Shine A Light
Terrinieka Powell draws on higher powers to confront Baltimore's HIV/AIDs epidemic.
Terrinieka Powell's epiphany came seven years ago in Flint, Michigan. Powell was talking with young people about the sexual health messages they heard in church. Then a postdoc in community psychology at the University of Michigan, she worked at the YOUR Center on a faith-based HIV prevention program led by Ms. Bettina Campbell. For the first time, Powell was hearing directly from adolescents themselves. They knew very little about the disease and how to prevent it.
“I remember one girl saying something like, ‘All we hear is, don’t have sex or you’ll get pregnant, get AIDS and die,’” says Powell, PhD, an assistant professor in Population, Family and Reproductive Health. “I thought, ‘Yikes! How did we get here?’”
Even allowing for imperfect recall, “That’s how young people were interpreting messages,” Powell says. “It was then that I realized we had to do better.”
The adolescents’ remarks made plain that many African-American churches in Flint and nationwide were failing young members by stigmatizing homosexuality and refusing to talk about sex and drugs—even as the HIV/AIDS epidemic devastated their communities.
Powell’s conversation with church youth marked a turning point that would lead her to partner with churches to provide evidence-based sexual health programs for youth in their congregations and community. “I started to think about the ways that I could help churches and faith leaders become better resources for young people,” Powell says.
Since arriving at the Bloomberg School five years ago, Powell has been gathering insights in black churches across Baltimore on how to align religious doctrine with adolescents’ need for sexual health and substance abuse prevention education.
The need is great in Baltimore and across the U.S. Although African-Americans comprise 63 percent of Baltimore’s population, they represent 83 percent (11,000 people) of those living with HIV/AIDS. Nationally, blacks represented 44 percent of all known HIV cases although they made up just 14 percent of the U.S. population in 2009, according to the CDC. In 2010, black young people made up nearly 60 percent of new infections among those ages 13 to 24. The CDC also reported in 2012 that African-Americans accounted for 54 percent of new infections among young men who have sex with men (MSM).
Powell’s collaboration with Baltimore faith communities coincides with proliferating efforts across the U.S. to marshal black churches against HIV/AIDS. Advocates in religious, health and civil rights organizations argue the disease is not a moral failing but a health crisis arising from unjust socioeconomic conditions. In 2012, the NAACP issued The Black Church and HIV: The Social Justice Imperative to mobilize faith leaders against HIV/AIDS—just as they fought for civil rights. Yet many spiritual leaders have dodged the conversation because it would force them to address taboo topics such as homosexuality, premarital sex, infidelity and drug abuse. Many have been critical of their resistance and silence at times, suggesting that churches may be missing opportunities to encourage church members to learn their HIV status and receive pre-exposure prophylaxis (PrEP), or lifesaving antiretroviral therapy if they test positive.
Black churches remain the anchor of community life for millions of African Americans. As a source of spiritual solace and personal empowerment, churches have the authority to open minds and influence behavior say activists such as Frank Lance, senior pastor of Mt. Lebanon Baptist Church in Baltimore. Today, though, churches’ silence on the subject of HIV/AIDS not only carries a deadly human cost—but jeopardizes their very existence, Lance says. When churches condemn “sinful behavior” rather than work to heal members, they become irrelevant, he says. “If a church fails to evolve, it will fail to exist.”
From Amazing Grace Evangelical Lutheran Church and Zion Baptist Church in East Baltimore, to Mt. Lebanon Baptist Church and Douglas Memorial Baptist Church on the west side, Powell has cultivated a roster of “pastor pals” in underserved neighborhoods where the risk of HIV infection is high and drug addiction is rampant. Her work begins with engendering trust that she’s not a “helicopter researcher” who collects data and disappears, Powell says. Her own church background puts faith leaders at ease. “When I partner with churches, I try to be very clear that it’s not always tied to research. I ask, ‘How can I contribute to your mission to help and provide wholeness to people?’
