Introduction Knowledge about Church leader’s attitudes towards HIV prevention is essential to understand the factors that enable them to take on leadership role in facilitating HIV prevention efforts. Church leaders can have a significant contribution in a Christian dominated state like Mizoram. The study aims to explore attitudes of church leaders on HIV prevention among the Presbyterian Church leaders in Aizawl City, Mizoram.

Methods A Cross sectional study using in-depth interviews and focus group discussions were used. From 15 Presbyterian churches randomly selected all over Aizawl city, 293 Church leaders representing the four groups of leadership (Pastor/Elder, Women, Youth and Men) completed a self administered questionnaire along with 12 in-depth interviews and 3 focus group discussions. Bivariate analysis was done to identify associated factors.

Results The proportion of Church leaders willing to advocate condom use for HIV prevention was 34.0 percent. Around 97.3 percent agreed that Church leaders should be concerned and intervene in HIV prevention. Nearly 90.4 percent felt it should be discussed in Church services. About 70 percent of the Church leaders, Biblical disobedience leads to HIV infection and almost 80 percent felt homosexuals deserve HIV infection. Abstinence (77.1%), marital fidelity (22.2%) and condom use (0.3%) were the preferred choice for HIV prevention. Although 66.9 percent agreed with the Church statement that condoms encourage pre-marital sex, more than 80 percent agreed that condom prevents spread of HIV infection. Personal contact with PLHIV does not seem to have positive influence with willingness to advocate condom use.

Conclusion Church leaders agreed that they have responsibilities towards HIV prevention but were restricted by the Church doctrine. Disobedience to Biblical teachings was believed to result in HIV infection which is seen as something sinful. Misconceptions around HIV persist irrespective of awareness programs within the Church. Sex education from early childhood, using Church media and educating Church leaders were recommended for effective HIV prevention.