Encouraging spirituality among people at risk for HIV may help alleviate depressive symptoms, which in turn can reduce rates of condomless anal sex that may lead to HIV infection, according to a study of 1,511 Black men who have sex with men (MSM) published in Journal of Acquired Immune Deficiency Syndromes.
The study focused on religiosity and spirituality, with each placed on equal footing when assessing their effect on depressive symptoms. All participants had engaged in condomless anal intercourse, with 26% reporting having done so under the influence of drugs.
Internalized HIV stigma was associated with depressive symptoms at all levels of spiritual beliefs. However, at each level of internalized stigma, people with a high degree of religious/spiritual belief were associated with a lower depressive symptom score compared to people with a low degree of religious/spiritual belief.
At low stigma levels, participants who reported regularly attending religious services had higher depression scores than those who never went to such events. But as stigma increased, depression rose faster among non-attendees than regular attendees of services.
Depressive symptoms are associated with a greater likelihood of engaging in sexual practices that increase the risk of seroconversion, such as condomless anal sex. Spirituality thus indirectly mediates risk behaviors through its effect on depressive symptoms, study authors wrote.
The authors noted a few caveats to the findings: people’s beliefs and practices may change over time; participants may have identified as religious at some point, but then turned away from their religion, perhaps due to non-acceptance of their sexuality; and not all spiritual beliefs and practices may have been captured in the study.
Nonetheless, “HIV-related intervention strategies that seek to facilitate a sense of meaning, global life purpose, and connectedness to others may be well-suited to including spirituality to address the effects of internalized HIV stigma on depression,” study authors concluded.