Patrick A. Wilson a, Natalie M. Wittlin a, Miguel Muñoz-Laboy a & Richard Parker a a Department of Sociomedical Sciences, Columbia University, New - PDF

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This article was downloaded by: [Columbia University] On: 01 November 2011, At: 12:36 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: Registered office: Mortimer House, Mortimer Street, London W1T 3JH, UK Global Public Health Publication details, including instructions for authors and subscription information: Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men Patrick A. Wilson a, Natalie M. Wittlin a, Miguel Muñoz-Laboy a & Richard Parker a a Department of Sociomedical Sciences, Columbia University, New York, NY, USA Available online: 06 Sep 2011 To cite this article: Patrick A. Wilson, Natalie M. Wittlin, Miguel Muñoz-Laboy & Richard Parker (2011): Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men, Global Public Health, 6:sup2, S227-S242 To link to this article: PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. Global Public Health Vol. 6, No. S2, October 2011, S227S242 Ideologies of Black churches in New York City and the public health crisis of HIV among Black men who have sex with men Patrick A. Wilson*, Natalie M. Wittlin, Miguel Muñoz-Laboy and Richard Parker Department of Sociomedical Sciences, Columbia University, New York, NY, USA (Received 1 November 2010; final version received 10 June 2011) Black men who have sex with men (MSM) are disproportionately affected by HIV and AIDS in New York City (NYC). Black churches in NYC have a history of engaging in community mobilisation; however, research suggests that churches play a role in promoting stigma against Black MSM, which impedes prevention efforts. The goal of this study was to explore church ideologies surrounding sexuality and health, and the relationship of these ideologies to church mobilisation in response to HIV/AIDS among Black MSM. We conducted interviews and focus groups with pastors and parishioners at Black churches in NYC. Three prominent themes were identified: (1) Love the sinner, hate the sin distinguishing behaviour and identity; (2) Don t ask, don t tell keeping samesex behaviour private; and (3) Your body is a temple connecting physical and spiritual health. We discuss the implications of these ideologies for church mobilisation and HIV prevention efforts. In doing so, we pay close attention to how ideologies may both impede and facilitate church dialogue around sexuality and heightened responses to the HIV crisis affecting Black MSM. Keywords: Blacks; men who have sex with men; HIV/AIDS; churches; religious ideology Introduction Black churches in the USA play an important role in the culture and social lives of many Black Americans (Lincoln and Mamiya 1990, Taylor et al. 1999). While Black communities and individuals vary in the extent to which they are directly involved with churches, Black churches remain a strong force in the lives of Black Americans. A recent Pew Forum (2008) survey of the US religious landscape found that of all racial/ethnic groups in the USA, Black Americans were the most likely to report being affiliated with a religious institution; 85% of Black Americans reported a Christian affiliation. Even among Black Americans who reported being religiously unaffiliated, three in four said that religion was either somewhat or very important in their lives (compared to just above one in three of the overall unaffiliated population). *Corresponding author. ISSN print/issn online # 2011 Taylor & Francis DOI: / S228 P.A. Wilson et al. Black churches and community mobilisation Many Black churches have historically been involved in social and political movements, the most commonly cited example being the Civil Rights Movement of the 1950s and 1960s. Then and now, churches have helped to mobilise Black communities around pressing social and health issues, thereby facilitating positive change (Lincoln and Mamiya 1990). Scholars have theorised about and debated the mechanisms by which Black churches enable or fail to enable mobilisation around social and health issues (Pattillo-McCoy 1998, Harris 1999, Barnes 2005, McClerking and McDaniel 2005). While research has tended to focus on church culture (i.e., common rituals and practices) rather than religious ideology, it has also considered the commonly held belief that God is active in worldly affairs (Pattillo- McCoy 1998). This work suggests that a unique relationship between culture and theology exists in many Black churches. Harris (1999) articulates this relationship, noting that Black church-based social movements have benefited from a sacred assurance, or the feeling that actions are validated by scripture and that God is on the side of the church. This sense of sacred assurance, Harris