Social Determinants of HIV-Related Stigma in Faith-Based Organizations

摘要

Objectives . To examine the association between social factors in faith-based settings (including religiosity and proximity to people living with HIV/AIDS) and HIV stigma. Methods . A total of 1747 congregants from primarily African American faith-based organizations of Project FAITH (Fostering AIDS Initiatives That Heal), a South Carolina statewide initiative to address HIV-related stigma, completed a survey. Results . Female gender ( P =?.001), higher education ( P 13 (p50) The association of HIV/AIDS with marginalized populations perpetuates stigmatizing attitudes toward AIDS. 14 Among African Americans, HIV-related stigma is layered with preexisting stigma. 15 Herek et al. found that between 1990 and 1999, the manifestation of stigma among African Americans shifted from public stigma (i.e., punitive policies) to more covert forms (i.e., avoidance of people living with HIV). 16 Age, education, HIV knowledge, income, and religiosity have been previously associated with HIV-related stigma. 17–20 Furthermore, persons with greater religious intensity have reported negative attitudes toward and unwillingness to interact with people living with HIV, likely because of the association of the disease with marginalized persons, particularly homosexuals. 18,21 Contact with people living with HIV has been suggested as a critical component for interventions to reduce HIV-related stigma. 13,22,23 Direct and indirect contact with people living with HIV prompts people to focus on the infected individual’s perspective, thus promoting empathy. 24 Institutionally supported contact, particularly between individuals of equal status, is the most effective type of contact. 25 African American churches have traditionally served as centers for spiritual growth and development, political and civic activity, and health promotion and disease prevention. 26 Churches have played a significant role in the development of Black communities since the time of slavery, and further serve as centers of social cohesion and organization. 27 Compared with other racial groups in the United States, African Americans are more likely to report formal religious affiliation (88% of African Americans vs 78% of Whites). Even among African Americans who are unaffiliated with formal religions, 72% report that religion is somewhat important in their lives, and 45% report that religion is very important in their lives. 28 Given the strong role of the African American church and religiosity among African Americans, faith- and church-based programs have been developed over the past decade to address HIV/AIDS, 19,29–35 and a framework for HIV prevention in African American churches has been presented. 36 HIV-related stigma has been identified as a salient barrier to HIV/AIDS ministries and programs in African American faith-based organizations (FBOs) and the reduction thereof as an area of emphasis in faith-based HIV/AIDS programs. 4,19,24,36–40 Furthermore, the National HIV/AIDS Strategy calls for increased integration of faith-based initiatives in addressing the HIV/AIDS epidemic in the United States. 41 The aims of this study were to examine how religiosity, contact with people living with HIV/AIDS, and demographic characteristics were associated with stigmatizing attitudes related to HIV/AIDS. This study was part of Project FAITH (Fostering AIDS Initiatives That Heal), which was a statewide initiative to address HIV-related stigma in South Carolina and has been described elsewhere. 17,36,42 Understanding the relationship between religiosity and stigma in faith-based settings may inform future intervention development for the reduction of HIV-related stigma in African American churches and FBOs.