Christopher A. Birt, MA, MSc, MB, BChir, FRCP, FFPH, DRCOG, Department of Public Health, University of Liverpool, UK. Chair, ASPHER’s working group on core competences; has organized numerous local workshops with representatives of schools of public healt

In-depth interviews were conducted with 39 very religious people living with HIV (16 had ever and 23 had never discontinued ART) to assess the role of religion in these treatment decisions and coping with HIV. Participants who had ever discontinued ART gave reasons such as: teachings and prophecies from religious leaders, and supporting Biblical scriptures all of which led them to feel that God and their faith, not ART, would help them; and testimonies by their “already healed” peers who had stopped ART. Participants who had never discontinued ART gave reasons such as continuous adherence counseling from multiple sources, improvement in physical health as a result of ART, beliefs such as God heals in different ways, non-adherence is equal to putting God to a test. High religiosity was reported to help participants cope with HIV through engagement in personal and or community protective behaviours; taking care of other illness; and reducing worries. When high religiosity among PHAs becomes a barrier to ART adherence, counseling interventions aimed at achieving better adherence outcomes should extensively use examples from cases when high religiosity has co-existed with ART adherence.