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Nicholas Van Wagoner, Michael Mugavero, Andrew Westfall, Larry Z. Slater, Greer Burkholder, Robert H. Van Wagoner, James L. Raper, John Holliman, Edward W. Hook, Reply to Rapose, Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014, Pages 316–317, https://doi.org/10.1093/cid/ciu263
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To theEditor—A map overlay of the US regions most devastated by human immunodeficiency virus (HIV) would largely cover the Southeast, darkening most of the country's most religious states [1, 2]. As an investigator/clinician at a large HIV clinic in Alabama, I frequently hear patients express fear that their communities—particularly their religious communities—will discover their diagnosis and infer their same-sex orientation. With time, the questions became obvious: “Could religious condemnation and stigmatization of HIV create tension for the churchgoing gay man? Could this tension influence his HIV screening and HIV-related health-seeking behavior?”
We retrospectively assessed the interrelatedness of church attendance and sexual behavior on CD4+ T-lymphocyte count in patients seeking first-time HIV care. During intake, patients were asked, “Do you attend a church, mosque, or synagogue?” Church attendance was dichotomized as yes (current attendance) vs no (never attended, or attended previously but not now). We found that churchgoing men who have sex with men (MSM) were more likely to present with a CD4 count <200 cells/µL than MSM who do not attend church [3].
