Journal of Religion and Health

, Volume 53, Issue 5, pp 1472–1486 | Cite as

Facilitators and Barriers to HIV Activities in Religious Congregations: Perspectives of Clergy and Lay Leaders from a Diverse Urban Sample

  • Peter Mendel
  • Kathryn Pitkin Derose
  • Laura Werber
  • Kartika Palar
  • David E. Kanouse
  • Michael Mata
Original Paper


This paper examines facilitators and barriers to HIV activities within religious congregations, the relative internal or external sources of these influences, and suggestive differences across congregational types. Results are based on in-depth interviews with clergy and lay leaders (n = 57) from 14 congregations in Los Angeles County, California, purposively selected to reflect diversity in racial-ethnic composition, denomination, size, and HIV activity level. Many common facilitators and barriers were related to norms and attitudes, only a few of which appeared overtly associated with theological orientations. Clergy support was a facilitator particularly prevalent among congregations having higher HIV activity levels, indicating its importance in sustaining and expanding HIV programs. Resource issues were also prominent, with material resource barriers more frequently mentioned by smaller congregations and human resource barriers more among larger congregations. Organizational structure issues were mostly centered on external linkages with various social service, public health, and faith-based entities. Analysis of internal versus external sources highlights the roles of different stakeholders within and outside congregations in promoting HIV activities. Potential differences across congregational types represent fruitful areas for future research.


Religious congregations HIV activities Facilitators Barriers 



This study was supported by Grant Number 1 R01 HD050150 (Derose) from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NICHD. The authors thank the members of the study’s Community Advisory Board who have provided much-valued guidance and counsel throughout the study, in particular Rev. Dr. Clyde W. Oden, Delis Alejandro, Deborah Owens Collins, Keesha Johnson, Mario Pérez, Rev. Chris Ponnet, the Rt. Rev. Chester Talton, and Richard Zaldivar. We also thank the 14 case study congregations and their leaders, who for confidentiality reasons, are not named. Finally, we thank our other colleagues at RAND, Ricky Bluthenthal, Blanca Domínguez, and Jennifer Hawes-Dawson, who helped conceptualize and carry out the overall study.


