The role of the church in addressing healthcare disparities, particularly human immunodeficiency virus (HIV) and/or acquired immunodeficiency syndrome (AIDS), and how pastors’ attitudes influence the development and effectiveness of HIV and/or AIDS interventions remains underexplored.
This study aimed to examine pastors’ attitudes towards people living with HIV (PLWH) and to explore the lived experiences of PLWH in relation to these attitudes.
Participants included pastors and congregational members living with HIV who resided in Thulamela Municipality and were affiliated with various Christian denominations.
A qualitative phenomenological design was employed using semi-structured interviews. Purposive sampling was used to recruit nine pastors, while six PLWH were recruited through snowball sampling. All participants resided in Thulamela Municipality.
Findings indicated that pastors generally expressed sympathetic, non-judgemental and normalising attitudes towards PLWH. However, discussions around sexuality and HIV and/or AIDS were often considered taboo within the church context. People living with HIV reported experiencing stigma, and a prevailing belief among congregants attributed HIV transmission to individuals outside the church. Some participants also associated HIV infection with demonic possession.
While pastors demonstrated compassion towards PLWH, inadequate knowledge contributed to persistent negative attitudes and stigma. Enhanced collaboration among pastors, interdenominational forums, healthcare professionals and communities is essential to promote accurate information sharing, reduce stigma and improve HIV and/or AIDS responses within faith-based settings.
This study highlights how pastor-led biblical discourse, influenced by limited theological training, shapes attitudes towards HIV and/or AIDS and underscores the need for stronger collaboration between churches and public health.
The role of the churches as an agent of change is one of the significant discussions in public health and communities worldwide.
Although the church has played a good role in public health, not all pastors and church communities are welcoming of marginalised people. In some cases, organised religion creates labels and stereotypes that stigmatise and vilify many marginalised groups.
Netshapapame et al.
Another challenge arises from the close connection between HIV and AIDS, sexuality and shame.
Human immunodeficiency virus-related stigma can stem from a variety of factors, including misinformation, cultural norms, social judgement and religious beliefs. In some contexts, stigma is reinforced by religious interpretations that view HIV as a moral failing or divine punishment, which may lead to shame and marginalisation of people living with HIV and/or AIDS (PLWHA).
In Mozambique, it was reported that pastors faced challenges in addressing HIV and/or AIDS-related stigma because of a lack of appropriate vocabulary and confidence.
Researchers are essentially in agreement that pastors have been part of the problem rather than being part of the solution.
A qualitative phenomenological design was adopted.
The study was conducted in the Thulamela Municipality of Limpopo province, South Africa. The study area is 5834.70 km2 with a population of approximately 618 462 (106.00 per km2), and 156 594 households (26.84 per km2). As of 2022, Limpopo recorded an HIV prevalence rate of 8.9%, a decrease from 10.1% in 2017, which translates to approximately 570 000 PLWH in the province.
The sample consisted of pastors and PLWH from various denominations, including African churches (Zion), Lutheran, Presbyterian, Roman Catholic, Methodist and Charismatic churches within the Thulamela Municipality. Purposive sampling was employed to select pastors, while snowball sampling was used to recruit PLWH. The study included lead or head pastors of congregations and members of those congregations who are living with HIV. Congregational members who were not living with HIV and were neither leaders nor lead pastors were excluded from the study.
Participants aged 50 years and above were deliberately selected. This decision was based on the study’s aim to engage with individuals who have extensive experience and historical insight into the church’s evolving response to HIV and/or AIDS. Senior pastors were deemed more likely to have ministered during critical periods of the epidemic, while older PLWH were able to provide retrospective accounts of their interactions with church support systems. In total, the study included 15 individuals, eight pastors, one bishop and six congregational members from nine different churches.
In-depth face-to-face interviews were conducted with both pastors and PLWH who consented to be part of the study. The research team explained the purpose and objectives of the study to lead pastors and PLWH. Pastors and PLWH were assured of the voluntary nature of their participation and were informed of their right to withdraw from the study at any point. None of the participants withdrew from the study. Interview appointments were scheduled with each participant at a location they deemed safe, private and free from disturbances. These locations included homes and church halls. Interviews were conducted in private rooms by T.S.N. (male, PhD), R.G.M. (male, BSc), C.B.N. (male, MSc), K.P.S. (male, MSc) and E.M. (male, PhD), who are experienced qualitative researchers. The interviews were conducted using a focused group discussion that consisted of socio-demographic characteristics and open-ended questions. The researchers used audio recorders along with notepads to record the interviews, which lasted approximately 45 min. Data were collected until data saturation was reached at participant number 13 (both pastors and PLWH). Only the research team and participants were present during the data collection.
