In Alabama, 70 % of new HIV cases are among African Americans. Because the Black Church plays an important role for many African Americans in the south, we conducted qualitative interviews with 10 African American pastors recruited for an HIV intervention study in rural Alabama. Two main themes emerged: (1) HIV stigma is prevalent and (2) the role of the Black Church in addressing HIV in the African American community. Our data suggest that pastors in rural Alabama are willing to be engaged in HIV prevention solutions; more formalized training is needed to decrease stigma, strengthen HIV prevention and support persons living with HIV/AIDS.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Historically, the Black Belt was known for its rich, fertile dark soils and association with the south’s antebellum plantations, cotton and slavery. Today, the Black Belt, which is largely populated by African Americans, is typically characterized by its demographics and economic downfall (Webster and Bowman 2008; Tullos 2004).
Agate, L. L., Cato-Watson, D. M., Mullins, J. M., Scott, G. S., Rolle, V., Markland, D., & Roach, D. L. (2005). Churches United to Stop HIV (CUSH): A faith-based HIV prevention initiative. Journal of the National Medical Association, 97(7 Suppl), 60S.
Aholou, T. M. C., Gale, J. E., & Slater, L. M. (2011). African American clergy share perspectives on addressing sexual health and HIV prevention in premarital counseling: A pilot study. Journal of Religion and Health, 50(2), 330–347. doi:10.1007/s10943-009-9257-7.
Berkley-Patton, J., Bowe-Thompson, C., Bradley-Ewing, A., Hawes, S., Moore, E., Williams, E., & Goggin, K. (2010). Taking it to the pews: A CBPR-guided HIV awareness and screening project with black churches. AIDS Education and Prevention, 22(3), 218. doi:10.1521/aeap.2010.22.3.218.
Berkley-Patton, J. Y., Moore, E., Berman, M., Simon, S. D., Thompson, C. B., Schleicher, T., & Hawes, S. M. (2013). Assessment of HIV-related stigma in a US faith-based HIV education and testing intervention. Journal of the International AIDS Society, 16(3 Suppl 2), 18644. doi:10.7448/IAS.16.3.18644.
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. doi:10.2105/AJPH.92.10.1668.
Bluthenthal, R. N., Palar, K., Mendel, P., Kanouse, D. E., Corbin, D. E., & Derose, K. P. (2012). Attitudes and beliefs related to HIV/AIDS in urban religious congregations: Barriers and opportunities for HIV-related interventions. Social Science and Medicine, 74(10), 1520–1527. doi:10.1016/j.socscimed.2012.01.020.
Bogart, L. M., Cowgill, B. O., Kennedy, D., Ryan, G., Murphy, D. A., Elijah, J., & Schuster, M. A. (2008). HIV-related stigma among people with HIV and their families: A qualitative analysis. AIDS and Behavior, 12(2), 244–254. doi:10.1007/s10461-007-9231-x.
Centers for Disease Control and Prevention. (2014). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2012. HIV surveillance supplemental report 2014, Vol. 19, No. 3. http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 26 March 2015.
Centers for Disease Control and Prevention. (2015). HIV surveillance report 2013, Vol. 25. http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 26 March 2015.
Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., & Fleming, T. R. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 365(6), 493–505. doi:10.1056/NEJMoa1105243.
Coleman, J. D., Lindley, L. L., Annang, L., Saunders, R. P., & Gaddist, B. (2012). Development of a framework for HIV/AIDS prevention programs in African American churches. AIDS Patient Care and STDs, 26(2), 116–124. doi:10.1089/apc.2011.0163.
Cotton, S., Puchalski, C. M., Sherman, S. N., Mrus, J. M., Peterman, A. H., Feinberg, J., & Tsevat, J. (2006). Spirituality and religion in patients with HIV/AIDS. Journal of General Internal Medicine, 21(S5), S5–S13. doi:10.1111/j.1525-1497.2006.00642.x.
Division of HIV/AIDS Prevention and Control, Alabama Department of Public Health. (2011). HIV/AIDS Integrated Epidemiological Profile. https://www.adph.org/aids/assets/IntegratedEpiProfile2011.pdf. Accessed 28 January 2015.
Division of HIV/AIDS Prevention and Control, Alabama Department of Public Health. (2014). HIV 4th Quarter. http://adph.org/aids/assets/HIV4thQuarter2014(Demo).pdf. Accessed 28 January 2015.
Eke, A. N., Wilkes, A. L., & Gaiter, J. (2010). Organized religion and the fight against HIV/AIDS in the black community: The role of the Black Church. In D. H. McCree, M. Kenneth Terrill Jones, & A. O’Leary (Eds.), African Americans and HIV/AIDS: Understanding and addressing the epidemic (pp. 53–68). New York, NY: Springer.
