AIDS and Behavior

, Volume 23, Supplement 3, pp 319–330 | Cite as

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

  • Amy NunnEmail author
  • William L. JeffriesIV
  • Pamela Foster
  • Katryna McCoy
  • Cassandra Sutten-Coats
  • Tiara C. Willie
  • Yusuf Ransome
  • Robin Gaines Lanzi
  • Edward Jackson
  • Jannette Berkley-Patton
  • Michael Keefer
  • Jason D. Coleman
Original Paper


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.


HIV prevention Southern United States Faith-based Organizations African Americans 


Compliance with Ethical Standards

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Research Involving Human Participants and/or Animals

This article did not include human or animal subjects, therefore, no institutional review board approval was needed.


  1. 1.
    Centers for Disease Control and Prevention. HIV in the United States by geography. Atlanta, Georgia; 2017.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention. HIV among African Americans. Atlanta, Georgia; 2017.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. HIV surveillance report, 2016; November 2017.Google Scholar
  4. 4.
    Centers for Disease Control and Prevention. HIV in the southern United States May 2016; 2016.Google Scholar
  5. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 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.Google Scholar
  13. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 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.Google Scholar
  16. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 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.Google Scholar
  18. 18.
    Goodenow MM. Nih strategic plan for HIV and HIV-related research, fy 2019/2020. In: Research OoA, ed.Google Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 20.
    U.S. Department of Health & Human Services. What is ‘ending the HIV epidemic: a plan for america’? 2019; 2019.
  21. 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; Accessed 9 Sept 2017.
  22. 22.
    Vidal AC. Faith-based organizations in community development; 1999.Google Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 25.
    Sahgal N, Smith G. A religious portrait of African americans. Paper presented at The Pew forum on religion and public life; 2009.Google Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Prevention CfDCa. High-impact prevention: At-a-glance. In: National Center for HIVB/AIDS Viral Hepatitis S, and TB Prevention, ed; 2018.Google Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 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.PubMedCrossRefGoogle Scholar
  42. 42.
    Foster PP, Gaskins SW. Older African americans’ management of HIV/AIDS stigma. AIDS Care. 2009;21(10):1306–12.PubMedCrossRefGoogle Scholar
  43. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 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.CrossRefGoogle Scholar
  47. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 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.CrossRefGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. 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.Google Scholar
  52. 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. Google Scholar
  53. 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.PubMedCrossRefGoogle Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. 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.PubMedCrossRefGoogle Scholar
  56. 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.PubMedCrossRefGoogle Scholar
  57. 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.PubMedCrossRefGoogle Scholar
  58. 58.
    Lassiter JM. Reconciling sexual orientation and christianity: Black same-gender loving men’s experiences. Ment Health Relig Cult. 2015;18(5):342–53.CrossRefGoogle Scholar
  59. 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.CrossRefGoogle Scholar
  60. 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. 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.CrossRefGoogle Scholar
  62. 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.PubMedCrossRefGoogle Scholar
  63. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Centers for Disease Control and Prevention. HIV and youth. Atlanta, GA; 2018.Google Scholar
  68. 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. 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.PubMedCrossRefGoogle Scholar
  70. 70.
    World Health Organization. Faith-based organizations play a major role in HIV/aids care and treatment in sub-Saharan Africa; 2007.Google Scholar
  71. 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. 72.
    Fulton BR. Black churches and HIV/aids: factors influencing congregations’ responsiveness to social issues. J Sci Study Relig. 2011;50(3):617–30.PubMedCrossRefGoogle Scholar
  73. 73.
    Centers for Disease Control and Prevention. Structural interventions; 2017.Google Scholar
  74. 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.Google Scholar
  75. 75.
    National HIV/AIDS strategy for the United States: Updated to 2020. In: Policy WHOoNA, ed; 2015.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Amy Nunn
    • 1
    • 2
    Email author
  • William L. JeffriesIV
    • 3
  • Pamela Foster
    • 4
  • Katryna McCoy
    • 5
  • Cassandra Sutten-Coats
    • 1
    • 2
  • Tiara C. Willie
    • 2
    • 6
  • Yusuf Ransome
    • 7
  • Robin Gaines Lanzi
    • 8
    • 9
  • Edward Jackson
    • 9
  • Jannette Berkley-Patton
    • 10
  • Michael Keefer
    • 11
  • Jason D. Coleman
    • 12
  1. 1.Center for Health Equity ResearchBrown UniversityProvidenceUSA
  2. 2.Rhode Island Public Health InstituteProvidenceUSA
  3. 3.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAntlantaUSA
  4. 4.Department of Community Medicine/Population HealthUniversity of Alabama School of Medicine, Tuscaloosa Regional CampusTuscaloosaUSA
  5. 5.School of Nursing & Health StudiesUniversity of Washington – BothellBothellUSA
  6. 6.Warren Alpert School of MedicineBrown UniversityProvidenceUSA
  7. 7.Department of Social and Behavioral SciencesYale School of Public HealthNew HavenUSA
  8. 8.Department of Health BehaviorUniversity of Alabama at BirminghamBirminghamUSA
  9. 9.Center for AIDS ResearchUniversity of Alabama at BirminghamBirminghamUSA
  10. 10.University of Missouri Kansas CityKansas CityUSA
  11. 11.School of Medicine and DentistryUniversity of Rochester Medical CenterRochesterUSA
  12. 12.School of Health and KinesiologyUniversity of Nebraska at OmahaOmahaUSA

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