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How Churches Fight the Stigma of H.I.V.

In the South, black houses of worship are reducing the social suffering of H.I.V. with an approach that recalls Dr. King’s teachings.

Credit…Raymond McCrea Jones for The New York Times (Click Here)

ATLANTA — The second Wednesday of the month is always crowded in the parking lot of Bible Way Ministries. That’s the day the church offers its community food bank — and as of this year, it’s also the day when an AIDS Healthcare Foundation mobile testing unit rolls up to provide H.I.V. testing to anyone who wants it.


ible Way had already been offering H.I.V. testing some Sundays and at special events for five years, said the senior pastor, the Rev. Dr. Monte Norwood, his voice barely audible over gospel music blaring from the black testing van. The testers have made one new diagnosis here, but even if they hadn’t, the van’s presence would have value, he said. “It’s a symbol that we’re interested in addressing this issue, people knowing their status and being connected to care and treatment if they need to,” he said, to “kind of remove the stigma.”


The message appears to be registering: The unit routinely tests more than 30 people per visit. Dr. Norwood himself was tested in front of his congregation.


Dr. Norwood, who began ministering to people with H.I.V. in mid-1980s Los Angeles, knows his parishioners are watching him. To anyone who might not be getting the message, he hopes the van makes the church’s message clear: “We would love everyone to come, no matter what your status, no matter what your orientation.”


In the early days of the AIDS epidemic, when black communities were hit hard, some black churches responded with ministries for those infected. But as the loudest voices in AIDS activism became those of gay white men, many of those churches retreated into silence, pulled there by a strong cultural current of homophobia. In places where the church was most powerful, people with H.I.V. were forced into the shadows.


When Pamela Foster moved to the South in the early 2000s, she immediately noticed a difference in the volume of H.I.V. activism. “The first thing I realized was the advocacy around H.I.V. was very loud in New York City, and in rural Alabama, it was totally silent. I was like, ‘What is going on here?’” she said. “‘Maybe it’s because there’s more stigma in the South, it’s more religious in the South.’”

Those questions drove her research at the University of Alabama, where she led a study from 2012 to 2016 that involved 12 black churches in rural Alabama. She and her team developed a faith-based, anti-stigma course built on curriculums used by the Christian Council of Ghana (one of the few such curriculums available) and the N.A.A.C.P.


The eight-hour course, conducted by a team member and a pastor or the wife of a senior pastor, taught facts about H.I.V. but also discussed the negative effects of stigma and encouraged efforts to fight it. Four congregations took the course, while eight other congregations served as control groups: four took a different course focused only on H.I.V. facts, while four others had brochures on H.I.V. placed in their churches’ lobbies.


Compared with the controls, the congregations that took the anti-stigma course had greatly reduced their negative opinions of H.IV. patients. The study is one of a growing number that suggest that black churches can reduce the H.I.V. epidemic’s effect on black Americans.

While treatment advances have greatly reduced H.I.V. transmission in many populations, some black communities continue to experience it as a full-blown crisis. Black people account for only 13 percent of the country’s population, but 43 percent of new H.I.V. diagnoses. In 2016, four times as many black women were diagnosed with H.I.V. as Latina or white women. The concentration of H.I.V. infection is highest in the South, where many black Americans live in poverty and with limited access to education, health care, housing and employment.

Credit…Raymond McCrea Jones for The New York Times
Jasmine Phillips of the AIDS Healthcare Foundation testing Dr. Norwood. He gets tested at every H.I.V. awareness event Bible Way Ministries holds.


Black gay and bisexual men, who represent 60 percent of the nearly 17,000 black Americans annually who are given H.I.V. diagnoses, are at particularly high risk: The Centers for Disease Control and Prevention predicts that one of every two men in this population will contract H.I.V. if current rates persist. Diagnosis and treatment have become simpler than ever, yet many black gay and bisexual men get H.I.V. care only in the later stages of illness, when they are more likely to transmit the infection and to suffer severe ailments or death.


Among researchers who study behavior associated with H.I.V. transmission, this is attributed to stigma directed at H.I.V., homosexuality, or both. Studies have shown that stigma, whether real or perceived, damages the health of people with H.I.V. They conceal their H.I.V. status, so they skip taking medicine when it can’t be done in secret. It also causes others to avoid H.I.V. testing, which means they can unknowingly transmit the virus. Stigma contributes to social isolation and poor mental health, risk factors for substance use and health care avoidance — factors that themselves can increase H.I.V. transmission.


Black Americans have higher levels of homophobia and stigma about H.I.V. than other groups. “To address it, you almost have to work with churches,” said Amy Nunn, assistant professor at the Brown University School of Public Health and director of the Rhode Island Public Health Institute, where she has conducted research on faith-based H.I.V. initiatives.


