Thinking back to the COVID-19 pandemic, many of us– including myself– were guilty of saying the phrase “we are all in the same boat.” For me, the pandemic offered a common goal that united me with members of my community. Upon reading the Viral Underclass and speaking with author and journalist Steven Thrasher, I realized that my approach was more privileged than I ever thought before. While we were all in some boat, that does not mean we were all in the same one– some of us had yachts and others had driftwood. Rough seas did not affect us all the same.

HIV

The social treatment of an HIV positive individual depended on the social group they ascribed to. Steven Thrasher explained that if you were one of the three “H’s” (heterosexual, heroine user, or Haitian), then no one cared how HIV affected you. It is not dramatic to say that a vast proportion of these individuals were also poor, showing how wealth impacts the respect/grace that people receive when they fall sick. Wealth disparities were widened by the HIV pandemic, showing how poor people are treated with little respect– even when they are sick. Both wealth and health are moralized.

COVID-19

Many might remember a video released early into the COVID-19 pandemic when several celebrities recorded clips of them sitting in their multi-million dollar mansions singing “Imagine” — in different keys, I might add. Not only were they literally tone-deaf, but also vastly unaware of how the COVID-19 pandemic might be for people who weren’t as rich and fit as them.

A comment under the video by user Alexa Ofelia puts it well:

If these celebrities were to contract COVID-19, it would likely be nothing more that a cold and few days of sickness. For others not so fortunate, testing positive for COVID-19 could be devastating.

Overall, everyone should be more aware that we are not all in the same boat. When we continue to perpetuate the idea that health crises are “equalizers” that put us all on the same playing field, the struggles of those who are in disadvantaged social groups become invisible, and we fail to create solutions that help everyone.

Today we met with Dr. Steven Thrasher, a professor of journalism at Northwestern who is currently on tour for his book, The Viral Underclass. In his book, he discusses 12 points that have contributed to how viruses have exposed the social determinants that keep marginalized peoples from achieving equity.

Something that struck me with Thrasher’s book was the humanity that was involved when discussing the relationship between the virus and marginalized peoples. While viruses expose inequities, they also expose how we connect to one another. While viruses such as HIV and Monkeypox originate their spread in particular communities, they expose the intricacies and tightness of communities that are formed when they are accepted as part of the norm. Other viruses, such as COVID, while concentrated in marginalized communities, have managed to spread to all parts of society, via breathing, one of the most integral parts of human commonalities and connection. Mere presence or conversation, methods that connect all humans to one another, was the perfect pathway for a virus to take advantage of.

Unfortunately, this form of transmission also exposes inequalities. It can be from contact with neighbors and colleagues or simple exposure to more people leading to a greater chance of an infected person. However, society interprets this as the person’s fault for getting the virus, or as an excuse to avoid the marginalized population so they don’t get sick.

Taking this perspective of humanity and knowing inequality, how do we shift blame from the infected person/population to the virus itself? How, in an individualist society, do we recognize that it’s not just the individual actions, but also the environment that increases the risk? If this is true, where do we draw the line between blaming outside sources and blaming ourselves for inequities or products of inequity? At what point should the government intervene? How do we maintain humanity throughout this process?

After discussing public health communication primarily through the internet, it was interesting to hear Dr. Musa Dube share her experience spreading awareness on HIV/AIDS at a time before the internet existed. During the initial increase in HIV/AIDS cases, many communities in various countries throughout Africa stigmatized the virus. Additionally, religious figures across the continent would claim that the virus was a punishment for those who sinned. Because the early association between HIV/AIDS and homosexuality, many communities of worship believed the virus to be a disease for those who were gay. Rather than bring people together to combat the virus, this narrative worsened the problem by creating a false explanation on how the virus was spreading. Combating the stigma on HIV/AIDS was an especially difficult challenge for two main reasons. First, religious figures, who were trusted by many community members at the time, created division between those with and without the virus. Because people already believed the virus was targeting those who were gay, educating them otherwise was especially challenging. Second, information did not spread as quickly as it does today, making it more difficult to combat perceptions of HIV/AIDS.

Despite these obstacles, Dr. Dube helped change the narrative surrounding HIV/AIDS throughout Africa. She realized that priests and other members of the church were not trained on dealing with HIV/AIDS because it was a new phenomenon. Therefore, rather than become adversarial with religious figures, she used them to echo the proper information about the virus. Dr. Dube found textual evidence in the Bible supporting the proposition that Jesus was infected with HIV/AIDS. When religious figures began to share this message to churchgoers, they helped humanize the virus to people who previously viewed it as a punishment. Because these figures had persuasive power within their respective communities, educating one priest could in turn educate hundreds, or even thousands of people. An additional catalyst to Dr. Dube’s theological mission was the fact that HIV/AIDS became more prevalent in Africa, even affecting some religious leaders who once believed the virus was for those who have sinned. As a result, people were more willing to become educated on how to avoid transmission and treat virus in an effort to rebuild their communities.

