HIV/AIDS Stigma and Religiosity Among African American Women

Abstract

African American women are disproportionately affected by HIV/AIDS compared with other ethnicities, accounting for two-thirds (67%) of all women diagnosed with HIV. Despite their increased risk of HIV infection, few studies have been conducted to understand culture-specific factors leading to their vulnerability. Given the central role of religious organizations in African American communities, this study explored whether and to what extent religiosity plays a role in stigma toward HIV/AIDS. Results of hierarchical regression showed that after controlling for key factors, religiosity was a significant factor predicting the level of religious stigma. Those with high religiosity displayed significantly higher stigma, associating HIV/AIDS with a curse or punishment from God. Verbatim responses to an open-ended question also revealed seemingly ingrained prejudice against HIV/AIDS from a religious perspective. The findings point to the important role of faith-based organizations (FBOs) in addressing HIV/AIDS issues within African American communities.

The human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) has emerged as a global public health concern requiring a multidimensional response. While nearly 95% of those infected reside in low- and mid-income countries, there is an increasing number of cases among poor and minority populations in higher-income countries (UNAIDS, 2005). Ethnic minorities in the United States are disproportionately affected by the epidemic, and this health disparity has become increasingly apparent among women of color. African American women account for two-thirds (67%) among all women diagnosed with HIV compared with 16% of Latinas and 15% of Whites. AIDS is also among the leading causes of death for African American women aged 25–34 years (CDC, 2005), which makes it a gender and ethnicity concern.

Research shows that HIV/AIDS-related stigma perpetuates the epidemic, hampering the response in many communities (e.g., Fullilove & Fullilove III, 1999; Holt et al., 1998; Johnny & Mitchell, 2006). Fear of stigmatization also impedes efforts to encourage testing and disclosure as well as treatment seeking (Johnny & Mitchell, 2006; Miller & Rubin, 2007), although the exact nature of stigma varies uniquely by communities and within cultures. One of the important aspects of African American culture is religion, which plays an important role in their lives, especially among women, who have been found to be more religious than other groups (Levin, Taylor, & Chatters, 1994).

Despite African American women's increased risk of developing HIV/AIDS, few studies have been conducted to understand the cultural and attitudinal precursors affecting their vulnerability. In fact, there is a growing concern that many intervention programs lack a cultural context that is specific to their target population (Airhihenbuwa 1995; Airhihenbuwa, Makinwa, & Obregon, 2000; Dutta-Bergman, 2005; Johnny & Mitchell, 2006). Anecdotal evidence, however, has been mounting to show the role of religious beliefs and values in instigating stigma and discrimination against those living with HIV/AIDS (Martin, Younge, & Smith, 2003; Fullilove & Fullilove, 1999; Quinn & Thomas, 1994; Rose, 1998). For example, many faith-based organizations (FBOs) associate HIV/AIDS with immoral behaviors, delivering the message to their congregations that “HIV/AIDS is a punishment by God” (UNAIDS, 2002, p. 4). Nonetheless, there is still limited systematic data or scientific knowledge on the role of religion-based stigma in light of the HIV/AIDS epidemic.

Given the central role of religious organizations in African American communities, a systematic scholarly investigation is warranted to determine whether and to what extent religiosity plays a role in stigma toward those with HIV/AIDS. To better understand culture-specific attitudinal structures of HIV/AIDS among African American women, religion therefore needs to be introduced as an antecedent. Compared with many studies addressing HIV/AIDS stigma in general (Herek, 2002; Miller, Fellows, & Kizito, 2007; Parker & Aggleton, 2003; Patterson, 2005; Singhal & Rogers, 2003), HIV/AIDS stigma stemming from religious perspectives has received little scholarly evaluation.

Role of Religiosity in Health

The role of religion and spirituality in relation to the lives of those with serious illnesses has received increasing scholarly attention (Aldridge, 2000). Studies have examined the association between religiosity and the reduced risk of illnesses such as cancer and hypertension, statistically associating religious values and beliefs with protective factors against these diseases and increasing the median survival time significantly (e.g., Aldridge, 2000; Calderón, 1997; Kaplan, Calman, Golub, Raddock, & Billing, 2006; Mathews, Berrios, Darnell, & Calhoun, 2006; Woods & Ironson, 1999). Other studies have shown a reduced mortality among people who regularly attend church services (Ironson, Stuetzle, & Fletcher, 2006). A number of studies also have focused on the role of FBOs in the reduction of mortality from diabetes and cardiovascular disease among African Americans (Holt, Lukwago, & Kreuter, 2003; Madru, 2003).

