Church Attendance in Men Who Have Sex With Men Diagnosed With HIV Is Associated With Later Presentation for HIV Care, Nicholas Van Wagoner et al., Clinical Infectious Diseases (2013)

Research and Journal Articles

This study finds that men who have sex with men (MSM) and who attend church are more likely to present with lower CD4+ T- lymphocyte counts (LC) when seeking initial treatment, than do MSM who do not attend church. The researchers hypothesized that among persons who attend church, patterns of previous HIV testing and timing of presentation for care would differ based on same-sex versus opposite-sex sexual behavior. They conducted a cross-sectional analysis of 508 self-reports from a clinic in the southeastern United Stated. Respondents were age 19 or older, presenting for initial care of an HIV diagnosis. In total, 60 percent of participants were MSM.

Church attendance was reported by 56 percent of patients overall: 53 percent MSM, 59 percent men who have sex with women (MSW), and 64 percent women who have sex with men (WSM). Researchers also gathered employment status, race, and level of education data. Approximately 32 percent of patients had an initial LC of less than 200 cells/μL at the time of entry into care. Compared to MSM who did not attend church, MSM who reported current church attendance were more likely to present with advanced stages of HIV (as evidenced by differences in LC) when beginning treatment and less likely to report a history of previous HIV screening. For MSW and WSM there was no association between church attendance and LC at the time of care entry.

While results show an association, there are limitations, including lack of diversity in the sample (predominantly African American and MSM) and lack of analysis of the other differences between people who did and did not attend church services. Additionally, it could not be explained why there were no significant differences in LCs for MSW or WSM.

Possible explanations for differences among MSM included norms held by some religious organizations regarding same-sex sexual behavior which may influence willingness of their same-sex members to participate in HIV screening and early presentation for care. Other explanations include denial of risk among churchgoing MSM or reverse causality – the idea that persons with HIV may turn to religion as they become more ill despite a formal diagnosis. This research suggests that churches may play a vital role in patient decisions related to medical treatment. Whereas attendance at religious services has otherwise shown to have positive effects on health and medical treatment adherence, it appears that for MSM who attend church the opposite may be true.