Using concept mapping to mobilize a Black faith community to address HIV.

IntroductionFaith communities, especially African American churches, have been suggested as a key partner to address HIV (1-3). HIV, or human immunodeficiency virus, can lead to a terminal condition known as AIDS (acquired immunodeficiency syndrome). African Americans are disproportionately affected by HIV (4). The Black church (evangelical congregations predominantly made up of African American members) has been a powerful voice in communities of color, but its role in shaping HIV-risk behaviors and HIV prevention/care has been mixed (1). A national study estimated that 5.6% of U.S. congregations provide programs or activities to people living with HIV (PLWH), which were facilitated by presence of PLWH in the congregation, formal community needs assessment activities, religious tradition (Black Protestantism), and openness to gays/lesbians (5). Another study has shown that only a third of Black Protestant congregations offer HIV prevention/counseling programs (2). The literature has identified stigma linked with religious doctrines and moral positions as a key barrier to effective HIV prevention/care (6). Even churches willing to address HIV in their communities defer from discussing specific HIV-risk behaviors (7). How to tackle doctrinal stances on HIV remains unclear, but mobilization and input directly from faith leaders and faith communities in specific local contexts are emerging as useful approaches (8).Involving community members in the process is considered as crucial to improving the success of health interventions (9). Research that partners with community stakeholders increases contextual relevance and community buy-in and therefore maximizes the chance for intervention success. As one strategy to HIV prevention, federal agencies have been funding Black churches as partners in HIV prevention (10). Most of this work has been capacity-building and HIV-related training. The development of community-based coalitions and partnerships is another effective strategy (11). Such connections have been seen as major opportunities for faith leaders to gain support and garner resources for faith communities' HIV involvement. Some faith institutions have been implementing HIV programs and services that they find acceptable within the context of their religious doctrine (12). Researchers have also begun engaging directly with faith leaders to learn about factors that facilitate or inhibit effective HIV prevention/care in at-risk communities (8).Unfortunately, data from such studies sometimes lack rigor because traditional research and evaluation methods are difficult to implement on a large scale and in "fluid" community settings. There are also several potential barriers to implementing health programs and in particular those addressing HIV within religious settings. These include the presence of mistrust and a reciprocal lack of understanding of the values, norms, and customs between religious organizations and their partners in science, public health, or academia (13). Therefore, innovative methodologies rooted in social sciences, not widely used within public health, are urgently needed. Furthermore, demonstrations and exploratory studies need to be repeated in a broad range of environments and might even be uniquely important in areas outside of epicenters in which relatively more motivations/resources are available. Finally, community mobilization with a focus on HIV can be effective, but such interventions are most effective when they occur spontaneously and emerge directly from communities (rather than being "implemented" by an outside agent) (14). There are few studies describing programs that emerge in such "organic" fashion.The purpose of the current study was to generate and then prioritize specific strategies to address HIV in a Black faith community. The intent was to inform the design of HIV intervention strategies based on the lived experience of the broader community of stakeholders - providers, faith-community stakeholders (faith leaders, health ministers, and congregants), community advocates, and health researchers. …