PROJECT NEW HOPE: A FAITH-BASED EFFORT TO PROVIDE HOUSING FOR PERSONS WITH HIV/AIDS

Demographics and Clinical Profiles of Patients Visiting a Free Clinic in Miami, Florida

Background: Although the ranks of the uninsured in the United States have decreased in recent years, some states still lack Medicaid expansion programs, leaving many Americans, especially the indigent and homeless, without adequate healthcare coverage. Free-for-care clinics are oftentimes the last safety net for these vulnerable populations. Because these clinics have limited funding, a thorough understanding of the patients they serve is necessary to effectively direct their resources. The objective of the present study is to investigate the characteristics and clinical profiles of patients utilizing a free clinic in Miami, Florida. Methods: Aggregate EMR data reflecting consecutive adult patient visits to the Miami Rescue Mission Clinic in Miami, Florida between January 1st, 2018 to March 15th, 2019 (n = 846) were reviewed for sociodemographic characteristics and chronic disease prevalence. Prevalence rates were compared by sex and to county estimates from the Florida Behavioral Risk Factor Surveillance System. Results: The most common conditions were mental health (19.3%), circulatory system (14.7%), and musculoskeletal system disorders (13.9%). Males had a greater prevalence of depression (difference = 6.6%; 95% CI [1.5 to 10.7%]; χ2 = 6.2; p = 0.013) and overall mental illness (22.0 vs. 10.4%, difference = 11.6%; 95% CI [5.7 to 16.4%]; χ2 = 13.2; p = 0.0003) compared to females, and male sex was identified as an independent risk factor for mental illness on multivariate logistic regression analysis (OR = 2.8; 95% CI [1.7 to 4.7]; p < 0.001). There was also a higher prevalence of depression (difference = 6.41%; 95% CI [2.1 to 10.2%]; χ2 = 8.0; p = 0.0047) and HIV (difference = 1.4%; 95% CI [0.3 to 3.0%]; χ2 = 7.3; p = 0.007) in male patients compared to county estimates. Rates of hypertension, diabetes, elevated cholesterol, asthma, and COPD were lower in the clinic population compared to the surrounding county. Conclusion: There is an acute need for mental health services in this population. The lowered prevalence of other chronic conditions is due to underdiagnosis and loss to follow-up. Such analyses are important in guiding policy decisions for meeting the health needs of vulnerable, at risk populations.

Public health and church-based constructions of HIV prevention: black Baptist perspective

The black church is influential in shaping health behaviors within African-American communities, yet few use evidence-based strategies for HIV prevention (abstinence, monogamy, condoms, voluntary counseling and testing, and prevention with positives). Using principles of grounded theory and interpretive description, we explored the social construction of HIV prevention within black Baptist churches in North Carolina. Data collection included interviews with church leaders (n = 12) and focus groups with congregants (n = 7; 36 participants). Analytic tools included open coding and case-level comparisons. Social constructions of HIV/AIDS prevention were influenced by two worldviews: public health and church-based. Areas of compatibility and incompatibility exist between the two worldviews that inform acceptability and adaptability of current evidence-based strategies. These findings offer insight into ways to increase the compatibility of evidence-based HIV prevention strategies within the black Baptist church context.

HIV/AIDS prevention, faith, and spirituality among black/African American and Latino communities in the United States: strengthening scientific faith-based efforts to shift the course of the epidemic and reduce HIV-related health disparities

Black/African American and Latino communities are disproportionately affected by the domestic HIV/AIDS epidemic. Blacks/African Americans and Latinos are also more likely to report a formal, religious, or faith affiliation when compared with non-Hispanic whites. As such, faith leaders and their institutions have been identified in the National HIV/AIDS Strategy as having a vital role to serve in reducing: (1) HIV-related health disparities and (2) the number of new HIV infections by promoting non-judgmental support for persons living with and at risk for HIV/AIDS and by serving as trusted information resources for their congregants and communities. We describe faith doctrines and faith-science partnerships that are increasing in support of faith-based HIV prevention and service delivery activities and discuss the vital role of these faith-based efforts in highly affected black/African American and Latino communities.

Attitudes and beliefs related to HIV/AIDS in urban religious congregations: barriers and opportunities for HIV-related interventions

HIV-related stigmas have been seen as a barrier to greater religious congregation involvement in HIV prevention and care in the United States and elsewhere. We explored congregational and community norms and attitudes regarding HIV, sexuality, and drug use through a qualitative case study of 14 diverse religious congregations in Los Angeles County, California between December 2006 and May 2008. Data collected included semi-structured interviews with 57 clergy and lay leaders across the congregations, structured observations of congregational activities, review of archival documents, and a questionnaire on congregational characteristics. Across and within congregations, we found a wide range of views towards HIV, people with HIV, and populations at risk for HIV, from highly judgmental and exclusionary, to "loving the sinner, not the sin," to accepting and affirming. Attitudes and norms about HIV, homosexuality, and substance abuse appeared to be related to the type and intensity of congregational HIV-related activities. However, even among the higher activity congregations, we found a range of perceptions, including ones that were stigmatizing. Results suggest that affirming norms and attitudes are not a prerequisite for a congregation to initiate HIV activities, a finding relevant for HIV service providers and researchers seeking to engage congregations on this issue. HIV stigma reduction is not a prerequisite for congregational HIV involvement: both may occur simultaneously, or one before the other, and they dynamically affect each other. Strategies that are congruent with congregations' current levels of comfort and openness around HIV can themselves facilitate a process of attitudinal and normative change.