Qualitative content analysis was used as recommended by Creswell and Guetterman
Summary of the results.
| Themes | Sub-themes |
|---|---|
| 1. Positive attitudes towards people living with HIV | Non-judgemental attitude Normalising HIV discussions and disclosure Sympathising with PLWH |
| 2. Negative attitudes towards people living with HIV | Addressing topics related to sexuality and HIV and/or AIDS within the context of the church is often perceived as taboo Language barriers Cultural barriers Imbalance in preaching about holiness that daily issues affecting congregants Stigmatisation Blaming the non-church members as the ones who infect Christians Relating HIV infection as a result of possessions by demons |
HIV; human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; PLWH, people living with HIV.
To ensure the accuracy and rigour of the study, the researchers followed Lincoln and Guba’s four evaluation criteria, which offer a structured framework for assessing the trustworthiness of qualitative research.
Ethical clearance to conduct this study was obtained from the University of South Africa’s Health Studies Higher Degrees Ethics Review Committee (No. HSHDC/976/2020).
Demographic data of the participants.
| Pseudonyms | Age (years) | Gender | Type denomination |
|---|---|---|---|
| Pastor 1 | 56 | Male | Charismatic |
| Pastor 2 | 54 | Male | Charismatic |
| Pastor 9 (Bishop) | 60 | Male | Charismatic |
| Pastor 3 | 65 | Male | Charismatic/Main Line |
| Pastor 4 | 60 | Male | Charismatic |
| Pastor 5 | 67 | Male | Charismatic |
| Pastor 6 | 62 | Female | Charismatic |
| Pastor 7 | 53 | Male | Charismatic |
| Pastor 8 | 54 | Male | Charismatic |
| Participant 1 | 56 | Female | Charismatic |
| Participant 2 | 58 | Female | Charismatic |
| Participant 3 | 68 | Male | Zion |
| Participant 4 | 64 | Male | Charismatic |
| Participant 5 | 50 | Male | Charismatic |
| Participant 6 | 70 | Male | Zion |
Two overarching themes of pastors’ attitudes towards HIV and AIDS emerged, which encompassed two distinct themes: positive and negative attitudes, both of which have significant implications for the lives of PLWH. The sub-themes for the positive attitude themes revealed the attitude of non-judgement, normalised attitudes and sympathetic attitudes towards PLWH. Perceptions of the topic of HIV being taboo, stigmatisation and blame and relating HIV to demon possessions have been noted as sub-themes to the negative attitude theme (
This theme focuses on pastors’ attitudes that positively influence the well-being of PLWH. The analysis revealed the emergence of the following sub-themes: non-judgemental attitude, normalisation and empathy towards those who are infected.
‘I take PLWH as my children like others. A person with HIV I takes that like any person who has got a chronic disease. To me, HIV is like any other disease. It is not all HIV-positive people who happen to be living a reckless life like what most people perceive. It does not make any sense that I have to find myself being uncomfortable while I am with a person with HIV while I am comfortable with a person with Sugar Diabetes or hypertension, so to me, I handled them the same.’ (Pastor 9, 60 years, male)
Similar perceptions were shared by PLWH. People living with HIV noted that they experienced less negativity from their pastors and felt encouraged to take their medication. The following extracts illustrate these findings:
‘In our church, my pastor is the person who loves all people despite their background, so he does not condone stigmatization in the church. At church, I sing, and I am a member of the worship team, so the day I disclosed this to him he said you need to continue doing what you do best without any hindrance.’ (Participant 1, 56 years, female)
Another person living with HIV highlighted that congregants are still discriminating against PLWH. This was the case during conferences or other organised events, where PLWHs were isolated and relegated for fear of infection. The participant had this to say as PLWH in the church:
‘During the conference, we are being given a job to make fire, we are not allowed to peel vegetables, but we are given this lousy job and are not involved in critical work because people are afraid that we might infect the food.’ (Participant 3, 68 years, male)
This finding reveals that even though pastors are striving to be non-judgemental and accommodating to PLWH, some congregants discriminate against PLWH.