Research shows that religion and spirituality take central places in African Americans' health-seeking behaviors (Dessio et al., 2004), in meaning making and in coping with serious illnesses (Mattis, 2002). As such, message interpretation and behavior changes often occur in a religious setting, and intervention programs that consider such a context will be more successful in enhancing attitudes and perceptions toward HIV/AIDS. How they perceive HIV/AIDS as a disease and whether their views are associated with religious activities and involvement will provide important insights to understand their increased vulnerability.

As Coleman and Holzemer (1999) purport, the history of African Americans' reliance on churches as spiritual resources and their contributions to psychological well-being would be beneficial within the context of living with HIV/AIDS. The authors also noted that there is an increase in spirituality and religiousness after HIV diagnosis (Coleman & Holzemer, 1999). The value of religiosity in dealing with HIV/AIDS, specifically in reducing HIV symptoms and improving quality of life for people living with the disease and their families, is also increasingly supported by research (Coleman & Holzemer, 1999; Green, 2003; Woodard & Sowell, 2001). For instance, higher spirituality postdiagnosis has been positively associated with lower cortisol, less depression and hopelessness, safer sex, and less smoking, thus adding to the quality and longevity of life (Ironson et al., 2006).

Despite the documented role of FBOs in the promotion of physical, social, and psychological well-being of ethnic minorities, empirical research on their contributions in mitigating HIV/AIDS-related stigma especially within African American communities has been scant. Elsewhere, in regions with high HIV prevalence, FBOs' contributions to religious-stigma toward those affected by the epidemic also has been reported and documented (Green, 2003; Parry, 2003; UNAIDS, 2002). In African countries, for instance, they have been charged with the following:

…being a sleeping giant; of promoting, stigmatizing and discriminating attitudes based on fear and prejudice; of pronouncing harsh moral judgments on those infected; of obstructing the efforts of the secular world in the area of prevention, and of reducing the issues of AIDS to simplistic moral pronouncements (Parry, 2003, p. 3).

In Parry's view, such accusations have made religious entities places of exclusion of those “out there” who are suffering the consequences of their own moral debauchery and sin, rather than places of refuge and solace. In the United States, Woods and Ironson (1999) found that people with HIV/AIDS were less likely to identify as religious and therefore concluded that at-risk groups for HIV, which include homosexuals and intravenous drug users, may have failed to find the support they needed from traditional religion.

HIV/AIDS Stigma and Religious Attributions

Qualitative studies have revealed religious attributions involving HIV/AIDS stigma and the influence of religious leaders to the stigma surrounding HIV/AIDS (e.g., Green, 2003; Madru, 2003; Muturi, 2008; Parry, 2003). HIV infection is viewed as a result of sinful acts and immorality and AIDS as a consequence of such behavior. Words like “unclean” and “impure” are used to describe those infected and thus stigmatized by the disease (Madru, 2003). Religious and moral values lead some people to conclude that having HIV/AIDS is a result of a moral fault (such as promiscuity or “deviant” sex) and is worthy of punishment (UNAIDS, 2002).

Such perceptions have been legitimately supported by the religious teachings of the Bible, for instance, verses like “Wages of sin is death” (Romans, 6:23); “Likewise, Sodom and Gomorrah and the cities near them, which like them committed sexual sins and engage in homosexual activities, serve as an example of the punishment of eternal fire” (Jude, 1:7); or “for all have sinned and come short of the glory of God” (Romans, 3:23). Such teachings have been used to justify religious stigmatization against those with HIV/AIDS or other health problems that are associated with individual behavioral choices. Religious leaders who associate HIV infection with the consequence of sexual immorality have been accused of pronouncing harsh moral judgments on those infected or living with the disease (Parry, 2003).

