What is health equity and why does it matter?

Health equity means that everyone has a fair opportunity to live a long, healthy life. It implies that health should not be compromised or disadvantaged because of an individual or population group’s race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition. Health equity is important because everyone deserves a fair chance to lead a healthy life. No one should be denied this chance because of who they are or their socio-economic opportunities.

There are great disparities in health, access to quality health care, and insurance coverage due to race and socioeconomic status in the United States.  According to the Agency for Healthcare Research and Quality, Black people receive lower quality health care than Whites and have poorer health outcomes across disease areas.  Within the context of HIV, health equity means that instead of an individual’s health outcome being determined by his or her employment status, income level, and/or ZIP code, the individual is provided with the same fair opportunities (i.e. access to HIV testing, treatment, and support) as their counterparts to live a long, healthy life. Through advocacy efforts, The Black Church & HIV  initiative aims to augment the political voices of Black communities as they pertain to the policies that affect health equity and access to HIV prevention, testing, and linkage to care.

What is a health disparity?

Health disparities are differences in the presence of disease, health outcomes, or access to health care between population groups. They are a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health, based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

What are social determinants of health?

The World Health Organization defines social determinants of health as “complex, integrated, and overlapping social structures and economic systems that include the social environment, physical environment, and health services; [the] structural and societal factors that are responsible for most health inequities. Social determinants of health are shaped by the distribution of money, power and resources at global, national, and local levels, which are themselves influenced by policy choices.”

Where we live, learn, work and play has a tremendous impact on our health. While going to the doctor and receiving medical care are essential for detecting and curing illness, access to health care can only account for 10 to 15 percent of preventable deaths. Social factors such as housing, education, income and employment greatly influence the health and quality of life in neighborhoods and communities. These social factors, generally referred to as the social determinants of health, determine whether or not individuals have parks and playgrounds to exercise, supermarkets to buy fresh and affordable fruits and vegetables, job opportunities to support their families, and other resources that allow them to be healthy. While it is definitely important for us to encourage people to make healthy choices, we must remember that people can only make healthy choices if they have healthy options.

Why does race matter?

On average, African Americans experience worse health outcomes than other racial and ethnic groups. More African Americans are diagnosed with HIV and more likely to die from HIV/AIDS than any other race. Many studies have suggested a link between experiences of racism and worse health outcomes. Whether it takes the form of overt discrimination or structural disadvantage, racism continues to influence how people are treated, what resources and jobs are available, where they are likely to live, how they perceive the world and their place in it, what environmental exposures they face, and what chances they have to reach their full potential. Important policies to address racism and its impact on health include more equitable school funding, better enforcement of anti-discrimination laws, housing mobility programs, better transportation, affirmative action, tax policy and land use, as well as economic revitalization, business investment and wealth accumulation in communities of color.

What is social justice and how does it related to health equity?

Social justice is the equitable distribution of social, economic and political resources, opportunities, and responsibilities and their consequences. It affects the way people live, their chance of illness, and their risk of premature death. Social justice is the sustained commitment to create a society based on equality and fairness for all people. It calls for fair and equal treatment of the “haves” and the “have not’s.” The social justice movement is centered on fighting all forms of oppression, discrimination, and disenfranchisement. It calls for systemic change of governments, policies, and practices that empower all people to live healthy and productive lives. Health equity means social justice in health (i.e., no one is denied the possibility to be healthy for belonging to a group that has historically been economically/socially disadvantaged).

How do we achieve health equity?

Strengthening health equity requires going beyond just the immediate causes of disease, but exploring the causes of the causes of disease. Health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.

Is HIV really a big deal for the Black community?

Yes, HIV has a significant impact on the Black community in the U.S. Here are a few key facts:

  • If Black America were its own country, it would rank 16th in the world in the number of people with HIV.
  • The rate of new HIV infection in African Americans is 8 times that of whites based on population size.
  • New cases of HIV in the Black community are increasing, especially among young males between the ages of 13 to 24.
  • Blacks are more likely to become infected, less likely to get treatment, less likely to know they have the disease, and more likely to die from HIV and AIDS than any other race. In 2012 half of all people diagnosed with AIDS were Black.
  • In 2013, it was estimated that African Americans accounted for 46 percent of all new HIV infections that year, despite representing 13 percent of the U.S. population.

A full fact sheet is available for download here.

What is the difference between HIV and AIDS?

The human immunodeficiency virus (HIV) is a virus that can lead to acquired immune deficiency syndrome, or AIDS.

HIV is no longer a death sentence. It is now considered to be a chronic, manageable condition, similar to diabetes or hypertension. With proper care and treatment, people living with HIV can live long and healthy lives.

How does someone know if they have HIV?

People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV still affects their bodies. The only way to know if you have HIV is to take an HIV test. Early diagnosis and treatment is crucial to ensuring that an HIV-positive person has a long and productive life. HIV testing is available in hospitals, clinics, and communities, as well as through dedicated testing centers across the country.

To locate a HIV testing center near you, visit www.AIDSVu.org/testing.

Why is the Black community more impacted by HIV than other races?

African Americans face a number of challenges that contribute to the higher rates of HIV infection. The greater number of people living with HIV (prevalence) in African American communities and the fact that African Americans tend to have sex with partners of the same race/ethnicity means that they face a greater risk of HIV infection with each new sexual encounter.

The poverty rate is higher among African Americans than other racial/ethnic groups. The socioeconomic issues associated with poverty – including limited access to high-quality health care, housing, and HIV prevention education – directly and indirectly increase the risk for HIV infection, and affect the health of people living with and at risk for HIV. Stigma, fear, discrimination, homophobia, and negative perceptions about HIV testing also may have a negative impact. Learn more by visiting the Centers for Disease Control and Prevention (CDC) website.

How is HIV a social justice issue?

Some population groups, in particular African Americans, continue to be disproportionately affected by HIV. African Americans have the highest rates of HIV and are more likely to die from HIV/AIDS than any other race or ethnicity. Environmental factors, such as housing conditions, social networks, and social support are key drivers of HIV, and discrimination and racism worsen the disparate impact of HIV on African Americans. These factors help shape a context of vulnerability that either contributes to increased individual risk of exposure to HIV or compromises the ability to protect oneself from infection.

When we see anything disproportionally affecting one group of people more than others, whether it is poverty, education or health, we must question if the root cause has to do with social injustices. HIV disparities have more to do with the systematic realities of health care and society than individual or group behaviors. The high rates of HIV for Black people in the U.S. point to the overwhelming injustices in the political, healthcare, economic, and educational systems. This threat to the survival and well-being of our community is a social injustice. HIV is impacting our community, and it is our responsibility to speak out and fight the systems that make and keep us vulnerable to HIV infection. We invite you to join our fight for a system that ensures that we all have access to the information, insurance, prevention, care, and treatment that we deserve.

Where can I find the initiative’s recommendations for HIV ministry?

The Black Church & HIV  has provided various suggestions, tools and strategies to help you and your congregation incorporate HIV activism through our Manual and Pastoral Brief. We also recommend viewing our Online Training Manual, to learn more about how you can incorporate HIV as a social justice issue within your congregations.

How did the initiative develop the strategies recommended in the Manual and Pastoral Brief?

This national strategic initiative is the result of a year-long, 11-city research tour with more than 250 faith leaders across denominations to identify best practices and challenges when addressing HIV within the Black Church. Through this process, the initiative collected ideas and reflections from ministers through individual interviews and survey data and used those to inform the program’s strategies.

Which cities were involved in the research tour?

Pastors and faith leaders in Atlanta, Georgia; Baltimore, Maryland; Chicago, Illinois; Detroit, Michigan; Houston, Texas; Los Angeles, California; Miami, Florida; New Orleans, Louisiana; New York, New York; Philadelphia, Pennsylvania; and Washington, D.C. participated. These are cities with a large Black population and high prevalence of HIV.

What is the Clinton Global Initiative Commitment to Action?

The NAACP, in partnership with Gilead Sciences, made a Clinton Global Initiative (CGI) Commitment to Action in 2013 to enlist faith leaders as change agents to address the disparate and severe impact of HIV on African Americans. The commitment aims to scale the initiative over five years in order to reach Black congregants in the 30 cities that make up nearly two-thirds of the nation’s HIV epidemic. Specifically, the initiative will:

  • Conduct faith leader trainings across the 30 cities with the greatest HIV burden
  • Obtain formal resolutions from mainline denominations to incorporate HIV messaging into Church activities
  • Integrate HIV-related materials into required course curricula in predominantly Black seminaries.

How does helping people with HIV relate to God’s message?

In Jesus’s time, He gave voice to the marginalized, loved those who were rejected by society, and gave power to the oppressed. People living with HIV often encounter stigma associated with the disease. Historically, the Black Church has been a place of healing – spiritually, physically and emotionally. We have learned in the past that when the Black Church and the NAACP come together, great things are accomplished. Eliminating HIV will take another great effort, and it is with the faith community and faith leaders, like you, that we can mitigate the effects of the epidemic.

Some pastors’ hesitation to engage in HIV ministry is based in the belief that anything outside of salvation is beyond the scope of the church’s obligation. This viewpoint goes against the way Jesus approached ministry. He did not focus on the condition, but instead on the individual. Therefore, ministers should not concentrate on how HIV is transmitted or contracted – rather, on identifying ways in which their ministry might support their congregants.

What does a ministry grounded in social justice look like?

The ministry should be:

  • Grounded in the social justice work and teachings of Jesus Christ,
  • Sensitive to and affirming of differences,
  • Based in fact, and
  • Sustained by committed leadership.

What can I do as a Faith Leader?

The Black Church & HIV is asking you to:

  • Read the Manual and Pastoral Brief to learn more about HIV and what role you could play in addressing HIV as a social justice issue.
  • Consider inviting the initiative or a local community-based health agency to facilitate in-person trainings about HIV as a social justice issue to help you and your leadership develop or expand your church’s response to the HIV crisis.
  • Increase dialogue about HIV and commit to on-going actions to raise awareness, engagement and advocacy about HIV as a social justice issue within your church and the larger community using the strategies outlined in the manual.

We also encourage you to participate in the annual Day of Unity, which unites faith leaders across the country in a movement against HIV. Learn more on our Day of Unity page.

Do I have to implement all the strategies recommended in the Manual?

We have provided various suggestions, educational tools, and strategies to help you and your congregation incorporate HIV activism. We understand that incorporating HIV activism into a spiritual setting may be perceived as a difficult process, but it is possible to begin with small steps even in the most conservative environments.  In reading the Manual, you may even learn that your church is already engaging in activities that address HIV as a social justice and not even be aware of your current activism. For example, if your church is hosting a Saturday workshop that teaches individuals how to job search, build a resume, and/or interview for a job you are not only helping someone to gain employment but addressing the high rates of unemployment among African Americans, which is one of the many socio-economic factors that plays a role in the high prevalence rates of HIV transmission in Black communities.

To help you further in your quest with implementing HIV/AIDS activities in your communities, we encourage you to connect with our Ambassadors, whom serve as on the ground leaders of the initiative working with pastors on how they can better impact their community and encourage action. We also encourage you to contact us for support as you implement strategies in your congregations. We become so overjoyed and excited when we receive photos, stories and feedback from faith leaders.

It is our hope that you find the information in the manual helpful and inspirational. Most importantly, we hope that it will move your spirit to join us in this fight to save our communities from the disproportionate impact of HIV.

What if my church doesn’t have the financial resources to commit to the strategies suggested?

While it was not the leading barrier to implementing HIV ministry in the NAACP’s nationwide survey, some ministers reported not having resources to engage in HIV prevention ministry. Commitment to making HIV a priority in your church does not have to cost any money. Through commitment, we can build partnerships and identify the resources. There are many free resources available to help you. Many are listed in the Resource section of the Manual and some are included on the online resources page.

Other resources include:

  • Health agencies,
  • Health professionals in your own congregation,
  • Brochures, litanies, prayers, and
  • Mobile testing units that can be made available to churches in many locations for no charge.

There are also some grants for faith-based HIV initiatives in some communities.