III. Down Low

         The second issue in locating potential HIV cases involves perhaps the hardest-to-find high risk population in Pittsburgh, the ‘down low’ community.  This group of African American men makes their gay sex lives secret to avoid conflict in a culture that values masculinity and fatherhood (9).  A major step in combating the spread of HIV in this group could be achieved with the strategic addressing of this virus by the generally conservative African American church.  In a study of African American magazines (Essence and Ebony), Clarke et al found that the African American community often turns to the church before the medical establishment when seeking assistance with AIDS and HIV problems (10).  In a study conducted to find the barriers to prevention services, it was discovered that in churches that didn’t offer prevention programs, the biggest hindrances came from a lack of financial resources (83.3%) or a lack of qualified AIDS and HIV prevention staff (50%) (12).  These barriers to general prevention services also block potential prevention services for ‘down low’ African American men.  While some conservative church goers see AIDS ministries as a condoning of homosexuality, their leaders believe are ultimately designed to save lives, an observation that displays the perfect opportunity for a public health official: to effectively combat a disease and save lives through a trusted institution (15).  These facts point to the notion that to successfully address AIDS and HIV in the African American church, the main requirement is money, and that the churches are not fundamentally morally opposed to the idea of and AIDS education and prevention program, but simply do not have the financial capabilities to deal with the epidemic.

Currently southwestern Pennsylvania has one AIDS ministry, located in zip code 15224 (the zip code with the 6^th highest AIDS rate per 100k residents).  While this church, the Shepherd Wellness Community, does a great job of addressing current AIDS and HIV problems in Pittsburgh, especially the needs of People Living With AIDS and HIV, the institution of the church is a crucial part of the African American community and must be more involved to address the problem of AIDS in the ‘down low’ community.   To do this, a church such as the Metropolitan Baptist Church, located in zip code 15212, with the 3^rd highest AIDS rate per 100k in Pittsburgh, and the highest in the North Side, should create an AIDS ministry, or at least an AIDS program, to help tackle this issue in the African American community.  The Shepherd Wellness Community reported expenses of $248,703 (less renovation costs for their buildings) in the year 2005, with these costs covering free dinners, a telephone assistance program, a newsletter, van trips to AIDS and HIV services, wellness education, alternative therapy, and support groups (11).  While these programs are geared towards People Living with AIDS or HIV, similar programs to create awareness and provide education, especially on a more focused, smaller scale initially, could be accomplished at a much lower cost.  An important note about this figure is that it was entirely covered by the church, with a large portion coming from the Ryan White program, donations, and fundraisers. 

To create a useful AIDS and HIV awareness program in a church such as this, a couple steps would have to be taken.  Of course, such a program couldn’t be imposed on the congregation, but would have to be accepted.  If studies such as (12) are true in Pittsburgh, a financial contribution from the government or a private donor (such as the Maurice Falk Medical Fund, Three Rivers Community Foundation, Jewish Health Care Foundation, Staunton Farm Foundation or the Birmingham Foundation, local foundations supporting AIDS prevention) would really help get the program off of the ground.  Also, a government official or a representative of a group such as the Pittsburgh AIDS Task Force would have to gain the trust of the church and become involved in the community to create partnership and gain the respect of the congregation (16).  The creation of this AIDS ministry would also have the effect of not only providing education and awareness to African American MSM, but also to their female partners.  While the crossing over of the HIV virus from bisexual males to the female population is not Pittsburgh’s biggest problem, heterosexual contact makes up for 77% of HIV cases and 53% of AIDS cases in women in Pittsburgh, so it is a problem that cannot be ignored (see Project 1, Tables 3.2, 3.5).

The breadth of services offered by the church’s AIDS prevention plan could start with simple programs like support groups or education sessions, which for the Shepherd Wellness Community represented $137,743 of their budget (11).  This large number also included services like alternative therapy and social gatherings, which although helpful, would not be included in a newly founded AIDS ministry, especially one focusing on education and prevention instead of People Living With AIDS or HIV.  Another important service that this program could provide would be transportation to and from off-site AIDS and HIV services.  The Shepherd Wellness Community was able to provide 731 van trips for only $15,304, which comes out to just under $21 per trip assuming there is similar demand (11).  A service like this could be helpful for a congregation that doesn’t have money to spare when it comes to health care needs, which is certainly true of zip code 15212 in the North Side, which has an average income of $26,712, a number well below the average of $35,820 in the other zip codes considered in this investigation.  Overall, Pennsylvania received $38,649,989 under the Ryan White Act in 2007, and considering how effective an AIDS ministry in the most highly infected area in the state’s second largest city could be, it would appear that the state could spare $200,000, about half a percent of the state’s total Ryan White grant money (17).

Proceed to IV. Testing

Back to II. Peer Referral