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Black churches increasingly play role in HIV prevention, but problems remain
Stigma, indifference are often the response
AIDS and African Americans: Special series on meeting the challenge of HIV epidemic in the black community
This is the second part of a series about the HIV/AIDS epidemic among African Americans and how the CDC, researchers, and others are responding. The cover story discusses the role of black churches in HIV prevention work, and inside stories discuss some specific prevention interventions targeting African Americans. In the June issue there were stories about the CDC's new initiative aimed at reducing HIV infection among African Americans, as well as a story about how Florida has made progress in HIV prevention through community partnerships at African American events.
The CDC made broader community mobilization a major goal in the new initiative to heighten the fight against HIV in the African American community.
And part of this mobilization includes working with faith leaders to help break the stigma and silence surrounding AIDS.
However, some say this will be a difficult goal to achieve because of entrenched disinterest among many African American church leaders.
Most African American church ministers will not open their churches up to the people who are most impacted by the HIV epidemic because they don't see it as their mission to have anything to do with people who have the virus, says George McRae, DMin, the reverend of Mount Tabor Baptist Church in Miami, FL. Mount Tabor, which has 5,900 members, has an extensive HIV/AIDS ministry, which includes having founded a full-service health clinic for HIV patients, testing services, prevention work that includes condom distribution, and spiritual support and care for those who are infected.
While the need has never been greater at a time when African Americans account for about half of the HIV/AIDS epidemic in the United States, McRae says he is not optimistic that black church leaders will open their doors anytime soon to gay men, drug users, and the homeless.
"I think it's because we don't fully understand the role and the mission of the church," McRae says. "We think the church is for 'good people,' but we don't understand that the church is made up of people who are wrong and still wrong and need to be helped."
CDC and Florida health officials are more hopeful and have held meetings about the epidemic with church leaders in the African American community.
The state of Florida started a Silence is Death initiative to mobilize the African American community, including its churches, and to encourage people to be HIV tested.
"One of our initiatives is with the AME church, which has committed to having one AME church in each county to be an HIV testing site," says Ronald Henderson, Florida statewide minority AIDS coordinator, Florida Department of Health in Tallahassee, FL.
"There have been several folks who have worked with faith leaders for a number of years," says Robert Janssen, director of the CDC division of HIV/AIDS prevention.
"There's more commitment now coming from the African American churches than there was," Janssen says. "In March, we had a community mobilization meeting bringing together national leaders, building on what has been done before in the African American community, and bringing in leaders to bridge the mainstream African American community in a dialogue about HIV, and the African American church was a very important part of that."
Still, African American churches largely have not provided the support and prevention messages that they are uniquely in a position to provide to their congregations, a researcher notes.
Black churches have made gay men decide to choose between their sexual orientation and their religion, says Robert L. Miller, Jr., PhD, MPhil, LMSW, an assistant professor in the School of Social Welfare at the University of Albany in Albany, NY.
This divide has been particularly notable when a gay member of the congregation dies of AIDS, Miller says.
"What I saw was that black gay men stayed in the church despite homosexual messaging," Miller says. "Where they left was when black preachers could not manage a pastoral response to the grief-stricken and bereaved."
One story Miller tells is of a man who had been a committed member of an African American church for about two decades, but when he became sick with AIDS, the pastor would not even visit him.1
At the man's funeral, the minister screamed at the dead man's friends, "Your friend's soul is lost — what are you going to do?" Miller says.
What makes this type of spiritual betrayal striking is the contrast of this behavior with the role that the African American church historically has had in the lives of African Americans, Miller explains.
"The black church was developed for religious education, and it also offered a buffer to social oppression," he says. "You have an institution that is historically a buffer to oppression, but when it begins to turn on itself, it does so with such exacting vengeance that it leaves families and individuals devastated."
Some behavioral scientists theorize that when black gay men are forced out of their churches, they lose a significant cultural and coping response to many oppressions, and this could make them more susceptible to drug use and highly-risky sexual behavior, Miller says.
"The black church has been seen as a psychological support and a way to maintain one's self-esteem, so to take it away from gay black men is to create a void," he adds.
McRae started Mount Tabor's HIV/AIDS ministry 18 years ago after he was called by a chaplain at the largest hospital in Miami.
"He asked me to come to the hospital to talk with him, and so I went to the hospital where he took me around on the AIDS floor," McRae recalls. "He shared with me that every day the majority of patients on that floor were African American, and they never got a visit from their preacher."
That was a Wednesday morning, and McRae was so moved by the experience that he vowed to God that these patients would receive at least one pastor visit from then on. So each Wednesday he visits the hospital, which continues to treat many black AIDS patients, he says.
McRae also formed an HIV ministry at his church and founded a center called MOVERS for Minority Overcoming the Virus through Education and Responsibility and Spirituality. MOVERS is now an independent clinic that provides full-service HIV/AIDS medical, testing, and prevention care.
At Mount Tabor, McRae and volunteers encourage members and visitors to be tested for HIV, and testing is a requirement for the more than 300 recovering drug addicts who have been served by the church's substance abuse ministry.
"The person who has been on drugs and on the street needs to be tested," McRae says.
Gay men are welcomed into the church fold, and condoms are available to anyone who needs them, he says.
"I've had a lot of negative feedback from passing out condoms," McRae says.
"They say when I give a woman or man condoms I'm promoting sexual sin," he says. "But I tell them, 'I've been preaching for 47 years, and I have never led a dead man to the Lord, not one time, so if I can keep him or her alive long enough to lead them to the Lord, then they won't need the condoms.'"
McRae's views could help break down the stigma surrounding HIV-infected people in the African American community, but even he doubts there will be many converts to his point of view.
"To be totally honest with you, I don't have any reason to be optimistic because the preachers are not pushing for [tolerance of gays and drug users], and if the preacher doesn't push, it's not going to happen in our community," McRae says. "I don't know if they don't understand the seriousness of the epidemic or what the problem is, but they're not pushing it, and that's frightening to me."
Many churches, including African American churches, will not allow condoms to be brought on church grounds, even if they are offered as part of HIV prevention during a health fair, Miller notes.
The only prevention work they will offer is HIV testing and abstinence-based programs, he adds.
While some say that perhaps it's asking too much of churches to expect full HIV prevention services, Miller disagrees.
"HIV prevention is an open, honest communication about how the disease is prevented and how to engage in harm-reduction behavior," Miller says. "You can still negotiate a risk in a way that improves your ability to avoid the virus, but if you cannot have condom conversations, I'm not really sure what you can achieve."
Florida health officials have taken the strategy of providing churches with as much information as they're comfortable using.
"We're cautious in terms of what we give churches," Henderson says. "When we talk to the pastors they tell us what type of material they need, whether it's condoms, a message with options that talks about abstinence, or other materials that they may accept."
Even if churches offer some HIV prevention messages and materials, they still are not doing what's needed if they don't address HIV stigma and homophobia, Miller says.
"I'm not interested in tacit acceptance or partial acceptance, because at the end of the day if you believe the salvation story that the church teaches, it's for full humanity," Miller says.
Mount Tabor's mission is to provide full acceptance to all of the church's members, including those who are HIV positive, McRae says.
"Right now, as I speak, we have 82 people in our church who are HIV positive, and they can belong to Mount Tabor and be loved and accepted and received with open arms," McRae says.