  1. Agate, L. L., Cato-Watson, D., Mullins, J. M., Scott, G. S., Rolle, V., Markland, D., et al. (2005). Churches united to stop HIV (CUSH): A faith-based HIV prevention initiative. Journal of the National Medical Association, 97(7 Suppl), 60S–63S.PubMedCentralPubMedGoogle Scholar
  2. Berkley-Patton, J., Bowe-Thompson, C., Bradley-Ewing, A., Hawes, S., Moore, E., Williams, E., et al. (2010). Taking it to the pews: A CBPR-guided HIV awareness and screening project with black churches. AIDS Education and Prevention, 22(3), 218–237.PubMedCentralPubMedCrossRefGoogle Scholar
  3. Berkley-Patton, J., Moore, E. W., Hawes, S. M., Thompson, C. B., & Bohn, A. (2012). Factors related to HIV testing among an African American church-affiliated population. AIDS Education and Prevention, 24(2), 148–162.PubMedCentralPubMedCrossRefGoogle Scholar
  4. Brown, E. J., & Wells, S. (2005). A faith-based integrated substance abuse and HIV prevention program for rural African American adolescents (vol. 11, pp. 344). APNA.Google Scholar
  5. Centers for Disease Control and Prevention. (2009). A review of the centers for disease control and prevention’s response to the HIV/AIDS crisis among blacks in the United States, 1981–2009. American Journal of Public Health, 99, S351–S359.CrossRefGoogle Scholar
  6. Chaves, M., & Anderson, S. L. (2008). Continuity and change in American congregations: Introducing the second wave of the national congregations study. Sociology of Religion, 69(4), 415.CrossRefGoogle Scholar
  7. Chaves, M., & Tsitsos, W. (2001). Congregations and social services: What they do, how they do it, and with whom. Nonprofit and Voluntary Sector Quarterly, 30(4), 660–683. doi: 10.1177/0899764001304003.CrossRefGoogle Scholar
  8. Chin, J. J., Mantell, J., Weiss, L., Bhagavan, M., & Luo, X. (2005). Chinese and south Asian religious institutions and HIV prevention in New York City. AIDS Education and Prevention, 17(5), 484–502.PubMedCentralPubMedCrossRefGoogle Scholar
  9. Cnaan, R. (2002). The invisible caring hand: American congregations and the provision of welfare. New York: New York University Press.Google Scholar
  10. Cnaan, R., Hernández, E. I., & McGrew, C. C. (2006). Latino congregations and social service: The Philadelphia story. Notre Dame: Institute for Latino Studies, University of Notre Dame. Research Report, vol. 2006.1.Google Scholar
  11. Cunningham, S. D., Kerrigan, D. L., McNeely, C. A., & Ellen, J. M. (2009). The role of structure versus individual agency in churches’ responses to HIV/AIDS: A case study of Baltimore city churches. Journal of Religion and Health. doi: 10.1007/s10943-009-9281-7.
  12. D’Aunno, T., Vaughn, T. E., & McElroy, P. (1999). An institutional analysis of HIV prevention efforts by the nation’s outpatient drug abuse treatment units. Journal of Health and Social Behavior, 40(2), 175–192.PubMedCrossRefGoogle Scholar
  13. Derose, K. P., Mendel, P. J., Kanouse, D. E., Bluthenthal, R. N., Castaneda, L. W., Hawes-Dawson, J., et al. (2010). Learning about urban congregations and HIV/AIDS: Community-based foundations for developing congregational health interventions. Journal of Urban Health, 1–14.Google Scholar
  14. Derose, K. P., Mendel, P. J., Palar, K., Kanouse, D. E., Bluthenthal, R. N., Castaneda, L. W., et al. (2011). Religious congregations' involvement in HIV: A case study approach. AIDS and Behavior, 15(6), 1220–1232.Google Scholar
  15. Eisenhardt, K. (1989). Building theories from case study research. Academy of Management Review, 14(4), 532–550.Google Scholar
  16. Foley, M. W., McCarthy, J., & Chaves, M. (2001). Social capital, religious institutions, and poor communities. In S. Saegert, J. P. Thompson, & M. R. Warren (Eds.), Social capital and poor communities (pp. 215–245). New York: Russell Sage Foundation.Google Scholar
  17. Francis, S. A., & Liverpool, J. (2009). A review of faith-based HIV prevention programs. Journal of Religion and Health, 48(1), 6–15.PubMedCrossRefGoogle Scholar
  18. Frenk, S. M., & Trinitapoli, J. (2012). U.S. Congregations’ provision of programs or activities for people living with HIV/AIDS. AIDS and Behavior. doi: 10.1007/s10461-012-0145-x.
  19. Griffith, D. M., Pichon, L. C., Campbell, B., & Allen, J. O. (2010). Your blessed health: A faith-based CBPR approach to addressing HIV/AIDS among african Americans. AIDS Education and Prevention, 22(3), 203–217.PubMedCrossRefGoogle Scholar
