Perceptions and social constructions of HIV prevention in the Black Baptist church

Introduction. Although the Black church (i.e., the Black Baptist church) has long exerted incomparable influence upon the health behaviors of African American communities, few have engaged in evidence-based interventions for HIV/AIDS prevention or collaborated with public health professionals on implementation. Because no research has examined the compatibility of these innovations with theological and socio-behavioral perspectives of Black church clergy and congregations, this study: 1) examines social constructions of HIV/AIDS and efforts to prevent HIV by rural and urban black Baptist churches in North Carolina; 2) identifies, compares, and contrasts key considerations about introducing 5 evidence-based HIV prevention innovations (abstinence, monogamy, condom use, voluntary counseling and testing, and prevention with positives) to Black Baptist churches; and 3) explores relevant, participant-driven HIV prevention models. Methods. This study used an exploratory qualitative design and methodological orientations of grounded theory and interpretive description. Data were collected using individual interviews and focus groups of respondents from 8 Black Baptist churches in North Carolina. A total of 1,117 interview minutes were audio-recorded and transcribed verbatim; the 638 resulting pages of text were managed using Atlas.ti 5.2. Analytic tools included open coding, memo writing, case-level comparisons, model development, and validation of the theoretical schema. Results. Case-level comparisons by church and by respondent segments revealed minimal distinctions. Respondents described social constructions of HIV/AIDS and its prevention in terms of 2 distinct worldviews, socio-behavioral and theological. Typical church responses to HIV/AIDS included silence, judgment, or maltreatment of persons living with HIV/AIDS. A combination of theological concepts, sin avoidance, and the socio-behavioral concept of avoidance of disease inform and enhance both the adaptability and acceptance of current evidence-based innovations. Participants also proposed non-evidence-based interventions. Conclusions. Findings offered insights into: expanding the utility of evidence-based HIV prevention models within Black Baptist church contexts; specific modifications to those models to increase compatibility; and additional Black church-based models that will require additional research. Further research is needed to reconcile socio-behavioral interpretations of homosexuality, accountability, and the consequences of sin within church-based contexts

Community-Based HIV Clinical Trials: An Integrated Approach in Underserved, Rural, Minority Communities

Although racial and ethnic minorities have disproportionately high rates of HIV infection, these groups are underrepresented in HIV-related clinical trials. This illustrates the need for more innovation in attempts to engage underrepresented populations in calls for interdisciplinary and translational research

Acceptability of a Mobile Health Unit for Rural HIV Clinical Trial Enrollment and Participation

Few rural minorities participate in HIV clinical trials. Mobile health units (MHUs) may be one strategy to increase participation. We explored community perceptions of MHU acceptability to increase clinical trial participation for rural minorities living with HIV/AIDS. We conducted 11 focus groups (service providers and community leaders) and 35 interviews (people living with HIV/AIDS). Responses were analyzed using constant comparative and content analysis techniques. Acceptable MHU use included maintaining accessibility and confidentiality while establishing credibility, community ownership and control. Under these conditions, MHUs can service rural locations and overcome geographic barriers to reaching major medical centers for clinical trials

Development of a Multilevel Intervention to Increase HIV Clinical Trial Participation Among Rural Minorities

Minorities are disproportionately affected by HIV/AIDS in the rural Southeast; therefore, it is important to develop targeted, culturally appropriate interventions to support rural minority participation in HIV/AIDS research. Using Intervention Mapping, we developed a comprehensive multilevel intervention for service providers (SPs) and people living with HIV/AIDS (PLWHA). We collected data from both groups through 11 focus groups and 35 individual interviews. Resultant data were used to develop matrices of behavioral outcomes, performance objectives and learning objectives. Each performance objective was mapped with changeable, theory-based determinants to inform components of the intervention. Behavioral outcomes for the intervention included: (a) Eligible PLWHA will enroll in clinical trials; and (b) SPs will refer eligible PLWHA to clinical trials. The ensuing intervention consists of four SPs and six PLWHA educational sessions. Its contents, methods and strategies were grounded in the theory of reasoned action, social cognitive theory, and the concept of social support. All materials were pretested and refined for content appropriateness and effectiveness

The Spoken Word Project: Using Poetry in Community Dialogue and Mobilization for HIV Prevention

Spoken word, a form of performance poetry, is a promising approach to HIV/AIDS awareness and prevention, as it has the potential to encourage dialogue among and within communities and address concerns regarding the social stigma present in rural communities. The purpose of this study is to describe the development and implementation of the Spoken Word Project (SWP), an HIV/AIDS pilot intervention in rural North Carolina designed to improve HIV-related attitudes and self-efficacy and decrease stigma through the use of performance poetry. Spoken word is a collaborative effort between residents of two rural counties in North Carolina and Project GRACE (Growing, Reaching, Advocating for Change and Empowerment), a community-based participatory research collaboration aimed at reducing health disparities in African American communities. The project included 15 adult and youth participants. Results indicated that spoken word has the ability to build upon local resources, generate community reflection, and engage a broad spectrum of performers and audiences. Our findings also showed that the effect of stigma and limited community conversations about HIV in rural communities can be abated through the use of spoken word

Silent Endurance and Profound Loneliness: Socioemotional Suffering in African Americans Living With HIV in the Rural South

We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering—the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole

Partnerships in Health Disparities Research and the Roles of Pastors of Black Churches: Potential Conflict, Synergy, and Expectations

The black church is a promising site to engage in health disparities research; however, little is understood about the pastors' perspectives. We used role theory to explore their expectations, potential conflicts, and synergy with research

Bridging Research, Practice, and Policy: The “Evidence Academy” Conference Model

Innovative models to facilitate more rapid uptake of research findings into practice are urgently needed. Community members who engage in research can accelerate this process by acting as adoption agents. We implemented an Evidence Academy conference model bringing together researchers, health professionals, advocates, and policy makers across North Carolina to discuss high-impact, life-saving study results. The overall goal is to develop dissemination and implementation strategies for translating evidence into practice and policy. Each one-day, single-theme, regional meeting focuses on a leading community-identified health priority. The model capitalizes on the power of diverse local networks to encourage broad, common awareness of new research findings. Furthermore, it emphasizes critical reflection and active group discussion on how to incorporate new evidence within and across organizations, health care systems, and communities. During the concluding session, participants are asked to articulate action plans relevant to their individual interests, work setting, or area of expertise

Curriculum Development to Increase Minority Research Literacy for HIV Prevention Research: A CBPR Approach

Minority engagement in HIV prevention research can improve the process and products of research. Using community-based participatory research (CBPR) to develop capacity-building tools can promote community awareness of HIV prevention, clinical research, and community roles in research

HIV Testing Experience and Risk Behavior Among Sexually Active Black Young Adults: A CBPR-Based Study Using Respondent-Driven Sampling in Durham, North Carolina

African Americans are disproportionately affected by the HIV epidemic inclusive of men who have sex with men, heterosexual men, and women. As part of a community-based participatory research study we assessed HIV testing experience among sexually active 18 to 30 year old Black men and women in Durham, North Carolina. Of 508 participants, 173 (74%) men and 236 (86%; p=.0008) women reported ever being tested. Barriers to testing (e.g., perceived risk and stigma) were the same for men and women, but men fell behind mainly because a primary facilitator of testing---routine screening in clinical settings---was more effective at reaching women. Structural and behavioral risk factors associated with HIV infection were prevalent but did not predict HIV testing experience. Reduced access to health care services for low income Black young adults may exacerbate HIV testing barriers that already exist for men and undermine previous success rates in reaching women