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Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality

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Abstract

Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation’s alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans’ religious participation, faith and spirituality may impact our nation’s HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.

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References

  1. Centers for Disease Control and Prevention. HIV in the United States by geography. Atlanta, Georgia; 2017.

  2. Centers for Disease Control and Prevention. HIV among African Americans. Atlanta, Georgia; 2017.

  3. Centers for Disease Control and Prevention. HIV surveillance report, 2016; November 2017.

  4. Centers for Disease Control and Prevention. HIV in the southern United States May 2016; 2016.

  5. Friedman SR, Cooper HL, Osborne AH. Structural and social contexts of HIV risk among African americans. Am J Public Health. 2009;99(6):1002–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Adimora AA, Schoenbach VJ, Doherty IA. HIV and African americans in the southern United States: sexual networks and social context. Sex Transm Dis. 2006;33(7):S39–45.

    Article  PubMed  Google Scholar 

  7. Aral SO, Adimora AA, Fenton KA. Understanding and responding to disparities in HIV and other sexually transmitted infections in African Americans. Lancet. 2008;372(9635):337–40.

    Article  PubMed  Google Scholar 

  8. Tillerson K. Explaining racial disparities in HIV/aids incidence among women in the us: a systematic review. Stat Med. 2008;27(20):4132–43.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hallfors DD, Iritani BJ, Miller WC, Bauer DJ. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health. 2007;97(1):125–32.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21(15):2083–91.

    Article  PubMed  Google Scholar 

  11. Rosenberg ES, Millett GA, Sullivan PS, del Rio C, Curran JW. Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study. Lancet HIV. 2014;1(3):e112–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Johnson AS, Hess KL, Hu S, et al. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data: United States and 6 dependent areas, 2016; 2018.

  13. Stopka TJ, Brinkley-Rubinstein L, Johnson K, et al. HIV clustering in mississippi: spatial epidemiological study to inform implementation science in the deep south. JMIR Public Health Surveill. 2018;4(2):e35.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nunn A, Yolken A, Cutler B, et al. Geography should not be destiny: focusing HIV/aids implementation research and programs on microepidemics in us neighborhoods. Am J Public Health. 2014;104(5):775–80.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chan PA, Patel R, Mena L, et al. One year retention in PrEP care outcomes in a three-site implementation science program in the United States. Paper presented at: HIV Research 4 Prevention 2018; Madrid, Spain.

  16. Arnold T, Brinkley-Rubinstein L, Chan PA, et al. Social, structural, behavioral and clinical factors influencing retention in pre-exposure prophylaxis (PrEP) care in Mississippi. PLoS ONE. 2017;12:e0172354.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Arnold T, Gomilla C, Bologna ES, et al. Young African American msms speak out: recommendation for enhancing retention in PrEP care for us implementation science programs in the deep south. 9th IAS Conference on HIV Science. Paris, France; July 2017.

  18. Goodenow MM. Nih strategic plan for HIV and HIV-related research, fy 2019/2020. In: Research OoA, ed.

  19. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the united statesending the HIV epidemiceditorial. JAMA. 2019;321(9):844–5.

    Article  PubMed  Google Scholar 

  20. U.S. Department of Health & Human Services. What is ‘ending the HIV epidemic: a plan for america’? 2019; https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. 2019.

  21. Cooperman A, Smith G, Comibert S. U.S. Public becoming less reglious: modest drop in overall rates of belief and practice, but religiously affiliated Americans are as observant as before. 2015; http://www.pewforum.org/2015/11/03/u-s-public-becoming-less-religious/. Accessed 9 Sept 2017.

  22. Vidal AC. Faith-based organizations in community development; 1999.

  23. Campbell MK, Hudson MA, Resnicow K, et al. Church-based health promotion interventions: evidence and lessons learned. Annu Rev Public Health. 2007;28:213–34.

    Article  PubMed  Google Scholar 

  24. Foster PP, Cooper K, Parton JM, Meeks JO. Assessment of HIV/aids prevention of rural African American baptist leaders: implications for effective partnerships for capacity building in American communities. J Natl Med Assoc. 2011;103(4):323–31.

