Journal of Prevention & Intervention in the Community

ISSN: 1085-2352 (Print) 1540-7330 (Online) Journal homepage: http://www.tandfonline.com/loi/wpic20

Stigma as a Barrier to HIV-Related Activities Among African-American Churches in South Carolina John B. Pryor, Bambi Gaddist & Letitia Johnson-Arnold To cite this article: John B. Pryor, Bambi Gaddist & Letitia Johnson-Arnold (2015) Stigma as a Barrier to HIV-Related Activities Among African-American Churches in South Carolina, Journal of Prevention & Intervention in the Community, 43:3, 223-234, DOI: 10.1080/10852352.2014.973279 To link to this article: http://dx.doi.org/10.1080/10852352.2014.973279

Published online: 07 Jul 2015.

Submit your article to this journal

Article views: 33

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=wpic20 Download by: [Texas A & M International University]

Date: 05 November 2015, At: 14:48

Journal of Prevention & Intervention in the Community, 43:223–234, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 1085-2352 print/1540-7330 online DOI: 10.1080/10852352.2014.973279

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

Stigma as a Barrier to HIV-Related Activities Among African-American Churches in South Carolina JOHN B. PRYOR Department of Psychology, Illinois State University, Normal, Illinois, USA

BAMBI GADDIST and LETITIA JOHNSON-ARNOLD South Carolina HIV/AIDS Council, Columbia, South Carolina, USA

South Carolina has one of the highest HIV/AIDS prevalence rates in the United States. More than 70% of those infected are African American. Traditionally, Black churches have been one of the primary sources of health outreach programs in Southern African-American communities. In this research, we explored the role of HIV-related stigma as a barrier to the acceptance of HIVrelated activities in Black churches. A survey of African-American adults in South Carolina found that the overall level of stigma associated with HIV/AIDS was comparable to what has been found in a national probability sample of people in the United States. Consistent with the stigma-as-barrier hypothesis, the degree to which survey respondents endorsed HIV-related stigma was related to less positive attitudes concerning the involvement of Black churches in HIV-related activities. KEYWORDS HIV-related stigma, Black churches Perceived HIV/AIDS stigma has a negative effect on the willingness of people at risk to seek HIV testing, the inclination of people living with HIV/AIDS (PLWHA) to disclose their HIV status to others, the help-seeking behavior of PLWHA, the quality of healthcare PLWHA receive, and the social support PLWHA solicit and receive (Brown, Macintyre, & Trujillo, 2003; Sengupta, Banks, Jonas, Miles, & Smith, 2011). African Americans represent Address correspondence to John B. Pryor, Department of Psychology, Illinois State University, Normal, IL 61790, USA. E-mail: [email protected] 223

224

J. B. Pryor et al.

approximately 14% of the U.S. population, but account for 44% of new HIV infections (Centers for Disease Control and Prevention, 2012). The experiences of stigma and discrimination significantly predict psychological symptoms among people of color who have HIV/AIDS (Clark, Lindner, Armistead, & Austin, 2003). Conversely, social acceptance buffers the negative effects of discrimination on mental health, substance abuse, and sexual risk behaviors (Brooks, Rotheram-Borus, Bing, Ayala, & Henry, 2003).

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

THE HIV EPIDEMIC IN SOUTH CAROLINA In 2010, South Carolina ranked 8th among 50 states and U.S. dependent areas (e.g., DC) in the annual AIDS prevalence rates per 100,000. Approximately 73% of adult and 80% of pediatric HIV/AIDS cases in South Carolina were found among African Americans in 2011 (South Carolina Department of Health and Environmental Control, 2012). In 2011, the most common exposure category among Black adult/adolescent South Carolinians with AIDS (based on Centers for Disease Control and Prevention designations) was heterosexual contact, accounting for 33% of the cases. Seventy-four percent of African Americans diagnosed with AIDS through 2011 in South Carolina have been 40 years old or older (South Carolina Department of Health and Environmental Control, 2012).