‘Congregants would come and say, pastor, I am HIV-positive. I would not show any expression as if I am shocked, for as a parent, I need to react normally for the benefit of the PLWH. Thereafter, I tell the PLWH that there is life after contracting HIV, and we start to look for a way forward because we cannot change the past.’ (Pastor 4, 64 years, male)
The study further reveals that pastors have played a pivotal role in fostering an inclusive and supportive church environment. By promoting acceptance and compassion, they have helped reduce fear and judgement, allowing PLWH to openly share their status and feel fully integrated into the church community, treated with the same dignity and respect as any other member. The following quotation supports these findings:
‘The pastor has made it a point that HIV is being taken like any sickness. When I give announcements, I always talk about HIV and encourage people to always be alert about HIV. Talking about HIV/AIDS in our church is easy for the pastor has created a conducive atmosphere.’ (Participant 5, 50 years, male)
Participants further emphasised the importance of PLWH feeling accepted and supported by their loved ones and the broader community, as this encouragement helps them adhere to their treatment and maintain hope for the future. Pastors show sympathy in assuming the role of reconciling and mediatory between the destitute PLWH and their families. People living with HIV and their families have been receiving pastoral care and counselling from pastors:
‘I have sympathy for those who have been impacted by HIV/AIDS. I always sympathize with them because, in most cases, they are being rejected by their families. I go and offer a word of encouragement, reconcile PLWH with the family.’ (Pastor 2, 54 years, male)
‘Sometimes you find families at loggerheads with each other because parents will be saying we used to rebuke the infected but could not listen so now is payback time for the ill-behaviour. So as a pastor, I come in between to forge the broken relationships and seek forgiveness on behalf of the PLWH to the family.’ (Pastor 9, 60 years, male)
Alongside the positive attitudes that contribute to the well-being of PLWH, this theme highlights that pastors have also displayed negative attitudes that can have adverse effects on PLWH. The following sub-themes emerged from data analysed from the interviews: regarding discussions about sexuality and HIV and/or AIDS in church as taboo, stigmatisation of PLWH, attributing blame to non-church members for infecting Christians, and associating HIV infection with demonic possession (
‘This is true I will talk from the experience where one of my associate pastors made mention of sexual intercourse while preaching, and that has created serious chaos inside the church. You must remember that our church has got a lot of older people. A complaint was lodged with me to say that, that was not supposed to be said moreover we had children in attendance. In our culture, it is taboo to talk about sexual intercourse.’ (Pastor 9, 60 years, male).
‘Culture is also contributing to hindering us as pastors to speak out on HIV and AIDS. There are some words and terms in our Tshivenda language that we as a Christian community are tough to utter in public e.g., sexual intercourse.’ (Pastor 3, 65 years, male)
The participants argued that people would die of HIV and/or AIDS while the church remained silent at such a time when the church, as one of the critical stakeholders, was supposed to be vocal. This attitude affects PLWH and the entire community to benefit from their Sunday church services over and above the day’s sermon. Most participants living with HIV expressed scepticism towards the church’s focus on preaching holiness and righteousness while failing to address the realities of HIV. They felt that this silence contributed to unnecessary suffering and believed the church should have taken a more active role in educating members about HIV transmission and prevention. As one participant stated:
‘So, it is incumbent upon the church to start to educate its members about the impact that HIV has got in a family setup. This health promotion and education on HIV need to start with Sunday school kids. Thus, in the day sermon pastor must dedicate a few minutes to talk about health-related issues beyond HIV/AIDS.’ (Participant 5, 50 years, male)
‘The challenge that I have to pick up is that at church, we speak of holiness, and we tend not to delve deep into issues that affect people like HIV/AIDS.’ (Participant 1, 56 years, female)
‘The reason is that most Christians failed to understand that HIV AIDS is like any other sickness. They are afraid to come out because they are afraid of being stigmatized that they will be referred to as people who are adulterous and careless. At the same time, there are so many ways that people can be infected by HIV and AIDS other than sexual intercourse.’ (Participant 2, 58 years, female)
Over and above stigmatisation, PLWHs are being discriminated against at church by being given less critical work in fear of HIV infection:
‘Sometimes church members are the problematic ones, not pastors when it comes to acknowledging people living with HIV and AIDS. When there are conferences, PLWHs are given a lousy job compared to preparing food for fear that they might infect the food.’ (Participant 1, 56 years, female)
The findings of this study indicate that within many religious circles, HIV is still perceived as a death sentence and is often linked to moral failings, particularly adultery. Such perceptions have contributed to fear, stigma and discrimination within church communities. Participants reported that some congregants avoid eating food prepared by PLWH because of irrational fears of transmission. This stigmatisation is deeply rooted in earlier church teachings that associated HIV and/or AIDS with sin and divine punishment. Notably, pastors were identified as key figures in reinforcing these harmful narratives, both through their preaching and attitudes, which have discouraged open dialogue and support for PLWH within the church.
