Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia’s most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia’s racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations’ existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders’ recommendations for tailoring HIV prevention for a faith-based audience

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Congregation-Based Programs to Address HIV/AIDS: Elements of Successful Implementation

Religious organizations may be uniquely positioned to address HIV by offering prevention, treatment, or support services to affected populations, but models of effective congregation-based HIV programs in the literature are scarce. This systematic review distils lessons on successfully implementing congregation HIV efforts. Peer-reviewed articles on congregation-based HIV efforts were reviewed against criteria measuring the extent of collaboration, tailoring to the local context, and use of community-based participatory research (CBPR) methods. The effectiveness of congregations’ efforts and their capacity to overcome barriers to addressing HIV is also assessed. We found that most congregational efforts focused primarily on HIV prevention, were developed in partnerships with outside organizations and tailored to target audiences, and used CBPR methods. A few more comprehensive programs also provided care and support to people with HIV and/or addressed substance use and mental health needs. We also found that congregational barriers such as HIV stigma and lack of understanding HIV’s importance were overcome using various strategies including tailoring programs to be respectful of church doctrine and campaigns to inform clergy and congregations. However, efforts to confront stigma directly were rare, suggesting a need for further research

Learning about Urban Congregations and HIV/AIDS: Community-Based Foundations for Developing Congregational Health Interventions

Religious congregations are important community institutions that could help fight HIV/AIDS; however, barriers exist, particularly in the area of prevention. Formative, participatory research is needed to understand the capacity of congregations to address HIV/AIDS. This article describes a study that used community-based participatory research (CBPR) approaches to learn about congregation-sponsored HIV activities. CBPR strategies were used throughout the study, including proposal development, community expert interviews, Community Advisory Board, congregational telephone survey, congregational case studies, and congregational feedback sessions. Involving community consultants, experts, and advisory board members in all stages of the study helped the researchers to conceptualize congregational involvement in HIV, be more sensitive to potential congregational concerns about the research, achieve high response rates, and interpret and disseminate findings. Providing preliminary case findings to congregational participants in an interactive feedback session improved data quality and relationships with the community. Methods to engage community stakeholders can lay the foundation for future collaborative interventions

Church Attendance as a Predictor of Number of Sexual Health Topics Discussed Among High-Risk HIV-Negative Black Women

Research suggests that sexual health communication is associated with safer sex practices. In this study, we examined the relationship between church attendance and sexual health topics discussed with both friends and sexual partners among a sample of urban Black women. Participants were 434 HIV negative Black women who were at high risk for contracting HIV through heterosexual sex. They were recruited from Baltimore, Maryland using a network-based sampling approach. Data were collected through face-to-face interviews and Audio-Computer-Assisted Self-Interviews (ACASI). Fifty-four percent of the participants attended church once a month or more (regular attendees). Multivariate logistic regression analyses revealed that regular church attendance among high-risk HIV negative Black women was a significant predictor of the number of sexual health topics discussed with both friends (AOR = 1.85, p =.003) and sexual partners (AOR= 1.68, p =.014). Future efforts to reduce HIV incidence among high-risk Black women may benefit from partnerships with churches that equip faith leaders and congregants with the tools to discuss sexual health topics with both their sexual partners and friends