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Advocating awareness

As the rate of HIV/AIDS cases
rises in black communities, some
Boone County ministers are raising the issue
of prevention to congregation members who are at risk
Sunday, February 4, 2007 | 12:00 a.m. CST; updated 1:27 p.m. CDT, Monday, July 21, 2008

In the late 1990s, the Rev. Raymond Hayes invited a young MU student named Violet to speak to his congregation at St. Luke United Methodist Church.

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Brenda Flowers has been living with HIV for 10 years. She helps others by speaking publicly about her virus and AIDS prevention. (ANN HERMES/Missourian)

Hayes had known Violet for several years and had listened to her stories about how AIDS was devastating her native country, Zimbabwe. She said that back home there were no weddings, only funerals for people who had died of a disease they knew little about. A volunteer at the Regional AIDS Interfaith Network of Central Missouri, or RAIN, Violet also had first-hand knowledge of a growing crisis closer to home: the increasing rates of HIV infection among black men and women in the United States. Violet urged Hayes to learn more by attending a luncheon at RAIN.

“The very next Sunday,” Hayes recalls, “I was preaching on AIDS.”

Hayes realized immediately that his congregation was nearly as ignorant about HIV as the impoverished people of Zimbabwe. He informed them that AIDS in the United States was not a disease that affected only gay men. He talked about how it was transmitted and, just as important, how it wasn’t transmitted. Above all, Hayes said, people must know their HIV status. By taking a simple blood test, they could protect themselves and their community. To prove his point, Hayes invited Violet up to the pulpit and, before God and congregation, allowed her to test him for the virus.

Hayes, who became pastor at St. Luke in 1980, was surprised by his congregation’s response.

“They were listening,” he says. “I had 17 people — I counted — 17 people that come up and said they wanted to do something. They knew somebody who knew somebody.”

Since Hayes began talking about HIV/AIDS, the impact of the disease on blacks in America has come into clearer focus. Today, about half the people diagnosed each year with HIV infection or AIDS are black, even though African-Americans represent about 13 percent of the U.S. population. AIDS has become the leading cause of death among black women and the second leading cause among black men, according to the Centers for Disease Control and Prevention.

In a 33-county area known to Missouri health officials as the North Central Region, which includes Boone County, blacks represent less than 5 percent of the population; yet 34 percent of the 148 cases of HIV infection or AIDS reported from 2001 to 2005 were black men and women. The regional case rate ­­— new HIV or AIDS diagnoses per 100,000 people — is 15 times higher for blacks than it is for whites, according to the Department of Health and Senior Services.

These statistics probably don’t tell the whole story, however. Cale Mitchell, a RAIN case manager, said that getting information about HIV prevention to the black community has been difficult. Not enough people are being tested, and therefore many people don’t know they are infected with the HIV virus. Mitchell says “history shows us there is one unreported case” for every reported case of HIV infection. RAIN predicts that the number of HIV and AIDS cases in the North Central Region could double within the next two years.

Hayes put himself on the local edge of a national trend when he started speaking up about AIDS prevention. In 1993, The Balm in Gilead, a nonprofit faith organization whose mission is to improve the health status of blacks around the world, started the Black Church National Day of Prayer for the Healing of AIDS, which will be held the week of March 4, in order to mobilize clergy and congregations. Two years later, the organization published “Who Will Break the Silence?: Liturgical Resources for The Healing of AIDS,” a prayer book designed for pastors to help black churches more actively respond to the growing crisis in their communities.

Hayes, who grew up in Columbia and taught for 25 years at Jefferson Junior High School, felt he had earned the right to speak about AIDS, even while other black religious leaders questioned his judgment. Hayes recalled one pastor telling a congregation member who expressed concern about HIV to go to St. Luke, Hayes’ congregation, because “they’ll accept anybody.”

When word got around that Hayes had submitted to an HIV test in the pulpit, says Roger Anderson, senior pastor at Shiloh Christian Worship Center, people speculated that Hayes had AIDS.

“He took that test in front of his church members, the public said he must be HIV-positive,” Anderson says. “Everybody run their mouth about stuff they don’t know nothing about.”

Hayes, who is not infected with the virus, did his best to ignore the gossip. Indeed, he says it only proved his point: that fear and ignorance were contributing to the AIDS-related deaths of thousands of black men and women each year.

“The issue keeps getting pushed to the back burner, and there’s too much at stake,” Hayes says. “It’s not going away, it’s not going to go away.”

