February 1, 2013 — Summary of "'In My House': Laying the Foundation for Youth HIV Prevention in the Black Church," Lightfoot et al., Progress in Community Health Partnerships: Research, Education, and Action, Winter 2012.
Although African-American teens represent 17% of U.S. adolescents ages 13 through 19, they account for 75% of HIV/AIDS diagnoses in that age group. "The disproportionate impact of HIV on the African American community warrants new approaches to HIV prevention with youth," wrote a research team led by Alexandra Lightfoot of the University of North Carolina-Chapel Hill's Center for Health Promotion and Disease Prevention.
The researchers collaborated with a community-based organization called Strengthening The Black Family (STBF), which operates in Wake County, N.C., in the historically African-American community of Southeast Raleigh. Although STBF has operated a Teens Against AIDS project in the area for more than 20 years, it had encountered resistance from churches because it demonstrates how to use condoms, "a cornerstone of effective HIV prevention education," the researchers noted.
The researchers worked with STBF to launch a pilot study to test whether a program called Focus on Youth with Informed Parents and Children Together (FOY + ImPACT) "could work in the context of faith settings in Wake County." They noted that the program has been proven effective among African-American youth ages 12 to 15 in urban settings.
For this paper, the researchers described "the challenges encountered and lessons learned by [their] community-academic partnership laying the groundwork for successful implementation on an adolescent HIV prevention curriculum in faith settings." They added that their assessments of data collected during post-intervention focus groups are discussed elsewhere.
About the Program
FOY + ImPACT, which CDC has designated as a Best-Evidence Effective Behavioral Intervention, targets locations where youth "are making decisions about high-risk activities -- in their neighborhoods and social networks." It includes comprehensive education about preventing HIV, coupled with messages emphasizing that abstinence is "the only sure way to protect against HIV, pregnancy, and other sexually transmitted diseases," according to the researchers.
The program also engages parents through an interactive, one-time skills building session designed to strengthen parent-child communications about sexual risk reduction.
Laying Groundwork for Implementation
The research team adopted a community-based participatory research approach, which included establishing a "diverse and intergenerational" Community Advisory Board (CAB) to advise on various aspects of the intervention. The team convened two pre-implementation focus groups with the CAB to identify issues such as barriers to HIV prevention in the church setting.
Next, researchers held monthly CAB meetings to discuss and expand upon themes raised in the focus groups, such as how HIV prevention curricula, including condom demonstrations, could be incorporated into a church's message of abstinence. The researchers found that the discussion at the meeting helped them "navigate the process of reaching out to church leaders and anticipate questions about how HIV prevention (particularly condom demonstrations) could complement not contradict the Church's message of abstinence," they wrote.
The researchers recruited a project coordinator who lived and attended church in the community to assist the researchers in gaining an understanding of each church's existing customs, practices, programs, values and unique culture. The project coordinator established and built relationships with influential church members who were close to the pastors at both churches involved. At the end of the outreach process, researchers formalized their relationship through a Memorandum of Agreement, which outlined responsibilities and clarified expectations to ensure mutual benefit from the program.
The researchers used various communication tools and strategies -- such as the church website, bulletin, flyers, announcements, word of mouth and post-service informational meetings -- to recruit parents and teens to participate in the FOY + ImPACT program. At the end of the recruitment phase, the researchers formed one group of boys and one group of girls at each church.
The FOY + ImPACT curriculum was delivered in nine sessions, with FOY occurring during teens' regular Bible Study time over an eight-week period. The single ImPACT session involved a facilitator who worked with a parent and his or her child one-on-one to engage in activities that highlighted the importance of parents talking to their children about their values and expectations regarding sex.
"Opening the door to comprehensive HIV prevention education in faith settings was a significant milestone achieved through our partnership's efforts," the researchers wrote. "Taking the time to learn the language, customs, and cultures of each church helped us to build effective relationships with faith leaders" and "enabled us to reach twice the number of youth and parents we had targeted," they added.
They added that lessons learned from implementing the pilot program are being used to broaden partnerships with the pilot churches, expand the program to an additional church and assess the impact of the intervention.
The researchers concluded, "Finding effective ways to build prevention conversations in faith settings and a role for faith leaders in evidence-based HIV prevention could have a significant impact in reducing HIV/AIDS disparities."
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