When people make religious attributions based on the assumptions of immoral behaviors and sins, stigma toward people with HIV/AIDS is exacerbated. Such religious stigma will not only degrade people with HIV/AIDS, but it also serves to justify their suffering under the name of “punishment,” or “curse.” Goffman (1963) defines stigma “as an attribute that is deeply discrediting,…a mark of shame, of spoiled social image” and notes that persons who are stigmatized are “reduced in our minds from a whole and usual person to a tainted, discounted one” (p. 3). Religious attributions viewing HIV/AIDS as a curse or punishment from God stigmatize people with HIV/AIDS with a distinctive mark of shame that falls short of respect and value.

In many cultures, HIV infection is indeed interpreted as a punishment or retribution for violating community norms. In such cases, the stigmatized person is held responsible for real or imagined ills that afflict the community, which can be cleansed only by the expulsion or isolation of the polluting influence (Patterson, 2005). In particular, within African American churches, HIV/AIDS is closely linked to homosexuality and carries a negative connotation (Schulte & Battle, 2004). The United Nations Joint Programme on AIDS (UNAIDS, 2002) notes that a series of powerful metaphors are mobilized that serve to legitimize AIDS stigmatization:

HIV/AIDS as death (e.g., through imagery such as the Grim Reaper); HIV/AIDS as punishment (for immoral behavior); HIV/AIDS as a crime (in relation to innocent and guilty victims); HIV/AIDS as war where the virus need to be fought; HIV/AIDS as a horror in which infected people are demonized and feared; and HIV/AIDS as “otherness” in which the disease is an affliction of those set apart. (p. 10)

Attribution theory (Weiner, 1980, 1985, 1986) predicts that religious attributions will heighten HIV/AIDS stigma. Weiner (1980) explains that when people interpret the causes of an event as controllable internal factors, rather than uncontrollable external environments, the pity and sympathy toward people will be significantly reduced. People tend to search for causes of disease, which primarily determine their attitudinal/behavioral reaction to a person with that disease. For example, when a mental illness is understood as a chemical imbalance, and treated as uncontrollable, people with such a condition are more likely to receive sympathy and less likely to be stigmatized (Corrigan, 2000). Studies on obesity (Anesbury & Tiggemann, 2000; Crandall, 1994) also showed that explaining the condition as caused by uncontrollable, physiological/metabolic factors reduced people's negative attitudes toward obese people.

Religious attributions categorizing people with HIV/AIDS as sinners are highly stigmatizing and lead to a greater distance and less sympathy toward people with HIV/AIDS. According to the recategorization theory, when people separate certain groups of people, they label “them” as different from “us.” The categorization of out-groups versus in-groups generates perceptual biases and discrimination (Devine, Plant, & Harrison, 1999). By contrast, the categorization of a person as an in-group member rather than an out-group member produces more positive evaluations (Brewer, 1979) and reduced attributions of personal responsibility for negative outcomes (Hewstone, Bond, & Wan, 1983).

Building on Goffman's (1963) seminal work, stigma has been examined from sociological, psychological, and anthropological perspectives linking it to individual attributes and societal characteristics. Yang and colleagues (2007) view the notion of stigma as a social, interpretive, or cultural process, and as a moral issue in which stigmatized conditions threaten what is at stake for sufferers. They note that stigma spans physical, emotional, social, and cultural domains; it is sociosomatic, intersubjective, and threatens what matters most, hence measuring it requires multiple perspectives and measures. In the current study, we attempt to capture the religious domain of stigma, which appears to be deep-rooted in religious beliefs and teachings of FBOs of African American communities.

Despite numerous studies on general HIV/AIDS-related stigma (Carr & Gramling, 2004; Fullilove & Fullilove III, 1999; Hamra, Ross, Karuri, Orrs, & D'Agostino, 2005; Johnny & Mitchell, 2006; Herek, 2002; Miller et al., 2007; Parker & Aggleton, 2003; Patterson, 2005; Singhal & Rogers, 2003), limited systematically acquired knowledge exists on religiosity-based stigma within the context of African Americans. Furthermore, we often assume positive roles of faith-based organizations in the health and well-being of people. If FBOs in African American communities disseminate stigmatizing views of HIV/AIDS as a by-product of religious teachings, either inadvertently or purposely, it is critical to evaluate such practices. As a first step, this study examines whether those with high religiosity manifest different levels of religious stigma, as opposed to those with low religiosity. Compared with previous studies' measurement of religiosity as a unidimensional act, limited to church/service attendance (Ironson et al., 2006), the current study examines religiosity as a multifaceted component that not only incorporates church attendance but also people's participation in other religious and spiritual activities, along with their self-evaluation.

