What leads religious congregations to address HIV?

Background: Faith-based organizations are uniquely positioned to address the HIV epidemic. They represent trusted social networks that can disseminate health information, and many have a history of engaging in social issues. However, few congregations have developed HIV programs. We examined the extent to which congregational factors and community factors are related to the existence of congregation HIV prevention or care activities. Methods: We used data from a nationally-representative sample of 1,506 congregations surveyed in the National Congregations Study; and measures of HIV prevalence and health compiled by the Robert Wood Johnson Foundation. We use multinomial logistic regression to assess factors that independently predict existence of a congregation-based health program (not including HIV); and an HIV program relative to no engagement in HIV-related programs. Results: Most congregations (69.8%) had at least one health-related program; fewer (9.9%) had an HIV program. Factors positively associated with having a health program included having an older age congregation, percent of attendees that are of African American, number of adults, number of service programs, and assessing community needs. Factors positively associated with having an HIV program include percent African American, number of paid staff, staff with 25% time devoted to service programs, collaborating with religious, and/or secular organizations, assessing community needs, a statement welcoming homosexuals, an openly HIV positive member, and allowing openly gay members. Conclusions: These results suggest that increasing resources, being externally engaged, and acceptance of gay and/or HIV positive persons can increase a congregation's likelihood of sponsoring an HIV program.