THE ROLE OF BLACK CHURCHES Eighty-seven percent of African Americans describe themselves as formally affiliated with a religious group. Compared to the general population, African Americans are more likely to report attendance in religious services, frequent prayer, and the importance of religion in life (Sahgal & Smith, 2009). As well as providing spiritual comfort, Black churches frequently provide health outreach programs in their communities (Markens, Taub, Fox, & Gilbert, 2002). However, many African-American PLWHA, especially men who have sex with men (MSM), often feel socially excluded from their churches (Malebranche, Peterson, Fullilove, & Stackhouse, 2004). Topics like homosexuality and bisexuality are often either taboos or the subject of open condemnation from the pulpits in many Black churches. Thus, many Black MSM are expected to keep their sexuality closeted in the church (Cohen, 1999). Studies show that a significant number of African-American MSM publicly identify themselves as heterosexual (Centers for Disease Control and Prevention, 2003). While church involvement is typically high among African-American women (Snowden, 2001), those who are HIV-positive do not often disclose their HIV status to other church members. Some of their reasons for concealment include fears of being stigmatized and that they might lose custody of their children (Clark et al., 2003). Black MSM with HIV may have more

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

HIV-Related Stigma

225

avenues for potential social support from the gay community than Black heterosexual women have from the African-American community. Because the HIV epidemic was initially concentrated in the gay community in the United States, social services for PLWHA developed historically to serve MSM. Not surprisingly, female Black PLWHA view HIV-related services to be less helpful than other social groups (Whetten, Reif, Lowe, & Eldred, 2003). While many African-American churches seem open to sex education programs, some taboo topics like homosexuality, bisexuality, anal sex, oral sex, and masturbation represent a significant barrier in discussing HIV (Coyne-Beasley & Schoenbach, 2000). In a qualitative study of churches in the Washington, DC area, Hicks, Allen, and Wright (2005) found that “homophobia, silence surrounding sex and sexuality, stigma, and the resulting discrimination are all-pervasive social barriers that impede African American community mobilization efforts against HIV/AIDS” (p. 194). While HIV-related stigma may present a formidable barrier to church involvement in HIV-related activities, it would be misleading to assume that all “Black churches” have invariably rejected PLWHA and ignored the impact of HIV on their communities. Different denominations and different congregations within denominations often have diverse stances on HIV-related church activities (Miller, 2001). Some faith-based organizations such as the Balm in Gilead have promoted HIV-related education among AfricanAmerican churches. Our study examined how attitudes toward church involvement were related to perceived HIV stigma in a sample of African-American adults from South Carolina. The stigma measures were modeled after Herek and colleagues’ research (Herek, Capitanio, & Widaman, 2002). Since Herek’s stigma measures have been studied in U.S. national samples, it also was possible to compare the general level of stigma in our sample to that of a national sample. We hypothesized that African-American adults who perceived a stronger HIV stigma would have more negative attitudes about church involvement in HIV-related activities. We also explored which stigma facets were most strongly related to attitudes toward church-involvement.

METHOD Participants Participants came from 18 different counties in South Carolina. We recruited volunteers (N ¼ 417 adult African Americans) from people attending town hall meetings and performances of an AIDS-related play organized by the South Carolina HIV/AIDS Council (SCHAC). The town hall meetings and play performances were advertised on local radio and television stations, with posters placed in Black-owned businesses and Black neighborhoods, and in Black churches. Anonymous surveys were distributed and returned after each event.

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

226

J. B. Pryor et al.

Participants were offered an opportunity to win a DVD player in a raffle as an incentive to complete the survey. Participants’ ages ranged from 18 to 91 (mean age of 45.22). One hundred and eight were men and 303 were women (6 failed to report their gender). Forty-three percent reported making less than $25,000 per year. The median income was between $25,000 and $30,000 per year. Twenty-four percent were from counties of less than 50,000 population, 46% were from counties with between 50,000 and 100,000 populations, and 30% were from counties of greater than 100,000 population. Sixty-nine percent reported attending religious services at least 2–3 times per month. Only 1.1% reported that they “do not attend church/mosque/synagogue.” Three hundred and sixty-six were included in the final analyses. Fifty-one were dropped from analyses because they did not return completed surveys.

Materials The survey contained 34 questions concerning various aspects of HIV stigma plus demographic information (i.e., age, gender, race/ethnicity, income, frequency of church attendance, home county, and zip code). Most stigma items were adapted from Herek and colleagues’ research (Herek et al., 2002). These stigma items assessed several domains: support for coercive policies (e.g., “People at risk should be required to be tested regularly for the HIV/AIDS virus”), negative emotions concerning PLWHA (e.g., level of fear, anger, and disgust), responsibility and blame (e.g., “Most people with HIV/AIDS are responsible for having their illness”), beliefs about transmission (e.g., the perceived likelihood of contracting HIV/AIDS from public toilets), intentions to avoid contact with PLWHA in social situations (e.g., likelihood of avoiding a co-worker with HIV/AIDS), and level of comfort with PLWHA in social settings (e.g., level of comfort of having a child attend class with PLWHA). We created three items to assess respondents’ attitudes toward church involvement in HIV-related activities (e.g., “Churches should be involved in HIV/AIDS prevention”).

