HIV Stigma in U.S. Faith Communities

Stigma remains a significant barrier to HIV prevention/treatment in African American communities. Religious congregations, especially black churches, have been called to address HIV stigma. Social forces such as religion may create reinforcing stigmatized conditions that predispose individuals to HIV infection and limit their ability to access HIV testing and treatment. However, scientific evidence examining the concept of HIV stigma and its effects in religious communities is limited. Our work is guided by the concept of stigma as “a social and cultural phenomenon linked to actions of whole groups of people.”  This approach emphasizes the need to examine social structures and processes and enable communities to move from individual-level perceptions to collectively identify and act upon negative stereotypes and discrimination against the stigmatized. Our multi-method study examines HIV-stigma in faith communities from the perspectives of congregations, community members, and people living with HIV.  We collected and analyzed data from interviews with faith leaders representing a theologically diverse sample of congregations; interviews with HIV-infected individuals; and, town-hall meeting-generated ideas about faith-based strategies to address HIV.  We used predictive modeling of factors linked to welcoming/alienating attitudes on the part of congregations, as well as content analysis and concept mapping to qualitatively assess the concept and extent of HIV stigma present in faith communities. In congregations, stigma was often attached to the perception of individual mode of infection: homosexual relations as most stigmatized, followed by injection drug use, heterosexual relations, and mother-to-child/healthcare-related situation. Some HIV-infected individuals reported feeling alienated in congregations because of stigma/discrimination. Finally, community stakeholders identified reducing stigma as the most important strategy to address HIV in their faith community; however, the feasibility of this strategy was questioned.  In the analysis, we triangulate/discuss the findings to explore the concept of stigma, its consequences, and potential stigma-reduction strategies in faith-based settings.