A Qualitative Examination of How Religion and Spirituality Influence HIV Risk and Protection Among at Risk Populations in Kuala Lumpur, Malaysia

Background and Purpose: Malaysia is a multicultural society with a Muslim majority, where Islam has significant social and political influence. In Malaysia and elsewhere, religion has been found to influence social and structural HIV risk environments, with relevance to understanding risk behavior, preventative interventions, treatment, and policy. This study seeks to explore how religion and spirituality may influence HIV related risk behaviors and reflection on preventative strategies among people at high-risk for HIV in Malaysia.

Methods: Twenty in-depth qualitative interviews were conducted with ten men who have sex with men (MSM) and ten female sex workers, including four who identified as transgender. From this sample, 70% of the respondents declared their religious affiliation to be Islam, while others declared Catholicism, Hindi, Buddhism, and Christianity. Ethnically, participants were Malay (n=11), Chinese (n=3), Indian (n=3), or Orang Asli (n=3). Four reported injection drug use in the prior 90 days. Interviews were transcribed verbatim, and content in Bahasa Malay or Chinese was translated into English. Guided by principles of grounded theory, we utilized NVivo software to identify and then categorize emerging themes.

Results: Five themes emerged from the sample of both MSM and FSW participants: 1) Religion teaches to take care of health. Maintaining health and practices such as exercising, eating well, and abstaining from drugs pertained to participant’s religious and spiritual beliefs. 2) Spirituality is central. Participants engaged in personal forms of worship, prayer in particular, more frequently than formal religious participation, and described strength and sense of self in maintaining a relationship with God. 3) God determines health. Participants described God as in control and determining challenges, diseases, and health problems people experience. As one female sex worker explained, “My life and death is on Him. Not from the medicine. Doctors only can suggest and advise me. But God will decide my life and death.” 4) Stigma from religious communities. Participants described feeling stigmatized in religious settings; as a MSM participant said, “I find religious people and authority are very, are the most stigmatizing people on HIV and AIDS.” 5) Religion should be incorporated into HIV campaigns. Respondents expressed that they would like to see more information about HIV in religious contexts, believing it would be productive for religion to be involved in campaigns promoting information about the risks of HIV and education on how to take care of their health and reduce risk behaviors.

Conclusions and Implications: Findings highlight the importance of spirituality in the lives of this sample of people at high risk for HIV in Malaysia. An individual relationship with God or other higher power, particularly through prayer, is an important foundation and reference in their lives, and influences how they conceptualize health. Attention to spirituality is therefore critical for health and service providers, and increased involvement of religious communities in HIV prevention efforts may be warranted, particularly related to decreasing stigma.