RESULTS Comparisons to a National Survey Using survey data from national probability samples, Herek and his colleagues (Herek et al., 2002) developed a nine-item summary stigma measure. This measure was computed by counting the number of stigmatizing responses survey respondents gave to items concerning negative feelings (i.e., anger, fear and disgust), avoidant behavioral intentions (i.e., avoiding a school child, co-worker, or grocer with HIV), quarantining PLWHAs, public revelation of the names of PLWHAs, and the belief that PLWHAs got what they deserve. This summary stigma index was a reliable measure in Herek’s studies

HIV-Related Stigma

227

(Cronbachs’ a ¼ .77 for the 1999 sample, N ¼ 669, M ¼ 1.5, SE ¼ 0.08). In the current sample, this summary index was also reliable (a ¼ .81) and the mean was 1.4 (SE ¼ 0.10). These two means were not significantly different.

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

Stigma as a Barrier to Church Involvement Three items concerned attitudes toward the involvement of Black churches in HIV-related activities: “Churches should be involved in HIV/AIDS prevention,” “The pastor of a church plays an important role in how people in the church see Persons Living With HIV/AIDS,” “I would support having an HIV/AIDS Care Team ministry at my church.” A principal components analysis revealed that all three items loaded in a single factor accounting for 65% of the variance. Factor loadings ranged from .79 to .82. We combined these items into a measure of attitudes toward church involvement in HIV-related activities (a ¼ .73). Herek’s summary stigma index provides one way to examine the potential relationship between stigma and attitudes toward church involvement. The correlation between attitudes toward church involvement and the summary stigma index was r ¼ –.13, p < .01. People who made more stigmatizing responses were less likely to have positive attitudes toward church involvement in HIV-related activities. The Herek stigma survey was developed to measure different aspects of the public stigma surrounding HIV/AIDS. To gain a more textured understanding of the relationship between stigma and attitudes toward church involvement, several summary scores were formulated based upon exploratory principal components analyses and the conceptual categories proposed by Herek et al. (2002). Table 1 shows the items that were used to measure each construct and the construct’s reliability level (Cronbach’s a). Cognitive variables involved specific HIV-related beliefs and included beliefs about blame (e.g., “People who got HIV/AIDS through sex or drug use have gotten what they deserve”)1 and beliefs (misconceptions) about transmission of HIV through casual contact (e.g., the likelihood of transmission through “Using public toilets”). Affective variables included comfort level in interacting with persons with HIV/AIDS (e.g., “How do you feel about working with an office co-worker who has HIV/AIDS?”) and negative emotional reactions (i.e., the level of fear, anger and disgust evoked by persons with HIV/AIDS). Behavioral variables were represented by items concerning avoidant intentions across various social settings (e.g., “Suppose you found out that the owner of a small neighborhood grocery store where you liked to shop had HIV/ AIDS. How likely would you be to avoid going to this owner’s grocery store?”). The SCHAC survey included additional avoidance situations relating to church (e.g., “Suppose you found out that a fellow Bible study or prayer partner had HIV/AIDS. How likely would you be to avoid that Bible study or prayer partner who has HIV/AIDS?”). The church-related avoidance items

