Wise J M, Kempf M C, Ott C, Footman A P, Hardy C, Araya B Y, Walker C, Latham C, Stockett R, Daniels G L, Alexander M, Lanzi R G
Department of Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA.
Department of Health Behavior, School of Public Health, UAB, Birmingham, AL, 35294, USA.
J Racial Ethn Health Disparities. 2024 Sep 16. doi: 10.1007/s40615-024-02122-w.
The Deep South is the epicenter of the HIV-epidemic in the United States, with rural AAs bearing the greatest burden. Traditional efforts to improve testing efforts have been largely unsuccessful due to their failure to recognize and leverage the sociopolitical and cultural factors that affect the uptake of HIV-screening interventions at the community level. The purpose of this study was to gain a deeper understanding of the socio-cultural contexts impacting HIV-testing in the rural South, and to assess strategies to increase testing in rural, Southern communities. Focus groups (n = 8) and semi-structured interviews (n = 31) were conducted among community and faith-based leaders in Alabama and Mississippi, to inform our understanding of local perceptions of HIV infection, barriers and facilitators impacting HIV-testing, and best strategies for improving testing efforts at the local level. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed to extract major themes. While both faith-based and community leaders reported at least some stigmatizing attitudes towards HIV infection, faith-based leaders were more likely to report discomfort being around someone with HIV and were more likely to link the spread of HIV to immoral behaviors. The combination of the cultural importance of the Church, deep-seated religiosity among community members, and faith-based messages associating HIV infection with immorality directly impacted HIV stigma within the community-in turn, decreasing willingness to participate in HIV-testing, disclose positive HIV serostatus, or openly discuss transmission protection behaviors. The Church was identified as crucial to include to improve HIV-testing efforts in the rural South, due to their prominent sociopolitical roles within communities and ability to influence community members' perceptions of HIV stigma. Faith-based leaderships should be included in initiatives to increase improve HIV-testing and awareness of status and reduce HIV disparities in the Deep South.
美国南部腹地是该国艾滋病疫情的中心，农村非裔美国人承受的负担最为沉重。传统的加强检测工作的努力大多未取得成功，因为这些努力未能认识到并利用影响社区层面艾滋病病毒筛查干预措施接受度的社会政治和文化因素。本研究的目的是更深入地了解影响美国南部农村地区艾滋病病毒检测的社会文化背景，并评估增加南部农村社区检测的策略。在阿拉巴马州和密西西比州的社区及宗教领袖中开展了焦点小组访谈（n = 8）和半结构化访谈（n = 31），以增进我们对当地对艾滋病病毒感染的看法、影响艾滋病病毒检测的障碍和促进因素以及改善当地检测工作的最佳策略的理解。访谈和焦点小组讨论进行了录音，逐字转录，并进行分析以提取主要主题。虽然宗教领袖和社区领袖都报告称至少对艾滋病病毒感染存在一些污名化态度，但宗教领袖更有可能报告与艾滋病病毒感染者相处时感到不适，并且更有可能将艾滋病病毒的传播与不道德行为联系起来。教会在文化上的重要性、社区成员根深蒂固的宗教信仰以及将艾滋病病毒感染与不道德联系起来的宗教信息的结合，直接影响了社区内的艾滋病污名化——进而降低了参与艾滋病病毒检测、披露艾滋病病毒阳性血清状态或公开讨论传播保护行为的意愿。教会被认为对于改善美国南部农村地区的艾滋病病毒检测工作至关重要，因为它们在社区中具有突出的社会政治作用，并且有能力影响社区成员对艾滋病污名化的看法。宗教领袖应参与到旨在增加艾滋病病毒检测和提高对感染状况的认识以及减少美国南部腹地艾滋病差异的倡议中。
