While faith-based organisations (FBOs) and churches in urban areas usually have greater access to financial resources and information on HIV/AIDS, those in South Africa's rural districts often find themselves isolated and unable to provide adequate support and guidance.
International religious groups, such as the World Council of Religion and Peace (WCRP), have called on religious leaders to talk more openly about HIV/AIDS and support those living with the virus, as they commanded authority and had the trust of their communities.
"Religious organisations are the first place people come to when they are in need. They must also be able to offer help to HIV-positive persons," said WCRP South Africa president Paddy Meskin.
Religious leaders in rural areas were paralysed and "desperate for help" in the face of high HIV/AIDS prevalence rates in their communities, said Reverend Beverley Haddad, senior lecturer in theology and development at the University of KwaZulu-Natal (KZN) in Pietermaritzburg.
"They continue to preach morality and abstinence because they don't know what else to preach," she commented.
Breaking the "ingrained ideology that AIDS equals immorality" was often a challenge to FBOs, agreed researcher Nicky Pope who works for the KZN AIDS Church Network.
Another obstacle facing FBOs working in rural communities was that speaking about sexuality was still taboo and they did not know "how to tackle the issue without alienating people," Haddad observed. To make matters worse, not enough priests were being tested and living openly with HIV/AIDS if they were positive.
Nevertheless, Meskin admitted that religious leaders were becoming more aware that they had contributed to the spread of the disease and stigma by denying it existed, by trying to hide it or by judging those infected.
Consequently, stigma and discrimination remained high in rural church communities and few people disclosed their HIV status. A large number of religious leaders continued to see their role predominantly as that of "teacher" and used a lecture-based preaching style.
Rural ministers needed culturally sensitive HIV/AIDS training, since few were equipped to counsel members of their congregations or deal with AIDS-related issues; a large number of religious leaders complained they "didn't have time" to deal with the pandemic, Pope commented.
Very few religious leaders in rural areas had a good knowledge of HIV/AIDS, according to Haddad, who is currently researching the attitudes and activities of churches in KwaZulu-Natal regarding AIDS.
Rural FBOs were struggling to adopt AIDS programmes - either because of financial constraints or a lack of access to information. The majority of these programmes were very informal and largely consisted of prayer, bible study or visiting the sick.
"Many rural churches are self-funded, run by lay ministers and don't have their own buildings. They operate from school classrooms and members' homes, for example," said Haddad.
Only a small number of FBOs had ties to aid organisations with HIV/AIDS-related programmes.
Many religious leaders were uncertain about whether to promote condom use or not. According to Pope, 97 percent of women's groups and 92 percent of ministers she interviewed insisted that the promotion of abstinence was the most effective tool for preventing AIDS - despite the fact that women in rural areas rarely had the power to negotiate sexual relationships.
According to the WCRP, much more work on HIV/AIDS needed to be done in South Africa's FBOs, which provided mostly financial and humanitarian support: for example, religious organisations offered material or monetary donations to orphans or vulnerable children, but few provided HIV/AIDS education and counselling.