Attitudes and Beliefs Related to HIV/AIDS in Urban Religious Congregations

Barriers and Opportunities for HIV-Related Interventions

Published in: Social Science & Medicine, v. 74, no. 10, May. 2012, p. 1520-1527

Posted on RAND.org on May 01, 2012

by Ricky N. Bluthenthal, Kartika Palar, Peter Mendel, David E. Kanouse, Dennis E. Corbin, Kathryn Pitkin Derose

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Research Questions

  1. What are the attitudes of urban religious congregations about HIV, sexuality, and drug use?
  2. How do these attitudes relate if at all to congregational level of HIV activity?

HIV-related stigmas have been seen as a barrier to greater religious congregation involvement in HIV prevention and care in the United States and elsewhere. We explored congregational and community norms and attitudes regarding HIV, sexuality, and drug use through a qualitative case study of 14 diverse religious congregations in Los Angeles County, California between December 2006 and May 2008. Data collected included semi-structured interviews with 57 clergy and lay leaders across the congregations, structured observations of congregational activities, review of archival documents, and a questionnaire on congregational characteristics. Across and within congregations, we found a wide range of views towards HIV, people with HIV, and populations at risk for HIV, from highly judgmental and exclusionary, to "loving the sinner, not the sin," to accepting and affirming. Attitudes and norms about HIV, homosexuality, and substance abuse appeared to be related to the type and intensity of congregational HIV-related activities. However, even among the higher activity congregations, we found a range of perceptions, including ones that were stigmatizing. Results suggest that affirming norms and attitudes are not a prerequisite for a congregation to initiate HIV activities, a finding relevant for HIV services providers and researchers seeking to engage congregations on this issue. HIV stigma-reduction is not a prerequisite for congregational HIV involvement: both may occur simultaneously, or one before the other, and they dynamically affect each other. Strategies that are congruent with congregations' current levels of comfort and openness around HIV can themselves facilitate a process of attitudinal and normative change.

Key Findings

  • Views ranged widely, from judgmental and exclusionary to accepting and confirming, though most congregations were somewhere in the middle.
  • Congregations' attitudes appeared to be related to level of HIV activity.
  • But even in high activity congregations, we found stigmatizing attitudes.
  • Affirming attitudes were not a prerequisite for HIV involvement and in fact involvement appeared to lead to more accepting attitudes over time.

Recommendation

  • Strategies that are consistent with a congregation's general openness about HIV can themselves help to change norms and attitudes.

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