In order to effectively control the spread of HIV in the United States, prevention efforts need to target individuals already living with HIV (Baskin, Braithwaite, Eldred, & Glassman, 2005). This is consistent with the emphasis placed by the Centers for Disease Control (CDC) on the need to prevent new infections by working with people already diagnosed with HIV (CDC, 2003). This is important because some HIV-positive individuals continue to engage in behaviors that could transmit HIV infection. (Gordon, Forsyth, Stall, & Cheever, 2005).

There is reason to believe that religiosity may promote safer sex practices. The limited literature on this topic provides support for the inclusion in prevention programs of what have been described as "other-sensitive" motivators for practicing safe sex (Nimmons & Folkman, 1999). In a qualitative study of sexually active gay men, a large majority of both HIV-positive and HIV-negative individuals reported engaging in safer sexual practices because of their desire to protect others based on their own personal ethical or moral beliefs (Nimmons & Folkman, 1999). For many in the sample, their prosocial values were directly related to a reported spiritual commitment in their lives. Moreover, the importance of concern for others' welfare is stressed by virtually all of the world's major religions (Koenig, McCullough, & Larson, 2001), providing a basis for an association between religiosity and prosocial behaviors like protecting one's sexual partners from HIV infection.

Studies examining the relationship between religiosity and sexual behaviors more generally (i.e., outside the HIV-risk context) have found that individuals who attend religious services more often are less likely to be sexually active, and if active, have fewer sexual partners and less frequent sexual intercourse (Lefkowitz, Gillen, Shearer, & Boone, 2004). Other studies that use different measures of religiosity have found similar results. For example, individuals who report having a religious affiliation have fewer sexual partners than those with no affiliation (Rowatt & Schmitt, 2003). These results suggest that religiosity may deter individuals from engaging in behaviors that could transmit HIV infection.

Religion is a dominant force in the lives of people in the United States (Fuller, 2001), including populations at risk for HIV. For example, data from the 1991-2000 General Social Surveys indicate that gay men (a major group affected by HIV in the United States) report a similar frequency of church attendance as male heterosexuals (3.21 and 3.28, respectively, with 0 signifying never and 8 signifying almost every day). Attendance among female heterosexuals was higher (3.90). In addition, gay men do not differ in their frequency of prayer from female heterosexuals (the most devout group; 4.76 and 4.80, respectively, with 1 signifying never and 6 signifying several times a day), whereas male heterosexuals (4.48) do not differ from gay males but have lower rates than female heterosexuals (Sherkat, 2002).

Among African Americans, a population disproportionately affected by HIV/AIDS (CDC, 2005), high levels of both church attendance and prayer are reported. Data from the National Survey of Black Americans found that, among the more than 90% of African Americans who report attending religious services as an adult (in addition to weddings and funerals), about 70% state that they attend services at least a few times a month (Taylor, Chatters, & Levin, 2004). Several national surveys have also consistently found that overall 80% of African Americans report praying several times a week (Taylor et al., 2004). Similarly, among Latinos religion plays an important role, although the level of religious involvement (such as church attendance or membership in church groups) by Latinos does vary, depending on their specific denominational affiliation (Hunt, 2000).

Given the role that religion plays in the lives of so many people, including major subgroups infected with HIV, and religion's potential in motivating prosocial behavior, it is important to examine how religiosity is related to HIV risk behaviors. Moderate to high levels of religiosity among people with HIV, together with an association between religiosity and risk, would suggest largely untapped methods of promoting safer sexual behavior among people with HIV. Possibilities include linking such behavior to religious values or promoting sexual safety through churches.

In addition to examining religiosity's relation to HIV-related risk behaviors, it is also important to examine how these behaviors may be associated with particular religious denominational affiliations. Religiosity and denominational affiliation need to be examined separately because they measure different constructs. An individual's denominational affiliation usually provides limited information about that person's religiosity because denominations include people with markedly different levels of devotion (Koenig et al., 2001).