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Tailor fitting a message

Thel Sargent’s title — HIV prevention educator for the Columbia/Boone County Health Department — is a bit misleading. Actually, Sargent is the only HIV prevention educator for the 33-county North Central Region. Sargent’s mission is to reach those most at risk of HIV infection, and one of his duties is distributing condoms. He’s usually running from county to county, from one information session to another. His goals, under the circumstances, are modest.

“If I can reach one person in a five-year period,” he says, “I’ve done my job.”

RAIN’s Mitchell can sympathize with Sargent’s plight. In 1996, AIDS killed more blacks than whites for the first time. HIV educators have been trying since then, as Mitchell puts it, to “tailor fit” a message of prevention to the black community.

Surveillance data from the CDC show that black men are most likely to be infected with HIV through sex with other men. Yet, because they fear being labeled homosexual, many black men who have sex with men identify themselves as heterosexual. In a 2005 CDC study of men who have sex with men, 46 percent of the African-Americans were HIV-positive, compared with 21 percent of the whites and 17 percent of the Hispanics. The study also showed that 64 percent of the black men with AIDS who have sex with men were unaware of their HIV infection, compared to 18 percent of the Hispanic men and 11 percent of the white men. The findings suggested that black men who have sex with men “may not relate to prevention messages crafted for men who identify themselves as homosexual.”

Efforts to craft an effective prevention message are further hampered by a lack of prevention specialists.

“Each state needs to have more people working in prevention to help get the numbers down,” Sargent says.

A few years ago, the North Central Region determined that few service agencies in the 33-county area had staff dedicated solely to HIV and sexually transmitted disease prevention, and many of those failed to have prevention programs targeting populations prioritized by the state as most at risk for HIV infection.

‘Love/hate relationship’

Sargent, who has been at the state Health Department for five years, remembers the day he spoke, at Hayes’ invitation, to a packed house at St. Luke United Methodist Church.

That day, Sargent witnessed the power of the church in the black community. Sargent realized that although he may reach 10 people during an information session, a man like Hayes can reach 300 people or more every Sunday.

“There are not a lot of groups that African-Americans are connected to or listened to more than the church,” Sargent says. “As far as the overall numbers changing, it’s going to take more than me. That’s why I’ve brought the pastors on board.”

Sargent and Kathy Davenport, a clinical coordinator at the Family Health Center, are co-founders of the Minority Alliance Faith Based Subcommittee, a local organization dedicated to dealing with African-American health disparities. In October, Sargent got the city of Columbia to contribute money to host a lunch for black religious leaders. Two dozen people attended. A highlight of the event was a screening of the ABC “Primetime” special, “Out of Control: AIDS in Black America.” Sargent also recited all the most recent statistics and, echoing the “Primetime” segment, explained that HIV had grown “out of control” in the black community through a combination of denial and failed leadership. He says the kind of feedback he got from pastors about the program suggested that few of them were aware of the severity of the problem.

Jack Davenport, assistant pastor at Shiloh Christian Worship Center, says that the information he absorbed that day caught him by surprise.

“You hear about the various types of meds and drug cocktails that people living with HIV/AIDS have, and you form the perception that maybe things are getting under control,” Jack Davenport says. “Then I went to the luncheon and found out that things are under control in one segment of the population, but not under control in another segment: the minority population.”

Jack Davenport describes Shiloh Christian Worship Center as a “pretty-well healthy” church. It’s a small congregation, about 50 people, he says. He considers it a young church; the oldest member is 56, and there are families with children in the pews every week. “I got a little alcohol in my church,” he says. “Mental folks in my church. A little drug use in my church.”

As for HIV/AIDS, while Jack Davenport opened up the discussion with his congregation after the ministers’ lunch, he says he is taking “baby steps” when talking about HIV prevention. He says he struggles with a conflict between his role as both an information source and spiritual guide. The Christian standard for talking about sex is abstinence, he says, and he is still trying to figure out how to uphold the standard while giving people the information they need to protect themselves.

The balance between promoting abstinence and healthy sex is difficult in a Christian setting, says Anthony Pinn, the Agnes Cullen Arnold professor of humanities and a professor of religious studies at Rice University. Because of how the disease is most commonly spread — by men having unprotected sex with men who then infect their female partners — many religious leaders have been reluctant to take up the cause with their congregations.

“Christianity in general has a love/hate relationship with the body,” Pinn says. “The body involves a troubled relationship with God. They have a troubled relationship with sex and sexuality and HIV and AIDS is related to sex.”

