J Relig Health (2012) 51:865–878 DOI 10.1007/s10943-010-9396-x ORIGINAL PAPER
Communicating HIV/AIDS Through African American Churches in North Carolina: Implications and Recommendations for HIV/AIDS Faith-Based Programs DaKysha Moore • Elijah O. Onsomu • Shirley M. Timmons Benta A. Abuya • Christina Moore
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Published online: 22 September 2010 Springer Science+Business Media, LLC 2010
Abstract This study explores HIV/AIDS communication strategies among church leaders at predominately African American churches in a metropolitan city and surrounding areas in North Carolina. The church leaders contacted for the study are members of an interfaith-based HIV/AIDS program. The researchers used semi-standardized interviews to explore how church leaders address HIV/AIDS in the church. The findings indicate that the seven church leaders who participated in the study use a variety of communication channels to disseminate HIV/AIDS information for congregants and their surrounding communities, which include both interpersonal and mass media. Keywords
African Americans HIV/AIDS Faith-based organizations
Figures 1 and 2 from North Carolina Department of Health and Human Services: Communicable disease branch (June, 2009). North Carolina HIV/STD quarterly surveillance report. Retrieved August 8, 2009, from http://www.epi.state.nc.us/epi/hiv/pdf/vol09no1.pdf. D. Moore (&) C. Moore Department of Visual, Performing, and Communication Arts, Johnson C. Smith University, 100 Beatties Ford Road, Charlotte, NC 28216, USA e-mail:
[email protected] E. O. Onsomu The School of Health Sciences, Winston Salem State University, 241 F.L. Atkins Building, 601 S. Martin Luther King Jr. Drive, Winston Salem, NC 27110, USA e-mail:
[email protected] S. M. Timmons School of Nursing, Clemson University, 528B Edwards Hall, Clemson, SC 29634, USA e-mail:
[email protected] B. A. Abuya Education Research Program, African Population Health Research Center (APHRC), Shelter Afrique Center, Longonot Road, Upper Hill, PO Box 10787, Nairobi 00100 GPO, Kenya e-mail:
[email protected]
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Introduction In 2006, approximately 1.1 million people in the United States (US) were living with HIV/ AIDS, and the majority of the cases were minorities with Blacks making up more than 45% of these cases (CDC 2008b). Furthermore, in 2006, there were slightly more than 56,000 new HIV/AIDS diagnoses (CDC 2008b). Among ethnicities and racial categories, Blacks are greatly affected by HIV/AIDS. In 2005, Blacks who encompass African Americans accounted for almost half of all new HIV/AIDS cases (CDC 2007b). Because of the enormous impact of HIV/AIDS in the Black community, it is important to continue to research communicative strategies that could be used to reach an audience that is at risk for contracting HIV/AIDS. The specific purpose of the study is to explore HIV/AIDS communication strategies among church leaders at predominately African American churches who are members of an interfaith-based organization (i.e., representing different denominations and faith beliefs). Because African American churches are important in the community and could play an important role in reducing the spread of HIV/AIDS, the current research study seeks to answer the following questions: RQ1 How do leaders at predominately African American churches who are members of an interfaith-based organization in North Carolina (NC) communicate HIV/AIDS information to their congregations and the surrounding community? RQ2 How do leaders at predominately African American churches who are associated with an interfaith-based organization address HIV/AIDS stigma? RQ3 How do leaders at predominately African American churches who are involved with an interfaith-based organization educate or conduct HIV/AIDS testing? The knowledge gained from this study could be used to assist health communicators in implementing more or new HIV/AIDS faith-based programs. These programs could help create more awareness, reduce stigma, and change behaviors which increase African Americans’ risk of becoming HIV/AIDS positive.
HIV/AIDS in the African American Community HIV/AIDS has had a severe impact on the African American community, and Blacks die faster from the disease. According to the CDC (2008a), in 2004, HIV/AIDS was the leading cause of death for Black women aged 25 through 34, and it is one of the leading causes of death for Black women of several other age groups. For Black men, the main causes of HIV/AIDS infection include unsafe sex with another man who is HIV/AIDS positive, sharing needles for illegal drug use with someone who is HIV/AIDS positive, and unsafe sex with a woman who has HIV/AIDS. However, for Black women, unsafe sex with an infected man and sharing needles for illegal drug use with an HIV/AIDS positive person are the main transmission modes (CDC 2007b). The main modes of HIV/ AIDS transmission for both Black men and women are based on individuals’ behaviors, which provide an opportunity for leaders within the African American community to address attitudes and behaviors that place African Americans at a greater risk for contracting HIV/AIDS. In NC, since the early 2000s, the number of HIV/AIDS cases has increased. For example, across the state from 2001 to 2002, the number of AIDS cases increased approximately 16% (NCDHHS 2003). By the end of 2006, approximately 31,000 people were HIV/AIDS positive and living in NC. During the previous year (2005), HIV/AIDS
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was the seventh leading cause of death for individuals between ages 25 and 44 (NCDHHS 2007). The population in NC with the highest percentage of HIV was Black men in 2006. Moreover, Black women had an infection rate that was 17 times more than White women. In 2005, in NC, Blacks were 12 times more likely to die from HIV compared to Whites (NCDHHS 2007). Furthermore, during a period from 2007 to 2009, the NC HIV/STD quarterly surveillance report (2009) shows the number of STDs increased across various NC counties, and STDs are an indicator of an individual’s risk of HIV/AIDS (CDC 2007c). Moreover, throughout the last three years, HIV cases in various NC counties decreased from January to March (see Fig. 1), but the AIDS cases during the time frame have increased (see Fig. 2). In order to diminish HIV/AIDS in communities around the world, many people are using a faith-based approach to help reduce the transmission of HIV/AIDS and assist people who are HIV/AIDS positive. In NC, there are faith-based organizations that give assistance to people who are HIV/AIDS positive and educate people about the disease. For the current research, the researchers explored HIV/AIDS communication strategies among African American/Black church leaders associated with an interfaith-based organization in NC. The interfaith-based organization has more than 45 churches that are partners with the
Fig. 1 Six highest counties with HIV cases in North Carolina from January to March (2007–2009), NCDHHS, 2009
Fig. 2 Six highest counties with AIDS cases in North Carolina from January to March (2007–2009), NCDHHS, 2009
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network. Understanding the communicative styles of faith-based programs is important, because community-based programs could be critical as an outlet for educating people about HIV/AIDS and creating more positive attitudes toward people who are HIV/AIDS positive by eliminating stigma that is sometimes associated with HIV/AIDS. Moreover, communication through both interpersonal and media channels are important in reducing HIV (UNAIDS 2004). It is important for people to have higher levels of knowledge and awareness about the illness, so they can protect themselves from becoming HIV/AIDS positive. The African American Church: Focal Point of the Community In the African American community, the church is considered the ‘‘cornerstone.’’ Dating back to slavery, the church in the African American community was a place that people could meet to discuss their oppressive situation, and it was a place where African Americans learned to read especially during Sunday school. The church helped establish financial institutions, housing, and schools in African American communities (Lincoln and Mamiyam 1990). During the civil rights movement, the church was a place of gathering to discuss and educate people about various social injustices (Isaac et al. 2007). The church has served as an institution for spiritual guidance and now a place to get health information. The pastor/preacher in the African American church also serves in many roles in the community. The African American minister’s role in the community is one of respect and even a visit to a churchgoer’s home is important. According to Hamilton (1972), ‘‘he is kind of a celebrity, and his presence adds prestige to the family and the occasion’’ (p. 13). Now, pastors within the Black community are taking on another role as ‘‘change agents’’ in health (Levin 1984, 1986). According to Rogers (2003), a change agent must have a connection with clients and must be seen as ‘‘credible’’ and someone people can ‘‘trust,’’ which is vital during the communication process. The African American preacher fits this role. Throughout recent years, the church has become involved in health programs ranging from mammography screenings (Markens et al. 2002) to addressing mental health issues within the African American community. Neighbors et al. (1998) found that more women sought counseling from ministers more often than men, and once an individual discussed the situation with the minister, he/she chose not to seek professional assistance from a mental health counselor. There have been other studies that show the importance of the Black church in providing mental health services (Blank et al. 2002; Taylor et al. 2000). Because of the church’s involvement with health issues affecting the African American community, it appears to be a good forum for starting discourse on HIV/ AIDS, a damaging disease in the African American community. The Church and HIV/AIDS During the beginning of the HIV/AIDS crisis in the African American community, the church did not take immediate action to address the health issue (Cohen 1999; Francis and Liverpool 2009). One possible reason for the church’s slow response is the difficulty of discussing the behaviors that increase a person’s risk of contracting HIV/AIDS. Ward (2005) describes some Black churches’ responses to gay relationships in a range from hostile to silent. However, the creation of organizations such as The Balm In Gilead may be a sign that African American ministers/leaders are starting to discuss HIV/AIDS and the risk factors.
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In both the United States and in African countries, public health officials and clergy are starting to unite to implement faith-based programs to reduce HIV/AIDS and reduce stigmas associated with the disease. There are faith-based programs such as ‘‘The SAVED SISTA Project,’’ which focus on African American women who are recovering from drug and alcohol abuse. Women who are HIV positive and negative are also participants of the program. Through the church, the program tries to reduce the behaviors that put homeless Black women at a higher risk for HIV/AIDS (Collins et al. 2007). Francis and Liverpool (2009) discussed the various faith-based HIV programs found during their literature search. Two of the four programs included Metropolitan Community AIDS Network (METRO CAN) and Teens for AIDS Prevention (TAP) in Connecticut. The literature indicates that there are more African American churches that are willing to participate in a faith-based approach to reducing the spread of HIV/AIDS within the Black community (Francis and Liverpool 2009).
Methodology For the current study, the researchers explored how church leaders associated with an interfaith-based organization in NC communicate information about HIV/AIDS. The researchers obtained a list of churches from the organization’s web site. The interfaithbased organization partners with more than 45 churches; however, there are less than 20 churches that are predominately African American. After approval from the Institutional Review Board (IRB), a researcher contacted 13 churches for the study and seven churches responded and agreed to participate, which is a 54% response rate. Semi-standardized interviews were used for collecting data, because it allows the interviewer to ask a predetermined set of questions, and it allowed the researchers to ask more in-depth questions based on the respondents’ answers. Furthermore, based on the questions and answers during the interviews, the interviewee also had the flexibility to give more information (Berg 2001). The instrument for the study consisted of eighteen questions for which seven were used to gain background information about the church. Several questions focused on the communication channels church leaders used to communicate HIV/AIDS information to the church. Some of the questions were (1) How do you communicate information about HIV/AIDS (sermons, workshops, speakers, etc.)? (2) Are there any scriptures that you use to address HIV/AIDS or behaviors associated with HIV/AIDS such as intravenous drug use? (3) How does your church plan to continue HIV/AIDS education? For the study, the researchers did not use the names of the church leaders nor the churches. The participants were promised that the researchers would keep their identities and church names confidential. The time of the telephone interviews ranged from 20 to 30 min, and the interviews took place between late July and early August of 2009. With the consent of the interviewees, the conversations were recorded and later transcribed. Even through the interviews were transcribed, for the quotes used in the study, the researchers did take out utterances and verbal fillers. Once the interviews were transcribed, the researchers used grounded theory developed by Glaser and Strauss (1967) for analysis. Grounded theory is sometimes used to help researchers understand data collected from interviews. The inductive approach allows through systematic data collection themes/theories to emerge from the data (Strauss and Corbin 1990), and previous studies have used this approach (Kearney et al. 1994; Markens et al. 2002). Furthermore, the researchers used open coding that enables ‘‘examining, comparing, conceptualizing, and categorizing data’’ (Strauss and Corbin 1990, p 61). In
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order to ensure the validity of the study, the researchers tried not to sway the church leaders’ answers; however, when necessary, the researcher who conducted the interviews did ask for clarification about various comments. After the researchers transcribed the tapes, they took notes while reading the data several times. The researchers used open coding to analyze the data for common categories. Through grounded theory, the researchers were able to discover the main communication modes the church leaders used which allowed for the development of four common themes.
Results The participants of the study consist of church leaders who are both men (57%) and women (43%), and the church leaders’ denominations are Baptist, Presbyterian, and Catholic (see Fig. 3). The church memberships ranged from small to large congregations; however, most of the churches have more than 500 congregants (see Fig. 4). Furthermore, the churches have been members of the interfaith-based HIV/AIDS organization for more than five years with more than half taking part for at least ten years (see Fig. 5). After reviewing the transcripts from the interviews, it was clear that four major themes emerged from the data. The themes are (1) disseminating information about HIV/AIDS through a combination of communication modes, (2) responsibility and obligation to create more awareness about HIV/AIDS, (3) reducing stigma by example, and (4) preaching and teaching compassion.
Fig. 3 Leaders’ denominations
Fig. 4 Number of congregants
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Fig. 5 Length of time
Theme 1: Disseminating Information about HIV/AIDS through a Combination of Communication Modes In disseminating information about HIV/AIDS, the churches that are part of the HIV/AIDS interfaith-based organization use several modes of communication to educate and create awareness on HIV/AIDS. Most of the methods include some form of interpersonal communication. A pastor described bringing together men in the church to give information about HIV/AIDS for which the session did not only include men from the church but also people from the community. Also, other forms of interpersonal communication methods include communicating with people during health events about basic HIV/AIDS facts and stigma. Again, like when we have our health fairs and our health seminars, general health fairs and seminars for the church. We will definitely have a booth setup for that, but I think within each of us many of the members will carry that mission (church leader 5, personal communication, July 23, 2009). The methods for circulating information about the disease did not only include giving information during health seminars, but most of the churches used various forms of print media to distribute information. Several churches discussed making sure that the information is given through the church bulletin. Furthermore, church leaders appeared to be aware of media informational tools that could be used to reach their congregations and community. We had a prayer breakfast and inside of the breakfast we took about 50 min and we shared the Out of Control AIDS in Black America report begun by Peter Jennings. And, we shared that and watched that and then facilitated a discussion around it with the men as well as we had a doctor that came and shared with the men more facts about HIV/AIDS (church leader 1, personal communication, July 23, 2009). It is apparent that the African American churches that are church partners with the HIV/ AIDS interfaith-based organization rely on interpersonal communication modes to stress the importance of not engaging in behaviors that put an individual at risk for the disease. However, as one church leader explained, the discourse through sermons or workshops is not adequate in accomplishing this goal. ‘‘We have the professional from the medical field, the interpersonal from personal experience with folks that are infected with the virus’’ (church leader 2, personal communication, July 23, 2009). In addition, one church uses
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symbols of HIV/AIDS to initiate questions and discussions. Church leaders wear red ribbons during certain Sundays to remind people that HIV/AIDS is still prevalent, and there are people who are suffering from the disease and in need of support. ‘‘They will want to know what the ribbon is for and we tell them this is for people who have HIV and AIDS’’ (church leader 4, personal communication, July 23, 2009). Most of the church leaders use various modes of communication that mainly consist of print materials such as pamphlets and placing educational brochures on bulletin boards. However, other clergy rely on more interpersonal channels. One of the churches decided to use an educational approach that involves teaching congregants and the community through classes. ‘‘We put on every year a 6 week HIV 101 /102 comprehensive course which is not only open to members of our church but to the community at large’’ (church leader 3, personal communication, July 23, 2009). The courses are the church’s method of a more comprehensive approach to educating about HIV/AIDS, which also stresses the importance of caring and compassion toward those with the disease. Through different forms of communication, the African American church leaders are trying to keep the actualities of HIV/AIDS in the Black community in the consciousness of congregants and people living in the surrounding communities. Theme 2: A Sense of Responsibility and Obligation to Create More Awareness about HIV/AIDS From the church leaders’ responses, it is evident that there is a feeling that the church has a special role and a responsibility of raising the levels of awareness about HIV/AIDS within the African American community. Leaders also acknowledge that the church has to be an institution in the African American community that is in the forefront of creating more awareness about the disease. Furthermore, because of the toll HIV/AIDS has taken on African Americans, many leaders felt that it was their duty to offer an HIV/AIDS ministry for people within the church community and to support people who are HIV/AIDS positive. We should be openly talking about HIV/AIDS. We should be that voice out in the community letting people know that we are willing to be open and willing to discuss that issue and to share with persons about what we are going to be doing in the community, so people will not have to go the route alone (church leader 6, personal communication, July 29, 2009). Addressing HIV/AIDS through the church is very important. The US Religious Landscape Survey conducted by the Pew Forum on Religion and Public Life found that more than 85% of African Americans self-identified as belonging to a religious group. In addition, almost 80% of African Americans reported that religion is important to them (The Pew Forum 2009). The leaders agreed that the church should be an advocate for those infected with the disease, and the church should be at the forefront of HIV/AIDS education. Even if it is something as simple as putting your statistics in your bulletin or having someone from … or other HIV/AIDS agency come and talk to your congregation. Being on a Sunday for an appeal or a Saturday you can have workshops or a couple of minutes prior to your Bible study on Wednesday. I think if you do just little things like that it could make a huge difference or even have posters in your church or put things on your web site just to make persons aware (church leader 7, personal communication, August 3, 2009).
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In order to stay committed to educating about HIV/AIDS and serving people who are infected with the virus, the church leaders plan to continue their HIV/AIDS ministries. Most of the leaders explained that they have had success with most of their events that focused on learning about HIV/AIDS; however, one leader expressed concerns regarding low attendance from congregants at various events. Although some of the events did not have a significant turnout, the leader said the church will continue to find other ways of educating the community. We are going to try to arrange something through the housing authority and perhaps have it with one of the housing areas that the housing authority owns and perhaps setup and offer a seminar that way. Therefore, we are doing community outreach and hopefully helping somebody understand about HIV and AIDS (church leader 5, personal communication, July 23, 2009). The discourse of the church leaders was very positive and communicated that the churches associated with an interfaith-based program takes an all-inclusive approach in HIV/AIDS education. Most of the church leaders have been partners with the organization for more than five years; therefore, it is understandable that church leaders try to use a comprehensive model to enlighten church members and the community on behaviors that increase the risk of HIV/AIDS. Theme 3: Reducing Stigma by Example The church leaders encourage their members to take an HIV/AIDS test, and most of the churches offer HIV/AIDS testing onsite during various events. Moreover, the leaders stressed the importance of each individual knowing his/her HIV/AIDS status. There are church leaders who use themselves as examples for their church members. The goal is to help people learn their HIV/AIDS status and to reduce the stigma. One church efforts were so successful that the leaders had to invite the local health department back twice for more HIV/AIDS testing. The church leader explained that there is power in using oneself as an example. …our pastor was the first one to get tested. In fact, he was tested inside the service, so it was in front of the church members that he was tested and then the rest of the church leadership were tested as well so our college elders and school of ministers, our board of deacons on so forth and so on lead the way (personal communication, church leader 1, July 2009). HIV/AIDS stigma has been an issue in the Black community since the pandemic started during the early 1980s. According to the CDC (2007a), a challenge of reducing HIV/AIDS in the Black community is denial. In many cases, African Americans may not discuss issues which are taboo such as same sex relationships and illegal drug use. A lack of open and honest discussions about the behaviors that put African Americans at greater risk for the disease has been a problem throughout the HIV/AIDS crisis. However, it appears that some Black churches are willing to address the disease. A self-described HIV-positive church leader discussed how the congregation has been accepting of the individual’s positive status. When I joined that church, they really loved me you know. I felt genuine love from them and I just opened up and started sharing with them more things about myself, and the love and embrace that they showed me; you know, the congregation actually
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loved me until I could love myself. I saw Christ in them before I could see Christ in myself and for myself (personal communication, church leader 2, July 2009). The aforementioned quote shows that some African American church leaders are embracing and accepting people who are HIV/AIDS positive and are more open to discussing behaviors that may increase an individual’s risk of becoming HIV/AIDS positive. Twenty years ago, it may have been almost unheard off to have a church leader within an African American church who is HIV positive; therefore, it shows that churches within the Black community are acknowledging the need for more HIV/AIDS awareness, education, and testing within their church communities. Theme 4: Preaching and Teaching Compassion The church leaders expressed the importance of reminding congregants that it does not matter how a person contracted the disease. However, making sure people who need HIV/ AIDS services get proper care and treatment should be a concern for the church and surrounding communities. I think one of the things that we have always tried to get out is not to look at HIV and AIDS as death sentence. And, it is not a curse against any particular group but this particular disease can and it has touched everybody in some way, so what our responsibility as people as a body of believers is to always see it through the eyes of Christ and to minister to every person and especially that person who is being challenged by HIV from a hand of love (personal communication, church leader 3, July 2009). There is a sense among the church leaders that people who are HIV/AIDS positive should have not only proper medical care, but the church should be a place where HIV/ AIDS-positive individuals should be able to obtain emotional support. Also, it should be a community that is free from stigma which can cause a negative effect on an individual’s overall health. The church leaders who participated in the study expressed that their church communities address HIV/AIDS stigma in the African American community. One means of educating churchgoers and the surrounding communities about HIV/AIDS is through testing. Almost all churches involved in the study conducted HIV/AIDS testing onsite. If HIV/AIDS testing was not available through the church, leaders would help churchgoers find a testing site in the community.
Discussion This study conducted telephone interviews with African American church leaders to gain insight about how their churches communicate prevention and health promotion information about HIV/AIDS. Communication plays a critical role in reducing the incidence of HIV infection and AIDS (UNAIDS 2004). The study revealed optimism about the role the church can play in helping to eliminate HIV disease (McNeal and Perkins 2007). It uncovered key characteristics of HIV/AIDS communications supported by church leaders. Communications identified were those that (a) embody diverse forms (e.g., print, verbal, electronic), (b) reflect an obligation to protect the well-being of congregants and reduce HIV/AIDS-associated stigma, and (c) convey love and caring toward those affected by the disease. In addition, African American church leaders accepted responsibility for helping
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to address HIV/AIDS prevention needs in the community and sought to fulfill this duty in a Godly or loving manner. This study corroborates findings of a recent report (Khosrovani et al. 2008) that examined the status of HIV/AIDS education and support services by Black churches. Khosrovani et al. (2008) identified sermons, informal and formal discussions, counseling sessions, and printed materials as effective strategies to educate congregants about HIV/ AIDS. Also, similar to the current study, Khosrovani et al. (2008), p. 667 found that ‘‘Nearly all of the ministers were convinced that churches must carry the burden of informing and educating the public.’’ Although church leaders in the current study did not convey that they perceived a sense of burden in providing HIV/AIDS-related services, they did reveal the need and desire to partner with other community organizations (e.g., housing authority) in hopes of finding the most effective ways of increasing awareness about the disease. Concurrently, NC has more than 10 historically Black colleges and universities that offer the opportunity to partner with African American churches to create successful HIV/ AIDS prevention programs. Partnerships might include church leaders and college/university lecturers, professors, students, and staff. Several of NC’s churches share a history of collaboration geared toward enhancing community health outcomes (Jackson and Reddick 1999; Reid et al. 2003). In fact, some churches in the metropolitan city and surrounding areas have routinely presented HIV/AIDS education to diverse community groups and congregations. Findings in this study also support those reported by Timmons (2009) who found that, when African American pastors were asked about the role of the church in implementing health programs, they reported that they valued their position as health advocate: ‘‘When environmental factors negatively affect the well-being of congregants whose needs are not being met within the community, the church intercedes’’ (p. 99). The current study found that church leaders were not only HIV/AIDS prevention advocates, but one leader also acknowledged his position as a role model for de-stigmatizing HIV/AIDS and related testing. HIV testing can help to normalize testing and convey that morality does not preclude the need for testing by all persons: church members and leaders. This finding highlights the need for future studies that test the effect of health behavior modeling by pastors on behavioral outcomes of their congregants. Communications designed to minimize HIV/AIDS-related stigma was described both in this study, and a similar report that examined potential contributions that Black churches provide in the prevention of HIV/AIDS (McNeal and Perkins 2007). McNeal and Perkins (2007), p. 227 described health education as the factor that helped congregants to decrease HIV/AIDS-related stigma: ‘‘It was through HIV/AIDS education that helped…Our church is designed to accept people where they are.’’ Since elimination of stigma is believed to be a potent deterrent to HIV/AIDS prevention (Young et al. 2009), this finding is an especially important one to consider at a time when HIV/AIDS is predicted to be severely underdiagnosed (CDC 2007a). Eliminating HIV-related stigma is also critical since people who are infected (with HIV), but unaware of the infection, are unable to engage in therapies that can mitigate the disease in themselves and others. Similarly, church leaders in this study ‘‘preached’’ about the spiritual mission of the church and the role of its members as unbiased and forgiving caregivers. The leaders reminded congregants of their responsibility as a body of believers (in God) where every person is loved regardless of the nature of their illness or how it was contracted.