notes, has promoted feelings of personal and collective efficacy among Black Christians involved in church mobilisation efforts. Other researchers have pointed to a number of specific factors and activities that affect church mobilisation including: dialogue and information-sharing among parishioners (McKenzie 2004); prayer groups and gospel music (Barnes 2005); cost-underwriting and obligation-creating activities (McClerking and McDaniel 2005); and a tool kit that includes prayer, call-and-response, verbal encouragement, Christian imagery and a sense of collective ethos (Pattillo- McCoy 1998). Recent Black church community mobilisation efforts have focused on a variety of public health issues including care for older adults (Madison and McGadney 2000), prison reintegration (O Connor et al. 1998) and breast and cervical cancer (Shapiro et al. 2006), among others. Black churches in New York City (NYC) the setting of our research study have played a particularly prominent role in community mobilisation efforts focused on social issues, historically and contemporarily (Bunche 1973). In the 1920s and 1930s, the social gospel movement flourished in Black communities, and social justice-oriented religious leaders such as Adam Clayton Powell, Sr., Reverdy Ransom, and Shelton Hale Bishop used churches as spaces for social service and action (Spencer 1996). Black churches in NYC have also made efforts to mobilise the community to prevent HIV/AIDS since the beginning of the epidemic. As reported by Quimby and Friedman (2003), Black churches in NYC began to mobilise against HIV/AIDS in late 1987, organising community forums and educational conferences held at various churches, including the historic Concord Baptist Church in Brooklyn. Contemporarily, Black churches in NYC are still involved in community responses to HIV/AIDS. For example, the current pastor of Abyssinian Baptist, Dr. Calvin O. Butts, III, sits on the Presidential Advisory Commission on HIV/AIDS (PACHA) and leads the National Black Leadership Commission on AIDS (United States Department of Health and Human Services [DHHS] 2010). Black churches in NYC have demonstrated leadership in promoting awareness and mobilisation around issues affecting the communities they serve. Global Public Health S229 Stigma and responses to HIV/AIDS among Black churches Stigma surrounding HIV, homosexuality and behaviours associated with HIV transmission have historically impeded Black church mobilisation in response to HIV/AIDS (Fullilove and Fullilove 1999, Quimby and Friedman 2003). Research suggests that associations between HIV/AIDS and homosexuality have hindered Black churches responses to the HIV/AIDS crisis affecting Black men who have sex with men (MSM). Black churches have often been sources of homophobia and heterosexism in the lives of Black MSM (Miller 2007, Harris 2009), and perceived associations between HIV/AIDS, homosexuality and White communities may impede their responses to the epidemic (Nelson 2005). In the past few years, however, researchers have documented efforts at HIV prevention, education and stigma reduction in churches and faith communities. For example, a faith-based intervention that aimed to increase HIV/AIDS awareness and decrease HIV stigma gained traction in a Black faith community in Michigan (Griffith et al. 2010). Also, a recent qualitative study of 14 Northeast churches with HIV/AIDS programming found that lay health leaders were organising both educational activities and testing events and that these leaders recognised barriers to prevention work, such as stigma, within the context of their churches. Results from the study suggested that a fundamental change in how Black churches are approaching HIV/AIDS in the Black community is underway and that churches appear to be fertile ground for prevention work (Davis 2008). The need for community-level responses from Black churches The current study aimed to explore NYC-based churches ideologies surrounding sexuality, health and HIV/AIDS, as well as how these ideologies relate to church mobilisation in response to the HIV/AIDS epidemic among Black MSM. HIV/AIDS among Black MSM is a public health crisis that has not been adequately addressed in the USA (White House Office of National AIDS Policy 2010). Black MSM are disproportionately affected by HIV/AIDS in the USA and continue to experience a rapidly increasing HIV incidence. A recently conducted epidemiological study of 8153 MSM in 21 US cities found that 28% of non-hispanic Black MSM were infected with HIV, the highest prevalence among all ethnic/racial groups examined (Centers for Disease Control and Prevention [CDC] 2010). In NYC, MSM compose the largest proportion of new HIV/AIDS diagnoses (Torian et al. 2009); Black MSM have twice the number of new diagnoses as White