Jack Davenport acknowledges the problem. Some religious leaders have been able to “walk that balance,” he says. For many others, it’s “unfamiliar ground.” He hasn’t yet established a formal program on HIV prevention at his church, but that could change, he says. Right now, he may bring it up at the end of a sermon by reminding people who have been sexually active to either stop or get tested. He hasn’t begun talking about other preventative measures, such as condoms, because of what his congregation members might think.

“If I talk about condoms, people might construe that as I’m all for promiscuity even though that is not the case,” Jack Davenport says. “People will form their own opinions based upon who they are and preconceived notions — a lot of pastors have a problem with that.”

Roger Anderson, Shiloh Christian’s senior minister, says talking about condoms might give people an excuse to act out sexually. “People are looking for excuses,” he says, adding that some might hear the message, “(The pastors) told me I could have sex if I put a condom on.”

Hayes understands what’s at stake when pastors begin discussions their congregations aren’t ready — or willing — to hear.

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National Black HIV/AIDS Awareness Day

Wednesday is the seventh National Black HIV/AIDS Awareness Day, which aims to increase awarness, participation and support for HIV prevention, testing, care and treatment among African Americans. For more information, go to www.blackaidsday.org.

“Some preachers know they will run into a lot of opposition,” Hayes says, “and it could cost them their pulpit.”

But Hayes says that pastors should remember the lessons of Jesus, who cared for the sick without malice or judgment. Hayes says he supports continued preaching about abstinence, but he has not hesitated to also talk about condom usage. “Abstinence has a shelf life,” Hayes says. “There’s a lot it can’t do.”

Balancing burdens

There are other barriers to more effective HIV prevention in the black community. According to a study of HIV transmission by the CDC in 2005, poverty, unemployment and other socioeconomic issues are contributing to a growing HIV problem among black women, who have a new infection rate that is 18 times that of white women. The study found that HIV-positive black women are more likely to be unemployed, thus willing to exchange sex for drugs or money than are HIV-negative black women.

Lisa Fitzpatrick, director of the CDC’s minority HIV/AIDS research initiative and an author of the study, says the result “suggests it’s a lot more difficult for women who are poor to even think of HIV as a health priority when there are so many other issues that they are dealing with.”

Kathy Davenport, co-founder of the Minority Subcommittee, agrees, adding that many black religious leaders are attempting to deal with those problems, as well.

“There are so many other topics out there that need to be covered,” Kathy Davenport says. “You just don’t know which one to pick first.”

The Rev. Lorenzo Lawson of the Chosen Generation Ministries has a small and transient congregation, which he described as people who are dealing with issues of drug addiction, alcoholism and unemployment. The church meets at the J.W. “Blind” Boone Center.

“We try to keep it less traditional as much as possible,” Lawson says, “for people who are “‘unchurch.’”

Lawson says he has invited someone to speak to his congregation about HIV/AIDS on a couple of occasions, but he has not talked about the disease. His congregation may live “risky” lifestyles, he says, but contemplating the potential threat of HIV infection isn’t their first concern. Rather, he says, his congregation tends to deal with “the pressing issue that’s pretty much dominating their life at the time.”

Lawson says most of his members think, “‘If I get the HIV virus, I’ll deal with that when it comes.’ This is how they deal with life. It’s more of a survival technique.”

Lawson recognizes the denial, among black men in particular. He says some of the male members of his congregation might be hesitant to get an HIV test out of fear for their reputation.

“They think, ‘If I get tested, people might think I’m homosexual,’” Lawson says.

State and federal health officials have long made it a priority to reach America’s black population. In 2000, then-Gov. Bob Holden created a task force of different government agencies to examine ways to reduce HIV infection rates in Missouri. The task force created an emergency response plan that established the priorities of officials in the six geographic areas that receive funding for HIV services. Most of the money goes to St. Louis and Kansas City, where infection rates are the highest in the state.

Sandra Hentges, an HIV-prevention planner for the Missouri Department of Health and Senior Services, says that the task force is “not really in place anymore” but that the agency is in the process of “re-evaluating” what needs to be done to keep infection rates in check among black men and women.

The North Central Region, the largest geographic area in Missouri, received $132,629 in 2006 — about 3 percent of the state total for HIV prevention, says Betsy Smith, an HIV-Prevention Planner for the Columbia/Boone County Department of Health. Smith says the agency would like to provide more services and reach more people, in particular black men who have sex with men who are 18 to 39 years old and black women 15 to 39 years old. But they can only do so much.

