Attitudes Toward the Uptake of Combination HIV Prevention Methods Among Young Black and Latino Heterosexual Couples Living in New York City: A Qualitative Study.

ABSTRACT: Couple-based HIV interventions that increase uptake of two or more effective biomedical HIV prevention methods may be a promising HIV prevention strategy for young Black and Latino heterosexual couples. We conducted in-depth, semi-structured individual interviews with 23 Black and Latino adolescent and young adult heterosexual couples that explored their attitudes toward using combination HIV prevention methods (CHPMs). A qualitative hybrid thematic analysis approach was used to identify key themes. Themes included: (a) attitudes that encouraged uptake-CHPMs increased assurance of safety against HIV/sexually transmitted infections and (b) attitudes that impeded uptake-CHPMs are too much to do and are not appropriate for serious relationships. Although Black and Latino adolescents and young adults may recognize the combined protective benefits of using multiple HIV prevention methods, personal and relational considerations play an instrumental role in uptake of CHPMs.

Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia.

This paper compares income-based inequities in access to psychotherapy and other mental health services in Canada and Australia, two federal parliamentary systems with sharply contrasting responses to high rates of unmet need. Income-based inequity is measured by need-standardized concentration indices, using comparable data from the Canadian Community Health Survey 2011-2012 and the Australian National Survey of Mental Health and Well-Being 2007. The results indicate that utilization of psychologist services is more concentrated at higher income levels (i.e. pro-rich) than the other provider groups in both countries, and may be more pro-rich in Canada than in Australia. While the distribution of unmet need for psychotherapy was expected (as a negative indicator of access) to be more concentrated at lower income levels (i.e. pro-poor) under Canada's two-tier system, unmet need was not more equitable in Australia despite expanded public insurance coverage. As psychotherapy was made universally affordable for the first time in Australia in 2006, a possible backlog effect may have driven up both service utilization and unmet need, particularly among lower-income Australians. The impact of different Medicare co-payment policies also warrants further exploration.

Strategies to Promote African-American Church Leadership Engagement in HIV Testing and Linkage to Care.

A vital piece in implementing and sustaining HIV testing and linkage-to-care within Black churches is the support of the pastors and church leadership. In order to promote church-based HIV testing and linkage-to-care, we explored pastor and church leaders' (1) HIV-related knowledge, (2) their perception of congregant and community engagement in HIV-related risks, and (3) the potential role of the church in HIV testing and linkage-to-care. We conducted focus groups with 57 church leaders and 8 interviews with pastors across 6 churches in Baltimore, MD, USA. Conventional content analysis was used to analyze the qualitative data. The leadership demonstrated different levels of knowledge of the need for confidentiality, and the HIV testing process and reported that low levels of HIV knowledge among their congregants was related to low perceived risk of contracting HIV. Pastors and church leaders indicated that community members engaged in sexual risk and drug use but denied that any of their congregants engaged in such behaviors. Finally, pastors and church leaders have stated that churches were best suited as HIV service centers. These findings can be used to develop culturally appropriate interventions for pastors and church leaders to be better equipped and willing to incorporate HIV testing and linkage-to-care in their churches.

African American Church Engagement in the HIV Care Continuum.

Providing comprehensive services across the HIV care continuum through African American churches may improve HIV treatment outcomes for African Americans. We explored the feasibility of a church-led HIV care program in six churches in Baltimore, Maryland. Church leaders (n = 57) participated in focus groups and eight pastors participated in interviews. Data were analyzed by qualitative hybrid thematic analysis. Findings revealed eight themes: four themes were related to linkage to care: being unaware of community resources, concerns about HIV-associated regulations, ongoing personalized contact with HIV-infected persons, and desire for integration of spiritual education; four themes were related to HIV care and support services, including existing church infrastructure, provision of HIV support groups, using the church as an HIV care resource hub, and prevention education for uninfected people. These findings can support initiatives and efforts to promote delivery of HIV services along the HIV care continuum through African American churches.

Moving Beyond Age: An Exploratory Qualitative Study on the Context of Young African American Men and Women's Sexual Debut.

