Innovative HIV prevention campaigns focus on high-risk youth, minorities
Black ministers step into HIV testing limelight, sending message home
It’s taken 12 years, but the watershed moment finally has arrived in HIV prevention, as far as The Balm in Gilead of New York City is concerned. The HIV prevention group’s campaign to engage African-American churches and ministers in efforts to fight the epidemic has begun to reap rewards, with prominent black ministers announcing that they are being tested for HIV and increasing numbers of churches participating in communitywide prevention projects.
"We feel this is a real turning point where we’re engaging churches to encourage African-Americans to be tested," says Pernessa Seele, founder and chief executive officer of The Balm in Gilead. "We’re no longer just talking about churches getting involved, but we’re now at a place where churches are calling on the community to get tested."
Some of the new HIV prevention campaigns aimed at minorities include the following:
• Researchers at the University of Illinois in Chicago have begun a unique project that provides prevention information and intervention to Latino women in Chicago communities. (See story on prevention project for Latino women, p. 89.)
• Florida has started an advertising campaign directed toward African-Americans and other minorities about HIV testing, condom use, and abstaining from sex. The ads, which feature young people talking about AIDS in social situations, will appear on television, radio, billboards, and newspapers during the next year.
• Alameda County in California has an AIDS education campaign that targets African-American and Latino gay men and minority teen-agers. The ads are explicit, showing shirtless men about to engage in sex, and caused a controversy among local officials. So instead of putting them on billboards and bus stop benches, the ads will be displayed on matchbooks and condom packages.
Low-rider car used to reach Latinos
• The California Department of Health Services last spring started a prevention campaign for minorities that features a 1953 Chevy Bel-Air low-rider car. The car, which is expected to draw a large Latino turnout, will be taken on a statewide tour through mid-2001. Local AIDS groups will hand out information and discuss HIV at each stop.
• A Detroit program called Sisters and Daughters of Sheba received a CDC grant earlier this year to provide HIV prevention services to African-American women. The program provides basic HIV information and discusses self-esteem issues with women, teaching them to care about themselves and their own health. It also involves peer mentors who teach teen-age girls about safe sex.
• About 70 ministers of minority churches in Georgia have formed a partnership with the Fulton County health department to educate their congregations about HIV/AIDS, teen pregnancy, cancer, and sexually transmitted diseases. There will be a teen summit and health screenings.
• Phoenix Body Positive in Arizona has expanded its prevention and AIDS support work to increasing numbers of women, Latinos, and African-Americans by working with churches, physicians, and testing centers to provide HIV counseling and support services, such as day care and respite care.
• The Harlem Directors Group and other organizations in New York City have begun a program called "Test, Link, Care — A Community Partnership" in Harlem. The program has 28 outreach workers who meet with people who do not know their HIV status, sending them to health care facilities and mobile units for testing.
• Washington, DC, has been running a series of print ads that feature the numeral 2000 with colored condoms in the place of zeros. The ads appear in bus shelters, subway stations, and in local newspapers, and they feature a Spanish version. Some of the ads feature a checklist of HIV prevention measures and mention abstinence.
• Community-based prevention programs in Arizona, including La Zona Hispana and TRIBE, try to increase HIV awareness among Hispanics and new Mexican immigrants by distributing pamphlets and condoms at bars and stores.
Hairdressers dispense HIV prevention advice
• Charlotte, NC-area barbers and beauticians hand out condoms and advice on safe sex and HIV prevention as part of a program that targets AIDS prevention in the African-American community.
The drive behind many of the new prevention projects is federal grant money made available specifically for HIV prevention programs for minorities.
"In October 1998, the Clinton administration declared HIV to be a severe health crisis in African-American communities and other communities of color, and with that announcement came $156 million for HIV intervention targeted to African-American communities," says Peter Velasco, director of communications for the National Minority AIDS Council in Washington, DC.
That money has taken some time to spread through the pipeline, and now, along with increases in 1999 funding, is finding its way to the community level.
"More resources became available to communities of color, and this enabled the communities to take action," Velasco adds. "We also saw several very prominent community leaders, including the Rev. Jesse Jackson, become tested for HIV and really display their leadership by sending the message that everyone should be tested for HIV."
