title: HIV and religion in the Congo: a mixed-methods study.
abstract: OBJECTIVE
  To explore the relationship between religious affiliation and HIV infection in a war-ravaged community in sub-Saharan Africa.
  
  
  METHODS
  Mixed quantitative and qualitative methods.
  
  
  METHODS
  Individuals attending HIV voluntary counseling and testing clinics in Butembo in Eastern Democratic Republic of the Congo (DRC) completed a questionnaire and were tested for HIV infection. Risk factors for HIV seropositivity were explored, with attention to religious affiliation as a potential risk factor. Structured interviews of key informants were used to complement quantitative data.
  
  
  RESULTS
  Three hundred and eighty individuals attending six clinics were enrolled. Nearly all participants (97%) self-identified as Christian (44% Catholic; 53% non-Catholic Christian). Twenty-eight patients (7.4%) tested positive for HIV. Age>30 years (adjusted OR 47 [95%CI 2.9-770, p=0.007), married status (adjusted OR 3.7 [95%CI 1.1-13, p=0.037), and Catholic religion (adjusted OR 2.7 [95%CI 1.1-6.8, p=0.030) were independent risk factors for HIV seropositivity in a multivariable logistic regression model. Rates of HIV were higher among Catholic than non-Catholic Christian participants in both single and married participants. The proportion of participants reporting condom use as a primary prevention modality did not differ significantly between religious groups; however, within both Catholic and non-Catholic Christian groups, increasing church attendance was associated with decreased use of condoms. Qualitative data highlighted divergent views toward condom use among Catholic health workers.
  
  
  CONCLUSIONS
  In this cross-sectional survey in Eastern DRC, Catholic (relative to non-Catholic Christian) religious affiliation was associated with an increased risk of HIV. Increasing dialogue between biomedical practitioners and religious leaders may strengthen HIV prevention efforts in SSA.
authors.affiliation: University of Toronto, Toronto, ON, Canada. michael.hawkes1@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Hawkes
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Sivasivugha
authors.forename: Simon K
authors.initials: SK
authors.lastname: Ngigi
authors.forename: Claude K
authors.initials: CK
authors.lastname: Masumbuko
authors.forename: Jason
authors.initials: J
authors.lastname: Brophy
authors.forename: Zacharie T
authors.initials: ZT
authors.lastname: Kibendelwa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012069:Religion and Psychology; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult