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Keeping the Faith: African American Faith Leaders' Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection- new published study interviews/survey with clergy in Philadelphia- barriers & suggested solutions
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(new study published in PLoSOne) Clergy can fight HIV on faith-friendly terms: "Seven in 10 new infections in Philadelphia are among black residents. With uniquely deep influence in their communities, nearly all of the 27 male and 11 female clergy said they could and would preach and promote HIV testing and treatment. 2% of Philadelphia's African American population is living with HIV/AIDS......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. Faith leaders understood how HIV is transmitted but were generally unaware of the gravity of Philadelphia's epidemic and high HIV incidence in neighborhoods where churches are located......more media and awareness campaigns about the local epidemic with a focus on engaging community leaders.....There is a code of silence in the Black community, which is our downfall with HIV.......Generally speaking, churches, pastors, religious leaders, have been silent. Or they've done what the bishop's said, they've taken the position that AIDS is God's curse on homosexual people. It's ludicrous to think that. We can no longer be silent. The majority of our religious communities never raised the issue, either in preaching, or teaching, or in-group sessions. It's very minimal.......participants commented that HIV/AIDS is still considered a "gay disease" in many African American social circles, explaining that fear of being perceived as gay and broader homophobia inhibited Pastors and Imams from discussing the HIV/AIDS epidemic more openly.......Many faith leaders agreed that addressing human sexuality in faith contexts was still often considered taboo and several often felt that discussing AIDS, human sexuality, risk behaviors, or condom use might be perceived as controversial in their churches or mosques......discussing HIV/AIDS at church might have detrimental impacts on church attendance and tithing, This highlights the fact that economic considerations impact faith leaders' decisions about addressing the epidemic: discussing AIDS has serious economic implications for some faith leaders......many faith leaders identified budget and resource constraints as barriers to hosting regular HIV prevention events.....Several younger pastors commented that they did not feel emboldened to discuss AIDS at church, fearing they might alienate parishioners who preferred not to discuss issues related to human sexuality.......Pastors had diverse opinions about discussing condom use: some felt comfortable discussing condoms, others mentioned they would like to be able to discuss condoms with their congregations but did not feel comfortable, and others endorsed abstinence-only prevention messages.........Taken together, these findings suggest that "diffusion of evidence-based interventions" (DEBIs) ( disseminated by the CDC for HIV prevention may be impractical for faith-based settings. Instead, a more diverse approach that includes tailoring programs to each faith institution will be critical for building public health alliances and HIV/AIDS programs in partnership with African American faith institutions. This may include programs that promote abstinence and delayed sexual debut......Many participants concurred that discussing human sexuality in religious contexts was the greatest barrier to engaging faith communities in HIV prevention efforts......several remarked that de-linking these issues from the AIDS discussion and focusing on HIV testing in particular might help mitigate the challenges and controversies that have historically limited the faith-based response to HIV/AIDS in the African American community.......In the faith community, we've taken positions promoting abstinence for so long that we don't want to mention condoms because people may think we're saying "You should be having promiscuous sex.""

"Another Pastor elaborated on the cultural roots of silence about HIV/AIDS:

The African American community has a cultural disposition not to talk about things that are painful and difficult. We don't talk about people who are drug users in our families or infidelity in marital relationships. We don't talk about sexuality, period. We try to be happier. We've got enough stress. Let's talk about nice things. What's driving this epidemic is our inability to talk about difficult topics, much less about HIV/AIDS."

"Research finds that stigma associated with HIV/AIDS [6] and homophobia [7] is more prevalent among African Americans than individuals of other races. Stigma has hindered efforts to reduce racial disparities in HIV infection among African Americans and has been associated with HIV risk behaviors [8]-[11] and barriers to HIV testing among African Americans"

"The positive, proactive, and concrete recommendations presented in this study provide a roadmap that can inform public policy about how to effectively collaborate with African American faith institutions to reduce the United States' racial disparities in HIV infection"

"This qualitative study has several limitations. First, approximately half of our sample was based on churches and mosques that had existing relationships with the Mayor's Office of Faith Based Initiatives or the principal investigator and are not necessarily representative of the broader Philadelphia faith community or the national African American faith community. Just under half of participants were affiliated with the two largest African American Christian denominations in Philadelphia: Baptists and African Methodist Episcopal churches. We do, however, note that leaders of most of Philadelphia's largest African American religious congregations did participate in the study and there was diversity among the Christian denominations represented. Their perceived barriers and recommendations for faith leaders to engage in HIV prevention may not be nationally representative of all African American faith leaders' opinions."