228

J. B. Pryor et al.

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

TABLE 1 Constructs Developed From the Survey Attitudes toward Church Involvement (3 items) α ¼ .73 Churches should be involved in HIV/AIDS prevention. The pastor of a church plays an important role in how people in the church see persons living with HIV/AIDS. I would support having an HIV/AIDS Care Team ministry at my church. Blame (2 items) α ¼ .53 People who got HIV/AIDS through sex or drug use have gotten what they deserve. Most people with HIV/AIDS are responsible for having got their illness. Misconceptions about Transmission (6 items) α ¼ .84 Likelihood of getting HIV/AIDS from … Kissing someone on the cheek that has HIV/AIDS. Sharing a drink out of the same glass with someone who has HIV/AIDS. Using public toilets Being coughed on or sneezed on by someone who has HIV/AIDS. Donating or giving blood From a mosquito or other bug bite Comfort Level (4 items) α ¼ .86 How do you feel about a child in your family attending school with a person who has HIV/ AIDS? How do you feel about working with an office co-worker who has HIV/AIDS? How do you feel about having a neighborhood grocer who has HIV/AIDS? How comfortable would you feel drinking out of a washed glass in a restaurant if someone with HIV/AIDS had drunk out of the same glass a few days earlier? Negative Emotions (3 items) α ¼ .80 How angry do you feel at people with HIV/AIDS? How afraid do you feel of people with HIV/AIDS? How sickened are you by people with HIV/AIDS? Avoidant Intentions (5 items) α ¼ .86 Suppose you had a young child who was attending school where one of the students was known to have HIV/AIDS. How likely would you be to avoid sending your child to school? Suppose you worked in an office where someone working with you developed HIV/AIDS. How likely would you be to avoid working with that person? Suppose you found out that the owner of a small neighborhood grocery store where you liked to shop had HIV/AIDS. How likely would you be to avoid going to this owner’s grocery store? Suppose you found out that the pastor of your church had HIV/AIDS. How likely would you be to avoid going to the church where the pastor has HIV/AIDS? Suppose you found out that a fellow Bible study or prayer partner had HIV/AIDS. How likely would you be to avoid that Bible study or prayer partner who has HIV/AIDS? Support for Required Testing (3 items) α ¼ .66 Women who are pregnant should be required to be tested for HIV in order to protect the health of their unborn baby. People at risk should be required to be tested regularly for HIV/AIDS. People from other countries who want to live in the United States should first be required to have an HIV test to prove they are not infected.

assessed similar intentions as the non-church items and were combined into an overall avoidant intentions scale.2 Policy-related attitudes included support for required HIV testing (e.g., “People at risk should be required to be tested regularly for HIV/AIDS”).3 A simultaneous entry multiple regression analysis was performed to examine the relationships of the stigma variables in unison to Attitudes

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

HIV-Related Stigma

229

toward Church Involvement. This analysis produced a significant Multiple R of .30, F(6,359) ¼ 6.06, p < .01. An examination of the beta weights showed that Blame (b ¼ 0.15, t ¼ 2.56, p < .01), Comfort Level (b ¼ 0.14, t ¼ 1.95, p < .05), and Support for Required Testing (b ¼ 0.19, t ¼ 3.76, p < .01), were all significant predictors of Attitudes toward Church Involvement. Participants who blamed PLWHA more, who felt less comfort when interacting with PLWHA, and who opposed required testing were less likely to favor HIV-related church activities. There was a marginal connection between having fewer misconceptions about transmission and support for church involvement (b ¼ 0.11, t ¼ 1.77, p ¼ .08). These relationships were significant even after controlling for various demographic variables (e.g., income level).

DISCUSSION Our results clearly demonstrate that people who held more stigmatizing reactions to PLWHA tended to have more negative attitudes toward the involvement of churches in HIV-related activities (e.g., prevention programs, PLWHA care programs, and pastor involvement). The two strongest correlates of attitudes toward church involvement were blame and comfort level. People who held PLWHA responsible for their illness and people who felt uncomfortable with PLWHA in social interactions tended to feel more negatively about church involvement with HIV-related activities. Blame represents a cognitive response to stigma and comfort level represents an emotional response. Blame is an important aspect of many different forms of stigma; blame is crucially related to some specific emotional reactions to stigma and people’s intentions to help or avoid the stigmatized (Weiner, 2006). Pity or compassion may be more likely when an individual is not blamed for the onset of the stigma; whereas, anger or irritation may be more likely when the individual is blamed for the onset of the stigma. Pity and compassion are positively related to helping a stigmatized person, whereas, feelings of anger or irritation are negatively related to helping tendencies. One potential source of feelings of discomfort concerning PLWHA may be a sense that PLWHA lack human faces; people may not know a PLWHA personally and thus may have only an abstract idea of what PLWHAs are like (Herek & Capitanio, 1997). Even though the prevalence of HIV/AIDS among African Americans in South Carolina is high, many of our participants may have been unaware of the PLWHA around them. PLWHAs commonly try to conceal their HIV-status from others because they fear being stigmatized (Clark et al., 2003). Interventions that incorporate open contact with a PLWHA reduce negative feelings that people have about interacting with them (Brown et al., 2003). Pettigrew and Tropp (2006) theorize that such contact may breed more positive reactions toward stigmatized groups by engendering feelings of

