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.

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