“Well, I can think of very few health initiatives that couldn’t benefit from more funding,” she says. “Obviously, if we had more resources or funding, we could provide more services. We don’t have that; we have to exist with the funding that’s available.”

Thel Sargent isn’t sure if bringing black religious leaders into the conversation about HIV will translate into wider awareness. He has been organizing monthly meetings of the Minority Subcommittee, but he fears the initial enthusiasm has waned. On Dec. 10, only six people attended the committee’s meeting, where they watched a presentation on chemical dependency, and heard Hayes talk about his heart surgery and Anderson discuss his recent stay in the hospital. During the chemical dependency presentation, Hayes and Anderson, the most senior of the pastors present, openly discussed the trouble of talking in church about drugs. Anderson says the church should be a place people turn to when they need help.

“The church has lost the perception of what it’s supposed to be. Folks that got it together don’t need church,” Anderson says. “Church is for the lost.”

Brian Williams, an associate pastor at Faithwalk Ministries in Paris, Mo., drove to Columbia for the meeting. Williams is the chairman of the Northeast Alliance — 22 Northeast Missouri counties — for the state’s Office of Minority Health. As part of the alliance, Williams says his job is to provide the Office of Minority Health a “snapshot” of minority concerns in the area.

Williams says there is a lot of participation from black churches in the northeastern part of the state, and Kathy Davenport and Sargent invited him to talk about how to get more local religious leaders involved. Williams says the subcommittee’s members shouldn’t be discouraged as their work gets off the ground. They need to come up with a plan that clearly defines what they’re trying to do, he says.

“If you don’t go through some of the proper planning, you might touch people’s hearts initially, but you won’t keep them at the table,” Williams says.

Caring for those in need

Once he touched his congregation’s hearts, Hayes knew how to keep them at the table. In 2000, church members created the St. Luke CARE team, which provides nonmedical “compassionate care” to people with HIV/AIDS. Ella Vallar, one of 10 current CARE team workers, says the group visits people with the disease and helps them with shopping and other errands. Vallar says the team realizes it is helping only a small part of the problem.

“We don’t take on all those that are infected,” Vallar says. “There’s plenty of work to be done.”

St. Luke member Kaye Thompson says that since Hayes first started talking about HIV and AIDS the congregation has been supportive of Hayes’ commitment.

“I’m happy that it became a topic of our church,” she says. “It needs to be known.”

On Dec. 3, two days after World AIDS Day, Hayes sat in the St. Luke lobby and waited. The roads were still icy from the big snowstorm, and Hayes wondered if anyone was going to come to church that day. As it got closer to the start of the service, a few people finally trickled in.

When Hayes took the pulpit, he promised to keep the service short. He encouraged the small group to move closer to the front. This would be an intimate service.

After testimonies from church members, Hayes asked the congregation to open their hymnals to “There is a Balm in Gilead,” a hymn about the healing powers of Jesus. The choir wasn’t there, so everyone seemed to sing louder. They sang “There is a Balm in Gilead to heal the sin-sick soul, to make the wounded whole.” The sound of the voices and the piano filled the empty pews as if the church were overflowing with people.

“Every time I sing that song it bring a sadness to my heart,” Hayes said. “Yet, at the same time, it brings hope.”

And with this, Hayes began to talk, once again, about AIDS.

“Since I have the knowledge, I have to speak up,” he said. “It’s an imperative from God.”

He told them that for a long time, HIV and AIDS weren’t front-page news, and although there is no cure for them, they are preventable. He urged them to educate themselves and, above all, to care.

“People think it’s in Africa and that it’s not that close to us,” he said. “But it’s right here. We know what will happen if we don’t do anything.”

He quoted world figures, like Kofi Annan, and he told his congregation to have compassion for those who already have HIV. This, he said, is what Jesus would have done. “I ask God to create in us a caring heart that we may be like Jesus,” Hayes said. “We too will look upon them with eyes of compassion. We will reach out and touch them.”

When Hayes finished this last sentence, a congregant asked to stand and speak.

“I have HIV,” said Sherwood Logan, with tears in his eyes and his voice cracking.

Hayes descended the pulpit and wrapped his hand around Logan’s arm to hold him up. Another church member put his arm around Logan’s shoulders.

“Sometimes, I feel like I’m dead,” Logan said. “Man, it’s hard.”

Hayes then called the rest of the congregation to come and create a prayer circle. Everyone stood hand-in-hand and reminded Logan that they loved him and cared for him.

“We must bear one another’s burdens,” Hayes said. “We must love those who the society considers unlovable.”


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