Spiritual coping predicts CD4-cell preservation and undetectable viral load over four years

Spiritual and religious aspects influence mental health and viral load: a quantitative study among young people living with HIV in Zimbabwe

INTRODUCTION

The role of religion and spirituality as social determinants of health has been widely discussed. Studies among people living with HIV describe positive and negative influences of religion and spirituality on health outcomes. With a HIV prevalence of 14.8% for females and 8.6% for males, and 22 000 AIDS-related deaths in 2020, HIV infection remains a life-threatening condition in Zimbabwe, especially in young people. The aim of this research was to measure the influence of religion and spirituality on the health outcomes of young people living with HIV in Zimbabwe.

METHODS

A quantitative questionnaire with three different validated measures of religion and spirituality (Belief into Action Scale, Brief Religious Coping Index, Religious and Spiritual Struggles Scale), demographic, cultural, behavioural and health questions was administered to 804 young Zvandiri programme clients in rural, urban and peri-urban Zimbabwe between July and October 2021. Regression analysis established significant relations between the result of the three different measures and mental health and viral load results.

RESULTS

Religious coping significantly reduced the probability of common mental disorder, while high religious activity increased the risk. The Religious and Spiritual Struggles Scale proved to be a reliable indicator of higher viral loads, risk for treatment failure and the probability of common mental disorder.

CONCLUSIONS

All three measures of religion and spirituality related to health outcomes. More research is needed to generalise and further explore these findings. Because the Religious and Spiritual Struggles Scale was a strong indicator for both, higher viral loads and common mental disorder, we suggest that it should be used and validated in other sub-Saharan contexts. It could serve as a new diagnostic tool for the early detection and prevention of treatment failure as well as of common mental disorder.

Psychometric Testing of the Daily Spiritual Experiences Scale (DSES) Among Black Gay, Bisexual, and Other Sexual Minority Men (SMM) and Black Transwomen in the Deep South: The MARI Study

Spirituality is a well-established protective psychosocial determinant of health. The current study examined the psychometric properties of the Daily Spiritual Experiences Scale (DSES) among Black gay, bisexual and other sexual minority men (SMM) and Black transwomen (TW) in the Deep South. Data were collected via self-interview technology and analyzed using factor analyses and correlation coefficients. We demonstrated a single-factor structure of the DSES with high internal consistency (Cronbach's α = 0.96). DSES was positively and significantly associated with multiple dimensions of religion, resilience, optimism and social support and not significantly associated with cynicism and anger expressions. Spirituality should be included in HIV prevention, treatment and care strategies focused on Black SMM and Black TW, especially those residing in the Deep South, USA.

Religiosidade/Espiritualidade e Adesão à Terapia Antirretroviral em Pessoas Vivendo com HIV

Resumo Dentre os fatores associados à adesão à Terapia Antirretroviral (TARV) em pessoas vivendo com HIV, destaca-se a religiosidade/espiritualidade (R/E). O objetivo deste estudo foi apresentar as evidências disponíveis sobre a relação entre a dimensão da R/E e a adesão aos antirretrovirais. Realizou-se uma revisão integrativa de literatura com buscas nas bases/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus e Web of Science. Foram selecionados artigos empíricos publicados entre janeiro de 2008 e junho de 2019, sendo recuperados 49 estudos após a aplicação dos critérios de inclusão/exclusão. Encontraram-se associações positivas, negativas e neutras entre R/E e adesão à TARV, evidenciando que a R/E é uma dimensão psicossocial que pode ser preditora da adesão aos antirretrovirais. O sentido dessa influência, no entanto, ainda não é um consenso na literatura científica. Recomenda-se que essas influências sejam compreendidas a partir de elementos contextuais dessa população e não apenas de marcadores pessoais.

Religious coping and hope in chronic kidney disease: a randomized controlled trial

OBJECTIVE

To evaluate the effect of prayer on religious/spiritual coping and on the hope of patients with chronic kidney disease undergoing hemodialysis.

METHOD

Randomized, controlled and blinded clinical trial, carried out in a dialysis unit, with a total of 62 patients undergoing hemodialysis - 31 participants in intervention group and 31 in the control group. Intercession prayer was applied three times, in alternate weeks, during hemodialysis sessions. Differences between groups in the outcome of the effect of prayer on religious/spiritual coping and hope were analyzed.

RESULTS

Participants used positive coping at high mean scores in both groups (control - 3.62 and intervention - 3.26) and negative coping had little use (control - 1.66 and intervention - 1.47). The use of total coping was between 2.35 and 2.48 in the intervention group (p = 0.015). Hope variables were better in the intervention group: optimism (p = 0.001), short- and long-term plans (p = 0.004), remembering happy moments (p = 0.039) and valuing life (p = 0.050).