    Article  PubMed  Google Scholar 

  25. Sahgal N, Smith G. A religious portrait of African americans. Paper presented at The Pew forum on religion and public life; 2009.

  26. Coleman JD, Lindley LL, Annang L, Saunders RP, Gaddist B. Development of a framework for HIV/aids prevention programs in African American churches. AIDS Patient Care STDS. 2012;26(2):116–24.

    Article  PubMed  Google Scholar 

  27. Nunn A, Cornwall A, Chute N, et al. Keeping the faith: African American faith leaders’ perspectives and recommendations for reducing racial disparities in HIV/aids infection. PLoS ONE. 2012;7(5):e36172.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Berkley-Patton J, Thompson CB, Martinez DA, et al. Examining church capacity to develop and disseminate a religiously appropriate HIV tool kit with African American churches. J. Urban Health. 2013;90(3):482–99.

    Article  PubMed  Google Scholar 

  29. Foster ML, Arnold E, Rebchook G, Kegeles SM. ‘It’s my inner strength’: spirituality, religion and HIV in the lives of young African American men who have sex with men. Cult Health Sex. 2011;13(9):1103–17.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nunn A, Parker S, McCoy K, et al. African American clergy perspectives about the HIV care continuum: results from a qualitative study in jackson, mississippi. Ethn Dis. 2018;28(2):85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Prevention CfDCa. High-impact prevention: At-a-glance. In: National Center for HIVB/AIDS Viral Hepatitis S, and TB Prevention, ed; 2018.

  32. Payne-Foster P, Bradley EL, Aduloju-Ajijola N, et al. Testing our faithh: HIV stigma and knowledge after a faith-based HIV stigma reduction intervention in the rural south. AIDS Care. 2018;30(2):232–9.

    Article  PubMed  Google Scholar 

  33. Ellison CG, Sherkat DE. The “semi-involuntary institution” revisited: regional variations in church participation among black americans. Soc Forces. 1995;73(4):1415–37.

    Article  Google Scholar 

  34. Taylor RJ, Ellison CG, Chatters LM, Levin JS, Lincoln KD. Mental health services in faith communities: the role of clergy in black churches. Soc Work. 2000;45(1):73–87.

    Article  CAS  PubMed  Google Scholar 

  35. Wyatt GE, Williams JK, Henderson T, Sumner L. On the outside looking in promoting: HIV/AIDS research initiated by African American investigators. Am Public Health. 2009;99(S1):S48–53.

    Article  Google Scholar 

  36. Sutton MY, Lanier YA, Willis LA, et al. Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities. Am J Public Health. 2013;103(12):2207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nunn A, Cornwall A, Thomas G, et al. What’s god got to do with it? Engaging African-American faith-based institutions in HIV prevention. Glob Public Health. 2013;8(3):258–69.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nunn A, Sanders J, Carson L, et al. African American community leaders’ policy recommendations for reducing racial disparities in HIV infection, treatment, and care: results from a community-based participatory research project in philadelphia, pennsylvania. Health Promot Pract. 2015;16(1):91–100.

    Article  PubMed  Google Scholar 

  39. Abara W, Coleman JD, Fairchild A, Gaddist B, White J. A faith-based community partnership to address HIV/aids in the southern United States: implementation, challenges, and lessons learned. J Relig Health. 2015;54(1):122–33.

    Article  PubMed  Google Scholar 

  40. Coleman JD, Tate AD, Gaddist B, White J. Social determinants of HIV-related stigma in faith-based organizations. Am J Public Health. 2016;106(3):492–6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Aholou TM, Cooks E, Murray A, et al. “Wake up! HIV is at your door”: African American faith leaders in the rural south and HIV perceptions: a qualitative analysis. J Relig Health. 2016;55(6):1968–79.

