services or antiretroviral treatment,” write the authors.

Black Africans are one of the groups most affected by HIV in the UK. The majority of HIV infections in black Africans are diagnosed late, defined as a CD4 cell count below 350 cells/mm³. Very little UK-based research has been undertaken examining the impact of religious belief on HIV testing and use of antiretroviral therapy.

“Faith and traditional sacred beliefs are often important to people from African communities in the UK,” explain the investigators. “They are more likely to identify as belonging to a religion.”

A team of researchers therefore designed a study examining the role of religion in the lives of black Africans recently diagnosed with HIV.

Participants completed a questionnaire enquiring about their religious identity, their frequency of worship and beliefs about the power of faith and prayer to cure HIV. Investigators then looked at the patients’ clinical records to see if there was any connection between belief and late diagnosis of HIV and the likelihood of starting antiretroviral therapy.

The patients were recruited from 15 HIV clinics in the London region, and the median time between HIV diagnosis and completion of the study questionnaire was 3.5 months. The participants had a median age of 34 years and median CD4 cell count at the time of diagnosis was 194 cells/mm³. Three-quarters of individuals were diagnosed late.

Nearly all the patients had a religious identity. Most identified as Protestant (56%), followed by Roman Catholic (35%) and Muslim (6%). Only 1% of individuals said that they did not belong to a religious group, and a single individual said that religion was not an important part of their life.

Frequent attendance at religious services was common. Almost two-third  (62%) of women and 37% of men reported attending a service on a weekly basis.

Patients who attended religious services at least once a month were significantly more likely to believe that “faith alone can cure HIV” than individuals who attended services less frequently (38% vs. 15%, p = 0.001).

Some 7% of participants were deterred from taking an HIV test because they believed God would protect them from the infection, and 5% of participants believed that taking HIV therapy implied a lack of faith in God. Most of these individuals (92%) belonged to a Christian denomination.

The investigators then conducted analyses to see if the strength of religious identity and beliefs were associated with HIV testing or use of HIV therapy.

No such associations were found.

There was no evidence that belief increased the risk of late diagnosis.

Nor was belief in the healing power of religion associated with starting HIV therapy. Three-quarters of those who stated that taking medication implied a lack of faith initiated therapy compared to 68% of patients who did not share such a belief.

“It seems that most individuals are able to reconcile their faith in the ability of God to heal HIV infection and the knowledge that they themselves will still need to take antiretroviral therapy to remain well,” write the authors.

However, the investigators found that 40% of participants agreed that disclosing their HIV status would lead to isolation within their faith community. This belief was slightly more prevalent among individuals who attended services more frequently.   “The role of religion may be an important factor in the high degree of stigma associated with HIV in these communities,” the investigators suggest.

Nevertheless, 8% of patients said they had consulted a member of the clergy before testing for HIV. The authors note that “harnessing the solidarity of faith communities to increase uptake of HIV testing has been effective in a range of communities, from Africa to the USA.”

Fakoya I et al. Religion and HIV diagnosis among Africans living in London. HIV Med, online edition. DOI: 10.1111/j.1468-1293.2012.01031x, 2012.