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

The Perception of Religious Leaders on HIV and Their Role in HIV Prevention: A Case Study of African, Caribbean, and Black (ACB) Communities in Windsor, Ontario

This paper explores the perception of African, Caribbean, and Black (ACB) religious leaders on HIV vulnerability and their role in HIV prevention among ACB communities in Windsor, Ontario. We conducted one semi-structured focus group discussion with nine Black religious leaders, most of whose congregants are members of the ACB community. Most religious leaders in the focus group had a negative perception of the transmission of HIV, but they acknowledged their own important role in HIV prevention strategies. This role is collaborative in nature, from the stage of designing HIV prevention strategies to implementing prevention messages. The religious leaders noted, however, that some challenges, such as church doctrine and congregational culture, are likely to impede their HIV prevention efforts.

Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study

BACKGROUND

In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection.

METHODS

As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach.

RESULTS

The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity.

CONCLUSION

Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.

Re-membering HIV in the Black Church: women's religious and social identity in relation to perceived risk and men on the down low

This analysis of 84 interviews with female Black Church leaders and members from Atlanta, GA, examined how women in Black churches construct definitions of, and identities in relation to, HIV narratives about men on the down low. We analyse these narratives as collective memories, through the theoretical lens of memory and trauma studies, by identifying how women understand themselves as the victims of men on the down low transmitting HIV; describe this as a painful experience; make public claims about this experience; and draw on theological understandings to make these claims. The narratives articulate how Black communal modes of meaning making have been disrupted by the HIV epidemic and assign responsibility for HIV transmission to men on the down low, who are perceived to be engaged in risky sexual behaviour. We discuss these results in relation to HIV education and prevention and suggest health educators can engage Black church leaders by understanding these narratives as forms of countermemory.

Rural Black Pastors: the Influence of Attitudes on the Development of HIV/AIDS Programs

This exploratory research addressed the question, among rural Mississippi African American Baptist pastors, what is the impact of attitudes toward HIV/AIDS on the development of HIV/AIDS programs in the church? It was hypothesized that empathetic attitudes toward HIV make programming more likely. The study used Froman and Owen's AIDS Attitude Scale (AAS) and a demographic questionnaire, which included a measure that assessed potential program development. A sample of more than 300 African American pastors participated. The findings suggested that there is a significant relationship between rural Mississippi African American Baptist pastors' empathetic attitudes toward AIDS and their willingness to develop an HIV/AIDS program.

Black Pastors' Views on preaching about sex: barriers, facilitators, and opportunities for HIV prevention messaging

OBJECTIVES

Despite the disproportionately high rates of heterosexually transmitted HIV infection among US Blacks and ongoing need for effective inexpensive behavioral interventions, the use of sermons as an HIV prevention tool in Black churches has received little research attention. The Black church plays an important role in Black communities and is a potential ally in development and delivery of sexual risk prevention messages. The objective of this study was to examine Black pastors' thoughts about whether sermons should address issues related to heterosexual relationships - and the barriers and facilitators to discussing these topics in a sermon setting.

DESIGN

We conducted in-depth semi-structured, individual interviews among 39 pastors of Black churches in North Carolina and analyzed the interview data using thematic analysis strategies based on grounded theory.

RESULTS

Pastors expressed widely ranging opinions, especially about discussion of condom use, but generally agreed that sermons should discuss marriage, abstinence, monogamy, dating, and infidelity - behaviors that impact sexual networks and HIV transmission. The major barriers to incorporation of these subjects into sermons include the extent to which a concept undermines their religious beliefs and uncertainty about how to incorporate it. However, scriptural support for a prevention message and the pastor's perception that the message is relevant to the congregation facilitate incorporation of related topics into sermons.

CONCLUSIONS

These findings have implications for the potential utility of sermons as an HIV prevention tool and suggest that it is possible for public health professionals and pastors of Black churches to form partnerships to develop messages that are consonant with pastors' religious convictions as well as public health recommendations.

The Role of Religious Socialization and Religiosity in African American and Caribbean Black Adolescents' Sexual Initiation

This study determined the nature of the associations between religious socialization, religiosity, and adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1170), a nationally representative study of black adolescents. Factor analysis, structural equation modeling, and logistic regression were used to evaluate hypotheses. Results indicated that as black adolescents received more messages about religious beliefs and practices, their religiosity was greater and, in turn, they were less likely to report sexual initiation; findings varied by ethnicity, gender, and age. Findings contribute to understanding religious socialization and its association with sexual initiation.

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders’ discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM.

