Jennifer Stewart, PhD, RN University of Pennsylvania School of Nursing Factors Contributing to the Development of an HIV Ministry within an African American Church Funded by Health Disparities in Underserved Populations Training Grant (T32NR007964; Barbara Dancy, PI) from the National Institutes of Health/National Institute of Nursing Research (NIH/NINR)

Background  The incidence of HIV infection among African Americans is the highest among any other racial/ethnic group  In the United States, 85% of African Americans report a religious affiliation, with 79% of African Americans reporting formal attendance at a Christian church.  A fairly large portion of churches are open to HIV programming f in alignment with church beliefs and values

Purpose: The purpose of this study was to examine how an African American church’s religious culture supported the development, implementation and maintenance of an HIV risk reduction program within the church. Research questions: What role did the religious culture have in the (1) development, (2) implementation, and (3) maintenance of an HIV risk reduction program within an African American church?

Dorr-Bremme’s Constitutive Ethnographic Theory of Social Organization Religious Culture  Shared beliefs, norms, attitudes, and acquired knowledge used to interpret experiences and generate social behavior 10,11  Model has been used to show how educational programs can be socially organized 12.  Culture and behavior of a social group have a continuous reciprocal relationship. Social Context Norms AttitudesKnowledge Beliefs Religious Culture Social Behavior

Method Research Designqualitative, ethnographic case study Settinglarge African American church in a Midwest urban setting Sampleone pastor, one pastor emeritus, one associate pastor and six individuals who were involved with the development, implementation, or maintenance of the HIV Ministry 50 members of the general congregation

Method Toolsnon-participant observation summary, Participant observation guide, Document review guide, Ethnographic interview guide, HIV risk reduction awareness questionnaire, Demographic questionnaire Recruitment Procedureconvenience sample, snowball technique Data Analysis analyzed and interpreted throughout the data gathering period and at conclusion Auerbach and Silverstein’s “grounded theory coding” method 16. prolonged engagement and triangulation thorough, detailed descriptions and rich quotations 15 taken directly from observations and interviews audit trail detailing the research process

Results Church Demographics Total Active Members: 8,854 Median Income of Surrounding Community: 43, 201

Results Observations, Documents, & Interviews  Four non participant observations were made, three participant observations were made, and nine documents were reviewed.  A total of nine individuals were interviewed, and 50 members of the general congregation were asked about their awareness of the HIV Ministry

Results--Development  Beliefs – the pastoral leadership and support was important in the development of an HIV Ministry; – acceptance of all individuals regardless of their sexual orientation.  Norm –the church’s role is to provide for the needs of its congregants whatever they may be.  Attitude – the congregation was positive, the developers felt compassion towards people with HIV.  Acquired Knowledge – promote knowledge for members and congregants.

Results--Implementation Belief members felt/feel they were/are called to fight against the stigma of HIV and help those who are infected or could be affected by HIV. Norm Christians are to help others and treat them with respect and dignity in all circumstances. Attitude a feeling of excitement and passion about their involvement in the HIV Ministry. Acquired knowledge HIV education was provided for members and congregants.

Results--Maintenance  Beliefs – Jesus calls all Christians to love others, particularly those who are generally neglected, ignored and discriminated against. – service in this ministry is about the belief that human beings deserve to be loved and cared for.  Norm –the HIV Ministry is an integral and important component of the church.  Attitude – the congregation enjoys maintaining the HIV Ministry.  Acquired Knowledge – members of the HIV Ministry know that rates are on the rise in the African American community particularly in certain age groups.

Discussion  Specifically, themes common were: a belief in helping others and treating them with respect and dignity, feelings of compassion towards individuals infected with HIV/AIDS, and an emphasis on the importance of HIV education for HIV Ministry church members as well as the general congregation.  Data from the development of the HIV Ministry also noted the importance of pastoral support and the importance of integrating the HIV Ministry into the culture of the church.

Notable Findings feelings of compassion towards individuals infected with HIV/AIDS “The first person to self identify in the membership of being full blown was Frank. Frank came to me. He said, ‘there’s no way of dancing around this, I’ve got AIDS and she [his wife] couldn’t deal with it and she left me’. Within three or four weeks he said something that really convicted me, he said, ‘nobody should have to die like this.’ And he was right. We made sure his death was as peaceful as it could be but then we decided that no, this can’t happen, this is not how a church is supposed to function and that was really the germination of the AIDS Ministry, how it started. pastoral support “I would say that’s very important, pastoral leadership. If they’re supportive its likelihood of taking off and being effective is much better than if they are resisting. If the pastoral leadership of the church is not supportive it ain’t going to happen because people will follow his lead.” integrating the HIV Ministry into the culture of the church “the HIV Ministry has been a continual tradition at the church. It has been a model program. It is in line with the teaching of the church over the years. The core values were already set in place before I got here. The hardcore work had already been done. So it’s a part of the culture now. It’s expected.”

Implications  Practice Implications –importance of gaining a strong understanding of church culture prior to attempting to develop church based HIV risk reduction programs. –can better develop programs that can be effective, well supported, and maintained if within the context of the church’s religious culture.  Research Implications –may provide an effective model with which to understand the development and maintenance of an HIV Ministry over time. –Using the concept of religious culture, a church can construct a role in the fight against HIV that is tailored to their needs and resonates with their beliefs and norms

Conclusion Findings show the importance of religious culture which is instrumental in providing a framework for understanding and supporting the church’s role in HIV Ministry. Additionally, findings support the idea that awareness and acceptance of individuals living with HIV, a theology that is open to addressing sensitive issues, pastoral support, and awareness of the prevalence of HIV in the surrounding community may be important building blocks in development of a HIV Ministry.

Acknowledgements  Dr. Barbara Dancy  Dr. Mi Ja Kim  Dr. Karyn Holm  Dr. Marilyn Sommers  Dr. Loretta Sweet Jemmott  Dr. Janet Deatrick  National Institutes of Health/National Institute of Nursing Research (T32NR007964; Barbara Dancy, PI)

Questions?