African American youth continue to be disproportionately affected by HIV. Early sexual debut has been identified as a major determinant of HIV risk. However, emerging research suggests that the overarching context in which first sex occurs may have greater implications for sexual health than simply age alone. The purpose of this exploratory, qualitative study was to better understand the broader context of African Americans' sexual debut. In-depth, semi-structured interviews were conducted with 10 African American men and women aged 18-24 years. Thematic analysis was used to analyze the data. The mean age at sexual debut for the sample was 15.4 (SD = 3.3), and youth framed their sexual debut as positive (50%), negative (30%), and both positive and negative (20%). The majority of youth initiated pre-sex conversations with their partners to gauge potential interest in engaging in sexual activity, and all youth utilized at least one HIV/sexually transmitted infection and pregnancy prevention method. However, most youth failed to talk to their partners prior to sex about their past sexual histories and what the experience meant for their relationship. Key differences emerged between youth who framed the experience as positive and those who framed the experience as negative or both positive and negative in terms of their motivations for initiating sex (i.e., readiness to initiate sex, pressure, and emotionally safety) and post-sex emotions (i.e., remorse and contentment). Findings provide further support for examining the broader sexual context of African American's sexual debut. A more comprehensive understanding of sexual debut will aid in the development and tailoring of sexual risk reduction programs targeting African American youth.

HIV Testing, Stigma, and Risk: A Comparison of Church Leaders and Their Congregants.

The involvement of African American churches in HIV testing and prevention is a viable community-based strategy in efforts to reduce rates of HIV among African Americans; however, church members' beliefs and attitudes are often barriers to successful implementation. This study aimed to compare church leaders and congregants regarding HIV testing behaviors, HIV-related stigma, HIV knowledge, and perceived risk. This comparative, cross-sectional study used self-reporting questionnaires across six churches in Baltimore, Maryland. Of the 173 participants (68 leaders, 105 congregants), leaders and congregants had equally high levels of HIV knowledge and equally low levels of HIV stigma, but leaders had higher homosexuality stigma than congregants t(169) = 1.773, p = .039. Congregants had higher perceived HIV risk t(170) = 3.814, p < .001, and were more likely to be tested annually for HIV than leaders, c2(1) = 8.940, p = .002. Given the higher rates of stigma, lower perceived risk and lower likelihood to be tested, interventions should focus on changing the beliefs and behaviors of church leadership to promote implementation of HIV efforts.

Messages of Hope: Helping Family Members to Overcome Fears and Fatalistic Attitudes Toward Cancer.

This qualitative study explored strategies family members of African-American cancer patients used to overcome their fears and fatalistic attitudes toward cancer. Twenty-four family members were recruited through criterion purposeful sampling. Data were collected and analyzed using open-ended interviews and thematic analysis. Fears and fatalistic attitudes could be traced to personal experiences with cancer and information being communicated within their networks. Strategies used to overcome fears and fatalistic attitudes toward cancer included an awareness of advances in cancer treatments, information obtained from their health-care providers, and faith in God. Family members supported the patient through efforts of encouraging them to talk about what they were going through, to be strong, to maintain a positive environment and normalcy, and to use spirituality as a source of strength. Family members also suggested that health-care providers and researchers tailor intervention studies to consider that the patient is a part of a larger family system and that the entire family needs support to overcome long-held fears and fatalistic attitudes toward cancer. These findings suggest that despite advances in cancer care and widespread media coverage to change perceptions about cancer, fears and fatalistic attitudes toward cancer persist and likely influence the family members' ability to optimally support the cancer patient. At the time of diagnosis, both patient and the entire family unit should be educated of advances in cancer care, that cancer is no longer a death sentence, and supported to overcome fears and fatalistic attitudes.

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.

Younger African American Adults' Use of Religious Songs to Manage Stressful Life Events.