“It’s a relationship. People have to believe you’re with them on this journey,” says Powell, who’s also an associate director of the Johns Hopkins Urban Health Institute and a faculty associate of the CDC-funded Johns Hopkins Center for Adolescent Health.
Where her efforts depart from existing faith-based HIV/AIDS prevention and treatment models is her focus on adolescents rather than older adults or women, she says.
Over the years, schools have become a popular setting for evidence-based interventions. She asks: Why not churches?
“It’s not beyond the realm of the possible for churches to deliver evidence-based interventions that we know work,” she says.
THE HARD CHOICES
On a late summer afternoon, Powell is deep in conversation with Gary Dittman, pastor of Amazing Grace Evangelical Lutheran Church, in his cluttered basement office. Their exchange calls to mind a back porch chat between friends. Powell is upbeat and empathetic as they catch up on church initiatives, a few setbacks and neighborhood politics. She’s quick to spot opportunities for promoting intergenerational fellowship and pleased to learn that Amazing Grace offers a program on healing from trauma. “You know I’m all about that!” she says.
Powell and Dittman contemplate using research funds to purchase a PlayStation 3 as a way of encouraging young men who are avid video gamers to participate in the church community. Although the topic of HIV/AIDS doesn’t come up directly in this particular conversation, they cover other critical issues from the neighborhood’s need for fresh vegetables to the young boy who lives in a three-bedroom house with 13 others and scrambles for food to feed his family.
Powell’s work with pastors takes into account the hard choices they have to make when allocating limited resources in communities with multiple health disparities. Not all are willing or able to launch HIV/AIDS ministries and outreach programs as Frank Lance has at Mt. Lebanon. Powell and Lance, who serves on the city’s HIV/AIDS commission, have spent hours discussing ways to incorporate HIV-related information and programming into the agendas of less progressive churches. “The greatest stigma [associated with men who have sex with men and HIV/AIDS] is still in the black church,” Lance says.
He blames the psychic wounds inflicted by slavery and systemic racism for black homophobia that continues to fuel self-hatred and shame among African-Americans. Overcoming stigma requires a pastor’s cooperation and a firm grasp of Scripture, he says. “Terri and I talk about how we take this message to churches in a way that is theologically sound and biblically sound.”
As her ties to faith leaders in less progressive churches strengthen, Powell can begin to assess their churches’ capacity for addressing the HIV/AIDS epidemic. Powell may give pastors ideas for incorporating messages about HIV/AIDS into a sermon, hosting an HIV screening event or making a list of resources available in a discreet location.
“My goal is always to say, ‘Well, what can you do? We should all be able to do something.’” Powell has found that even black churches that remain hostile to homosexuality are increasingly receptive to addressing the HIV/AIDS epidemic. Not all are ready to fully embrace prevention efforts, however. Often, Powell says, an aversion to discussing sexuality isn’t what’s holding them back. “One of the things that I hear repeatedly, is, ‘It’s not in my training to talk about HIV, mental health, domestic violence.’ That’s not how pastors are trained.”
Powell aims to create a synergistic relationship between Baltimore’s faith communities and the Bloomberg School. “Public health and church partnerships are necessary,” she says. “We know a lot about interventions and about what works.” For such partnerships to succeed, churches must tap into their own expertise as well, says Powell, who often hires church and community members to help conduct research.
Her brand of public health outreach is a model for the School, says her mentor, Carl Latkin, PhD, a professor in Health, Behavior and Society. “Terri’s approach of integrating community-based research with practice and rigorous methods represents the direction Hopkins should be heading to improve Baltimore City,” Latkin says.'
