Background Within the context of imam training/orientation in Bangladesh, limited attention has been paid to imam’s behaviour change for effective participation in HIV prevention interventions. This study aimed at identifying factors influencing imams in promoting or inhibiting HIV message delivery consistently through mosques.

Method Three imam groups were trained for generating effective participation in HIV prevention in Bangladesh. Both quantitative (survey and exit interview) and qualitative (observation and focus group discussion) methods were conducted among imams, Friday sermon session and mosque attendees.

Results More than 90% imams in three imam groups delivered selected HIV transmission and prevention messages. However, only 11% in Group 1, 3% in Group 2 and none in Group 3 could articulate HIV transmission message consistently. Consistent delivery rate for HIV prevention message was 20% and 8% respectively in the first two groups. Observation and exit interview results were consistent to that of the survey result. All imams related sexual relationships outside marriage with the transmission of HIV as they felt it is consistent with religious doctrine. Despite imams’ high knowledge on HIV, they were unwilling to pronounce ‘unprotected sex’ and ‘condom’. Spiritual value of Friday sermon, presence of mixed age group of attendees and perceived reaction by community prohibited the full discussion on HIV prevention by imams.

Conclusion Strategies for generating effective participation by imams in HIV prevention interventions require extensive dialogue between policy makers and religious scholars. Dialogue on removing the discrepancies between risk awareness and actual knowledge in light with Quaran is likely to be more effective.