CONCLUSION

The use of prayer promotes an increase in religious/spiritual coping and hope. Brazilian Registry of Clinical Trials: RBR-4pphkf.

Experience of religion and spirituality among socially marginalised people living with HIV in Mississippi

African Americans in Mississippi have the highest HIV-related mortality and poverty rates in the USA, and they tend to be religious. Attitudes toward gender and sexuality are changing, yet few studies have investigated religion and spirituality among special populations living with HIV. Using grounded theory and qualitative methods, we investigated the experience of health and illness of a low-income, socially marginalised population living with HIV in two locations of Mississippi in 2015. In a context of high stigma and HIV-related health disparities, individuals turned, or returned, to religion, church and spirituality as sources of community and strength, which also motivated safer health behaviours. Findings underscore how religion and spirituality are enabling social determinants of health that are under-explored, untapped, potentially culturally acceptable, sustainable interventions at the community-level. We posit, given diminished funding for community-based services, the most significant influence churches could exert is in decreasing HIV stigma. Given the current US plan to end HIV by 2030, with appropriate stakeholder participation, the role of religion, spirituality and clergy could be further amplified via linkage to care providers and the 'normalisation' of the HIV discourse, to address disparities and improve the health of African Americans.

Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study

Religion and spirituality have been associated with higher survival and improved biological markers among people living with HIV/AIDS (PLWH). Prior results have largely been among small cohort studies. We examined the association using a larger sample and longitudinal data from the Veterans Aging Cohort Study (VACS) years 2002-2012 (n = 3,685). Attending services at least monthly was associated with higher social support (80% vs 75%, p = 0.002), less unhealthy alcohol use (35% vs 39%, p = 0.006), less marijuana use in the past year (23% vs 32%, p < 0.001), less overall drug use within the past year (27% vs 31%, p = 0.01), and lower depression (20% vs 24%, p = 0.004). Attending services monthly was associated with a reduced mortality risk adjusting for age, race, gender, education, MSM, HCV, VL, CD4, and adherence to ARV (adjusted HazardRatio [aHR] = 0.89, 0.80-0.99). However, after controlling for smoking status, this association of mortality and religious attendance became non-significant (aHR = 0.93, 0.84-1.04).

Physical symptoms and sleep disturbances activate coping strategies among HIV-infected Asian Americans: a pathway analysis

How to activate adaptive coping strategies has an important and practical meaning for the quality of life of people living with HIV (PLHIV); however, few studies have focused on the effects of sleep disturbances and HIV-related physical symptoms on coping strategies. The specific relationships among coping strategies, sleep disturbances and HIV-related physical symptoms were unknown. We performed a path analysis to examine the proposed model of relationships among sleep disturbances, physical symptoms, and coping strategies. A convenience sample of 69 HIV-positive Asian Americans in San Francisco, Los Angeles, and New York City were recruited and data were collected on demographics, sleep disturbances, HIV-related physical symptoms, and coping strategies. Sleep disturbances directly affect maladaptive coping (β = 0.34), and physical symptoms directly affect adaptive coping (β = 0.30) and maladaptive coping (β = 0.24). Interventions designed to decrease sleep disturbances and physical symptoms should be developed to enhance adaptive coping and reduce maladaptive coping among Asian Americans with HIV.

What Do Adults With HIV Want? End-of-Life Care Goals, Values and Beliefs by Gender, Race, Sexual Orientation

OBJECTIVE

We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH).

METHODS

223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACE™-HIV Advance Care Planning clinical trial.

FINDINGS

The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life care preferences: (1) a Relational class (75%) who prioritized family and friends, comfort from church services, and comfort from persons at the end-of-life; and (2) a Transactional/Self-Determination class (25%) who prioritized honest answers from their doctors, and advance care plans over relationships. African Americans had 3x the odds of being in the Relational class versus the Transactional/Self-determination class, Odds ratio = 3.30 (95% CI, 1.09, 10.03), p = 0.035. Males were significantly less likely to be in the relational latent class, Odds ratio = 0.38 (CI, 0.15, 0.98), p = 0.045. Compared to non-African-Americans, African-American PLWH rated the following as important: only taking pain medicines when pain is severe, p = 0.0113; saving larger doses for worse pain, p = 0.0067; and dying in the hospital, p = 0.0285. PLWH who were sexual minorities were more afraid of dying alone, p = 0.0397, and less likely to only take pain medicines when pain is severe, p = 0.0091.

