HIV/AIDS, long thought an urban disease, has migrated south to rural communities. Nearly 50 percent of all new cases of HIV infection in the United States are in the South, and African-American men and women living in the South are hardest hit.
In Alabama, in the impoverished Black Belt region, counties like Lowndes, Hale, Greene, Macon, Dallas and Montgomery routinely rank among the highest in new incidence rates for HIV in the state. Only a quarter of the population of Alabama is black, but nearly 75 percent of HIV patients there are, according to the Emory University Rollins School of Public Health.
In addition to a reluctance to talk about HIV and AIDS is the stigma of being gay, especially in the African-American community, says Pamela Payne-Foster, MD, an associate professor of Community and Rural Medicine for the College and deputy director of its Institute for Rural Health Research. Foster says that stigma puts people at risk for HIV.
Foster studies the spread of HIV in the South, and some of her work was recently cited in an article by New York City-based Al Jazeera America, an American news organization launched in 2013 with 12 bureaus in major cities around the country and three broadcast centers.
In the article, Foster said that when she interviews people living with HIV in rural Alabama, they regularly list church as the place they feel most stigmatized. “One of their greatest fears is that when they tell the pastor that they are HIV-positive, that information will spread throughout the congregation. They feel it should be confidential so they say, ‘If you want to keep a secret don’t tell anybody in the church.’”
At the same time, Foster said, HIV-positive men and women report a deep desire for a connection to their church communities. In many of these isolated towns, including those in the Alabama Black Belt, churches also function as a social club, after-school program and food bank. “The church should be a place that is open for people living with HIV/AIDS,” she says.
A few years ago, Foster borrowed an anti-stigma curriculum that had been used in churches in Ghana and decided to test it in Alabama. It took her a year and a half to recruit 12 churches to participate in the study. She hopes the study will not only educate congregations about HIV/AIDS, but also reduce stigma around it.