Method

A survey was administered at various locations where the target population, African American women, frequently visit. These locations included faith-based organizations, community centers, and at various community events. Respondents received cash incentives after filling out the paper and pencil questionnaire. The survey measured the key variables in the following order: (1) general stigma toward people with HIV/AIDS, (2) religious stigma of HIV/AIDS, (3) knowledge of HIV/AIDS, (4) religiosity, (5) perceived influence of religion on their views of people with HIV/AIDS, (6) personal relevance of HIV/AIDS, and (7) demographics.

Religious stigma was measured by six items (α = .84) on a scale of 1 (strongly disagree) to 5 (strongly agree). Table 1 displays descriptive statistics on the six items. The religious stigma index was created by averaging six scores. That is, higher values indicate a higher level of religious stigma. Items were generated from focus groups. Four focus groups conducted within FBOs prior to this study revealed African Americans' religious stigmatization of those with HIV/AIDS, where judgmental words such as “sin,” “curse,” or “punishment” were repeatedly used.

Table 1. Descriptive statistics of religious stigma

Religious stigma	Mean (standard deviation)
(1) HIV/AIDS is a punishment from God	1.64 (1.23)
(2) HIV/AIDS is a sin	1.44 (1.02)
(3) HIV/AIDS is a punishment for sin	1.72 (1.27)
(4) HIV/AIDS is a curse from God	1.57 (1.19)
(5) HIV/AIDS is a sin in the eyes of God	1.50 (1.08)
(6) People with HIV/AIDS need no mercy	1.43 (1.04)

We also measured general stigma toward HIV/AIDS. Stigma was measured by seven items (Herek & Capitanio, 1992). The seven items (α = .72) follow: “People have many different feelings toward people with HIV/AIDS. Please tell us how you personally feel”: (1) “How about feeling angry at them?”; (2) “How about feeling afraid of them?”; (3) “How about feeling disgusted by them?”; (4) “People with HIV/AIDS should be legally separated from others to protect the public health”; (5) “The names of people with HIV/AIDS should be made public so that others can avoid them.”; (6) “People who get HIV/AIDS have gotten what they deserve.”; and (7) “Most people with HIV/AIDS are responsible for having their illness.” The items 1 through 3 were measured on a 4-point scale, that is, very angry to not at all angry, while items 4 through 7 were measured on a scale of 1 (strongly disagree) to 5 (strongly agree). The total general stigma index was created by combining seven scores, with the items 1 through 3 reversely coded. That is, higher values indicate more general stigma toward HIV/AIDS.

Four questions were created to measure religiosity (α = .81). The first question aimed to measure the frequency of attending religious services: “How often do you usually attend religious services?” That was followed by a question to assess level of religious involvement: “Besides regular service, how often do you take part in other activities at your place of worship?” The third question was, “How often do you read the Bible or other religious literature?” The three questions were measured on a scale of (1) nearly everyday (4 or more times a week), (2) at least once a week (1 to 3 times), (3) a few times a month (1 to 3 times), (4) a few times a year, (5) less than once a year, and (6) never. The fourth question was a self-evaluation of their religiosity: “How religious would you say you are? (1) Very religious, (2) Fairly religious, (3) Not too religious, (4) Not religious at all.” The religiosity index was an average score of four values, where lower values indicate high religiosity.