Emlet, C. A. (2007). Experiences of stigma in older adults living with HIV/AIDS: A mixed-methods analysis. AIDS Patient Care and STDs, 21(10), 740–752. doi:10.1089/apc.2007.0010.
Foster, P. P., Cooper, K., Parton, J. M., & Meeks, J. O. (2011). Assessment of HIV/AIDS prevention of rural African American Baptist leaders: Implications for effective partnerships for capacity building in American communities. Journal of the National Medical Association, 103(4), 323–331.
Foster, P. P., & Gaskins, S. W. (2009). Older African Americans’ management of HIV/AIDS stigma. AIDS Care, 21(10), 1306–1312. doi:10.1080/09540120902803141.
Gielen, A. C., O’campo, P., Faden, R. R., & Eke, A. (1997). Women’s disclosure of HIV status: Experiences of mistreatment and violence in an urban setting. Women and Health, 25(3), 19–31. doi:10.1300/J013v25n03_02.
Goffman, E. (1963). Stigma. notes on the management of spoiled identity. New York: Simon and Shuster.
Golub, S. A., Operario, D., & Gorbach, P. M. (2010). Pre-exposure prophylaxis state of the science: Empirical analogies for research and implementation. Current HIV/AIDS Reports, 7(4), 201–209. doi:10.1007/s11904-010-0057-1.
Guest, G., MacQueen, K. M., & Namey, E. E. (2011). Applied thematic analysis. Thousand Oaks: Sage.
Guest, G., & McLellan, E. (2003). Distinguishing the trees from the forest: Applying cluster analysis to thematic qualitative data. Field Methods, 15(2), 186–201. doi:10.1177/1525822X03015002005.
Heckman, B. D. (2006). Psychosocial differences between whites and African Americans living with HIV/AIDS in rural areas of 13 US states. The Journal of Rural Health, 22(2), 131–139.
Herek, G. M., Capitanio, J. P., & Widaman, K. F. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92(3), 371–377. doi:10.2105/AJPH.92.3.371.
Hicks, K. E., Allen, J. A., & Wright, E. M. (2005). Building holistic HIV/AIDS responses in African American urban faith communities: A qualitative, multiple case study analysis. Family & Community Health, 28(2), 184–205.
Hruschka, D. J., Schwartz, D., John, D. C. S., Picone-Decaro, E., Jenkins, R. A., & Carey, J. W. (2004). Reliability in coding open-ended data: Lessons learned from HIV behavioral research. Field Methods, 16(3), 307–331. doi:10.1177/1525822X04266540.
Ironson, G., Stuetzle, R., & Fletcher, M. A. (2006). An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. Journal of General Internal Medicine, 21(S5), S62–S68. doi:10.1111/j.1525-1497.2006.00648.x.
Jeffries, W. L, I. V., Townsend, E. S., Gelaude, D. J., Torrone, E. A., Gasiorowicz, M., & Bertolli, J. (2015). HIV stigma experienced by young men who have sex with men (MSM) living with HIV infection. AIDS Education and Prevention, 27(1), 58–71. doi:10.1521/aeap.2015.27.1.58.
Lemelle, A. (2004). African American attitudes toward gay males: Faith-based initiatives and implications for HIV/AIDS services. Journal of African American Studies, 7(4), 59–74. doi:10.1007/s12111-004-1019-8.
Lincoln, C. E., & Mamiya, L. H. (1990). The Black Church in the African American experience. Durham, NC: Duke University Press.
Lindley, L. L., Coleman, J. D., Gaddist, B. W., & White, J. (2010). Informing faith-based HIV/AIDS interventions: HIV-related knowledge and stigmatizing attitudes at Project FAITH churches in South Carolina. Public Health Reports, 125(Suppl 1), 12. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788404/.
Litwinczuk, K. M., & Groh, C. J. (2007). The relationship between spirituality, purpose in life, and well-being in HIV-positive persons. Journal of the Association of Nurses in AIDS Care, 18(3), 13–22. doi:10.1016/j.jana.2007.03.004.
Lorenz, K., Hays, R. D., Shapiro, M. F., Cleary, P., Asch, S. M., & Wenger, N. S. (2005). Religiousness and spirituality among HIV-infected Americans. Journal of Palliative Medicine, 8(4), 774–781. doi:10.1089/jpm.2005.8.774.