CONCLUSION

Integrating culturally-sensitive palliative care services as a component of the HIV care continuum may improve health equity and person-centered care.

Building towards common psychosocial measures in U.S. cohort studies: principal investigators' views regarding the role of religiosity and spirituality in human health

BACKGROUND

The goal of this study was to understand prospective cohort study Principal Investigators' (PIs') attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research.

METHODS

One-hour, semi-structured qualitative interviews were conducted with 20 PIs, who represent 24 different National Institutes of Health (NIH)-funded prospective cohort studies in the U.S. Collectively, these PIs collect detailed health data on approximately 1.25 of every 100 adult Americans. Sample size was calculated to achieve thematic saturation.

RESULTS

The majority of PIs we interviewed viewed R/S as potentially important factors influencing disease etiology, particularly among minority communities that report higher levels of religiosity. Yet nearly all PIs interviewed felt there was not yet a compelling body of evidence elucidating R/S influences on health, and the potential mechanisms through which R/S may be operating to affect health outcomes. PIs identified 5 key areas that would need to be addressed before they would be persuaded to collect more R/S measures in their cohorts: (1) high-quality, prospective studies that include all appropriate covariates for the outcome under study; (2) studies that posit a plausible biological mechanism of effect; (3) well-validated R/S measures, collected in common across multiple cohorts; (4) the need to address bias against R/S research among investigators; and (5) NIH funding for R/S research.

CONCLUSIONS

Results of this study provide a roadmap for future R/S research investigating the impact of R/S influences on disease etiology within the context of U.S. prospective cohort studies. Identifying significant R/S influences on health could inform novel interventions to improve population health. Given the higher levels of religiosity/spirituality among minority communities, R/S research may also provide new leverage points for reducing health disparities.

Preliminary study on the effects of treatment for breast cancer: immunological markers as they relate to quality of life and neuropsychological performance

BACKGROUND

Immunological biomarkers were related to quality of life and neuropsychological performance in women recently diagnosed with breast cancer through the first six months of treatment. A comparison group of breast cancer survivors in remission were also evaluated.

METHOD

Twenty women newly diagnosed with breast cancer and 26 breast cancer survivors at least a year after treatment were evaluated four times over a course of six to 8 months. The assessments included quality-of-life, emotional and spiritual well-being, sleep quality, computerized neuropsychological performance, and cytokine immunology biomarkers using flow cytometry. The principal immunological markers examined were the CD4+, CD8+, and CD16+ counts.

RESULTS

Although equivalent at enrollment, active treatment women reported higher anxiety, depression, poorer quality-of-life, and poorer processing speed and accuracy on memory, logical processes, and coding neuropsychological tasks. They also had significantly higher CD8+ and CD16+ cell count levels during treatment over the next six to eight months than comparison group women in remission. Women undergoing chemotherapy as well during treatment phase also had a significant decline in CD4+ counts. Higher percent CD8+ levels during treatment was associated with poorer quality of life and more depression, while higher CD4+ and CD8+ were associated with poorer neuropsychological memory and processing speed performance.

CONCLUSION

Significant increases in CD8+ is a sensitive biomarker of a broad range of poorer quality-of-life and neurocognitive functioning outcomes during breast cancer treatment, especially in women undergoing chemotherapy. Quality of life should be monitored in breast cancer patients and psychosocial support made available as a standard of care.

Religiosity/Spirituality and Physiological Markers of Health

The long-standing interest in the effects of religiosity and spirituality (R/S) on health outcomes has given rise to a large and diverse literature. We conducted a meta-analysis on research involving R/S and physiological markers of health to elucidate both the scope and mechanism(s) of this phenomenon. A combined analysis found a significant, but small, beneficial effect. Subgroup analyses found that some measures of both extrinsic and intrinsic religiosity were significantly associated with health. Several outcome measures, including blood pressure, C-reactive protein, and cardiovascular health markers, were significantly associated with R/S. Our findings suggest that R/S benefits health, perhaps through minimizing the disruptive effects of stress/depression on inflammation. We hope that researchers can use these results to guide efforts aimed at elucidating the true mechanism(s) linking religious/spiritual beliefs and physical health.