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

230

J. B. Pryor et al.

familiarity through mere exposure (Zajonc, 1968) and by reducing feelings of threat and uncertainty (Stephan et al., 2002). Ironically, our data suggest support for required HIV-testing was related to more favorable attitudes toward church involvement. Herek and his colleagues considered these required-testing items to be relevant for attitudes regarding coercive social policies. In a national survey, Herek and colleagues (2002) found that support for required testing generally declined from 1997 to 1999. A key word concerning coercive intent in each of the items in this construct is “required” (Table 1). One possibility is that some participants may not have focused on “required” and instead responded to these items in terms of their general attitudes about HIV-testing. A similar possibility is that there may have been different interpretations about the meaning of “required.” For example, some respondents could have interpreted “required” as “ordered or commanded by authority,” while others could have interpreted the word as “asked as necessary or appropriate.” The first interpretation emphasizes the coercive implication intended by Herek. The second interpretation seems less coercive. Thus, as a group, participants’ responses to these items could have correlated with both more stigmatizing responses and more support for HIV-related church activities. Future research will be needed to clarify the nature of this finding. Analyses of the overall level of stigma using Herek’s stigma index revealed that our sample of Black South Carolinians were not more likely to endorse HIV-related stigma items than a national sample surveyed in 1999. An earlier survey conducted by Herek and Capitanio (1993) that compared national samples of Blacks and Whites found similar results—while Blacks and Whites differed on some specific aspects of stigma, their overall reactions were similar.

Why Should Black Churches Be Involved in HIV-Related Activities? First, several studies suggest that religious or spiritual well-being predicts better mental health among African Americans with HIV/AIDS (Coleman, 2004; Simoni, Martone, & Kerwin, 2002). It is possible to achieve a sense of well-being without church involvement (Miller, 2001), but church involvement may offer social support. A lack of social support and perceived social isolation both predict depression among African Americans with HIV (Blaney et al., 2004). Second, church involvement could help overcome suspicion about ulterior motives in government-sponsored health promotion programs (Bogart & Thorburn, 2005; Stampley, Mallory, & Gabrielson, 2005). The involvement of Black churches has proved to be effective in many other health promotion programs (Baskin, Resnicow, & Campbell, 2001; Markens et al., 2002). Keys to successful church involvement in health promotion programs include establishing trust among the clergy in Black churches and

HIV-Related Stigma

231

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

a recognition that many Black churches are already overburdened in trying to administer to community needs. Finally, the health promotion ministries of Black churches often fulfill unmet needs in Black communities. These needs are often related to economic factors. Nationally, nearly 1 in 4 African Americans lives in poverty. In South Carolina, 26.4% of African Americans have incomes at or below the poverty level (South Carolina Budget and Control Board, Office of Research and Statistics, 2005); and HIV infection is related significantly to poverty (Centers for Disease Control and Prevention, 2005).

Interventions Interventions to reduce HIV-related stigma represent an important step toward greater Black church involvement in the care of PLWHAs and HIV prevention programs. Recent successful stigma-reduction interventions in hospital settings have targeted popular opinion leaders for intensive training and education regarding HIV-related stigma (Li et al., 2013). A similar strategy might prove effective in Black churches in which pastors are targeted for stigmareduction interventions. A thorny issue for stigma reduction interventions in many Black churches in South Carolina and elsewhere is the social acceptance of homosexuals (Pew Research Center, 2013). Although most PLWHA in South Carolina claim to have contracted HIV through heterosexual contact, stigmatized reactions to both homosexual and heterosexual PLWHA are connected to anti-gay attitudes (Pryor, Reeder, Yeadon, & Hesson-McInnis, 2004). Compounding the problem, many of the clergy of Black churches are openly opposed to greater societal acceptance of homosexuals (Hodges, 2012). While challenging, attitude change even on this issue is possible. The most powerful determinant of gay-related attitudes is having a close friend or relative who is gay. As openness regarding sexual orientation increases in the Black community, Black pastors may become more accepting of homosexuality.

