Exploring urban congregations' capacity for HIV prevention & care: A case study analysis

Religious congregations reach many lives, and some believe congregations could play an influential role in the fight against HIV/AIDS. However, there have been few systematic assessments of congregational engagement in this area. Here we report on in-depth case studies of 14 congregations located in high-risk, urban areas of a large west coast metropolitan area. The cases represent a range of religious denominations/faiths, races and ethnicities (African American, Latino, and white), and levels of health- and HIV-related program or ministry activities. For each case, we conducted in-depth interviews in English or Spanish with clergy and lay leaders and systematic observations of religious services, health activities, and neighborhood contexts. Audio recordings of interviews (n = 60) were transcribed for analysis with qualitative coding software. Extensive interview and field notes were also prepared to create case reports that were presented to congregational leaders for feedback. Principal findings based on within-case and cross-case analyses suggest that congregations' capacity and propensity for engaging in health- and HIV/AIDS-related activities are affected by congregational demographics, norms and attitudes, organizational structure, community factors, and internal and external resources. Congregations with active HIV programs typically had a clergy or lay leader personally affected by HIV who initiated and sustained efforts over time. The availability of external resources also facilitated HIV-related activities. Declining urgency around HIV/AIDS due to improved treatments has led to a loss of volunteer support for on-going HIV care activities. HIV prevention efforts have been hindered by clergy perceptions that congregants are low-risk and difficulty discussing sexuality.