Black PRAISE: An intervention to strengthen how Black congregations understand HIV affecting Black communities
Black PRAISE (Pastors Raising Awareness and Insight of Stigma through Engagement) is an HIV-related knowledge and stigma awareness raising program focused on bringing information on HIV to Black congregations in Ontario, Canada. The program brought resources in the form of a booklet, a sermon and a short film to congregation members to strengthen congregants’ critical awareness of HIV-related issues in Black communities. In the quantitative component of a study that evaluated the program, Black PRAISE was associated with increased HIV knowledge and reduced HIV stigma among congregants who received the intervention.1 In the qualitative component of the study, congregants expressed appreciation for Black PRAISE even though it challenged some of their beliefs and ideas about HIV and people who are affected.2
Black PRAISE aimed to increase HIV-related knowledge and decrease HIV-related stigma in Black churches. The program used a congregation-based approach and strived to prompt people to critically appraise their individual beliefs and knowledge related to HIV and HIV stigma. The program also aimed to build the capacity of churches to address critical health issues among Black communities.
A community-based participatory approach that engaged pastors and congregation members was used to develop Black PRAISE. The program took place in six Black churches in Ontario (Toronto, Mississauga, Ottawa) that were identified through community consultation. Pastors/leaders at each of the churches were men of Caribbean or African background.
User-friendly information related to HIV among Black communities was developed for the program, in the form of a booklet, a sermon and a short film. The components of the intervention were sequenced over time and addressed multiple issues related to stigma. The following resources addressed HIV-related knowledge and stigma to promote critical awareness:
- Booklet: A booklet addressed fear of HIV by conveying information about how HIV is transmitted and tested for and how it can be prevented in Black communities. The booklet also addressed issues of equity, justice and the social determinants of health and provided research data on how HIV disproportionately affects Black communities and specific information on HIV programs for Black communities in Ontario.
- Sermon: A sermon on love, compassion and social justice was delivered by pastors to their congregations. The sermon referenced biblical teachings related to reducing stigma and used anecdotes about experiences of stigma in church settings. Through these anecdotes, the sermon provided an audience for the voices of people living with HIV.
- Film: An 8-minute film featured Black Canadians discussing HIV stigma and how the church could help to reduce stigma. The film also illustrated how HIV stigma is layered with other dimensions of social oppression such as racism, sexism and heterosexism and showed the diversity of Black populations directly affected by HIV. The film was shown during church services.
The resources were distributed and/or presented to congregation members during their regular Saturday or Sunday service on an agreed schedule.
A study of the program took place from October 2016 to March 2017 and evaluated changes in HIV-related knowledge and stigma at baseline, immediately after the intervention and at a 3-month follow-up using surveys. Although the intervention was provided to anyone who attended the Saturday or Sunday service where the resources (i.e., booklet, sermon, film) were shared, only congregants who identified as African, Caribbean or Black were eligible to participate in the surveys. Knowledge of HIV and HIV stigma were assessed using separate validated tools.1
A total of 173 study participants completed the baseline survey and at least one of the surveys after the intervention. Participants identified predominantly as Caribbean (54%) or Black (52%), female (74%), heterosexual (98%) and foreign born (68%). Additionally, 48% indicated that they had tested for HIV at least once and 95% indicated that they were HIV-negative or had never been diagnosed with HIV. Approximately 47% of participants indicated that they were exposed to one component of the intervention and 38% that they were exposed to all three components. The study investigators found that:1
- There was a significant increase in HIV knowledge when baseline HIV knowledge was compared with HIV knowledge immediately after the intervention and at the 3-month follow-up.
- In an analysis of participants who reported high levels of stigma at baseline (i.e., people whose stigma scores exceeded the mean for the group), stigma decreased significantly after the intervention.
- Participants exposed to all three components of the intervention had a significant reduction in their stigma score compared with those exposed to just one or two components.
A qualitative study on the Black PRAISE program was completed between June and August 2017. It included 18 interviews with congregants and pastors to understand their experience with the program. Generally, participants’ experience with the program was positive. Some congregants shared that addressing stigma in a faith-based context led to a dilemma for them (i.e., viewing behaviours that may have exposed someone to HIV through the moral lens of their religion). The study suggested that successful interventions should support critical reflection of the underlying implicit assumptions and beliefs that motivate faith organizations, researchers and public health decision-makers. Moreover, this process of critical reflection should be ongoing to ensure longevity of similar interventions.2
What does this mean for service providers?
Service providers could consider inviting Black faith communities to play a more active role in their work, to engage African, Black and Caribbean populations in responding to HIV. Using a community-based participatory approach for program and resource development could help to ensure that resources are relevant to the populations that programs are targeting, in addition to helping elicit support from participating church leaders and congregants. Service providers should also consider using multiple resources that address a variety of issues that contribute to HIV stigma (e.g., individual beliefs, systemic conditions) when engaging community members in these critical awareness-building efforts. Phase 2 of Black PRAISE will engage a larger and more diverse group of Black churches across Ontario, using a more streamlined process that churches can use to administer the program.
Operation Hairspray (CATIE)
Many Men, Many Voices (3MV) (CATIE)
- Husbands W, Kerr J, Calzavara L et al. Black PRAISE: engaging Black congregations to strengthen critical awareness of HIV affecting Black Canadian communities. Health Promotion International. 2020. https://doi.org/10.1093/heapro/daaa057
- Husbands H, Nakamwa J, Tharao W et al. Love, judgement and HIV: congregants’ perspectives on an intervention for Black churches to promote critical awareness of HIV affecting Black Canadians. Journal of Racial and Ethnic Health Disparities. 2020. https://doi.org/10.1007/s40615-020-00808-5