ACKNOWLEDGMENTS The authors thank Eddie Clark, Karen Breejen, Aida Cajdric, Karen Johnston, Megan Markey, and Christine Rufener for their valuable comments on an earlier draft of this article.

FUNDING This research was funded by grants to the authors from the Academy for Educational Development.

232

J. B. Pryor et al.

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

NOTES 1. The SCHAC and Herek’s original surveys contained the item: “Most people with HIV/AIDS don’t care if they infect other people with the AIDS virus.” Herek argued this item was related to the construct of responsibility (called blame here). However, the item was not correlated with the other two blame items in the SCHAC sample and it substantially lowered the reliability of the blame sub-scale and its correlations with other measures. So, we excluded this item from the blame measure analyses. Herek’s surveys and the SCHAC survey also included two items concerning symbolic contact—a desire to avoid things somehow associated with HIV/AIDS. One item was actually a difference between how people felt wearing a secondhand sweater worn by someone with HIV/AIDS and how people felt about wearing a secondhand sweater. The other item involved one’s comfort level in drinking from a glass in a restaurant that had been used by someone with HIV/AIDS some days earlier. These two items were not correlated in the current study. Principal components and reliability analyses showed that the drinking glass item fit well into the comfort construct (Table 1). So, the drinking glass was included in that construct and the contaminated sweater item was excluded altogether. 2. Analyses including and excluding these items from the avoidant intentions construct produced similar results. 3. Herek conceptualized the construct of support for coercive policies to include three facets: support for quarantines of PLWHA, support for publicly identifying PLWHA, and support for mandatory testing. Analyses of the interrelationships among these items in the SCHAC survey led us to condense these items to support for required testing in order to achieve an internally consistent measure.

REFERENCES Baskin, M. L., Resnicow, K., & Campbell, M. K. (2001). Conducting health interventions in Black churches: A model for building effective partnerships. Ethnicity & Disease, 11, 823–833. Blaney, N. T., Fernandez, M. I., Ethier, K. A., Wilson, T. E., Walter, E., & Koenig, L. J. (2004). Psychological and behavioral correlates of depression among HIVinfected pregnant women. AIDS Patient Care and STDs, 18, 405–415. Bogart, L. M., & Thorburn, S. (2005). Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? Journal of Acquired Immune Deficiency Syndrome, 28, 213–218. Brooks, R., Rotheram-Borus, M. J., Bing, E. G., Ayala, G., & Henry, C. L. (2003). HIV and AIDS among men of color who have sex with men and men of color who have sex with men and women: An epidemiological profile. AIDS Education and Prevention, 15, Suppl A, 1–6. Brown, L., Macintyre, K., & Trujillo. L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15, 49–69. Centers for Disease Control and Prevention. (2003). HIV/STD risks in young men who have sex with men who do not disclose their sexual orientation—Six US cities, 1994–2000. Mortality & Morbidity Weekly Report, 52, 81–85. Centers for Disease Control and Prevention. (2005). HIV transmission among Black women—North Carolina, 2004. Mortality & Morbidity Weekly Report, 54, 89–92. Centers for Disease Control and Prevention. (2012). Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report, 17(4), 1–26. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/ #supplemental