MSM (New York City Department of Health and Mental Hygiene [NYCDOHMH] 2007). Taken together, these data suggest that, without a heightened community-level response aimed at reducing risk and vulnerability to HIV, the HIV epidemic will continue to rage among Black MSM. The need for community-level responses to prevent HIV/AIDS among Black MSM is noted in the National HIV/AIDS Strategy (White House 2010) and has been called for by researchers and policy-makers (Kegeles et al. 1996, Bing et al. 2008, Wilson and Moore 2009). S230 P.A. Wilson et al. Methods We conducted interviews and focus groups at churches in predominantly Black (i.e., African-American, Afro-Caribbean and/or African immigrant) neighbourhoods in NYC. Most of the churches included in the study engaged in HIV prevention or other HIV-related efforts on some level (e.g., sponsored information sessions on HIV, engaged in HIV testing efforts, participated in The Balm in Gilead s National Week of Prayer for the Healing of AIDS, etc.). Some of the churches had HIV/AIDS ministries, which actively sought to mobilise church members, parishioners and community members in response to the HIV/AIDS epidemic. Sample A number of strategies were used to recruit participants. The first author collaborated with a local HIV/AIDS community-based organisation that was working with Black churches to develop HIV/AIDS ministries. Members of our research team also approached leaders at churches they were familiar with. Other participants were recruited through referrals. The resulting convenience sample consisted of 81 women and men representing 6 Baptist churches, three African Methodist Episcopal (AME) churches, two Catholic churches, three inter/nondenominational churches and one Presbyterian church. The churches included in the study were located in neighbourhoods with large Black populations in four boroughs (the Bronx, Brooklyn, Manhattan and Queens) of NYC. The participating churches were concerned with mobilising in response to the local HIV/AIDS epidemic. A sample of this type enabled us to explore ideologies among churches with the potential to become active players in the fight against HIV among Black MSM. We conducted a total of 10 focus groups with parishioners and 10 interviews with pastors and other church leaders. All but one of the church leaders interviewed were men. The majority of the participants were Black. Interview and focus group protocols Semi-structured interviews and focus groups were primarily conducted in churches. Interviews and focus groups lasted 12 hours and were audio recorded with the written consent of the participants. Interview and focus group topics focused on churches /worship traditions values related to sexuality (condom use, unprotected sex and homosexuality in particular); health and illness; stigma; and HIV/AIDS (including church responses to HIV/AIDS). Probes were used to explore issues and salient points raised. Interviews with pastors provided information on churches official stances and decision-making processes, as well as insight into pastors internal conflicts. The individual interviews also allowed us to have more intimate and detailed conversations with church leaders than would have been afforded in a group environment. Focus groups consisted of approximately 57 church parishioners. Focus groups provided parishioners with opportunities to delve deeply into issues and to discuss and debate their church s values with their peers. The use of focus groups enabled us to gain a better understanding of dynamics within the churches, as well as of which topics were least and most controversial. Global Public Health S231 Analytic approach All interviews and focus groups were transcribed by a professional transcription company. We employed a multistage, iterative process in analysing transcripts. The analysis was guided by the principles of Grounded Theory (Strauss and Corbin 1990), in which key themes and codes used to organise themes emerge out of the data and are not determined a priori. The process included several steps. The first step involved reviewing transcripts and memoing. Memos were then compared and discussed, and a working codebook was developed; codes were added and their definitions refined over a series of meetings. We then engaged in a process of systematically coding each interview and focus group transcript. In this article, we focus on the following codes: Acceptance, Church Response, Community Mobilisation, Discrimination, HIV/AIDS, Homosexuality, Homophobia, Religious Ideology, Sin and Stigma. These codes were used to identify and compare themes. Themes were integrated into a finding matrix, which was used as a framework for condensing findings and fulfilling the research goals. Findings We sought to explore the relationship between church