The following quotes illustrate these sentiments:
‘When this sickness started, I was among people who criticized HIV-positive people … this sickness was associated with adulterous behaviour and being careless. My experience with this sickness is very painful because I used to stand up behind the pulpit and criticize PLWH. This in a way caused a lot of pain to people who have been victims of these HIV/AIDS.’ (Pastor 9, 60 years, male)
‘However, many people are still afraid to speak out of their status since a lot of people are still associating HIV and AIDS with the sin of adultery.’ (Pastor 2, 54 years, male)
‘HIV has been associated with ill-behaviour discouraging people to come to us pastors with fear to be judged … It is easier for PLWH to confide to people outside the church than with the pastor for the fear of being judged.’ (Pastor 6, 62 years, female)
‘There are pastors who regard us PLWH as people who had an adulterous history … At times it is difficult even to secure an appointment with the pastor for most of them do not want to associate with us for fear of HIV.’ (Participant 1, 56 years, male)
‘… Ok! let me start by saying when this sickness started, I was among people who criticized people who were HIV-positive. Because always this sickness was associated with adulterous behaviour and being careless. As time goes on when we started to have the people inside the church who were infected and affected by HIV AIDS, People whom you know very well that they have been living faithful life. So, when you start to get involved you realise that the woman was living a faithful life but this infection was brought back home by the husband who was leaving unfaithful life. What hit me so hard was one person who was closer to me and my wife. She came and confide it with me saying that ever since she was born, she never had any sexual intercourse with anybody other than her husband the most worrying factor was that the husband kept on blaming the wife that she’s the one who is the cause of the sickness. My experience with this sickness is very much painful for the reason that I used to stand up behind pulpit and criticize people living with HIV.’ (Pastor 9, 60 years, male).
‘… Yes, while I was still working for the Department, I found out I was HIV-positive. I was very worried and anxious that my husband who is not into church stuff infected me … I went to counselling. I was told that there is no need to cry over spilt milk and I should try to look forward to the future. I was counselled and told that I need not to divorced because I was contemplating to lodge a divorce … I was told to sit down with my partner and talk through this and live a healthy life for there is still life after being infected by HIV.’ (Participant 2, 58 years, female)
‘They even go up to the extent of saying that they had incidents where people were said to be having demons but later found that those people got tested and they were found to be HIV-positive.’ (Pastor 7, 53 years, male)
‘Biblically, they might be partly wrong and partly right because the life we are living starts in the spirit and then manifest in the physical. However, HIV and AIDS are more physical than spiritual and are being transmitted physically through sexual intercourse and contaminated blood contact. HIV is a spirit, you cannot reject it, but the truth is it is more physical than.’ (Pastor 5, 67 years, male)
Besides the attitudes that the pastors have explicated, there are practices that pastors are explicating towards HIV and/or AIDS in churches. The participants revealed that PLWH are vulnerable and exposed to false prophets who discourage them from adhering to their medication, thereby compromising their health and treatment outcomes. The participant also indicated that false prophets are propelling messages that undermine the effect of normalising HIV and/or AIDS:
‘These false prophets and pastors are the ones who are always propelling this propaganda that there is a different kind of HIV that is demonic, they are sowing a bad seed in the minds of people who are infected by HIV and that is irresponsible.’ (Participant 1, 56 years, male)
The study aimed to explore the pastors’ attitudes towards PLWH and to investigate the lived experiences of PLWH. The findings of the present study revealed that the pastors have not been judgemental towards PLWH; instead, they have shown love and compassion. Moreover, the PLWH indicated that they are happy at church and that both preaching and personal support from pastors encourage them to adhere to their HIV medication. This finding aligns with the literature from UNAIDS,
Previous studies indicated that pastors are willing to engage in open, honest conversations about HIV and are supportive of PLWH,
In addition to normalising talking about HIV and/or AIDS within the church, pastors are demonstrating empathy towards individuals who are infected. The findings of the present study are in agreement with a study by Sivelä, who indicated that pastors are striving to normalise HIV in the church so that it must not be taboo to talk about it.
Religious leaders ought to exhibit sensitivity towards the needs of PLWH and take on a significant role in fostering a culture of acceptance and respect towards them. This includes promoting ideas of responsibility and tolerance within their communities.
However, while these positive attitudes support the well-being of PLWH, pastors have also shown negative attitudes that can cause harm to PLWH. The present study indicated that talking about sexuality and HIV and/or AIDS at Church is taboo; the pastors indicated that the cultural barrier remains a stumbling block for HIV through the limiting of free talk about HIV, illustrating that certain cultures do not condone talking about sexuality. In agreement with the present study, several studies reported similar findings.