    Article  PubMed  Google Scholar 

  42. Foster PP, Gaskins SW. Older African americans’ management of HIV/AIDS stigma. AIDS Care. 2009;21(10):1306–12.

    Article  PubMed  Google Scholar 

  43. Foster PP, Thomas M, Lewis D. Reverse migration, the black church and sexual health: implications for building HIV/aids prevention capacity in the deep south. AIMS Public Health. 2016;3(2):242–54.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Berkley-Patton J, Bowe-Thompson C, Bradley-Ewing A, et al. Taking it to the pews: a cbpr-guided HIV awareness and screening project with black churches. AIDS Educ Prev. 2010;22(3):218–37.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Berkley-Patton J, Moore EW, Hawes SM, Thompson CB, Bohn A. Factors related to HIV testing among an African American church-affiliated population. AIDS Educ Prev. 2012;24(2):148–62.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Berkley-Patton J, Thompson CB, Bradley-Ewing A, et al. Identifying health conditions, priorities, and relevant multilevel health promotion intervention strategies in African American churches: a faith community health needs assessment. Eval Progr Plan. 2018;67:19–28.

    Article  Google Scholar 

  47. Berkley-Patton J, Thompson CB, Moore E, et al. An HIV testing intervention in African American churches: pilot study findings. Ann Behav Med. 2016;50(3):480–5.

    Article  PubMed  Google Scholar 

  48. Berkley-Patton JY, Moore E, Berman M, et al. Assessment of HIV-related stigma in a US faith-based HIV education and testing intervention. J Int AIDS Soc. 2013;16(3 Suppl 2):18644.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Berkley-Patton JY, Thompson CB, Moore E, et al. Feasibility and outcomes of an HIV testing intervention in African American churches. AIDS Behav. 2018;23(1):76–90.

    Article  Google Scholar 

  50. Wingood GM, Simpson-Robinson L, Braxton ND, Raiford JL. Design of a faith-based HIV intervention: successful collaboration between a university and a church. Health Promot Pract. 2011;12(6):823–31.

    Article  PubMed  Google Scholar 

  51. Lanzi RG, Footman A, JAckson R, et al. Love with no exceptions: a community-engaged faith-based HIV training with African methodist episcopal (ame) clergy and laity in the deep south. Paper presented at 146th Annual American Public Health Association Meeting; San Diego, CA; November, 2018.

  52. Lanzi RG, Footman AP, Jackson E, et al. Love with no exceptions: a faith-based community partnership for HIV training in the African methodist episcopal church—a statewide initiative in Alabama. AIDS Behav.

  53. Pichon LC, Griffith DM, Campbell B, et al. Faith leaders’ comfort implementing an HIV prevention curriculum in a faith setting. J Health Care Poor Underserved. 2012;23(3):1253–65.

    Article  PubMed  Google Scholar 

  54. Pichon LC, Powell TW, Ogg SA, Williams AL, Becton-Odum N. Factors influencing black churches’ readiness to address HIV. J Relig Health. 2016;55(3):918–27.

    Article  PubMed  Google Scholar 

  55. Pichon LC, Williams TT, Campbell B. An exploration of faith leaders’ beliefs concerning HIV prevention: thirty years into the epidemic. Fam Community Health. 2013;36(3):260–8.

    Article  PubMed  Google Scholar 

  56. Obong’o CO, Pichon LC, Powell TW, Williams AL. Strengthening partnerships between black churches and HIV service providers in the United States. AIDS Care. 2016;28(9):1119–23.

    Article  PubMed  Google Scholar 

  57. Jeffries WL IV, Sutton MY, Eke AN. On the battlefield: the black church, public health, and the fight against HIV among African American gay and bisexual men. J Urban Health. 2017;94(3):384–98.

    Article  PubMed  Google Scholar 

  58. Lassiter JM. Reconciling sexual orientation and christianity: Black same-gender loving men’s experiences. Ment Health Relig Cult. 2015;18(5):342–53.

    Article  Google Scholar 

  59. Baldwin JA, Daley E, Brown EJ, et al. Knowledge and perception of STI/HIV risk among rural African-American youth: lessons learned in a faith-based pilot program. J HIV AIDS Prev Child Youth. 2008;9(1):97–114.

    Article  Google Scholar 

  60. Collins CE, Whiters DL, Braithwaite R. The saved sista project: a faith-based HIV prevention program for black women in addiction recovery. Am J Health Stud. 2007;22(2):76–82.