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

HIV-Related Stigma

233

Clark, H. J., Lindner, G., Armistead, L., & Austin, B. J. (2003). Stigma, disclosure, and psychological functioning among HIV-infected and non-infected AfricanAmerican women. Women & Health, 38, 57–71. Cohen, C. J. (1999). The boundaries of Blackness: AIDS and the breakdown of Black politics. Chicago, IL: University of Chicago Press. Coleman, C. (2004). The contribution of religious and existential well-being to depression among African American heterosexuals with HIV infection. Issues in Mental Health Nursing, 25, 103–110. Coyne-Beasley, T., & Schoenbach, V. J. (2000). The African-American church: A potential forum for adolescent comprehensive sexuality education. Journal of Adolescent Health, 26, 289–294. Herek, G. M., & Capitanio, J. P. (1993). A second decade of stigma: Public reactions to AIDS in the United States, 1990–91. Journal of Public Health, 83, 574–577. Herek, G. M., & Capitanio, J. P. (1997). AIDS stigma and contact with persons with AIDS: Effects of direct and vicarious contact. Journal of Applied Social Psychology, 27, 1–36. Herek, G. M., Capitanio, J. P., & Widaman, K. (2002). HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health, 92(3), 371–377. Hicks, K. E., Allen, J. A., & Wright, E. M. (2005). Building holistic HIV/AIDS responses in African American urban faith communities: A qualitative, multiple case study analysis. Family & Community Health, 28, 184–205. Hodges, C. F. (2012, September 6). Black clergy rip Obama on gay marriage. The Charlotte Post. Retrieved from http://thecharlottepost.com/index.php?src=news &refno=4944&category=News Li, L., Wu, Z., Liang, L., Lin, C., Guan, J., Jia, M., … Yan, Z. (2013). Reducing HIVRelated stigma in health care settings: A randomized controlled trial in China. American Journal of Public Health, 103, 286–292. Malebranche, D. J., Peterson, J. L., Fullilove, R. E., & Stackhouse, R. W. (2004). Race and sexual identity: Perceptions about medical culture and healthcare among Black men who have sex with men. Journal of the National Medical Association, 96, 97–107. Markens, S., Fox, S. A., Taub, B., & Gilbert, M. L. (2002). Role of Black churches in health promotion programs: Lessons from the Los Angeles Mammography Promotion in Churches Program. American Journal of Public Health, 92, 805–810. Miller, R. L. (2001). African American churches at the crossroads of AIDS. Focus: A Guide to AIDS Research and Counseling, 16, 1–4. Pettigrew, T. F., & Tropp, L. R. (2006). A meta-analytic of intergroup contact theory. Journal of Personality and Social Psychology, 90, 751–783. Pew Research Center. (2013). Growing support for gay marriage: Changed minds and changing demographics. Retrieved from http://www.people-press.org/ 2013/03/20/growing-support-for-gay-marriage-changed-minds-and-changingdemographics/ Pryor, J. B., Reeder, G. D., Yeadon, C., & Hesson-McInnis, M. (2004). A dual process model of reactions to perceived stigma. Journal of Personality and Social Psychology, 87, 436–452.

Downloaded by [Texas A & M International University] at 14:48 05 November 2015

234

J. B. Pryor et al.

Sahgal, N., & Smith G. (2009). A religious portrait of African Americans. Washington, DC: Pew Research Center, The Pew Forum on Religion and Public Life. Sengupta, S., Banks, B., Jonas, D., Miles, M. S., & Smith, G. C. (2011). HIV interventions to reduce HIV/AIDS stigma: A systematic review. AIDS & Behavior, 15, 1075–1087. Simoni, J. M., Martrone, M., & Kerwin, J. (2002). Spirituality and psychological adaptation among women with HIV/AIDS: Implications for counseling. Journal of Counseling Psychology, 49, 139–147. Snowden, L. R. (2001). Social embeddedness and psychological well-being among African-Americans and Whites. American Journal of Community Psychology, 29, 519–536. South Carolina Budget and Control Board, Office of Research and Statistics. (2005). South Carolina statistical abstract 2005. Retrieved from http://www.ors2.state. sc.us/abstract/chapter13/income14.asp South Carolina Department of Health and Environmental Control (2012). South Carolina’s STD/HIV/AIDS data: STD/HIV Division surveillance report. Columbia, SC: Author. Stampley, C. D., Mallory, C., & Gabrielson, M. (2005). HIV/AIDS among midlife African American women: An integrated review of the literature. Research in Nursing & Health, 28, 295–305. Stephan, W. G., Boniecki, K. A., Ybarra, O., Bettencourt, A., Ervin, K. S., Jackson, L. A., … Renfro, C. (2002). The role of threats in the racial attitudes of Blacks and White. Personality & Social Psychology Bulletin, 28, 1242–1254. Weiner, B. (2006). Social motivation, justice, and the moral emotions: An attributional approach. Mahwah, NJ: Lawrence Erlbaum Associates. Whetten, K., Reif, S., Lowe, K., & Eldred, L. (2003). Gender differences in knowledge and perceptions of HIV resources among individuals living with HIV in the Southeast. Southern Medical Journal, 97, 342–349. Zajonc, R. B. (1968). Attitudinal effects of mere exposure. Journal of Personality & Social Psychology, 9, 1–27.

Stigma as a Barrier to HIV-Related Activities Among African-American Churches in South Carolina.

South Carolina has one of the highest HIV/AIDS prevalence rates in the United States. More than 70% of those infected are African American. Traditiona...
291KB Sizes 2 Downloads 8 Views