The results of the current study illustrate that the church, even though it is strategically situated in the community to address issues that concern HIV and/or AIDS, is unable to fulfil its duties because of the cultural barriers and the language gap. The finding further indicated a need for the church to break down cultural barriers and begin openly discussing HIV within the church environment without fear. Creating safe spaces for dialogue and testimony may also empower PLWH to share their experiences and help reduce stigma within the faith community. Human immunodeficiency virus and/or AIDS control programmes should therefore prioritise partnerships with churches to establish such safe spaces and integrate faith-based education modules that encourage dialogue, disclosure and collective action against stigma.
The participants argued that people would die of HIV or AIDS while the church remained silent at such a time when the church, as one of the critical stakeholders, was supposed to be vocal.
The findings are consistent with a prior study conducted by Murungi,
This study’s findings revealed that some of the pastors continue to uphold the belief that HIV is the ultimate consequence of leading a sinful life, and they view it as a divine punishment inflicted by God. Sarur and Kaba
This study has several limitations that should be acknowledged. Firstly, the sample was predominantly composed of pastors and participants from charismatic denominations, with limited representation from Mainline and Pentecostal churches. While the findings offer valuable insights into the experiences of the participants, they may not be directly transferable to all Christian denominations or context. Efforts to include participants from other denominations were met with logistical constraints and limited willingness to participate. Secondly, all interviewed pastors were above the age of 50 years. This age-based selection was intentional, as the study aimed to gather insights from experienced clergy who have been involved in pastoral care over an extended period, particularly during the peak of the HIV and AIDS epidemic. However, this criterion may have excluded the perspectives of younger clergy who could offer contemporary or alternative approaches to pastoral support. Thirdly, this study did not explore pastors’ own HIV status, their relationships with PLWH or their sources of HIV-related knowledge. It also did not assess the presence or absence of church-based HIV and/or AIDS programmes. These factors are critical in shaping attitudes and responses towards PLWH. Their omission limits the depth of interpretation and practical recommendations. Future research should consider including a more diverse sample in terms of denomination, gender and age to provide a more comprehensive understanding of pastoral care practices.
The study revealed that there is a good relationship between PLWH and pastors. Despite pastors showing love and compassion towards PLWH, some pastors still feel that HIV is associated with the infected person’s adulterous behaviour. People living with HIV still experience discrimination and stigmatisation from the church. The study revealed that PLWH often face subtle but hurtful forms of stigma within church settings. For instance, participants shared that during church conferences, they were assigned menial tasks such as making fires, while being excluded from food preparation because of unfounded fears that they might transmit the virus through handling food. Such actions reflect persistent misconceptions about HIV transmission within some congregations. Additionally, a belief persists that HIV is brought into the church by outsiders or non-members, creating a false narrative that isolates and blames others. This perception fosters a divisive environment and may prevent open dialogue and effective prevention strategies. The study also found that HIV and/or AIDS is still frequently associated with spiritual causes, with some church members viewing it as a manifestation of demonic possession or satanic attack. As a result, affected individuals often resort to religious rituals aimed at spiritual cleansing rather than seeking biomedical treatment or psychosocial support. These findings underscore the need for faith-based HIV education grounded in both theology and science to challenge stigma and misinformation. These rituals negatively affect the health-seeking behaviour, which makes them reluctant to take treatment. The church still has to win its battle with the cultural barriers that exist, hindering the church from addressing HIV and/or AIDS accordingly.
The church, as the agent, needs to further stop discourse preaching that says HIV is a demon and needs spiritual warfare that includes fasting, leading the PLWH to default on their medication, thus compromising their health in the process. There is an urgent need for the collaboration of different stakeholders, which include pastors, pastors’ forums, interdenominational conferences, health practitioners and the community at large to curb discrimination and stigmatisation of PLWHA.
We would like to thank the participants of this study.
This article is based on research originally conducted as part of Tshifhiwa Sinky Netshapapame thesis entitled, ‘Development of a model for combating HIV/AIDS among Christians in Thulamela churches: Limpopo Province’, submitted to the Health Science Department of Public Health, University of South Africa, 2022. The thesis was supervised by Prof. A.H. Mavhandu-Mudzusi. The original thesis is available at the UNISA Library website –
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Tshifhiwa S. Netshapapame: Conceptualisation, Formal analysis, Investigation, Methodology, Validation, Writing – original draft. Cairo B. Ntimana: Formal analysis, Methodology, Writing – original draft, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or the publisher. The authors are responsible for this article’s results, findings and content.