Moore, D., Onsomu, E. O., Timmons, S. M., Abuya, B. A., & Moore, C. (2012). Communicating HIV/AIDS through African American churches in North Carolina: Implications and recommendations for HIV/AIDS faith-based programs. Journal of Religion and Health, 51(3), 865–878. doi:10.1007/s10943-010-9396-x.
National Association for the Advancement of Colored People (NAACP). (2014). The Black Church and HIV: The social justice imperative. http://www.theblackchurchandHIV.org. Accessed 28 January 2015.
Nunn, A., Cornwall, A., Chute, N., Sanders, J., Thomas, G., James, G., & Flanigan, T. (2012). Keeping the faith: African American faith leaders’ perspectives and recommendations for reducing racial disparities in HIV/AIDS infection. PLoS One, 7(5), e36172. doi:10.1371/journal.pone.0036172.
Nunn, A., Cornwall, A., Thomas, G., Callahan, P. L., Waller, P. A., Friend, R., & Flanigan, T. (2013). What’s God got to do with it? Engaging African-American faith-based institutions in HIV prevention. Global Public Health, 8(3), 258–269. doi:10.1080/17441692.2012.759608.
Poindexter, C. C., & Linsk, N. L. (1999). HIV-related stigma in a sample of HIV-affected older female African American caregivers. Social Work, 44(1), 46–61. doi:10.1093/sw/44.1.46.
Siegel, K., & Schrimshaw, E. W. (2002). The perceived benefits of religious and spiritual coping among older adults living with HIV/AIDS. Journal for the Scientific Study of Religion, 41(1), 91–102. doi:10.1111/1468-5906.00103.
Simoni, J. M., Martone, M. G., & Kerwin, J. F. (2002). Spirituality and psychological adaptation among women with HIV/AIDS: Implications for counseling. Journal of Counseling Psychology, 49(2), 139. doi:10.1037/0022-0126.96.36.199.
Smith, J., Simmons, E., & Mayer, K. H. (2005). HIV/AIDS and the black church: What are the barriers to prevention services? Journal of the National Medical Association, 97(12), 1682–1685.
Stall, R., Hoff, C., Coates, T. J., Paul, J., Phillips, K. A., Ekstrand, M., & Diaz, R. (1996). Decisions to get HIV tested and to accept antiretroviral therapies among gay/bisexual men: Implications for secondary prevention efforts. JAIDS Journal of Acquired Immune Deficiency Syndromes, 11(2), 151–160. doi:10.1097/00042560-199602010-00006.
Stroman, C. A. (2005). Disseminating HIV/AIDS information to African Americans. Journal of Health Care for the Poor and Underserved, 16(4), 24–37. doi:10.1353/hpu.2005.0085.
Sutton, M. Y., & Parks, C. P. (2013). HIV/AIDS prevention, faith, and spirituality among Black/African American and Latino Communities in the United States: Strengthening scientific faith-based efforts to shift the course of the epidemic and reduce HIV-related health disparities. Journal of Religion and Health, 52(2), 514–530. doi:10.1007/s10943-011-9499-z.
The White House Office of National AIDS Policy. (2010). National HIV/AIDS strategy for the United States. Retrieved from http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf.
Tullos, A. (2004). The Black Belt. Retrieved April 3, 2015, from http://southernspaces.org/2004/black-belt.
U.S. Census Bureau. (2013). United States Census Bureau State & county quick facts: Alabama. United States Census Bureau. http://quickfacts.census.gov/qfd/states/01000.html.
Vyavaharkar, M., Moneyham, L., Corwin, S., Saunders, R., Annang, L., & Tavakoli, A. (2010). Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural southeastern united states. Journal of the Association of Nurses in AIDS Care, 21(2), 144–152. doi:10.1016/j.jana.2009.07.008.
Webster, G. R., & Bowman, J. (2008). Quantitatively delineating the black belt geographic region. Southeastern Geographer, 48(1), 3–18. doi:10.1353/sgo.0.0007.
Wooster, J., Eshel, A., Moore, A., Mishra, M., Toledo, C., Uhl, G., & Aguero, L. W. (2011). Opening up their doors: Perspectives on the involvement of the African American faith community in HIV prevention in four communities. Health Promotion Practice, 12(5), 769–778. doi:10.1177/1524839910362313.
This study was funded in part by the Centers for Disease Control and Prevention, Program Announcement PS11-003; 5U01PS003320. We thank all of the ministerial liaisons and pastors who participated in this study.
Conflicts of interest
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no financial conflicts of interest relevant to this study.
About this article
Cite this article
Aholou, T.M., 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 55, 1968–1979 (2016). https://doi.org/10.1007/s10943-016-0193-z
- Black Church
- African Americans
- Rural south