Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection

Abstract

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia’s most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia’s racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations’ existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders’ recommendations for tailoring HIV prevention for a faith-based audience.

Public health and church-based constructions of HIV prevention: black Baptist perspective

“…promoting marriage among single congregants to achieve monogamy, emphasis on condom use as appropriate among PLWHA); however, most leaders and congregants supported comprehensive HIV prevention, beyond abstinence-only, delivered through the church. These findings are consistent with recent studies in which churches indicated interest in, support of, and acceptance of the responsibility for conducting HIV prevention activities within the church [33,35,39,[54][55][56][57][58][59]. However, there exists a range of potential strategies and formats for engaging in HIV prevention, and these findings provide specific cultural insight and language that can help tailor prevention strategies for black Baptist churches, which has been limited in the literature from this perspective.…”

“…Previous studies on HIV prevention within the black church have largely focused on the attitudes and opinions of pastors and church leaders [33,38,39] while overlooking the influence of congregants' perspectives on shaping church contexts for HIV prevention programming. However, this study is among the first to document the perception and support for comprehensive church-based HIV prevention by congregants.…”

“…Although churches in this study were broadly supportive of prevention interventions within the church, their discussions were targeted at heterosexual partnerships. Given many church views on the parameters for sexual activity, homosexuality remains a difficult area for many black churches to address [33,56,62,64,68,69,70]. This challenge has implications in particular for Black men who have sex with men, who remain at highest risk of HIV [71].…”

“…In addition to catalyzing social, political and educational improvements, the black church has successfully partnered with public health researchers and practitioners to promote adoption of a range of health behaviors, including fruit and vegetable consumption [26][27][28][29], physical activity and weight loss [29,30], and mammography screening [23]. Despite this ability to promote health [22] and shape members' perceptions of health behaviors [31], the involvement of black churches in sexually transmitted HIV prevention has been limited [32][33][34][35]. Challenges noted have included financial restraint [33,34,36], concerns with homosexuality and promiscuity and their association with HIV/AIDS [32][33][34][35]37] time constraints [34], lack of understanding about the disease [38], difficulty with discussions about sexuality [34,38] and low perceptions of risk for HIV/AIDS among churchgoers [32,34,35].…”

“…Despite this ability to promote health [22] and shape members' perceptions of health behaviors [31], the involvement of black churches in sexually transmitted HIV prevention has been limited [32][33][34][35]. Challenges noted have included financial restraint [33,34,36], concerns with homosexuality and promiscuity and their association with HIV/AIDS [32][33][34][35]37] time constraints [34], lack of understanding about the disease [38], difficulty with discussions about sexuality [34,38] and low perceptions of risk for HIV/AIDS among churchgoers [32,34,35]. More recently, researchers have explored and validated black church interest and willingness to engage in HIV prevention activities [33-35, 39, 40]; however, HIV prevention can be broadly defined and little is still known about how to translate existing HIV prevention evidence to black church settings.…”