The aim of this study was to explore the use of religious songs in response to stressful life events among young African American adults. Fifty-five young African American adults aged 18-49 participated in a qualitative study involving criterion sampling and open-ended interviews. Data analysis included content analysis and descriptive statistics. Stressful life events were related to work or school; caregiving and death of a family member; and relationships. Religious songs represented five categories: Instructive, Communication with God, Thanksgiving and Praise, Memory of Forefathers, and Life after Death. The tradition of using religious songs in response to stressful life events continues among these young adults. Incorporating religious songs into health-promoting interventions might enhance their cultural relevance to this population.

A Contextualized Approach to Faith-Based HIV Risk Reduction for African American Women.

HIV/AIDS has a devastating impact on African Americans, particularly women and young adults. We sought to characterize risks, barriers, and content and delivery needs for a faith-based intervention to reduce HIV risk among African American women ages 18 to 25. In a convergent parallel mixed methods study, we conducted four focus groups (n = 38) and surveyed 71 young adult women. Data were collected across four African American churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting, and financial burdens into faith-based HIV risk-reduction interventions. Incorporating additional social context-related factors into HIV risk-reduction interventions for young African American women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings.

African American church-based HIV testing and linkage to care: assets, challenges and needs.

The US National HIV AIDS strategy promotes the use of faith communities to lessen the burden of HIV in African American communities. One specific strategy presented is the use of these non-traditional venues for HIV testing and co-location of services. African American churches can be at the forefront of this endeavour through the provision of HIV testing and linkage to care. However, there are few interventions to promote the churches' involvement in both HIV testing and linkage to care. We conducted 4 focus groups (n = 39 participants), 4 interviews and 116 surveys in a mixed-methods study to examine the feasibility of a church-based HIV testing and linkage to care intervention in Philadelphia, PA, USA. Our objectives were to examine: (1) available assets, (2) challenges and barriers and (3) needs associated with church-based HIV testing and linkage to care. Analyses revealed several factors of importance, including the role of the church as an access point for testing in low-income neighbourhoods, challenges in openly discussing the relationship between sexuality and HIV, and buy-in among church leadership. These findings can support intervention development and necessitate situating African American church-based HIV testing and linkage to care interventions within a multi-level framework.

Readiness to Implement HIV Testing in African-American Church Settings.

HIV and AIDS continue to impact Black Americans at disproportionately high rates. Promotion of HIV testing and linkage to care is a national health imperative for this population. As a pillar in the Black community, the Black Church could have a significant impact on the promotion of HIV testing within their churches and surrounding communities. Churches, however, have varied levels of involvement in testing. Furthermore, little is known about how to assess a church's readiness to integrate HIV testing strategies into its mission, much less how to promote this practice among churches. This qualitative study used interviews and focus groups with pastors and church leaders from four churches with varying levels of involvement in HIV testing to identify key stages in the progression of toward church-based HIV testing and linkage to care. Findings showed that churches progressed through levels of readiness, from refusal of the possibility of HIV interventions to full integration of HIV testing and linkage to care within the church.

A multi-level approach for promoting HIV testing within African American church settings.

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.

A developing framework for the development, implementation and maintenance of HIV interventions in the African American church.

The African American church has promoted the health of African Americans through supporting interventions that target a wide variety of diseases, and it is a crucial community partner in the development of HIV prevention interventions. Although research has described the development of church-based HIV interventions, there is a significant lack of frameworks and approaches available to guide the implementation and maintenance of HIV interventions within church-based settings. A developing framework of a comprehensive church-based intervention, derived from an ethnographic study about the development, implementation, and maintenance of an HIV/AIDS Ministry within an African American church is presented. This approach can provide guidance to support the development, implementation, and maintenance of HIV interventions in faith settings.

Implementation of evidence-based HIV interventions for young adult African American women in church settings.