Increasing numbers of prevention strategies also are being aimed at stopping HIV infection among minority and white youths, using language and visual cues that are relevant to this population, as well.
For example, the Henry J. Kaiser Family Foundation of Menlo Park, CA, has opened an on-line resource for teen-agers who have questions about sex, STDs, HIV, and birth control. The Web site is located at www.itsyoursexlife.com.
"In the United States, it’s estimated that one in four people with HIV were infected by age 21," says Donna Futterman, MD, director of the Adolescent AIDS Program at Montefiore Medical Center in the Bronx, NY. "So do the math with the numbers of people who have AIDS, and there are maybe 100,000 young people in the U.S. with HIV infection, and the vast majority don’t know they’re infected," Futterman says.
An estimated 16% of youths infected with HIV are aware of their status, compared with two-thirds of adults who are aware of their HIV status.1
This problem is coupled with the fact that studies have shown that adolescents are twice as likely as adults to engage in risky behavior. For instance, a new surveillance study published by the Centers for Disease Control and Prevention in Atlanta indicates that about half of all high school students have had sexual intercourse, and 42% of these students had not used a condom during their last sexual intercourse experience. More than 16% of the students said they had had four or more sexual partners. The youths also had a high prevalence (81%) of having tried alcohol, and more than 47% had tried marijuana. While only 1.8% of youths said they had ever injected illegal drugs, nearly 15% had sniffed glue or used other inhalants, 9.5% had used cocaine, and more than 9% had used methamphetamines.2
"For most young people, their prevention strategy is thinking they can tell if their partner has HIV. They say, He looks clean, he looks fine,’" Futterman says. "Three-quarters of the HIV-positive kids didn’t know their partner was positive, so I think prevention messages have to be given consistently over time."
Teen HIV prevention programs also need to provide affordable and easily accessible condoms, says Janet Livingstone, director of U.S. programs for Population Services International in Washington, DC. The private nonprofit agency has a goal of improving the health status of low-income populations.
"Most of our work has been targeted at teens who are sexually active and at risk of sexually transmitted diseases," Livingstone says. (See story on youth-oriented prevention campaigns, p. 88.)
While youth-oriented campaigns try to reach teens in their favorite places to hang out, such as skating rinks, record stores, and video arcades, the campaigns aimed at African-Americans largely involve ministers of Christian churches, because they have tremendous influence within the black community.
"The most influential persons in our community are the preachers, and the loudest voice we have is the pulpit," Seele says.
Launched in June, The Balm in Gilead’s new campaign, called "The Black Church Lights The Way: The Black Church HIV Testing Campaign," involves 10,000 churches nationwide. Seele says that when she started the organization in the late 1980s, there were only 50 Harlem churches involved with HIV prevention. Now the organization receives CDC funding to provide free guidance to black churches and organizations through the Black Church HIV/AIDS National Technical Assistance Center.
Black church traditionally helps with crises
The new campaign draws on the history of black churches traditionally providing support to African-Americans through years of slavery, segregation, poverty, church bombings, and police brutality.
The Balm in Gilead’s HIV testing campaign brochure tells people to get tested because one in 50 black men and one in 160 black women are living with HIV, and AIDS is the No. 1 cause of death among black men between the ages of 25 and 44. For more information about HIV testing, call The Balm in Gilead hotline at (800) 864-8607 or visit its Web site at www.balmingilead.org. Black churches that wish to join the campaign can call (888) 225-6243.
One example of a black church taking a leadership role in preventing HIV is Antioch Baptist Church in Cleveland, Seele says.
"They changed the basement of the church into an HIV testing clinic and partnered with the Cleveland Medical Clinic," she explains. "I think it’s an extraordinary linkage, because you have nurses and health care providers at a testing place where people can receive spiritual counseling as well as HIV/AIDS counseling."
References
1. Rotheram-Borus MJ, Futterman D. Promoting early detection of human immunodeficiency virus infection among adolescents. Arch Pediatr Adolesc Med 2000; 154:435-439.
2. Kann L, Kinchen SA, Williams BI, et al. Youth risk behavior surveillance — United States, 1999. MMWR 2000; 49(SS05):1-96.
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