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This study supports the importance of the church as an institution that can help to meet physical, social, and emotional needs of the community. It also highlights how pastors prioritize the use of diverse communication strategies (i.e., print, verbal) to increase knowledge about HIV/AIDS and the church’s commitment to support those affected by the disorder. The study also points to the role of the church as collaborator with other organizations in the elimination of HIV disease. These findings are in light of a prevailing belief that African American churches generally resist acknowledging the problem of HIV/ AIDS in their community (McNeal and Perkins 2007). This study informs this belief by identifying attributes of HIV/AIDS-related communications that are acceptable to some African American church leaders.
Conclusions Involving African American churches in health education is just one part of reducing the spread of HIV/AIDS. As a culturally significant institution, some churches appear to be willing to play a more active role in HIV/AIDS prevention. They may be prepared to model behaviors that reduce HIV-related stigma, lead congregants in providing care for those affected by the disease, and acknowledge responsibility for addressing community health needs associated with it. Accordingly, implications and recommendations related to these findings are presented.
Implications and Recommendations 1. African American churches that communicate HIV/AIDS prevention education can serve as models for other churches. 2. African American church leaders should be assessed for their preferred mode(s) of communication about HIV/AIDS education. 3. African American churches can be supported to address health promotion initiatives that are prioritized within their organizational strategic plans. 4. Universities/colleges can offer education and skill building sessions that help African American church leaders perform as HIV/AIDS peer educators. 5. Universities/colleges can support faculty and staff to provide HIV/AIDS education to (and in collaboration with) African American churches. 6. Openness to discussing HIV/AIDS can be fostered among African American church leaders who are members of the NC interfaith-based program. 7. Community health organizations and partners can prepare and/or provide culturally relevant, printed and verbal, HIV/AIDS educational resources to African American churches to increase congregants’ knowledge and awareness about the disease. Acknowledgment I would like to thank the Smith Institute for Applied Research for providing funding for the current research project.
References Berg, B. L. (2001). Qualitative research methods: For the social sciences (4th ed.). Boston: Allyn and Bacon.
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Blank, M. B., Mahmood, M., Fox, J. C., & Guterbock, T. (2002). Alternative mental health services: The role of the Black church in the South. American Journal of Public Health, 92(10), 1668–1672. Centers for Disease Control and Prevention (CDC). (2007a). Rapid HIV testing in outreach and other community settings—United States. Morbidity and Mortality Weekly Report, 56(47), 1233–1237. Centers for Disease Control and Prevention (CDC). (2007b). HIV/AIDS and African Americans [cited 2009 July 28]; Available from: http://www.cdc.gov/hiv/topics/aa/index.htm. Centers for Disease Control and Prevention (CDC). (2007c). Is there a connection between HIV and other sexually transmitted diseases? [cited 2008 August 11]; Available from: http://www.cdc.gov/hiv/ resources/qa/qa24.htm. Centers for Disease Control and Prevention (CDC). (2008a). HIV/AIDS among women [cited 2009 August 10]; Available from: http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm. Centers for Disease Control and Prevention (CDC). (2008b). HIV prevalence estimates United States, 2006, 57(39), 1073–1076 [cited 2009 July 28]; Available from: http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5739a2.htm. Cohen, C. J. (1999). The boundaries of blackness: AIDS and the breakdown of Black politics. Chicago, Il: University of Chicago Press. Collins, C. E., Whiters, D. L., & Braithwaite, R. (2007). The SAVED SISTA project: A faith-based HIV prevention program for Black women in addiction recovery. American Journal of Health Studies, 22(2), 76–82. Francis, S. A., & Liverpool, J. (2009). A review of faith-based HIV prevention programs. Journal of Religion and Health, 48(1), 6–15. Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter. Hamilton, C. V. (1972). The black preacher in America. New York: Morrow. Isaac, E. P., Rowland, M. L., & Blackwell, L. E. (2007). Fighting health disparities: The educational role of the African American church. Cross Currents, 57(2), 261–265. Jackson, R. S., & Reddick, B. (1999). The African American church and university partnerships: Establishing lasting collaborations. [Abstract]. Health Education and Behavior, 26(5), 663–674. Kearney, M. H., Murphy, S., & Rosenbaum, M. (1994). Mothering on crack cocaine: A grounded theory analysis. [Abstract]. Social Science and Medicine, 38(2), 351–361. Khosrovani, M., Poudeh, R., & Parks-Yancy, R. (2008). How African-American ministers communicate HIV/AIDS-related health information to their congregants: A survey of selected Black churches in Houston, TX. Mental Health, Religion and Culture, 11(7), 661–670. Levin, J. S. (1984). The role of the Black church in community medicine. Journal of the National Medical Association, 76(5), 477–483. Levin, J. S. (1986). Roles for the Black pastor in preventive medicine. Pastoral Psychology, 35(2), 94–103. Lincoln, C. E., & Mamiyam, L. H. (1990). The Black church in the African-American experience. Durham, NC: Duke University Press. Markens, S., Fox, S. A., Taub, B., & Gilbert, L. (2002). Role of Black churches in health promotion programs: Lessons from the Los Angeles mammography promotion in churches program. American Journal of Public Health, 92(5), 805–810. McNeal, C., & Perkins, T. (2007). Potential roles of Black churches in HIV/AIDS prevention. Journal of Human Behavior in the Social Environment, 15(2/3), 219–232. Neighbors, H. W., Musick, M. A., & Williams, D. R. (1998). The African American minister as a source of help for serious personal crises: Bridge or barrier to mental health care? Health Education and Behavior, 25(6), 759–777. North Carolina Department of Health and Human Services (January, 2003). AIDS Case Report for 2002, North Carolina [cited 2009 June 1]; Available from: http://www.rabies.ncdhhs.gov/epi/hiv/pdf/ aids2002.pdf. North Carolina Department of Health and Human Services (September, 2007). Epidemiologic profile for HIV/ STD prevention and care planning [cited 2008 August 11]; Available from: http://www.rabies.ncdhhs. gov/epi/hiv/epiprofile0707/Epi_Profile_2007.pdf. Reid, L., Hatch, J., & Parrish, T. (2003). The role of historically Black university and the Black church in community-based health initiatives: The project direct experience. [Abstract]. Journal of Public Health Management and Practice, 9, 70–73. Rogers, E. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press. Strauss, A., & Corbin, J. (1990). Basic of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications, Inc. Taylor, R. J., Ellison, C. G., Chatters, L. M., Levin, J. S., & Lincoln, K. D. (2000). Mental health services in faith communities: The role of clergy in Black churches. Social Work, 45(1), 73–87.
123
878
J Relig Health (2012) 51:865–878
The Pew Forum on Religion and Public Life (2009). A religious portrait of African-Americans [cited 2009 August 10]; Available from: http://pewforum.org/docs/?DocID=389. Timmons, S. M. (2009). Pastors’ influence on research-based health programs in church settings. Journal of Health Disparities Research and Practice, 3(2), 92–102. UNAIDS (2004). The media and HIV/AIDS: Making the difference [cited 2009 September 9]; Available from: http://data.unaids.org/Publications/IRC-pub06/JC1000-Media_en.pdf. Ward, E. G. (2005). Homophobia, hypermasculinity, and the US Black church. Culture, Health and Sexuality, 7(5), 493–504. Young, S. D., Monin, B., & Owens, D. (2009). Opt-out testing for stigmatized diseases: A social psychological approach to understanding the potential effect of recommendations for routine HIV testing. Health Psychology, 28(6), 675–681.
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