The role of religion and spirituality in HIV prevention: A systematic literature review and network analysis

Abstract

Religion and spirituality play an important role in shaping attitudes, beliefs, social norms, and preventive behaviors related to Human Immunodeficiency Virus (HIV) prevention across diverse populations and cultural settings. This study aimed to synthesize the existing evidence regarding the effectiveness of faith-based interventions in influencing HIV preventive behaviors, examine how religious and spiritual factors contribute to stigma and community norm formation, and explore the mediating roles of gender, age, and psychosocial determinants. A systematic literature review integrated with bibliometric network analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. A structured search was performed in the Scopus database on 06 September 2025 using predefined Boolean strategies across titles, abstracts, and keywords. Bibliometric analysis of 438 publications was carried out using VOSviewer, OpenRefine, Tableau, and R Studio to identify publication trends, collaboration networks, thematic evolution, and institutional contributions. After screening and eligibility assessment, 48 empirical studies were included in the final review. The findings indicated that faith-based interventions generally demonstrated positive but heterogeneous effects on HIV preventive behaviors, particularly in improving condom use, promoting HIV awareness, and delaying sexual debut. Religious leaders' endorsement, theological framing, and faith-community social capital emerged as major pathways influencing stigma, discrimination, and social norms related to HIV prevention. Gender mediated intervention outcomes through masculinity and femininity norms, whereas age influenced prevention behaviors through peer interaction, parental influence, and professional socialization. Psychosocial mediators included stigma perception, self-efficacy, leadership authority, doctrinal orientation, and social support networks. Overall, religion and spirituality functioned as both facilitators and barriers depending on the sociocultural and theological context. The findings highlight the importance of multilevel and culturally adaptive HIV prevention strategies that actively engage faith communities, reduce stigma, and utilize digital platforms to improve intervention scalability and public health impact.

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