Dr. Dube’s use of religious figures to spread awareness about a pandemic may seem outdated in a secularizing society, but her methods could still be just as powerful in certain communities across the globe. For example, during the COVID-19 pandemic, some religious institutions spread narratives regarding vaccines or testing that conflict with current scientific knowledge. With over 80% of the world population associating with a religion, Dr. Dube’s methods would likely be effective in corrective misrepresentations regarding COVID-19.

Dr. Dube’s presentation about her experience with religious leaders in Africa when dealing with the HIV pandemic was very impactful. I was impressed with her ability to work with these religious leaders and come to an understanding and build trust in the community. Once Dr. Dube built this trust, she made meaningful changes in the community. She helped save lives by changing the narrative and educating people about HIV and the best way to deal with it.

I could not help but see the parallels between the COVID pandemic and religious leaders in our country. During the pandemic, I remember a heated debate regarding lockdowns and people’s right to go to their religious institutions for worship. Certain communities were having weddings and religious gatherings despite COVID protocols. This raised supreme court questions, which often ruled in favor of religious protections.

https://www.nytimes.com/2020/10/18/nyregion/nyc-covid-hasidic-wedding.html

https://www.usatoday.com/story/news/politics/2020/12/15/churches-take-covid-19-supreme-court-sides-religious-freedom/3813310001/

Our country would have greatly benefited if we had someone like Dr. Dube reaching out to these communities and having serious conversations about COVID-19 and safety. Often, these communities were chastised and looked down upon, which did not help build trust, but rather mistrust. Instead of chastising communities, open and honest communication is the answer, preferably from someone who is a part of their community. We need leaders who unite our citizens, like Dr. Dube, not divide them further. If not, communities will not trust the public health authorities as they should. This mistrust will lead to more unnecessary deaths during public health emergencies.

I so greatly appreciated Dr. Dube’s storytelling and the impact of religious entities on stigma and health. Throughout the COVID pandemic, this has also been seen, but in other religions as well. In the Orthodox Jewish communities of both New York and in Israel, there have been ongoing conversations on striking the balance between religious law and controlling infectious disease.

Early in the pandemic, celebrations for Jewish holidays served as super-spreader events. This eventually led to tension between the government entities involved in curbing the spread and religious leaders. However, a key component of stopping infection is to work WITH communities and not against. There have been examples of this unity in both the United States and Israel where there are large populations of Orthodox Jews (see here and here).Similar to the stories Dr. Dube shared, community and respect for religious leaders are incredibly important to this population. By engaging both, a mutual benefitting relationship can be formed. Interestingly, in Israel experts had to use various strategies to educate the public on COVID safety. Not only did they seek out guidance from Rabbis, they utilized Orthodox telephone news hotlines called nayes to stop misinformation.

Like in Dr. Dube’s story, once these religious figures were educated on the risk, they saw the value in speaking on it and implementing safety measures. However, the Jewish Orthodox oftentimes being a closed off community, this meant a give and take had to take place. With the help of Rabbis, members of the Synagogue could worship together if masking was enforced and vaccinations were encouraged. We have learned from these stories of the pandemics that change occurs not from outside dictation, but from community buy-in.

Last Tuesday, we had the privilege of hearing from Dr. Musa Dube. Her discussion, as storytelling, included details about her life as a theologian and her work with churches. Her journey began as an academic and evolved into rounding the entire continent of Africa to hold workshops with various Christian leaders to change the discourse involving HIV/AIDS. Something that stood out to me in her conversation was the following assertion: “Jesus is HIV positive.” It is rather profound for lectures and informational sessions to conclude that the God of a well-known religion has HIV. Dr. Dube noted that the aforementioned statement, when backed with evidence from the Bible, helped address the discrimination toward African individuals who had HIV/AIDS. Dr. Dube shared that, unfortunately, the shame associated with HIV/AIDS that began due to the disease’s sexual nature (in terms of transmission) worsened to the thought that individuals who tested positive for HIV were sinners and deserved their suffering. However, Dr. Dube found that sharing that Jesus is HIV positive makes people question if they can be discriminatory towards people who have HIV/AIDS because you undoubtedly cannot be discriminatory towards God.