ideologies of sexuality, bodies and HIV/AIDS and church mobilisation, or lack thereof, in response to the HIV crisis affecting Black MSM. In general, church responses to HIV focused on support of and prayer for those who are sick, HIV/AIDS and sex education (e.g., health fairs, workshops and pastoral counselling), and referrals to prevention and treatment services in the community. A few churches engaged in condom distribution, while others considered it to be outside the realm of church-sanctioned activities; however, many recognised the importance of condoms as an effective way to maintain sexual health. For example, a male member of a non-denominational church in Brooklyn noted, While abstinence is the ideal we are very realistic about who our membership is and who the people in the community we serve are so we don t provide condoms but we will connect them with resources where they can take care of themselves. None of the churches reported specifically responding to the crisis among Black MSM, nor did any address the reality that men are having sex with men within the context of HIV mobilisation activities. Only one church reported holding an HIV testing and education workshop for LGBT youth of faith. Our analysis of interview and focus group data revealed the following prominent themes, which can help explain the lack of MSM-focused mobilisation efforts: (1) Love the sinner, hate the sin (LSHS) The belief that homosexual behaviour can be distinguished and separated from homosexual identity. (2) Don t ask, don t tell The belief that homosexual identities and behaviours should be kept private. (3) Your body is a temple The belief that spiritual and physical health are interconnected. We discuss these findings in terms of their implications for church mobilisation in response to HIV among Black MSM. S232 P.A. Wilson et al. Love the sinner, hate the sin : behaviour vs. identity When parishioners and pastors were asked about homosexuality, a common response across denominations was that Christians should love the sinner but hate the sin. As one female member of an HIV Ministry at an AME church in Queens stated: But the thing is we might not condone [homosexuality], but everybody is a child of God. So God doesn t say, I m not gonna love you because you are a certain way. But God says that [homosexual] behaviour is an abomination. So know it for what it is. And then govern yourself from that. So you know we have these discussions all the time, cause I have plenty of gay friends. The specific phrase love the sinner, hate the sin was referred to by many of our focus group and interview participants. For example: You know, I have a number of people who I interact with and, you know, and they are homosexual and I love them. One of the things that I know is that God loves people, but he might not love the sin, and the reason that God, I believe, is opposed to it is because it doesn t reproduce, okay? So two men can t reproduce and two women can t reproduce and that was the reason that God created them. *Female pastor, non-denominational, Brooklyn Other participants alluded to the LSHS ideology by distinguishing between lifestyle and the individual. In our practice, we believe in the way that Jesus taught, which was that everyone deserves love. Everyone needs love. Everyone needs service and ministry. And so, we do our best not to judge, but just to love all. I mean that, you know, the church is open to all of God s children. And anyone who is seeking God is a child of God. However, you know, our church does not believe in male-to-male marriage or female-to-female marriage. We don t try to dive into peoples bedrooms. But on our exterior, you know, we the fundamentals of our theology will not allow us to promote the lifestyle, even though we love the individual. *Male Elder, AME, Bronx A male pastor of an AME church in Washington Heights stated: I am decidedly and intentionally heterosexual. I make no bones about that. I have no issues with that. And I think God s intention for humanity was that men and women would be together. I think that was God s intention. Now, having said that, we realize that that s not what s happening in our society. I am obligated to love you even if I don t like what you do...so, I have taken the approach of I preach family and I preach that God s intention and design for family was a man and a woman. I teach that. But I have a number of homosexual men and lesbian women who are members of our church. Because I tell them upfront, Look, I love you. I m not judging you. But here is where I am with this. Now, having said that, if you can sit under my teaching and my preaching, I will never bash you, never make you feel uncomfortable, never make fun of you, never do any of that.
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