Peer reviewed article:

May 16, 2012 | Contact: David Orenstein | 401-863-1862

Spreading the word - Pastors march in Philadelphia to help stop the spread of HIV. Pastors say they can reinforce public health messages about testing and social justice that are faith-friendly. Credit: Carol Bates Photography

In the United States, where blacks bear a disproportionate burden of the HIV/AIDS epidemic, black religious institutions could help turn the tide. In a new study in PLoS ONE based on dozens of interviews and focus groups with 38 of Philadelphia's most influential black clergy, physicians and public health researchers find that traditional barriers to preaching about HIV prevention could give way to faith-friendly messages about getting tested and staying on treatment.

PROVIDENCE, R.I. [Brown University] - The public health community has long struggled with how best to reduce HIV infection rates among black Americans, which is seven times that of whites. In a new paper in the journal PLoS ONE, a team of physicians and public health researchers report that African-American clergy say they are ready to join the fight against the disease by focusing on HIV testing, treatment, and social justice, a strategy that is compatible with religious teaching.

"We in public health have done a poor job of engaging African-American community leaders and particularly black clergy members in HIV prevention," said Amy Nunn, lead author of the study and assistant professor of medicine in the Warren Alpert Medical School of Brown University. "There is a common misperception that African American churches are unwilling to address the AIDS epidemic. This paper highlights some of the historical barriers to effectively engaging African American clergy in HIV prevention and provides recommendations from clergy for how to move forward."

The paper analyzes and distills dozens of interviews and focus group data among 38 African-Amereican pastors and imams in Philadelphia, where racial disparities in HIV infection are especially stark. Seven in 10 new infections in the city are among black residents. With uniquely deep influence in their communities, nearly all of the 27 male and 11 female clergy said they could and would preach and promote HIV testing and treatment.

That message, delivered by clergy or other influential figures, would provide a needed complement to decades of public health efforts that have emphasized risk behaviors, Nunn said. Research published and widely reported last year, for example, suggests that testing and then maintaining people on treatment could dramatically reduce new infections because treatment can give people a 96-percent lower chance of transmitting HIV.

"For decades, we've focused many HIV prevention efforts on reducing risky behavior," said Nunn, who is also based at The Miriam Hospital. "Focusing on HIV testing and treatment should be the backbone of HIV prevention strategies and efforts to reduce racial disparities in HIV infection. Making HIV testing routine is the gateway to getting more individuals on treatment. African American clergy have an important role to play in routinizing HIV testing."

The barriers clergy members face

Many religious leaders acknowledged that they've struggled with how best to combat the epidemic, particularly with challenges related to discussing human sexuality in church or mosque, according to the analysis in the paper.

"One time my pastor spoke to young people about sex, mentioning using protection," the paper quotes a clergy member as saying in one example. "I was sitting in the clergy row; you could feel the heat! I was surprised he said that. Comments from the clergy highlighted they were opposed to that. It's a tightrope walk."

Many clergy members also said they face significant barriers to preaching about risk behaviors without still emphasizing abstinence.

"It's my duty as a preacher to tell people to abstain," one pastor told the research team, "but if they're still having sex and they're getting HIV, there has to be another way to handle this."

What clergy can do

Many clergy members suggested couching the HIV/AIDS epidemic in social justice rather than behavioral terms, Nunn said. They also recommended focusing on HIV testing as an important means to help stem the spread of the disease and reduce the stigma.

"We need to standardize testing," one pastor told the researchers. "One thing that we could do immediately is to encourage our congregations - everybody - to get tested. ... We're not dealing with risk factors. And we're all going to get tested once a year. That's the one thing that we could do that doesn't get into our doctrine about sexuality."

In general, many of the religious leaders said they could encourage discussion of HIV not only in main worship services, but also in ministries and community outreach activities.

The streets of Philadelphia

Nunn and collaborators have already begun such work in the city. In 2010, for example, she worked with prominent pastors, local media companies and Mayor Nutter's office of faith-based initiatives to promote and destigmatize HIV testing across the city. This year, in partnership with dozens of churches and other community leaders, she will oversee an HIV prevention campaign that includes door-to-door testing in an entire zip code of Philadelphia with high infection rates.

"Religious leaders are, in fact, willing to engage in dialogue and HIV prevention if you do it in a culturally appropriate and faith-friendly way," Nunn said. "This means that HIV prevention should be couched in social justice and public health rather than in exclusively behavioral terms. HIV testing should be the backbone of any strategy to engage African American clergy in HIV prevention."

In addition to Nunn, the paper's other authors are Michelle Lally and Tim Flanigan of Brown and The Miriam, Alexandra Cornwall of The Miriam, former Brown students Nora Chute and Julia Sanders, Gladys Thomas and Stacey Trooskin of the University Pennsylvania, and George James of the Council for Relationships.

Editors: Brown University has a fiber link television studio available for domestic and international live and taped interviews, and maintains an ISDN line for radio interviews. For more information, call (401) 863-2476.

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