Personal relevance of HIV/AIDS was measured: “Does anyone you know, like your family or friends, have HIV/AIDS? (1) Yes; (2) No.” Knowledge of HIV/AIDS was measured by four items: “(1) HIV is contracted from a toilet seat, (2) It is possible to get HIV when a person gets a tattoo, (3) A person can get HIV by sitting in a hottub or a swimmingpool with a person with HIV, and (4) Douching after sex will keep a woman from getting HIV.” The items were selected from Carey, Morrison-Beedy, and Johnson (1997). Those who provided a correct answer received 1, while those who chose an incorrect answer received 0. The knowledge index was an average score of four items, ranging from 0 for those who did not give any correct answers to 4 for those who answered all four questions right. We also asked an open-ended question about their perceived influence of religion on their views of people with HIV/AIDS: “Does your religious belief affect your view of people with HIV/AIDS? Why or why not? Write down how it affects (or does not affect) your view of people with HIV/AIDS.”

Results

Sample Characteristics

A total of 205 surveys were completed. The average age of the sample was 29 (SD = 10.38). Table 2 shows other basic demographic characteristics. The sample was fairly evenly distributed in terms of their level of religious service attendance. There were 8% of participants who reported attending religious services nearly every day, while 4% said they never attend. The majority, 40% of respondents, reported that they attend at least once a week. About their participation in other religious activities, 7% participate nearly every day, and 15% do not participate at all. Similar responses were obtained for at least once a week (22%) and a few times a year (23%). When asked about their reading of the Bible and religious literature, 24% read nearly every day, whereas 7% never do. The sample assessed their religiosity as quite high: 22% said they were “very religious,” and 46% responded as “fairly religious.” Although the level of participation in religious services or other activities varied, most participants considered themselves quite religious.

Table 2. Sample characteristics

Education
Grade school or less	2%
Some high school	11%
Completed high school	20%
Some college	26%
Completed college	23%
Graduate school or more	17%
Marital status
Never married	52%
Married	31%
Separated	3%
Widowed	2%
Divorced	6%
Refused to answer	6%
Income
Less than $10,000	22%
$10,000 to $20,000	18%
$20,001 to $35,000	16%
$35,001 to $50,000	16%
$50,001 to 75,000	10%
$75,001 to $90,000	3%
$90,001 to $115,000	2%
$115,001 or more	2%
Refused to answer	11%

In terms of personal relevance of HIV/AIDS, 37% answered that they had family or friends who have HIV/AIDS. The average of HIV/AIDS knowledge was 3.55 (SD = .78) on a scale of 0 (those who did not get any question right) to 4 (those who answered all four questions right). The dependent variable, religious stigma index, showed an average of 1.54 (SD = .85) on a scale of 1 to 5, indicating a relatively low to moderate level of religious stigma for the whole sample.

Religiosity and Religious Stigma of HIV/AIDS

To see how religiosity plays a role in predicting religious stigma, a hierarchical regression was run with other key factors. The first block included key demographic and motivational factors: age, income, education, and personal relevance of the HIV/AIDS issue. Among them, education was a significant factor (β = −.18, p < .05), indicating that educated respondents showed a lower level of religious stigma. The first block explained about 5% of the total variance (R² = .05). The second block tested knowledge of HIV/AIDS to see whether the level of basic knowledge was related to religious stigma. Knowledge of HIV/AIDS was significantly related to religious stigma (β = −.25, p < .01): Those with low knowledge tended to display a higher level of religious stigma. The second block significantly increased R² to .12.

Finally, after controlling for the above factors, we found that religiosity was significantly associated with the level of religious stigma (β = −.18, p < .05). Those with high religiosity displayed significantly higher religious stigma, believing that HIV/AIDS is a sin or curse, and not deserving mercy. Table 3 shows that the regression model accounted for about 14% of the total variance in explaining religious stigma.

Table 3. Regression analysis on religious stigma toward HIV/AIDS

Predictor variables	β	t	R^2
Age	−.011	−.120
Income	.032	.397
Education	−.183	−2.161*
Know anyone with HIV/AIDS	.125	1.646	.05
Knowledge on HIV/AIDS	−.252	−3.316**	.12
Religiosity	−.179	−2.205*	.14

We also analyzed responses to an open-ended question: “Does your religious belief affect your view of people with HIV/AIDS? Why or why not? Write down how it affects (or does not affect) your view of people with HIV/AIDS.” A total of 131 individual responses were obtained, while 74 respondents declined to write down any thoughts. Results indicate a mixed role of FBOs in terms of reducing stigma attached to HIV/AIDS.

