December 10, 2018
Amy Nunn, Sc.D. (Courtesy of Amy Nunn)
While many in the field of infectious disease research and medicine have noted the decline in new investigators and practitioners entering the workforce, the HIV Medicine Association and the Infectious Diseases Society of America Foundation have teamed up to do something about it. Over the summer, they announced a program to fund 15 medical students in the U.S. for clinical learning and research projects, each to be paired with an experienced mentor to support the student's research area of interest.
We spoke with Amy Nunn, Sc.D., associate professor of medicine and behavioral and social sciences at Brown University and executive director of the Rhode Island Public Health Institute. The Institute's mission is to translate research into public health practice and to reduce health disparities in Rhode Island and beyond. We also spoke with Philip Chan, M.D., M.S., associate professor of medicine and behavioral and social sciences at Brown University and medical director of the only publicly funded sexually transmitted infections clinic in Rhode Island and the state's only dedicated pre-exposure prophylaxis (PrEP) program. Their mentee, Alex Rosenthal, is a medical student in the Primary Care and Population Medicine master's program at the Warren Alpert Medical School of Brown University in the M.D.-Sc.M. class of 2021. She also spoke with us about the project that is the subject of the thesis she will complete for the master's degree.
Jeanine Barone: How much of a role do you believe community faith-based public health programs play in reducing the disparity we see among African Americans contracting HIV?
Amy Nunn: I think their role is paramount in the Deep South, which is where most new infections are happening; and most of the people that are newly infected with HIV are African Americans and Latinos. Both of those populations tend to participate more in formalized religious services, and also to report that faith and spirituality play an important role in their day-to-day lives. And this also has important roles in the social fabric of both of those communities.
JB: What is some of the best evidence showing that engaging with faith-based leaders in at-risk communities can impact HIV screening?
AN: I've written several papers on that. Basically, it's pretty simple: Show up, and do what the pastors say is important for their congregation. When you do that, you're usually able to work with them pretty effectively.
JB: What strategies are effective in these at-risk communities when engaging with faith-based institutions?
AN: What works is getting clergy to talk about testing and treatment. We give clergy members a menu of things they can do that day, and that has really worked. They can get tested in front of their congregation, they or their health ministry can preach about testing and treatment, they can speak out about it on the radio or from the pulpit, they can have their health ministry start offering screenings, they can talk about embracing people living with HIV.
JB: What do you think contributes to you being so successful in terms of working with faith-based leaders?
AN: The gay movement has been very influential and successful in promoting health equity, but oftentimes they have started conversations with pastors about human sexuality, condom use, and homosexuality. And that's not always a great way to start conversations. I always get there, but that's not how I start. I start with asking the pastor what he or she thinks is important, and what they think their congregations need. And then I talk about testing and treatment. If you do all that, you will get to the sexuality question. For example, I've worked extensively with faith-based leaders in Philadelphia. Yet, everyone said that I would never be able to get a particular Pentecostal megachurch on board. When I finally got a meeting with the minister at this church, he asked me a lot of questions, and he wanted me to talk to his youth ministry and his health ministry. So, there I was in the basement of this ultraconservative Pentecostal Black church in South Philadelphia, and his congregant that chairs these committees asked me about anal sex. (This got everyone's attention.) I asked the pastor how he would like me to respond. He said, "I want you to answer all their questions." So, I found myself doing the impossible: talking to a Pentecostal minister and all of his senior leaders about anal sex. Pastors want to take care of their flock.
JB: How do you get faith-based leaders on board if they are initially uncomfortable?
AN: What a lot of people don't know is that people with HIV can live a long, healthy, normal life if you get them on treatment early. Also, they're much less likely to transmit HIV to other people [if on successful treatment]. So, I talk about how it's good for their congregation and their community. Oftentimes, the conversation about geography really resonates. For example, I might say, "Pastor, did you know you're in a neighborhood that has 4% seroprevalence? That's on par with Sub-Saharan Africa. Whether you know it or not, the people in this community are living with HIV. They may or may not have shared it with you; they may or may not know it. But this is a hot spot." And when you frame it like that, people will say they had no idea. That's because no one has talked in a way that made sense to them.
Philip Chan, M.D., M.S. (Courtesy of Philip Chan)
JB: What are the challenges faced when engaging with faith-based leaders in these at-risk communities?
Philip Chan: The research and public health community has been reluctant to engage faith-based leaders on sensitive health-related topics like HIV or substance use. There is often the belief by the research community that faith-based institutions may be reluctant to talk about these topics. This may be the case in some situations, but we have found that there are some really engaging and progressive faith leaders that understand the importance of health and addressing disparities and are willing to take on these issues. We as research and public health institutions need to do a better job engaging faith leaders.
JB: Do you think funding (federal, state, or other sources) for these faith-based community HIV awareness initiatives might decline, given the current political climate?
PC: I actually think that funding for faith-based initiatives may increase in the current political climate. As is the case with any sensitive topic like sexual health, we just have to be respectful and nonjudgmental of different opinions, and to make sure to work toward the common goal of improving health outcomes and addressing disparities in our community.
Alex Rosenthal (Courtesy of Alex Rosenthal)
JB: Is HIV/AIDS a topic you had planned to study?
Alex Rosenthal: HIV/AIDS in local and global contexts is a topic that I planned to learn more about in medical school. As a second-year medical student, I am still unsure what my career will look like long-term, but infectious disease, including HIV, is a field that I plan to continue to explore because of its relevance and importance in the public health sphere in the U.S. and abroad.
JB: What does this project hope to address?
AR: Broadly, this project aims to address three major steps in working with faith communities in Rhode Island with regard to key community health issues. These steps include 1) meeting people through worship and community outreach programs; 2) talking to faith leaders about their community needs; and 3) getting faith leaders' feedback on how to best work with their congregations to create a system of bidirectional communication between medical and faith communities.
JB: When church leaders may not find it acceptable, are you exploring whether these leaders may still allow some sort of HIV prevention or screening?
AR: Education about prevention, testing, and treatment empowers faith leaders to provide their community with resources. While we have not yet completed the interview process, there has been acceptance of providing services to church communities. The interviews we are doing, however, are important because they allow faith leaders to identify the most effective way to do this in individual church settings (sermons, bible studies, health fairs, etc.).
JB: If church leaders find this topic unacceptable, are you finding that it's mostly from stigma?
AR: We address that topic of stigma, and thus far we have generally not found that stigma within faith institutions differs from the stigma in the general public. Many of the progressive faith leaders in Rhode Island are actively speaking to their congregations either from the pulpit or in private counseling about challenging topics, with the ultimate goal of reducing the stigma within their communities by allowing people a safe space to discuss challenging topics.
Jeanine Barone is a scientist and journalist with an eclectic background. She's a nutritionist and exercise physiologist who regularly writes about travel, health, fitness, and food for numerous top-tier publications. Jeanine enjoys active travel, especially long-distance cycling and cross-country skiing.
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