A Multi-Level Approach for Promoting HIV Testing Within African American Church Settings

Abstract

The African American church is a community-based organization that is integral to the lives, beliefs, and behaviors of the African American community. Engaging this vital institution as a primary setting for HIV testing and referral would significantly impact the epidemic. The disproportionately high HIV incidence rate among African Americans dictates the national priority for promotion of early and routine HIV testing, and suggests engaging community-based organizations in this endeavor. However, few multilevel HIV testing frameworks have been developed, tested, and evaluated within the African American church. This article proposes one such framework for promoting HIV testing and referral within African American churches. A qualitative study was employed to examine the perceptions, beliefs, knowledge, and behaviors related to understanding involvement in church-based HIV testing. A total of four focus groups with church leaders and four in-depth interviews with pastors, were conducted between November 2012 and June 2013 to identify the constructs most important to supporting Philadelphia churches' involvement in HIV testing, referral, and linkage to care. The data generated from this study were analyzed using a grounded theory approach and used to develop and refine a multilevel framework for identifying factors impacting church-based HIV testing and referral and to ultimately support capacity building among African American churches to promote HIV testing and linkage to care.

African American Church Engagement in the HIV Care Continuum

“…First, it is one of the first studies to consider how African American churches may assist HIV efforts beyond prevention, education, and testing. Second, it reinforces previous findings that some African American churches are eager to support HIV care (Stewart, 2015) and offers strategies to promote their involvement. Third, our study can serve as a foundation on which future researchers and practitioners can build as they partner with churches, local AIDS service organizations, and individual patients to improve the health and well-being of those infected with and affected by HIV.…”

“…As other investigators have indicated, partnerships with other community-based organizations would be needed to meet the goal of church-based HIV linkage to care and treatment (Stewart, 2015). Other investigators have indicated the need to promote compassion and reduce HIV stigma in training church leadership (Galvan, Davis, Banks, & Bing, 2008).…”

Stakeholder conceptualisation of multi-level HIV and AIDS determinants in a Black epicentre

“…This includes intervening against generalised homophobia (Garcia et al 2016), Black men’s ideology that they cannot decline sex (Bowleg et al 2011) and the normativity of infidelity by Black women (Bowleg, Lucas, and Tschann 2004). Third, we need an intergenerational approach, with the engagement of families (Adimora and Schoenbach 2012), as well as key community institutions such as Black churches (Stewart 2015). Last and most important is to understand how the intersectionality and lived experience of racism, gender-based discrimination and stigma influence HIV and AIDS disparities (Smedley 2014; Bowleg 2013; Bowleg et al 2013), particularly among those who experience multiple forms of marginalisation.…”

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

“…We used the previously developed multi-level church-based HIV testing model (Stewart, 2015c) in conjunction with previous research to identify potential factors that would impact the likelihood of African American churches having a HIV or AIDS program. Three levels are suggested in this model: individual, organizational and social.…”

“…Organizational factors include the norms, regulations and rules associated with the organization. Lastly, social factors include aspects of social conditions that directly affect lifestyles including education and location (Stewart, 2015c; World Health Organization, 2015). …”