BROWN (US) — By offering messages about getting tested and staying on treatment, black clergy could break through barriers imposed by traditional preaching about HIV prevention.
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 published 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,” says lead author Amy Nunn, assistant professor of medicine at Brown University.
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)
“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-American 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 says.
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,” says Nunn. “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.”
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 suggest couching the HIV/AIDS epidemic in social justice rather than behavioral terms, Nunn says. They also recommend 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 say 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 Philadelphia. In 2010, for example, she worked with prominent pastors, local media companies, and the office of Mayor Michael 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 says “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.”
Researchers from the University of Pennsylvania contributed to the study.
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