Morris Singletary knows all about how stigma can distance men like him from the black church: as a youngster in Atlanta, church was his life — but for nine years after his 2006 H.I.V. diagnosis, his faith was shaken. “Basically, I almost committed suicide without committing suicide,” he told me. Mr. Singletary couldn’t reconcile his existence with his church’s teachings about the sinfulness of homosexuality.


Eventually, he concluded that those teachings were not the true word of God, but the oral tradition of flawed humans — “I am an independent thinker,” he said. His voice rose when he talked about what others endure at the hands of church-based stigma: “No one should ever question,” he said, that “when you walk in a place that’s safe, that is built on love, if you’re going to get that love regardless of what they call your sin.”

William Jeffries, an H.I.V. epidemiologist at the C.D.C., said, “In the black community, the black church is the main organization that shapes public thought.” Black Americans prioritize church and faith more than most other Americans, even when church hurts: Several studies have shown that gay and bisexual black men put church and religion at the center of their lives. One study found they did so at rates fivefold those of their Latino and white counterparts.


Although Mr. Singletary’s church still condemns homosexuality, its “magnificent community,” as he puts it, remains deeply important to his sense of well-being. “The medicines are going to work,” he said, “and I thank God for them.”


“But you know what really helps?” he continued. Going to church, with people who share his beliefs and are in the same space he is: “We can sit together and love each other.”

Dr. Norwood with members of his congregation at an event  where H.I.V. testing was offered.

Credit…Raymond McCrea Jones for The New York Times


Although Dr. Foster’s study is the only controlled trial of a faith-based H.I.V. intervention to be published so far, other projects have explored the feasibility and effectiveness of leveraging the black church’s influence for H.I.V. prevention. They have had mixed but generally encouraging results.


In one study, a partnership including Kansas City pastors, public health authorities, AIDS service organizations and researchers developed and tested a church-based intervention titled “Taking It to the Pews.” Over nine months, participating pastors did at least two activities from the project’s tool kit, which included sermon guides, responsive readings, bulletin inserts, and other materials.


After the intervention, 70 percent of participants surveyed said they were comfortable sharing a pew with an H.I.V.-infected person (there was no baseline study for comparison purposes). But 42 percent still expressed fear of people with H.I.V., and half were concerned about discrimination after a positive H.I.V. test result.

Another program, Faith in Action, has been tested in Philadelphia and Jackson, Miss. Its programs engaged black Christian and Muslim clergy in exploring barriers to faith-based H.I.V. prevention activities, and then in citywide public H.I.V. awareness and screening campaigns, with several H.I.V. testing events held at churches and mosques. Those congregations in which clergy encouraged testing had the highest testing turnout: In one church where a pastor preached about H.I.V., more than 100 people were tested, while only 10 people from three churches without H.I.V.-related preaching were tested.


Between 2013 and 2019, the N.A.A.C.P. developed an initiative to develop a national network of faith leaders and religious institutions committed to reducing the impact of H.I.V. on black communities, and a curriculum to assist them. As a result, more than 2,000 faith leaders in 45 cities were trained in H.I.V. ministry, and five seminaries agreed to incorporate H.I.V. into the readings, lectures and classroom exercises in their own curriculums.


Campaigners for victims of H.I.V. who focus on the church’s role believe that the programs with the largest successes pitch H.I.V. ministry in terms that land firmly within black faith leaders’ wheelhouses. “The church isn’t there for a condom demo — they’re there to uplift,” said the Rev. William Francis, an Atlanta pastor and ambassador of the N.A.A.C.P. project, which casts H.I.V. as a social justice issue, recalling the black church’s historical role as an engine of change during the civil rights movement. Dr. Jeffries’s focus is on liberation theology, a framework that encourages social action to address human suffering that was embraced by the Rev. Dr. Martin Luther King Jr.


Avoiding difficult topics also makes pastors more likely to use the curriculum. “Of course we should talk about, you know, sexuality in faith contexts, but it’s not where I start — it’s usually where I finish,” said Dr. Nunn, of Brown University. She approaches clergy members with a focus on the social and structural factors that drive the H.I.V. epidemic. She said no pastor has ever turned her down.


The Trump administration is proposing an initiative that would put $291 million toward stigma reduction, reaching historically unreachable groups, and identifying people without access to care in the counties and states with the highest H.I.V. rates. Public health authorities could use the money to expand collaborations with community partners, including faith-based organizations; Dr. Nunn hopes they do.


Morris Singletary is hopeful, too. “I look at what the church should do and what it means, what it did for civil rights,” he said. “Why can’t it do the same thing for H.I.V.?”

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