NOT THERE YET
When Powell herself was an adolescent, she attended Trinity United Church on Chicago’s South Side, an activist African-American church renowned for its commitment to social justice. (Also sitting in Trinity’s pews at the time was a community organizer named Barack Obama and his family.) Powell found spiritual grounding there, but initially didn’t recognize the church’s potential for improving the physical and mental wellbeing of the congregation and surrounding community. At the time, she was mystified that the church had a prison ministry. “They [the prisoners] must have done something bad,” she remembers thinking. Sermon by sermon, Powell came to see the Gospel and social justice as one and the same. “The more I grew, the more I started to understand what the pastor said: ‘Everyone has the right to sit at the feet of God.’” In other words, as her pastor elaborated, “All people deserve the opportunity to be healthy.”
Powell now worships at Douglas Memorial Community Church, a stately pillar of West Baltimore since 1857, with its own history of activism. A couple of years ago, senior pastor Todd Yeary got tested for HIV as he stood on the pulpit in Douglas Memorial’s bright, blue sanctuary. It was a way to normalize the procedure for congregants. “You’ve got to know your status even though you might be a saint,” Yeary says. Afterward, church members in their Sunday finest lined up for a church testing event, he recalls.
One of the things that I hear repeatedly, is, 'It's not in my training to talk about HIV, mental health, domestic violence.' that's not how pastors are trained.
Still, community refusal to confront the epidemic persists as a source of frustration for Yeary, who was part of the NAACP’s effort to produce The Black Church and HIV, and is writing two books on HIV/AIDS as a social justice issue. One of the “multiple types of violence that plays out in our community is the denial of public health issues,” he says. “We cannot be willing participants in denying our communities are dying because we’re unwilling to deal forthrightly with HIV/AIDS.”
Perceptions gleaned from pastors and their congregations form the foundation of Powell’s research. One study, published this summer in the journal AIDS Education and Prevention, sought recommendations from 30 churchgoing young black men who have sex with men (YBMSM) in Baltimore for fostering more inclusive HIV prevention efforts within the church. In the study, participants endorsed a two-tiered approach that concurrently tackled stigmatization and the sexual health needs of all congregants. Prevention efforts should have equal standing with ministry to the sick, participants said. They also advocated for bringing in public health experts to instruct church members on correct condom use and for the creation of support groups for YBMSM.
In relying on the impressions and experiences of YBMSM, Powell’s study gave voice to a population often overlooked: black gay adolescents who attend church. Their responses laid bare the pain of worshipping in a church where they don’t always feel welcome. Interview participant Kurt Ragin regularly attends the church where he grew up, but can’t shake the sense of shame that overcomes him on Sundays. He feels as if he’s “a disgrace to a community that I thought I was a part of. I have to take that with me everywhere I go,” Ragin says.
Powell’s study also demonstrated that members of a marginalized population can make valuable contributions to the design of a public health intervention—and to their own congregations. Participating in the interview gave Ragin, an outreach worker for an adolescent HIV/AIDS prevention program at the University of Maryland’s School of Medicine, the opportunity to provide heart-felt answers to hard questions. What’s more, Ragin realized that when confronted by misunderstanding and fear in his church home, “I have the power to advocate for the culture of being black and gay.”
When designing health education programs, there is no need to reinvent the wheel, Powell’s research reveals. Faith leaders and churchgoing families would approve of current evidence-based sexual health and HIV interventions for youth —with the addition of relevant references to Scripture. “This has also surprised me given the strong perception that churches are only interested in ‘abstinence only’ rhetoric,” Powell says.
Faith-based sexual health and HIV research has a long way to go, Powell notes. Researchers must continue to partner with black churches to promote HIV/AIDS testing, treatment and care. Powell’s yardstick for success is the HIV Care Continuum, a model that identifies the five stages of HIV medical care, starting with a diagnosis and ending with achievement of viral suppression, a milestone attained by only 30 percent of those living with HIV. “One of the goals is to have everyone who is HIV positive to be virally suppressed,” Powell says. “We’re not there yet.”
Her own goal is perhaps less ambitious, but no less important: to see more church communities connecting with young people, especially those who may be at risk for the disease and making sure they are cared for. "At every phase of this continuum," she says, "there are opportunities for folks to be engaged."