First, religious entities appear to address AIDS-related stigma through promoting care and support of those affected by the disease. Based on some of respondents' statements, religions “teach people to be compassionate toward those who are suffering including people with HIV”; “we are taught to accept and pray for everyone”; “emphasizes empathy, support and tolerance by not looking down upon people with HIV”; and “Not to judge others according to Luke 6;37, ‘Judge not and ye shall not be judged; condemn not, and ye shall not be condemned.’” Such statements implied a positive aspect of religion.

Not everyone, however, expressed a positive role of religion. Some responses indicated the negative influence of religion on their views about people living with HIV/AIDS. Their varied responses were organized and coded into three broad categories: (1) positive view—understanding, love, care, support, encourage, etc.; (2) negative view—sinful, punishment, fault, not deserving, etc.; and (3) neutral view—not judging, don't care, doesn't matter, doesn't affect, not my concern, etc. Two coders categorized the verbatim responses and achieved 99% agreement. Among the 131 responses, 37% expressed a positive view. Examples of statements that indicated a positive view follow:

The Bible teaches kindness towards others despite their situation.

My belief teaches me to love and shower those with HIV/AIDS with affection. This helps me to treat them like any other human being.

My religion it teaches people to be compassionate toward those who are suffering including people with HIV.

Our church teaches to visit, support sick people and discrimination of any kind is prohibited, so church affects my view.

All people are equal in the eyes of the Lord.

The majority of respondents (53%) indicated either a neutral stance regarding those living with HIV/AIDS or their views were not affected by religiosity. Respondents in this category indicated limited or no effect of religiosity on their views about people living with HIV/AIDS. Examples of such a stance follow:

I do not believe in linking HIV with religions. It's never occurred to me as something to link it to religion.

No, AIDS is more of a social issue, not religion.

No, it's about your sexual use, not your religious life.

My religion has nothing to do with HIV.

On the other extreme, about 11% indicated a negative effect of religion, attributing their health status to sin or immoral behavior in the context of religion. Statements made to demonstrate this view include:

Most of them contract HIV through sinful ways.

Yes, they are sinners.

Because premarital sex is forbidden.

Because some people would say it is a sin.

Given that 74 respondents (36%) did not offer any written answers to the open-ended question, it is not known how they would have expressed the influence of religion on their views of people with HIV/AIDS.

To check for the level of general stigma toward HIV/AIDS by those with high religiosity, a different regression was run with general stigma toward HIV/AIDS as a dependent variable. As Table 4 shows, however, religiosity was not a significant factor when predicting general stigma toward people with HIV/AIDS. Only the variables “education” and “HIV knowledge” were significant factors, showing that those with less education and lower HIV knowledge tend to possess a higher level of general stigma toward HIV/AIDS. Those with high religiosity were not necessarily more or less likely to possess high general stigma toward HIV/AIDS. The results of two regressions highlight the significant effect of religiosity on degrading views toward people with HIV/AIDS from a religious perspective, along with the insignificant role of religiosity on general attitudes toward HIV/AIDS.

Table 4. Regression analysis on general stigma toward HIV/AIDS

Predictor variables	β	t	R^2
Age	.051	.563
Income	.102	1.246
Education	−.290	−3.332**
Know anyone with HIV/AIDS	.082	1.045	.09
Knowledge on HIV/AIDS	−.165	−2.109*	.12
Religiosity	−.079	−.947	.12

Discussion

HIV/AIDS communication studies continue to emphasize the need for interventions that take into consideration the cultural context (Dutta-Bergman, 2005; Kalichman, Russell, Hunter, & Sarwer, 1993; Muturi, 2008; Singhal & Rogers, 2003; Tufte, 2005). Religiosity, as a cultural component, plays a significant role in the lives of many African American women and therefore provides the cultural context for interventions and messages that seek to address important health issues. In the current study, the majority of participants identified themselves as being highly religious, also indicating the important role of FBOs.

Unlike studies that show a positive effect of religion (see Holt & McClure, 2006), this study found a negative association between religiosity and AIDS-related stigma among women. That is, the more religious they were, the more stigma they demonstrated against those affected by HIV/AIDS. The linkage between religiosity and stigma was supported by descriptive responses from the open-ended question that measured respondent's self-assessment of the effect of religiosity on their perceptions. Statements respondents made in the open-ended question indicated a negative view of the disease, labeling those living with it as “immoral,” “sinners,” with “poor judgment,” and “making wrong choices.”