According to a Healthcare (Basel) journal article by Rewerska-Juśko and Rejdak, patients suffering from COVID-19 often suffer from social stigma. Social stigma is “the attitude of discrimination, disapproval, or negative perception of a given group due to the properties and features it represents” (Rewerska-Juśko and Rejdak, 2022). Rewerska-Juśko and Rejdak found that the social stigma towards COVID-19 patients can be significant when considering attitudes involving vaccination status, social status, etc., and social rejection. At the height of the pandemic in 2021, I can vividly recall members of my extended family making comments that people contracting COVID-19 lead an incredibly unhealthy lifestyle or are simply suffering from the consequences of living a virtue-free and religion-free life. Therefore, I wonder, if religious leaders made comments that religious entities were COVID-19 positive, could we have minimized the social stigma toward COVID-19 patients? What do you all think?

In many early civilizations, health beliefs and practices where generated from religious or spiritual paradigms. While advances in biomedicine have allowed scientists to better explain the mechanisms of disease, the importance of religion in how we illness has remained. In her lecture, Musa Dube speaks to the influence of religious leaders as public health advocates.

Religion and HIV

Referencing her own experience during the HIV/AIDS epidemic, Musa Dube explained how she used Bible passages to show support for those with HIV. The social view of HIV at the time was that it was a “gay” disease that only affected men who had sex with men. Do to its perceived tied with homosexuality, many religious groups and organizations opposed those with HIV. Through religion, HIV was moralized in a way where those with the diagnosis were seen as evil or bad. It is clear that religion and spirituality are integral aspects of health and illness, especially during the HIV pandemic.

Religion and COVID-19

While religion was not used to blatantly discriminate against those with COVID-19 like seen during HIV, religion still played a huge role. According to results from the Pew Research Center, in 11 of 14 countries surveyed, the share who say their religious faith has strengthened is higher than the share who say it has weakened, including in the United States. During isolation or any time of health crisis, a connection to some community is integral. In this case, many found connection in religious or spiritual faith. Personally, I noticed that my own mother (who was previously not very spiritual) begin to do daily rituals connected to the Hindu faith. When I asked why, she said that these prayers and practices gave her a sense of routine in a time of limbo. Though she has begun to go back to the office again for work, my mother still continues to engage in these spiritual practices, as they make her feel more grounded.

During any crisis, a connection to community is critical. When individuals share any sort of belief or practice, it is easier to begin to work together to formulate solutions. As Musa Dube detailed in her lecture, religion can be a uniting force. So, during health crises like the HIV/AIDS and COVID-19 pandemic, we must consider religion and spirituality as a tool for connection.

I was captivated by Dr. Dube’s storytelling and inspired by her determination to improve the health of communities across Africa. Her experiences are the epitome of what one can accomplish when combining public health movements with cultural awareness and understanding. This is especially true in regards to the Christian community, where friction exists between HIV/AIDS discussion and religious leaders. Dube’s initiatives in local churches included open discussion about sex and sexuality. As she brought up, how are you supposed to ask a pastor to stand at the pulpit and talk about HIV prevention?

To accomplish this, it is critical to thoroughly understand the people and practices of the specific community. I would love to learn more about how Dr. Dube adapted her approach to each of the churches across the continent. Outside of Christianity, I’m interested in other faiths’ attitudes towards HIV/AIDS and the responses of their places of worship, especially with religion being such a central part of people’s community life. Dr. Dube’s visit to our class also left me wanting to know more about her curriculum intertwining theology with the epidemic. What exactly does it look like to read the bible in the context of HIV/AIDS? How did she reshape these discussions into a theology of compassion, when previous readings of the bible from this perspective treated HIV as a punishment for immoral lives? These questions intersecting science, culture, and religion deeply interest me, and I feel so grateful to have heard Dr. Dube’s incredible story firsthand.

Why is it so hard to effectively relay health information? I find it interesting that the promotion of health behaviors and the avoidance of disease and the spread of it heavily relies on the act of health communication. And yet, public health professionals fall short of accomplishing this crucial step. Why is that and what can we—as public health professionals—do to improve?

I really enjoyed hearing from Susan as she detailed the steps to relaying proper health communication. I found the information related to how to speak with reporters and other news outlets especially interesting. Susan stressed the importance of walking into a conference knowing the information you plan to share instead of worrying about what they my ask you. Susan also described various tips about how to not only discuss the health information at hand, but also how the health professional should behave.

As a member of both the Public Health field and also the public who often receives health information, I have identified general qualities that health communication should have. 1) Health communication should be clear, simplified, accessible, and timely. 2) If health information is subject to change—the information gained and shared at the beginning of a pandemic, for example—health professionals should preface messages by saying “this information is subject to change as our knowledge does”. 3) The health information should come first from our most credible source and encourage other, more community specific resources to share the same information so that the information circulated is consistent and accurate.

The recent COVID-19 Pandemic has highlight that failure to provide quick, concise, understandable health communication (in combination with other factors) leads to distrust and decreased credibility. I look forward to seeing how health communication improves and evolves as various means of communication grow in popularity and even credibility (e.g., TikTok and other social media platforms).  What type of improvements and/or evolution do you predict?