Feasibility and Acceptability of a Telephone-Based Chaplaincy Intervention to Decrease Parental Spiritual Struggle

Spiritual struggles (SSs) are distressing spiritual thoughts associated with poorer health outcomes. This study's purpose was to test feasibility, acceptability, and fidelity of an intervention to decrease SS of parents of children with CF. Parents screening positive for SS were enrolled and were randomized to intervention or attention-control condition. Intervention focused on intra-, inter-, and divine SS. Mixed linear modeling examined between-group differences. We present analyses of N = 23, and participants all showed decreased levels of SS. Acceptability was high; feasibility was higher in the intervention arm. GuideSS_CF is acceptable and feasible and warrants development as a potentially efficacious intervention.

Sexual Orientation, Religious Coping, and Drug Use in a Sample of HIV-Infected African-American Men Living in the Southern USA

Religiosity and spirituality are associated with reduced drug use in the general population, but it is unclear whether this relationship generalizes to sexual minorities. This study investigated the relationship between religious coping, drug use, and sexual orientation in a sample of HIV-infected African-American men (40 heterosexuals; 64 sexual minorities). Most participants (76%) reported being "moderately" or "very" religious. We found no main effect of religious coping or sexual orientation on frequency of drug use. However, there was an interaction between positive religious coping and sexual orientation. Among heterosexuals, positive religious coping was inversely associated with frequency of drug use. However, this relationship was not significant among sexual minorities. Findings suggest HIV-infected African-American sexual minorities living in the South may need additional coping resources to decrease vulnerability to drug use.

Assessing spirituality: is there a beneficial role in the management of COPD?

Here,we report on the role of spirituality assessment in the management of chronic obstructive pulmonary disease (COPD). Although a positive effect of addressing spirituality in health care has been proved in a number of chronic diseases, its potential in COPD has received less attention. Although limited, available evidence suggests that spirituality may play an important role in improving quality of life of patients with COPD. The fruitful results in other long-term conditions may lay the foundation for further research on addressing spirituality in COPD. This should focus where the burden of COPD is greatest, including low-resource settings globally. Implementation research should include exploration of an acceptable consultation process to identify patients who would welcome spiritual discussions; how to integrate spiritual approaches into health care professional curricula so that they are aware of its importance and have the confidence to raise it with patients and how to integrate spiritual approaches into holistic COPD care.

Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women's Health Study

Background

The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by buffering adverse physiological effects of stress.

Methods

We prospectively assessed the association of R/S with hypertension within the Black Women's Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one's R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables.

Results

During 2005-2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures.

Conclusion

R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.

Religion, Spirituality, and HIV Clinical Outcomes: A Systematic Review of the Literature

This systematic review evaluates the association between religion, spirituality and clinical outcomes in HIV-infected individuals. A systematic literature review was conducted for all English language articles published between 1980 and 2016 in relevant databases. Six hundred fourteen studies were evaluated. 15 met inclusion criteria. Ten (67%) studies reported a positive association between religion or spirituality and a clinical HIV outcome. Two (13%) studies failed to detect such an association; and two (13%) demonstrated a negative association. One study (7%) identified features of religiosity and spirituality that had both negative and positive associations with HIV clinical outcomes. Recognizing the religious or spiritual commitments of patients may serve as an important component of patient care. Further longitudinal studies and interventions might be required to further clarify the potential impact of religion and spirituality on HIV clinical outcomes.

Religious and spiritual coping in people living with HIV/Aids

OBJECTIVE

evaluate the religiosity and the religious/spiritual coping of people living with HIV/Aids.

METHOD

descriptive, cross-sectional study with quantitative approach, conducted in a reference HIV/Aids outpatient clinic in a university hospital of Recife-PE, Brazil, from June to November 2015. At total of 52 people living with HIV/Aids (PLWHA) participated in the research, which employed own questionnaire, the Duke University Religion Index (DUREL), and the Religious/Spiritual Coping Scale (RCOPE).

RESULTS

the sample presented high indices of organizational religiosity (4.23±1.66), non-organizational religiosity (4.63±1.50), and intrinsic religiosity (13.13±2.84). Positive RCOPE was used in high mean scores (3.66±0.88), and negative RCOPE had low use (2.12 ± 0.74). In total, use of RCOPE was high (3.77±0.74), having predominated the positive RCOPE (NegRCOPE/PosRCOPE ratio=0.65±0.46).

CONCLUSION

it is evident the importance of encouraging religious activity and RCOPE strategies, seen in the past as inappropriate interventions in clinical practice.

Relationship Between Spiritual Coping and Survival in Patients with HIV

BACKGROUND

Studies of spirituality in initially healthy people have shown a survival advantage, yet there are fewer research studies in the medically ill, despite the widespread use of spirituality/religiousness to cope with serious physical illness. In addition, many studies have used limited measures such as religious service attendance.

