2119.0 - Fewer Churches, Lower HIV; Increase in Congregants, Higher HIV: Rethinking Religious Influences on Public Health
Session: HIV Prevention and Care in International Settings - Poster Presentation
Presenter: Yusuf Ransome
Author: James Frater
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Abstract
Introduction
Religious institutions are significant social and cultural resources in many neighborhoods throughout the United States. The density of religious institutions has been linked to lower rates of poor health and mortality outcomes in the U. S. population. The distribution of religious institutions and other aspects of the religious landscape, such as the prevalence of church members (i.e., adherents), may be associated with HIV incidence. Empirical findings on this topic remain scant.
Methods
We used geospatial and multivariate ecological analyses to test the associations between three religious environment variables and new HIV diagnoses in 2022 across N = 2020 counties with available HIV data. The three variables were: (1) rates of churches that closed in specific windows (e.g., between 2009 and 2014). A church is classified using Standard Industry Classification code 8661.07; (2) change in the rates of adherents between 2010 and 2020; and (3) change in the rates of congregations in the U.S. between 2010 and 2020. We conducted zero-inflated binomial regression, adjusting for the percentage of Black individuals, the percentage of Hispanic individuals, the GINI coefficient, mobility, percentage of overcrowding, socioeconomic deprivation (including income, education, unemployment, and poverty), and whether the county was prioritized for the Ending the HIV Epidemic initiative.
Results
Church closings, religious adherence, and congregation change were significantly clustered. Counties with the highest/5th quintile of church closings (compared to the lowest) had lower rates of HIV (Incidence Rate Ratio (IRR)= 0.26, 95% CI = 0.18- 0.37, p = 0.000. An increase in adherence rate was associated with 21% higher rates of new HIV diagnoses (IRR=1.21, 95%CI=1.07-1.37, p=0.002. The highest quartile of increase in congregations (compared to no or low change) was also associated with higher rates of new HIV diagnoses IRR=1.32, 95%CI=1.03-1.76, p=0.03).
Conclusions
Specific aspects of the religious environment shape HIV differently, possibly, through multiple complex social mechanisms, including stigma, community norms, and access to information. Interrogating this relationship is crucial for developing effective HIV prevention strategies. Public health practitioners should reconsider assumptions about religious contexts when designing community-based approaches to HIV prevention and testing, particularly in areas with strong religious participation.