    Google Scholar 

  61. Medved Kendrick H. Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature. AIDS Care. 2017;29(1):1–13.

    Article  Google Scholar 

  62. Doolittle B, Justice A, Fiellin D. Religion, spirituality, and HIV clinical outcomes: a systematic review of the literature. AIDS Behav. 2018;22(6):1792–801.

    Article  CAS  PubMed  Google Scholar 

  63. Van Wagoner N, Mugavero M, Westfall A, et al. Church attendance in men who have sex with men diagnosed with HIV is associated with later presentation for HIV care. Clin Infect Dis. 2013;58(2):295–9.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Balaji AB, Oster AM, Viall AH, et al. Role flexing: how community, religion, and family shape the experiences of young black men who have sex with men. AIDS Patient Care STDS. 2012;26(12):730–7.

    Article  PubMed  Google Scholar 

  65. Williams MV, Palar K, Derose KP. Congregation-based programs to address HIV/AIDS: elements of successful implementation. J Urban Health. 2011;88(3):517–32.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Ransome Y, Bogart L, Nunn A, et al. Faith leaders’ messaging is essential to enhance HIV prevention among black Americans: results from the 2016 national survey on HIV in the black community (NSHBC). BMC Public Health. 2018;18(1):1392.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Centers for Disease Control and Prevention. HIV and youth. Atlanta, GA; 2018.

  68. Centers for Disease Control Prevention. Results from the school health policies and practices study 2014. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2015. p. 60–74.

    Google Scholar 

  69. Lightfoot AF, Woods BA, Jackson M, et al. “ In my house”: laying the foundation for youth HIV prevention in the black church. Prog Community Health Partnersh. 2012;6(4):451–6.

    Article  PubMed  Google Scholar 

  70. World Health Organization. Faith-based organizations play a major role in HIV/aids care and treatment in sub-Saharan Africa; 2007.

  71. Blevins J. Are faith-based organizations assets or hindrances for adolescents living with HIV-they are both. Brown J World Aff. 2015;22:25.

    Google Scholar 

  72. Fulton BR. Black churches and HIV/aids: factors influencing congregations’ responsiveness to social issues. J Sci Study Relig. 2011;50(3):617–30.

    Article  PubMed  Google Scholar 

  73. Centers for Disease Control and Prevention. Structural interventions; 2017.

  74. Bush S, Magnuson D, Rawlings MK, et al. Racial characteristics of ftc/tdf for pre-exposure prophylaxis (PrEP) users in the US. ASM Microbe/ICAAC; 2016.

  75. National HIV/AIDS strategy for the United States: Updated to 2020. In: Policy WHOoNA, ed; 2015.

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Authors and Affiliations

  1. Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA

    Amy Nunn & Cassandra Sutten-Coats

  2. Rhode Island Public Health Institute, Providence, USA

    Amy Nunn, Cassandra Sutten-Coats & Tiara C. Willie

  3. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Antlanta, USA

    William L. Jeffries IV

  4. Department of Community Medicine/Population Health, University of Alabama School of Medicine, Tuscaloosa Regional Campus, Tuscaloosa, USA

    Pamela Foster

  5. School of Nursing & Health Studies, University of Washington – Bothell, Bothell, USA

    Katryna McCoy

  6. Warren Alpert School of Medicine, Brown University, Providence, USA

    Tiara C. Willie

  7. Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA

    Yusuf Ransome

  8. Department of Health Behavior, University of Alabama at Birmingham, Birmingham, USA

    Robin Gaines Lanzi

  9. Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA

    Robin Gaines Lanzi & Edward Jackson

  10. University of Missouri Kansas City, Kansas City, USA

    Jannette Berkley-Patton

  11. School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA

    Michael Keefer

  12. School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, USA

    Jason D. Coleman

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  1. Amy Nunn
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Correspondence to Amy Nunn.

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Nunn, A., Jeffries, W.L., Foster, P. et al. Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality. AIDS Behav 23 (Suppl 3), 319–330 (2019). https://doi.org/10.1007/s10461-019-02631-4

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