OBJECTIVE

We aimed to examine if, independent of medication adherence, the use of spirituality/religiousness to cope with HIV predicts survival over 17 years.

DESIGN

This was a longitudinal study, started in 1997. Study materials were administered semi annually.

PARTICIPANTS

A diverse sample of 177 HIV patients initially in the mid-stage of disease (150-500 CD4-cells/mm(3); no prior AIDS-defining symptoms) participated in the study.

MAIN MEASURES

Participants were administered a battery of psychosocial questionnaires and a blood draw. They completed interviews and essays to assess current stressors. Spiritual coping (overall/strategies) was rated by qualitative content analysis of interviews regarding stress and coping with HIV, and essays.

KEY RESULTS

Controlling for medical variables (baseline CD4/viral load) and demographics, Cox regression analyses showed that overall positive spiritual coping significantly predicted greater survival over 17 years (mortality HR = 0.56, p = 0.039). Findings held even after controlling for health behaviors (medication adherence, substance use) and social support. Particular spiritual coping strategies that predicted longer survival included spiritual practices (HR = 0.26, p < 0.001), spiritual reframing (HR = 0.27, p = 0.006), overcoming spiritual guilt (HR = 0.24, p < 0.001), spiritual gratitude (HR = 0.40, p = 0.002), and spiritual empowerment (HR = 0.52, p = 0.024), indicating that people using these strategies were 2-4 times more likely to survive.

CONCLUSIONS

To our knowledge this is the first study showing a prospective relationship of spiritual coping in people who are medically ill with survival over such a long period of time, and also specifically identifies several strategies of spirituality that may be beneficial.

Reported Church Attendance at the Time of Entry into HIV Care is Associated with Viral Load Suppression at 12 Months

The Southeast has high rates of church attendance and HIV infection rates. We evaluated the relationship between church attendance and HIV viremia in a Southeastern US, HIV-infected cohort. Viremia (viral load ≥200 copies/ml) was analyzed 12 months after initiation of care. Univariate and multivariable logistic regression models were fit for variables potentially related to viremia. Of 382 patients, 74 % were virally suppressed at 12 months. Protective variables included church attendance (AOR 0.5; 95 % CI 0.2, 0.9), being on antiretroviral therapy (AOR 0.01; 95 % CI 0.004, 0.04), CD4(+) T lymphocyte count 200-350 cells/mm(3) at care entry (AOR 0.3; 95 % 0.1, 0.9), and education (AOR 0.5; 95 % CI 0.2, 0.9). Variables predicting viremia included black race (AOR 3.2; 95 % CI 1.4, 7.4) and selective disclosure of HIV status (AOR 2.7; 95 % CI 1.2, 5.6). Church attendance may provide needed support for patients entering HIV care for the first time.

Maladaptive coping strategies and glaucoma progression

The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or worse visual field mean deviation.A hospital-based case-control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = -0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (β = -1.37, 95% confidence interval [CI] -2.32, -0.41), Haitian ethnicity (β = -7.78, 95% CI -12.52, -3.04), and the number of glaucoma medications (β = -1.20, 95% CI -2.00, -0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.

Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature

Much attention has been given to the relationship between religion/spirituality (R/S) and HIV in recent years, but comparatively little has been explored in regard to R/S and HIV testing, retention in care, and adherence to medication. Religious views concerning HIV risk behavior pose challenges to communication and education about sexual health in religious communities and may serve as barriers to HIV treatment and care. Conversely, religious coping and spiritual well-being, as well as social support could serve as facilitators to HIV treatment and care. This study aims to fill a gap in the literature by addressing the following questions: (1) what dimensions of R/S have been found to be factors associated with HIV outcomes?; (2) which R/S factors function as barriers or facilitators to care among people living with HIV (PLWH)?; and (3) which R/S factors, if any, vary across socio-demographic groups? Thirty-three empirical articles were identified for systematic review. Of the 33 empirical studies included, 24 studies found that at least one measure of R/S was associated with better adherence and clinical health outcomes. Twelve studies found at least one measure of R/S to be associated with poorer adherence and clinical health outcomes. Seven of the studies found at least one R/S measure to have no significant association with outcomes. Though all of the studies included in this review focused on R/S experiences of PLWH, there was very little consistency in regard to measurement of R/S. Studies in this review included a wide range of R/S measures, including beliefs, religious/spiritual practices, R/S coping, organizational religion, and many more. Of the 33 studies reviewed, only 9 focused on unique populations such as women, people with histories of substance abuse, immigrants, etc. Findings from this review highlight opportunities for more studies in various populations using standardized R/S measures.