Barriers and challenges affecting the contemporary church's engagement in health promotion

Issue addressed Christian churches have historically undertaken welfare and community service activities to practise faith and increase their relevance to communities. However, the church in Australia has received little attention from health promotion practitioners and researchers. The objective of this qualitative study was to explore the barriers and challenges that affect church engagement in health promotion to assist practitioners' understanding of the potential for these civil society organisations to play a role in health promotion programs and partnerships. Methods The research was based on interviews with five directors of church-affiliated organisations and with the church leaders (ministers, pastors, priests) of 30 churches in urban and rural Victoria. Analysis was iterative using open, axial and thematic coding. Results The challenges to church involvement in health promotion, as articulated by church leaders, fell under the themes of the social context of churches and the attributes of congregations. Major issues raised were perceived relevance, mistrust, contested agendas, discordant values within congregations, and risk management. Conclusion Although churches may take a different stance to health promotion agencies on a range of social and health issues, many have experience addressing social disadvantage and are prepared to commit resources to meet the needs of people outside their congregations. However, several factors inhibit the engagement of churches in health promotion including perceived irrelevance and community mistrust, agendas of conversion and values that conflict with health promotion. So what? Churches have a history of addressing social determinants of health such as housing, employment and food security. Deeper understanding of the challenges and barriers church leaders experience in undertaking health promotion work will facilitate more realistic and effective engagement by practitioners with these organisations.

Process Evaluation of a Peer-Driven, HIV Stigma Reduction and HIV Testing Intervention in Latino and African American Churches

Purpose: Faith-based organizations may be effective in addressing HIV-related disparities, but few interventions have been implemented across diverse churches. The Facilitating Awareness to Increase Testing for HIV (FAITH) intervention harnessed peer leadership to decrease HIV stigma and promote HIV testing in African American and Latino congregations. A pilot study found more consistent effects among Latino congregations. This process evaluation evaluates implementation of FAITH to better understand the pilot study's findings.

Methods: Data sources included HIV education and peer leader workshop evaluation forms, participant views of the community's perspective of HIV, and peer leader follow-up interviews. Data were triangulated with systematic observation notes and analyzed using process-related themes of recruitment, reach, context, implementation, dose-delivered, and fidelity.

Results: At the Latino churches (compared to the African American church), facilitators spent more time addressing community-based misconceptions about HIV. The peer leader model was well received, especially among Latino participants, and most said that after the workshop they felt comfortable speaking with others about HIV-related topics. Latino peer leaders reported speaking with up to 20 people within their social networks (particularly with family members); African Americans reported up to 4. Implementation challenges at the African American church may have contributed to the limited intervention effects. Nevertheless, we found the peer motivator model feasible and acceptable across diverse faith settings.

Conclusion: Peer-based models within faith settings are promising for addressing HIV. However, differences among groups in HIV knowledge, social network characteristics and norms, and church preferences may influence overall effectiveness.

Predictors of HIV/AIDS Programming in African American Churches: Implications for HIV Prevention, Testing, and Care

Using data from the National Congregational Study, we examined predictors of having an HIV/AIDS program in predominately African American churches across the United States. We conducted regression analyses of Wave II data ( N = 1,506) isolating the sample to churches with a predominately African American membership. The dependent variable asked whether or not the congregation currently had any program focused on HIV or AIDS. Independent variables included several variables from the individual, organizational, and social levels. Our study revealed that region, clergy age, congregant disclosure of HIV-positive status, permitting cohabiting couples to be members, sponsorship or participation in programs targeted to physical health issues, and having a designated person or committee to address health-focused programs significantly increased the likelihood of African American churches having an HIV/AIDS program. A paucity of nationally representative research focuses on the social-, organizational-, and individual-level predictors of having HIV/AIDS programs in African American churches. Determining the characteristics of churches with HIV/AIDS programming at multiple levels is a critical and necessary approach with significant implications for partnering with African American churches in HIV or AIDS initiatives.

Understanding cancer screening service utilization by Somali men in Minnesota

This study examined factors that influence use of cancer screening by Somali men residing in Minnesota, USA. To better understand why recent immigrants are disproportionately less likely to use screening services, we used the health belief model to explore knowledge, beliefs, and attitudes surrounding cancer screening. We conducted a qualitative study comprised of 20 key informant interviews with Somali community leaders and 8 focus groups with Somali men (n = 44). Somali men commonly believe they are protected from cancer by religious beliefs. This belief, along with a lack of knowledge about screening, increased the likelihood to refrain from screening. Identifying the association between religion and health behaviors may lead to more targeted interventions to address existing disparities in cancer screening in the growing US immigrant population.