Although results of verbatim responses indicated that religious organizations do make efforts to address HIV/AIDS issues by emphasizing care and support of those affected by the disease, it has become our concern that religious organizations may reinforce HIV/AIDS stigma as a by-product of religious teachings. Religious leaders' heavy emphasis on moral values and sharing of such views among congregations may have instilled a stigmatizing view of people with HIV/AIDS as sinners. Only about 37% indicated a positive effect of religious beliefs on their attitudes toward people with HIV/AIDS. The majority (53%) indicated limited or no effect of religiosity on their views of those affected by the disease in spite of the FBO efforts. More importantly, about 11% expressed a negative effect of religion.

It is important to note that religiosity was a significant factor predicting religion-specific stigma, whereas it was not in predicting general stigma toward HIV/AIDS. Those with high religiosity were not necessarily more or less compassionate or sympathetic toward people with HIV/AIDS. The insignificant role of religiosity on the general stigma, coupled with the significant negative effect on religious stigma, prompts us to pay more attention to the role of FBOs.

Given the specific relationship between religiosity and religious stigma, a further study is needed to examine the sources of that stigma. Although we found a significant association between religiosity and stigma, the current survey cannot explain why and through what process this linkage can occur. A further study will benefit the field by examining the content of communication at churches and between members. More importantly, messages from religious or opinion leaders should be closely monitored in terms of their framing of the issue and presentation styles. Whether the churches perpetuate stereotyping of HIV/AIDS patients and increase stigma toward HIV/AIDS needs to be more systematically investigated with a larger sample of African American women. Also, a qualitative study can examine in depth the different roles of religious activities such as church attendance, community participation, and Bible reading, respectively. Such knowledge is also necessary in determining the association between religiosity and risk perception among African American women in the context of HIV/AIDS. Also, limitations of the current study include any order effects or the role of social desirability in responses to such sensitive questions as stigma and religiosity. Also, types of religion and their impact on religious stigma await further investigation.

Certain implications can be made from this study. First, a culture-specific intervention that targets African American women should take religion into consideration given the role it plays in their lives and culture. Culture also determines information-seeking behaviors and how health messages are interpreted. A study about cultural sensitivity in relation to AIDS communication (Kalichman et al., 1993) found that African American women who received AIDS information specifically framed within a cultural context were more likely to identify AIDS as a personal threat, compared with women who viewed a standard public health message. Communicating about HIV/AIDS within a religious context is therefore a strategy for reaching African American woman.

Second, when addressing AIDS-related stigma, it is important to differentiate various forms based on their origins and address them appropriately within the context in which they are formed. As demonstrated in this study, addressing the general form of HIV/AIDS stigma would not be sufficient. Apart from the general stigma toward HIV/AIDS, those with high religiosity revealed a high level of religious stigma, degrading people with HIV/AIDS and stripping them of respect and value. Further study is needed to highlight HIV/AIDS interventions that address culture- and situation-specific stigma separately from the general AIDS-related stigma.

Finally, whereas addressing religious stigma is a challenging and sensitive issue based on the perceived role of FBOs as compassionate entities that offer solace for those with serious health issues, more attention should be paid to evaluate the impact of FBOs to find a better way to address HIV/AIDS issues targeting the African American population. Not knowing the origin and sources of stigma makes it difficult to create and implement effective intervention programs. Designing effective intervention programs in light of religious stigma requires a more sensitive community-based communication approach that will involve community partners in intervention development.

Overall, a better understanding of the sources of stigma will lead to better health outcomes of African American women whose health disparity deserves more scholarly attention. Although exploratory, this study contributes to the literature of HIV/AIDS studies by focusing on African American women in relation to religiosity, an area that has not yet been systematically examined.

Notes

The six items were measured on a scale of 1 (strongly disagree) to 5 (strongly agree).

β values are standardized coefficients.

*p < .05, **p < .01.

β values are standardized coefficients.

*p < .05, **p < .01.