The HIV epidemic continues to have a disproportionate impact on African Americans living in the South [1]. Despite an overall decline by 9% of new HIV diagnoses in the United States from 2015 to 2019, the highest concentration of new diagnoses was in the US South [1]. Moreover, from 2015 to 2019, the percentage of Black/African American people diagnosed with HIV in the South was 52% as compared to 18% in the West, 40% in the Northeast, and 47% in the Midwest [1]. As of 2019, North Carolina ranks 6th among all states, representing 4% of new national HIV cases [2].
Healthy North Carolina (Healthy NC) 2030 outlined goals for reducing HIV diagnosis rates from 13.9 per 100,000 to 6 per 100,000 by 2030 [3]. One lever for making this change is addressing structural racism that limits access to health care for people vulnerable to, and living with, HIV. In particular, the Healthy NC 2030 strategy includes recommendations for increasing access to PrEP for high-risk individuals, improving access to treatment, making testing easier, ensuring linkage with appropriate care and availability of condoms, and increasing Medicaid eligibility [3]. The strategy to end HIV in North Carolina also includes connecting community-based organizations with local health departments to improve access to HIV prevention and treatment services [3]. Addressing the complex issues of HIV in North Carolina requires culturally informed strategies that include influential faith leaders working alongside medical professionals to provide education that encourages a holistic approach to health and combats HIV-related stigma. Historically, African American congregations have influence in African American communities [4–6]. Research shows that faith-based public health interventions, such as health and wellness programs, have been successful at increasing the capacity of faith communities to integrate health messaging and programming and establish health ministries. However, most faith-based interventions have been implemented in only one church at a time, thereby limiting potential impact [7]. Establishing a network of faith leaders connected to medical providers can allow churches to build partnerships that enhance health and address HIV-related stigma at the community level [4, 7]. Thus, there is an unprecedented opportunity to deeply engage faith communities in conversations about long-taboo topics like HIV by considering how to build faith-based coalitions to address the disease and related stigmas.
The Faith Coordinating Center (FCC) at Wake Forest University was founded in 2021 as part of a commitment from Gilead Sciences to fund $100 million over 10 years to support the COMPASS (COMmitment to Partnership in Addressing HIV/AIDS in Southern States) Initiative. COMPASS is a program working to address the HIV/AIDS epidemic in the South by collaborating with local community organizations to use evidence-based solutions to meet the needs of people living with and affected by HIV. FCC is committed to engaging faith communities aboutHIV stigma to advance efforts to end the HIV epidemic, especially among the most vulnerable populations.
FCC integrates Black liberation theologies [8], womanist theology [9], and racial justice in HIV philanthropy principles [10] to guide the organization’s work. Black liberationists adopt an approach focused primarily on freedom from oppression and a rejection of white supremacist frameworks. Further, womanist theologians argue that any liberative praxis must address theologies that denigrate Black women and demonize LGBTQ people [11, 12]. Racial justice-centered HIV philanthropy encourages practices that provide capacity-building opportunities and flexible, long-term funding to organizations led by Black, Indigenous, and People of Color (BIPOC) to ultimately dismantle structural racism and its effects [10].
The main thrusts of FCC engagement include 1) grantmaking, 2) storytelling through innovative social marketing, and 3) educational and capacity-building trainings to transform the way Black Southern faith communities address HIV stigma.
In 2021–2022, FCC funded nearly $1 million to 17 organizations committed to engaging faith communities around HIV. Our North Carolina-based funded partners include North Carolina Council of Churches (Raleigh), Fayetteville Area Health Education Center, and Lenoir County Circle of Friends (Greenville). They have conducted trainings and sponsored a billboard that encouraged people to seek HIV testing and treatment in rural North Carolina. Other funded partners are also doing innovative work with historically Black colleges and universities (HBCUs) across the South (Interfaith Youth Core); leveraging podcasts (Theo Labs), TV, and radio shows (Foundations for Living, Relationship Unleashed); and holding in-depth faith leader trainings (Vision Community Foundation, Cooperative Baptist Fellowship of Mississippi, Tampa Metropolitan Charities) to mobilize faith communities toward more inclusive, educated, and safe spaces for people living with HIV.
FCC uses the art of storytelling and social marketing to develop online materials that educate the public and challenge traditional notions about love and acceptance of people living with HIV and LGBTQ persons. Over the course of 12 months, we engaged 115,000 unique users online with content related to faith and HIV. Additionally, FCC has published a faith leader toolkit for National Faith HIV/ AIDS Awareness Day and co-produced a film about the shared responsibility required to combat HIV and LGBTQ stigma in communities. We also partnered with celebrity Lil Nas X, who helped raise awareness about HIV and raise over $500,000 for BIPOC and LGBTQ-led organizations. Additionally, in 2021, FCC hosted a virtual panel discussion with activist Hydeia Broadbent, faith leaders, and HIV cure researchers to discuss the connections between wholistic health and spirituality, community wellness, and finding a cure for HIV. The FCC also developed a toolkit to build the capacity of faith organizations to highlight 14 days of HIV awareness from World AIDS Day (Dec 1) to HIV Cure Research Day (Dec 14) through social media engagement. Dr. Allison Mathews and Kimberly Knight co-founded HIV Cure Research Day in 2016 to increase the number of BIPOC community members engaging with HIV cure clinical research [13].
FCC also collaborated with experts from Wake Forest University and other organizations to facilitate a robust series of workshops in 2021 to enhance the knowledge and skills of faith communities to raise awareness and address HIV-related stigma. These trainings reached 1169 people, with an average of 50 attendees per workshop.
Educating faith-based organizations to integrate scientifically accurate and theologically inclusive messages about HIV provides a needed holistic approach to transforming the way Black Southern faith communities address HIV stigma. Working with experts in divinity, public health, and medicine to address HIV through partnerships with faith communities to engage in grant-making, transformative storytelling, and educational trainings serves as a model for expanding the reach and effectiveness of addressing HIV in the South. NCMJ
Acknowledgments
Disclosure of interests. The Faith Coordinating Center is funded by Gilead Sciences, which manufactured PrEP and now manufactures Descovy, a second formulation of the drug. The authors disclose no further interests.
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