  20. Haugk, K. C. (1976). Unique contributions of churches and clergy to community mental health. Community Mental Health Journal, 12(1), 20–28.PubMedCrossRefGoogle Scholar
  21. Hernández, E. I., Burwell, R., & Smith, J. (2007). Answering the call: How Latino churches can respond to the HIV/AIDS epidemic. Philadelphia: Esperanza.Google Scholar
  22. Hicks, K. E., Allen, J. A., & Wright, E. M. (2005). Building holistic HIV/AIDS responses in African American urban faith communities: A qualitative, multiple case study analysis. Family and Community Health, 28(2), 184–205.PubMedCrossRefGoogle Scholar
  23. Koenig, H. G. (2003). Health care and faith communities: How are they related? Journal of General Internal Medicine, 18(11), 962–963.PubMedCentralCrossRefGoogle Scholar
  24. Lasater, T. M., Wells, B. L., Carleton, R. A., & Elder, J. P. (1986). The role of churches in disease prevention research studies. Public Health Reports, 101(2), 125–131.PubMedCentralPubMedGoogle Scholar
  25. Leong, P. (2006). Religion, flesh, and blood: Re-creating religious culture in the context of HIV/AIDS. Sociology of Religion, 67(3), 295–311.CrossRefGoogle Scholar
  26. Lincoln, C. E., & Mamiya, L. H. (1990). The black church in the African American experience. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  27. Malle, B. F., Knobe, J. M., & Nelson, S. E. (2007). Actor-observer asymmetries in explanations of behavior: New answers to an old question. Journal of Personality and Social Psychology, 93(4), 491–514. doi: 10.1037/0022-3514.93.4.491.PubMedCrossRefGoogle Scholar
  28. McKoy, J., & Peterson, R. (2006). Reducing African-American women’s sexual risk: Can churches play a role? Journal of the National Medical Association, 98(7), 9.Google Scholar
  29. McNeal, C. S., & Perkins, I. (2007). Potential roles of black churches in HIV/AIDS prevention. Journal of Human Behavior in the Social Environment, 15, 2(3), 219–232. doi: 10.1300/J137v15n02_13.
  30. Merz, J. P. (1997). The role of churches in helping adolescents prevent HIV/AIDS. Journal of HIV/AIDS Prevention and Education for Adolescents and Children, 1(2), 45–55.Google Scholar
  31. Min, P. G. (2002). Introduction. In J. H. Kim (Ed.), Religions in Asian America: Building faith communities. Walnut Creek, CA: AltaMira Press.Google Scholar
  32. Olson, L. M., Reis, J., Murphy, L., & Gehm, J. H. (1988). The religious community as a partner in health care. Journal of Community Health, 13(4), 249–257.PubMedCrossRefGoogle Scholar
  33. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.Google Scholar
  34. Smith, J., Simmons, E., & Mayer, K. H. (2005). HIV/AIDS and the black church: What are the barriers to prevention services? Journal of the National Medical Association, 97(12), 1682–1685.PubMedCentralPubMedGoogle Scholar
  35. Stewart, J. M. (2012). Pastor and lay leader perceptions of barriers and supports to HIV ministry maintenance in an African American church. Journal of Religion and Health. doi: 10.1007/s10943-012-9627-4.
  36. Tesoriero, J. M., Parisi, D. M., Sampson, S., Foster, J., Klein, S., & Ellemberg, C. (2000). Faith communities and HIV/AIDS prevention in New York State: Results of a statewide survey. Public Health Reports, 115(6), 544–556.PubMedCentralPubMedCrossRefGoogle Scholar
  37. Thomas, S. B., Quinn, S. C., Billingsley, A., & Caldwell, C. (1994). The characteristics of northern black churches with community health outreach programs. American Journal of Public Health, 84(4), 575.PubMedCentralPubMedCrossRefGoogle Scholar
  38. Williams, M. V., Haas, A., Griffin, B. A., Fulton, B. R., Kanouse, D. E., Bogart, L. M., & Derose, K. P. (2013). Predictors of congregational HIV programs: Similarities and differences compared with other health issues (submitted).Google Scholar
  39. Yin, R. K. (1994). Case study research: Design and methods (2nd ed.). Thousand Oaks: Sage Publications.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Peter Mendel
    • 1
  • Kathryn Pitkin Derose
    • 1
  • Laura Werber
    • 1
  • Kartika Palar
    • 2
  • David E. Kanouse
    • 1
  • Michael Mata
    • 3
  1. 1.RAND CorporationSanta MonicaUSA
  2. 2.Fielding School of Public HealthUniversity of CaliforniaLos AngelesUSA
  3. 3.Fuller Theological SeminaryPasadenaUSA

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