We are trying to work with opinion leaders, which are often religious and community leaders, to recognize that stigmatizing attitudes have a profoundly negative effect on prevention.
BALTIMORE — When the Rev. Keron Sadler of the NAACP tried to persuade churches around the country to play a more active role in HIV/AIDS education, she drew some hostile reactions. One pastor said his congregants might think he was gay. Another said AIDS is a curse. Yet another walked out of the room rather than discuss the topic.
Those reactions highlight the challenges facing Baltimore as it enlists church outreach for its ambitious goal of curbing new HIV/AIDS cases by 25 percent in the next four years.
The disease remains a sensitive topic among some ministers, as Sadler found when a similar NAACP initiative took her to churches in 11 cities, including Baltimore. Discussing HIV/AIDS means delving into topics — gay sex, promiscuity and drug use — that churches may not want to be seen as embracing or condoning. Some churches ignore the subject, while others tackle it in a way that passes judgment on lifestyles, leaving some people reluctant to seek help.
Bishop Willard Saunders Jr. of the Created For So Much More Worship Center in the Cherry Hill neighborhood said that he promotes HIV/AIDS education, but does not sacrifice the beliefs of the church in doing so. The church tells members that gay sex, sex with multiple partners and drug use are all unsavory, risky behaviors that lead to bad consequences such as HIV/AIDS.
"If you choose to live an unhealthy lifestyle, it puts you at risk," Saunders said. "I believe homosexuality is wrong. I believe it's wrong the same way adultery is wrong. The same way that lying is wrong."
S. Todd Yeary, the pastor of Douglas Memorial Community Church in West Baltimore, takes a different approach. He knows that in educating about HIV/AIDS, churches may be confronted with issues that go against their beliefs. Churches, he said, need to learn to teach about prevention without passing judgment.
"Part of the challenge of dealing with the dilemma of HIV has been a reluctance to be honest with the fact that our job is not to police what goes on in people's bedrooms," Yeary said.
Many AIDS activists say the church has to be a part of the fight against the disease, reaching residents who may already have it or people with behaviors that put them at risk.
Churches are the heart of many neighborhoods in Baltimore, where HIV/AIDS affects more than 13,000 residents. And it is from the pulpit that many residents — especially African-Americans, who make up 85 percent of Baltimore cases — get their messages. To many people, the pastor's word is sacred.
"The church is a foundation of bringing communities together," said Baltimore City Health Commissioner Oxiris Barbot. "We need them to help get out the message about AIDS."
A 2002 survey found that 46 percent of Baltimore injection drug users had attended church in the past month. A recent survey of 300 clients with HIV who get treatment through the Jacques Initiative health program at the University of Maryland said faith is important in their lives, and 44 percent said faith became even more important after they were diagnosed with the disease.
Churches already do charitable work, such as food drives and homeless outreach, that would complement HIV-prevention efforts, health officials said. Some churches have HIV/AIDS programs that include testing, workshops and education, and city officials hope to have them reach out to peers who may be more hesitant.
The city recently announced plans to reach out to churches as part of an initiative for fighting the disease at its earliest stages, by limiting its transmission and pushing for more widespread testing. The goal of the plan, crafted by the Baltimore City Commission on HIV/AIDS, is to cut the annual number of new diagnoses from 505 to 379 by 2015.
Other recommendations called for expanding needle-exchange programs, promoting testing in primary-care doctors' offices, and targeting outreach to gay and sex clubs, schools, senior centers and prisons.
"We are trying to work with opinion leaders, which are often religious and community leaders, to recognize that stigmatizing attitudes have a profoundly negative effect on prevention," said commission chairman William Blattner, who is associate director of the Institute of Human Virology at the University of Maryland School of Medicine. "We are trying to get them to recognize we're here to help people, not judge them, and get pastors to have a more enlightened approach."
Blattner and others said they are not asking churches to sacrifice their religious beliefs.
"We don't have an agenda other than providing important public health messaging," Barbot said. "We're very cognizant of steering away from the moral issue. For us it's a public health issue, not a moral issue."
The city wants to target churches in areas with the highest HIV/AIDS concentrations and risk factors. Barbot said they can work with churches to approach the subject in broad, general terms. Some churches may not feel comfortable giving out free condoms. Others may give out literature, but not want to talk about HIV/AIDS from the pulpit.
"The reality is there are some churches that will be initially hesitant because they may have some preconceived notion to what we are looking to do," Barbot said. "We want people to know we will meet them where they are."
In Baltimore, issues that may be controversial to some ministers are at the heart of the AIDS epidemic — particularly homosexuality.
Heterosexual contact was the most common way people contracted the disease, according to a 2009 survey. About 38 percent of people contracted the disease this way.
But a disproportionate number of cases came from men having sex with men; about 36 percent of people contracted the disease this way. While the number of gay men in the city is not known, they make up about 2 percent of the national population.
HopeSprings, a Baltimore nonprofit that trains church leaders on HIV/AIDS education, said their comfort level varies on sensitive topics.
"We try to present them with all the different options," said Erin Donovan, executive director of HopeSprings. "We want them to do what fits their church."
A committee for the Baltimore-based NAACP is creating a manual for churches on how to teach HIV/AIDS prevention methods. Research for the guide led Sadler on the 11-city tour to talk to churches.
Sadler said the HIV Faith & Social Justice manual would present AIDS prevention as a social justice issue that addresses health disparities along with the teachings. It will provide pastors with optional sermons, such as teaching that the Bible says people should not judge others.
"We have to reshape the conversation when it comes to HIV because it is so taboo and rejected," Sadler said.
Some church programs have made strides in efforts to address HIV/AIDS. Project Shalem, under the Jacques Initiative, has tested close to 5,000 people at churches throughout the city. In the process, workers discovered 10 new HIV/AIDS cases and were able to get additional treatment for 96 others.
"For us, not energizing the church is a big mistake," said Derek Spencer, executive director of the Jacques Initiative. "There are people sitting in church affected by HIV/AIDS."
John Smith, pastor of the First Baptist Church of Essex, said his church hasn't done any AIDS outreach, but said it could be done without delving into people's sexual histories.
"Whether or not it should be tied to the issue of sexuality, I don't know," Smith said. "I don't know if that would be one in the same. I think it would simply be enough to address the AIDS epidemic as a terrible disease that we have a responsibility to do something about."