OBJECTIVE: To assess the barriers and facilitators to using African American churches as sites for implementation of evidence-based HIV interventions among young African American women. DESIGN: Mixed methods cross-sectional design. SETTING: African American churches in Philadelphia, PA. PARTICIPANTS: 142 African American pastors, church leaders, and young adult women ages 18 to 25. METHODS: Mixed methods convergent parallel design. RESULTS: The majority of young adult women reported engaging in high-risk HIV-related behaviors. Although church leaders reported willingness to implement HIV risk-reduction interventions, they were unsure of how to initiate this process. Key facilitators to the implementation of evidence-based interventions included the perception of the leadership and church members that HIV interventions were needed and that the church was a promising venue for them. A primary barrier to implementation in this setting is the perception that discussions of sexuality should be private. CONCLUSION: Implementation of evidence-based HIV interventions for young adult African American women in church settings is feasible and needed. Building a level of comfort in discussing matters of sexuality and adapting existing evidence-based interventions to meet the needs of young women in church settings is a viable approach for successful implementation.

Pastor and lay leader perceptions of barriers and supports to HIV ministry maintenance in an African American church.

Clergy and lay leaders have a pivotal role in the development and maintenance of HIV Ministries within the African American church. However, little is known about the actual roles these men and women have, the barriers they face and the supports they have found in the development and maintenance of an HIV Ministry. The purpose of this study is to examine the role, barriers and supports clergy and lay leaders experienced in the development of a long-standing HIV ministry in an African American church. These data were gathered from a larger ethnographic study, which examined the role of religious culture in the development, implementation and maintenance of an HIV ministry. Data for this study were collected through in-depth semi-structured interviews. Results revealed that the primary role of clergy and lay leaders involved dispelling myths surrounding HIV and ensuring congregational support. The primary barrier to the development and maintenance was views regarding sexuality. The primary support was their relationships with congregants that lived with HIV and AIDS. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries.

Attitudes and beliefs toward biobehavioural research participation: voices and concerns of urban adolescent females receiving outpatient mental health treatment.

BACKGROUND: Biobehavioural research methodology can be invasive and burdensome for participants - particularly adolescents with mental illnesses. Human biological researchers should consider how methodological impositions may hinder adolescent research participation. However, literature on adolescent's voices and concerns toward biobehavioural research participation is virtually non-existent. AIM: This study was designed to determine adolescents' perceptions of participation in research involving the collection of biomarkers via blood, saliva and/or urine samples. SUBJECTS AND METHODS: Urban adolescent females (aged 12-19) receiving outpatient mental health treatment (n = 37) participated in focus groups with concurrent survey administration to explore attitudes, beliefs and willingness/intentions toward biobehavioural research participation. RESULTS: Participants had favourable attitudes toward biobehavioural research and were amenable to provide each specimen type. Mistrust for research emerged, however, and concerns related to privacy and confidentiality were expressed. CONCLUSION: Participant recruitment is a critical component in study design and implementation; this includes knowledge of population-specific recruitment barriers and facilitators. This innovative paper provides a context for the research participants' decision-making process, strategies to allay fears and concerns and concrete areas to target in research-related interventions. Although the findings are from a specific, US-based sample, the implications warrant replication of the research in other geosocial settings.

The Black church, sexual health, and sexuality: a conceptual framework to promote health through faith-based organizations.

There is a growing body of literature that documents the unique impact of black churches on social and health-related changes in the black community. Sexual health and sexuality, however, have long been sources of contention within the institution. The purpose of this article was to refine existing theoretical models that undergird sexual health research in faith-based organizations. The proposed conceptual model explores social-level factors (racism, homophobia, and heterosexism) and church organizational-level factors (beliefs, social trust, norms, and social support/influence). We make an argument in favor of illuminating the negative social-level barriers and affirming the internal cultural supports.

Factors contributing to the development of an HIV ministry within an African American church.

Having an HIV ministry within a church depends on the religious culture of that church. However, little is known about how a church's religious culture influences an HIV ministry. This study's purpose was to examine how an African American church's religious culture supported the development, implementation, and maintenance of an HIV ministry within the church. An ethnographic case study research design was used. Data were collected through interviews, nonparticipant and participant observations, review of pertinent documents, and survey of congregants. Results revealed the following as important for an HIV ministry: (a) a belief in helping others and treating everyone with respect and dignity, (b) feelings of compassion toward individuals infected with HIV, and (c) HIV education. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries.