Chinese Immigrant Religious Institutions’ Variability in Views on Preventing Sexual Transmission of HIV

John J Chin; Torsten B Neilands

doi:10.2105/AJPH.2015.302924

. 2016 Jan;106(1):110–118. doi: 10.2105/AJPH.2015.302924

Chinese Immigrant Religious Institutions’ Variability in Views on Preventing Sexual Transmission of HIV

John J Chin ^1,^✉, Torsten B Neilands ¹

PMCID: PMC4695928 PMID: 26562121

Abstract

Objectives. We examined Chinese immigrant religious institutions’ views on teaching about preventing sexual transmission of HIV and the consistency of their views with public health best practices in HIV prevention.

Methods. We used 2009 to 2011 survey data from 712 members of 20 New York City–based Chinese immigrant religious institutions to analyze their views on (1) teaching adolescents about condoms, (2) discussing homosexuality nonjudgmentally, and (3) promoting abstinence until marriage.

Results. Religion type was a significant predictor of views in the 3 domains, with Evangelical Protestants in least agreement with public health best practices, Buddhists in most agreement, and mainline Protestants between them. Greater HIV knowledge was significantly associated with agreement with best practices in all 3 domains. The frequency of prayer, meditation, or chanting and the level of acculturation were significant predictors of views on teaching adolescents about condoms and promoting abstinence until marriage.

Conclusions. The best practice messages about HIV prevention that Chinese immigrant religious institutions find acceptable vary according to religion type and several other key factors, including HIV knowledge; frequency of prayer, meditation, or chanting; and level of acculturation.

In recognition of their important role and reach in communities, policy initiatives encourage religious institution involvement in community health promotion.^1,2 We examined whether the benefits of religious institution involvement in health promotion extend to HIV prevention education, particularly regarding sexual transmission. It is unclear whether religious institutions are well positioned to lead evidence-based education programs on preventing sexual transmission of HIV. To examine this question, we analyzed religious institution leaders’ and members’ views on acceptable approaches to HIV prevention education by using data from a National Institute of Health–funded study of Chinese immigrant Christian churches and Buddhist temples in New York City (NYC). We compared views across 3 religion types (Evangelical Protestant, mainline Protestant, and Buddhist) and accounted for other potentially relevant factors, such as HIV knowledge and intensity of religious practice.

We aimed to learn specifically about an Asian American population and to increase understanding of religious institution involvement in HIV prevention more generally. Although HIV prevalence in Asian American populations has been relatively low, addressing HIV prevention in Asian American communities remains important because studies of Asian Americans show low levels of HIV knowledge^3–5 and testing,⁶ and high levels of stigma^3,4,7–16 and risk behavior.^{4,7,8,14,17–22} According to the Centers for Disease Control and Prevention, between 2001 and 2004, among all US racial groups, Asians were the only racial group with statistically significant percentage increases in annual HIV/AIDS diagnosis rates.^23,24 A follow-up analysis examining the period 2001 to 2008 found a similar trend.²⁵

RELIGIOUS INSTITUTIONS AND HEALTH PROMOTION

Religious institutions may be good partners in health promotion for a variety of reasons. First, they reach a large portion of the population. The United States is one of the most religious of the world’s developed countries: about 80% of Americans (and 75% of Asian Americans) identify as belonging to a religion.^26,27 In 2007 and 2008, we identified 200 NYC Chinese immigrant community religious institutions,²⁸ which make up almost half of all the various types of community institutions.^5,29

Religious institutions often have access to charitable resources, volunteers, and facilities where people gather regularly,³⁰ and they may have contact with hard-to-reach populations.^30,31 Because of the high level of trust and respect they command in their communities, partnering with them can increase the legitimacy of outsider organizations, such as governmental and secular nonprofits.³⁰ Religious institutions can also influence values and behavior,³² some of which may protect health.^33,34 This role may be larger in immigrant communities, where individuals rely more on religious institutions for practical and emotional support because of their isolation from the wider society.^4,35–41

RELIGIOUS INSTITUTION INVOLVEMENT IN HIV PROGRAMS

Reviews of religious institution involvement in health promotion suggest that involvement in HIV programs, especially prevention education covering sexuality and homosexuality, might conflict with religious values.^30,42 Studies of HIV-related attitudes in religious institutions serving African American, Latino, Asian American, and other populations discuss such tensions.^{5,28,30,42–49} Partly as a result of these barriers, religious institutions have generally had limited involvement in HIV-related activities,^50,51 even in communities that have been disproportionately affected by HIV.^43–45

Nevertheless, religious worldviews and orientations span a wide spectrum. Most Christian churches in the United States can be broadly classified as Catholic or Protestant, with Protestant denominations ranging along a continuum from fundamentalist or orthodox to liberal or modern.⁵² Evangelical Protestants have been generally associated with more socially conservative views, whereas mainline Protestants (e.g., Methodists, Presbyterians) have been associated with more socially liberal views,⁵³ and these patterns have extended to HIV.⁵⁴ Elements of religiosity and religious worldview that predict HIV-related views include beliefs about the literalness of the Bible and church attendance.⁵⁴

Despite barriers, Christian churches have demonstrated highly visible involvement in HIV/AIDS programs and services. The Bible contains sufficient material on compassion and social responsibility to craft a scripturally supported argument for a nonjudgmental approach to HIV,^28,55 and numerous HIV programs have been developed that use Christian theology as a foundation.^55–57 Catholic churches were among the first institutions to take up caring for people living with HIV/AIDS, both in the United States and abroad⁵⁸; and in Brazil, the Catholic Church was one of the primary leaders of the country’s national HIV/AIDS response.⁵⁸ Religious institutions have played a particularly important role in addressing the global HIV/AIDS epidemic.⁵⁹ In the United States, numerous Christian churches have played an active role in community HIV prevention efforts and in providing support and care to people living with HIV in African American, Latino, and other communities.^55,60–63

Compared with Christian churches, Buddhist temples have had relatively little presence in HIV/AIDS programs in the United States, in large part because the Buddhist presence is small. Although Buddhists make up more than 7.0% of the global population (about 500 million people),⁶⁴ they constitute only 0.7% of the US population, compared with 70.6% for Christians.⁶⁵ Among Asian Americans, 14.0% identified as Buddhist (compared with 42.0% identifying as Christian) in 2012.⁶⁶ Making broad generalizations about Buddhist theology is difficult because “Buddhism has never been a unified faith either doctrinally or institutionally.”⁶⁷^(p361) Most Chinese Buddhist temples in the United States follow Pure Land or Zen traditions (both within the Mahayana school), but cross-pollination of these traditions has made them more similar than different, and we treat them as a single religion type in our analysis.

As reflected in written doctrines, Buddhism’s stance on homosexuality and gender equality appears to leave more space than does Christian doctrines for a nonjudgmental discussion of safer sexual practices for men who have sex with men and for heterosexuals. Because of the Buddha’s relatively neutral teachings on homosexuality and gender, their treatment in Buddhist practice in various cultures has reflected those cultures’ prevailing social norms.^68,69 Some of the factors that are relevant for understanding HIV-related attitudes among Christians are also important for understanding such attitudes among Buddhists. For example, Buddhists who interpret the concept of karma as literal and direct punishment for sins committed in this life or in previous lives tended to have more judgmental views of people living with HIV, believing that they deserved their illness.²⁸

As with Christianity, there are numerous Buddhist teachings and texts on compassion and proper conduct that would support a nonjudgmental approach to HIV prevention. Drawing on these teachings, researchers have attempted to tailor HIV prevention messages for Buddhists, for example, using the Buddhist precept against destroying life as the foundation for promoting condom use to avoid life-destroying infection.⁴ Some highly visible Buddhist-led HIV programs have been developed in countries where Buddhism is more dominant.⁷⁰

BEST PRACTICES AND VIEWS ON ACCEPTABLE APPROACHES

HIV is a largely sexually transmitted disease: worldwide, about 85% of HIV infections occur through sexual contact.⁷¹ Because of religious institutions’ often well-defined views about acceptable sexual practice, they could be highly influential either in reducing risk and raising awareness or in promoting misinformation and stigma. Stigma is not simply the result of interpersonal interactions but, rather, exists within a framework of a socially constructed and vigilantly protected community structure,^72,73 of which religious institutions are important architects.²⁹ HIV-related stigma and homophobia have contributed to barriers to learning about HIV, getting tested for HIV, and seeking proper HIV medical treatment.^3,74–78

A substantial body of research suggests that public health best practices for teaching about the prevention of the sexual transmission of HIV include (1) teaching adolescents about safer sexual practices and proper use of condoms, as opposed to primarily promoting virginity^71,79; (2) addressing same-sex sexual behavior nonjudgmentally and without stigmatization^80–87; and (3) promoting condom use among heterosexual adults alongside a discussion of abstinence until marriage as a prevention strategy, rather than promoting abstinence alone.^71,88,89 By assessing the match between these public health best practices and religious institutions’ views on acceptable approaches to HIV prevention education, we examined whether religious institutions’ involvement in HIV prevention, particularly concerning sexual transmission, should be promoted as a general public health policy strategy. We compared views across 3 religion types and accounted for other potentially relevant factors, such as HIV knowledge and intensity of religious practice.

METHODS

Sampling religious institution members involved multiple steps to achieve a random sample of both religious institutions and their members. First, we enumerated Chinese religious institutions in NYC with published institution listings, Internet searches, and field visits (2007–2008). We stratified the 200 identified institutions by religion type and randomly selected 83 to complete an organizational survey. We then stratified those 83 institutions by religion type and randomly selected 10 Buddhist temples and 10 Christian churches for in-depth study, with refusal rates of 41% and 55%, respectively, to reach that sample size. Reasons given for refusal were lack of time or resources (3 Christian churches, 6 Buddhist temples), deeming HIV an inappropriate topic of discussion for the institution (4 churches), having other, more important priorities (3 churches), and no reason provided (2 churches, 1 temple). We conducted interviewer-administered closed-ended surveys (2009–2011) with approximately 40 randomly selected active members within each institution (n = 802). We conducted 85% of the interviews in Chinese (Mandarin or Cantonese) and the remainder in English.

Data Management

We removed 35 cases because of missing data and 55 individuals because they were born in the United States, leaving 712 cases. Using PROC GLIMMIX in SAS version 9.4 (SAS Institute, Cary, NC), which can account for within-organization clustering of responses, we developed 3 multivariable models for 3 dependent variables.

The 3 dependent variables indicated survey participants’ level of agreement (1 [strongly disagree] to 5 [strongly agree]) with 3 statements about a hypothetical HIV prevention workshop taking place within their institution: (1) “a workshop targeted to teens should teach them about the proper use of condoms,” (2) “during the workshop, it would be important to maintain a nonjudgmental attitude toward homosexuality,” and (3) “the main point of the workshop should be to teach that sexual abstinence until marriage is the best way to prevent getting HIV/AIDS.”

For the third statement, we recoded responses so that a higher value indicated greater disagreement with an abstinence-only approach, allowing higher values for the 3 dependent variables to indicate greater consistency of views with public health best practices in HIV prevention education (i.e., support for teaching adolescents about condoms, maintaining a nonjudgmental attitude toward homosexuality, and not prioritizing an abstinence-only approach).

Analysis

We examined the following independent variables: religion type (Evangelical Protestant, mainline Protestant, and Buddhist), age in years, acculturation level (ranging from 0 [least acculturated] to 16 [most acculturated]),⁹⁰ education level (ranging from 1 [< 8 years of schooling] to 7 [graduate school and beyond]), church or temple attendance (ranging from 0 [never] to 8 [resides at the church or temple]), devoutness (frequency of prayer, meditation, or chanting alone, ranging from 0 [never] to 6 [many times a day]), HIV knowledge (ranging from 0 [low] to 16 [high]),⁹¹ gender, whether foreign-born, ethnic/national identity (mainland Chinese, Taiwanese, Hong Konger, other), leadership role at the church or temple, and knowing someone of Chinese ancestry with HIV/AIDS in the past 5 years.

We ran each of the 3 models with main effects and single interaction terms to prescreen for interactions between religion type and each of the other independent variables. We retained all interaction terms that were significant at P < .05 and included them together in a starting multivariable model that also contained all the independent variables as main effects. We used backward elimination until all remaining interactions and main effects were significant at P < .05. For significant interactions, we used post hoc analyses to examine slopes within religion type.

We made the a priori decision to screen for interactions with religion type on the basis of hypothesized large differences in religious worldviews between Christians and Buddhists and possibly between Evangelical and mainline Protestants. Accounting for interactions with religion type was necessary to avoid potentially biased main effects. We hypothesized, for example, that church or temple attendance and frequency of prayer, meditation, or chanting might affect the dependent variable differently across religion types because greater religious devotion might further emphasize religious differences in opposite directions.

RESULTS

Religious organizations overall agreed that HIV workshops should teach adolescents about condoms and maintain a nonjudgmental attitude toward homosexuality (Table 1). They disagreed most with public health best practices on teaching about abstinence, generally agreeing that the primary message should be to promote abstinence until marriage.

TABLE 1—

Chinese Immigrant Church or Temple Member Attitudes and Characteristics by Religion Type: New York City, 2009–2011

Variable	Buddhist (n = 365), Mean ±SD or %	Evangelical (n = 232), Mean ±SD or %	Mainline (n = 115), Mean ±SD or %	Total (n = 712), Mean ±SD or %
Attitudes (dependent variables; range = 1–5)
Teach adolescents about condoms	4.21 ±1.01^a	3.67 ±1.31^b	3.97 ±1.16	3.99 ±1.16
Be nonjudgmental about homosexuality	4.23 ±0.90^a	3.55 ±1.36^b	4.01 ±1.10^c	3.97 ±1.14
Do not use an abstinence-only approach	2.39 ±1.28^a	1.98 ±1.19^b	2.20 ±1.24	2.22 ±1.26
Characteristic
Age, y	53.41 ±12.90^a	43.21 ±15.39^b	48.67 ±15.41	49.32 ±14.87
Acculturation level (range = 0–16)	2.73 ±3.30	4.47 ±4.42	3.01 ±3.22	3.35 ±3.77
Education level (range = 1–7)	3.41 ±2.06^a	4.23 ±2.00	5.03 ±1.75^b	3.94 ±2.08
Church or temple attendance (range = 0–8)	3.50 ±1.76^a	4.12 ±1.01^b	4.13 ±0.84^b	3.81 ±1.46
Prayer, meditation, or chant frequency (range = 0–6)	3.52 ±2.02^a	4.69 ±1.53^b	4.70 ±1.44^b	4.09 ±1.88
HIV knowledge (range = 0–16)	9.04 ±3.50^a	10.26 ±3.09	10.57 ±2.62^b	9.68 ±3.31
Characteristics—mean percentages within religion type
Female	77.0^a	58.6^b	59.1^b	68.1
Ethnic/national identity
Mainland China	46.6	50.0	44.3	47.3
Taiwan	18.1	10.3	35.7	18.4
Hong Kong	16.7	19.0	19.1	17.8
Other	18.6^a	20.7^a	0.9^b	16.4
Holds formal leadership role	8.8^a	35.3^b	27.0^b	20.4
Knows Chinese person with HIV	7.7	6.9	6.1	7.2

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Note. Different superscripts (within row) denote significant differences between means by religion type at P < .05. P values are corrected for clustering within organization.

Evangelical Protestants and Buddhists were at opposite ends of the spectrum on all 3 outcome variables, with Buddhists in most agreement with public health best practices. There were also significant differences in member characteristics by religion type (Table 1). Buddhists were oldest and had the lowest educational attainment; church or temple attendance; prayer, meditation, or chanting frequency; HIV knowledge; and proportion of members in leadership roles. They had the highest female membership.

Bivariate Correlations

To assess convergent validity of outcome variables and scales (e.g., acculturation, HIV knowledge), we generated a correlation matrix of all continuous and binary (0 or 1) variables (a correlation table is available as a supplement to the online version of this article at http://www.ajph.org). All 3 outcome variables are significantly and positively correlated, which is to be expected because they each indicate the level of agreement with public health best practices. Greater age (which may be a proxy for more conservative views) is significantly associated with less opposition to abstinence-only prevention messages.

As expected, acculturation is significantly and positively associated with education, HIV knowledge, and holding a formal leadership position. Greater frequency of church or temple attendance, which may reflect more religious devotion, is significantly associated with less support for a nonjudgmental approach to discussing homosexuality and less opposition to an abstinence-only prevention message. Frequency of prayer, meditation, or chanting behaves similarly. Higher HIV knowledge is significantly associated with more support for a nonjudgmental approach to discussing homosexuality, more opposition to an abstinence-only prevention message, younger age, greater acculturation, and higher education. Overall, these correlations strongly support the validity of the measures.

Multivariable Analysis Results

Religion type was a significant predictor of the dependent variable in all 3 models, as either a main or an interaction effect (Table 2).

TABLE 2—

Factors Associated With Chinese Immigrant Religious Institutions’ Views on Approaches to HIV Education: New York City, 2009–2011

	Model 1^a		Model 2^b		Model 3^c
Predictors	b (95% CI)	P or F; P	b (95% CI)	P or F; P	b (95% CI)	P or F; P
Intercept	4.78 (4.03, 5.54)	≤ .001	3.44 (3.14, 3.73)	≤ .001	3.14 (0.02, 6.25)	.049
Religion type		F(2, 687) = 3.70; .025		F(2, 691) = 10.02; ≤ .001		F(2, 680) = 0.76; .47
Buddhist	−0.78 (−1.35, −0.21)	.008	0.3002 (0.07, 0.53)	.009	−0.41 (−3.26, 2.43)	.776
Evangelical	−0.63 (−1.31, 0.05)	.07	−0.4563 (−0.83, −0.09)	.016	0.05 (−2.80, 2.90)	.972
Mainline (Ref)	0.00		0.00		0.00
Age, y					−0.02 (−0.02, −0.01)	≤ .001
Acculturation level (range = 0–16)	−0.041 (−0.07, −0.01)	.006			−0.10 (−0.20, −0.01)	.035
Church or temple attendance (range = 0–8)					−0.27 (−0.78, 0.25)	.304
Prayer or meditation frequency (range = 0–6)	−0.24 (−0.45, −0.04)	.019			−0.06 (−0.10, −0.01)	.011
HIV knowledge (range = 0–16)	0.04 (0.01, 0.07)	.006	0.05 (0.03, 0.08)	≤ .001	0.13 (0.10, 0.17)	≤ .001
Male					0.26 (0.03, 0.49)	.028
Religion × acculturation						F(2, 680) = 6.59; .002
Religion × church or temple attendance						F(2, 680) = 3.61; .028
Religion × prayer or meditation frequency		F(2, 687) = 3.92; .02
Religion × HIV knowledge						F(2, 680) = 4.39; .013

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Note. CI = confidence interval.

^{^a}

Model 1: support for teaching adolescents about condoms (n = 712).

^{^b}

Model 2: support for nonjudgmental discussion of homosexuality (n = 712).

^{^c}

Model 3: disagreement that teaching abstinence should be main point of workshop (n = 712).

Teaching adolescents about condoms.

For the adolescents and condoms dependent variable (Table 2, model 1), there was a significant interaction between religion type and devoutness (prayer, meditation, or chanting frequency). Figure 1 shows slope values and plots for the significant interactions reported in Table 2.

For Buddhists, the interaction slope was nonsignificant (Figure 1a). By contrast, for Evangelical and mainline Protestants, greater devoutness was significantly associated with less support for teaching adolescents about condoms; this was strongest for mainline Protestants. Overall, Buddhists were most in support of teaching adolescents about condoms. However, because of their significant negative interaction slope, mainline Protestants were most in support of teaching adolescents about condom use at the lower end of devoutness.

There were 2 significant main effects (acculturation and HIV knowledge) in the adolescents and condoms model. As acculturation increased, support for teaching adolescents about condoms dropped. As HIV knowledge increased, support for teaching adolescents about condoms increased.

Nonjudgmental approach to discussing homosexuality.

For the homosexuality model, there were 2 significant main effects (religion type and HIV knowledge) and no significant interactions (Table 2, model 2). Model-based least-squares means showed that Buddhists (mean = 4.262; SE = 0.071) supported discussing homosexuality nonjudgmentally the most, followed by mainline Protestants (mean = 3.962; SE = 0.091), and then Evangelical Protestants (mean = 3.506; SE = 0.165).

There were significant differences between all religion types (P ≤ .001 for Buddhist vs Evangelical; P = .009 for Buddhist vs mainline; and P = .016 for mainline vs Evangelical). For the HIV knowledge main effect, support for a nonjudgmental approach to homosexuality increased as knowledge increased.

Disagreement with an abstinence-only approach to HIV education.

As with the other models, Buddhists were overall in most agreement with public health best practices (i.e., expressing less support for an abstinence-only approach), and Evangelical Protestants were in least agreement (i.e., most support for an abstinence-only approach). Age; frequency of prayer, mediation, or chanting; and gender were significant main effects (Table 2, model 3). Greater age; higher frequency of prayer, meditation, or chanting; and being female were associated with less agreement with public health best practices regarding abstinence-only messages.

Religion type was a significant predictor in interaction with acculturation level, church or temple attendance, and HIV knowledge (Table 2; Figure 1). For Evangelical and mainline Protestants, greater acculturation was significantly associated with less agreement with public health best practices (Figure 1b). More frequent church attendance was significantly associated with less agreement with public health best practices only for Evangelical Protestants (Figure 1c). Greater HIV knowledge was significantly associated with greater agreement with public health best practices for all 3 religion types, with the effect most pronounced for mainline Protestants (Figure 1d).

DISCUSSION

Religion type and HIV knowledge were robust predictors, significant in all 3 models, as either a main effect or an interaction. In descriptive and multivariable analyses, Evangelical Protestants and Buddhists were consistently at opposite ends of the continuum. Overall, Evangelical Protestants were least in support of teaching adolescents about condoms and approaching homosexuality nonjudgmentally and least in disagreement with an abstinence-only approach to HIV education. Analyses of interactions showed that mainline Protestants’ views varied the most as HIV knowledge and frequency of prayer changed. For all religion types, in all 3 models, greater HIV knowledge was consistently associated with greater agreement with public health best practices.

Understanding the consistent role of religion type and HIV knowledge may be helpful to practitioners interested in partnering with religious institutions. With basic information about religion type, practitioners can develop a strategy for inviting religious institutions to collaborate while being realistic about what HIV prevention messages these institutions will find acceptable. Practitioners can also aim to increase members’ HIV knowledge to help increase religious institutions’ support for evidence-based prevention education approaches.

Additional significant predictors might be more difficult for an outsider to assess. For models 1 and 3, greater devoutness and acculturation were associated with less agreement with public health best practices. The counterintuitive role of acculturation may suggest that more acculturated participants had greater concerns about the Americanization of the next generation. This interpretation is suggested by our qualitative data (described in a previous publication)²⁸ in which some study participants expressed concern that the next generation would overly acculturate to US culture, which they perceived as too permissive. This finding suggests the importance of a more nuanced understanding of the role of acculturation.

Only 2 independent variables (religion type and HIV knowledge) were significantly associated with views on discussing homosexuality nonjudgmentally (model 2). One possible explanation for the small number of significant predictors is the intransigence of views on homosexuality as the result of high levels of stigma and strong religious messages about the topic. Conversely, HIV knowledge—a characteristic that can be changed through external intervention (e.g., HIV education)—was a significant main effect predictor in this model, indicating that there may be at least 1 avenue for encouraging change in attitudes.

In aiming to fill gaps in research on HIV prevention in Asian American communities, we chose to focus on the Chinese population because it is the largest Asian American ethnic group in the United States and in NYC (45.2% of NYC’s Asian population).⁹² An obvious weakness is that our findings may not apply to other populations. However, limiting the sample to 1 ethnic population in 1 geographic area allowed us to create a rigorous sampling frame of relevant religious institutions; at the same time, NYC’s sizable Chinese population is large enough to support a wide range of religious institutions, allowing us to recruit a sufficient number to make fruitful comparisons between major world religions. Additionally, holding ethnicity constant allowed a clearer understanding of differences between religion types.

Having randomly sampled both religious institutions and members within each institution increases our confidence that our findings are generalizable at least to Chinese immigrants in NYC and possibly beyond as well. The literature suggests that some of the issues that religious institutions confront in addressing HIV/AIDS are similar across ethnic/racial groups, notably the tension between religious doctrine and the need to address sex and homosexuality nonjudgmentally in HIV prevention education.^5,30,42–49 We also examined variation in views on HIV prevention by characteristics such as intensity of religious practice, factors that may operate somewhat consistently across varying ethnic/racial populations.

Findings may be most applicable to contexts in which religious institutions play an important role as opinion leaders, such as in immigrant and minority populations and in smaller cities and towns. A final caveat is that half of the organizations we approached to reach our sample of 20 religious institutions refused to participate for a variety of reasons, including discomfort with the topic of HIV, suggesting that the overall support we found for teaching adolescents about condoms and discussing homosexuality nonjudgmentally may be overstated.

Religious institutions can be productive partners in delivering HIV prevention education programs that address sexual topics. However, policies or initiatives that encourage partnerships with religious institutions for community health promotion should be designed with awareness about their views. This may be particularly important when addressing HIV prevention and other sensitive issues, such as reproductive health and domestic violence, which require the exploration of sexuality and gender roles. Future studies can build on emerging research concerning the effectiveness of initiatives designed to increase religious institutions’ involvement in HIV programs^93,94 and of resulting church- or temple-led HIV prevention programs.^95,96

ACKNOWLEDGMENTS

This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the US National Institutes of Health (NIH; award R01HD054303).

The authors would like to thank Elana Behar, Po Chun Chen, Min Ying Li, and the religious institutions that participated in the study. Appreciation also goes to Katherine Chen, Jacqueline Johnson, Howard Lune, and Miranda Martinez for commenting on drafts of this article.

Note. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

HUMAN PARTICIPANT PROTECTION

Study protocols were approved by the Hunter College, City University of New York institutional review board.

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PERMALINK

Chinese Immigrant Religious Institutions’ Variability in Views on Preventing Sexual Transmission of HIV

John J Chin, PhD

Torsten B Neilands, PhD

Abstract

RELIGIOUS INSTITUTIONS AND HEALTH PROMOTION

RELIGIOUS INSTITUTION INVOLVEMENT IN HIV PROGRAMS

BEST PRACTICES AND VIEWS ON ACCEPTABLE APPROACHES

METHODS

Data Management

Analysis

RESULTS

TABLE 1—

Bivariate Correlations

Multivariable Analysis Results

TABLE 2—

Teaching adolescents about condoms.

FIGURE 1—

Nonjudgmental approach to discussing homosexuality.

Disagreement with an abstinence-only approach to HIV education.

DISCUSSION

ACKNOWLEDGMENTS

HUMAN PARTICIPANT PROTECTION

REFERENCES

ACTIONS

PERMALINK

RESOURCES

Cite

Add to Collections

PERMALINK

Chinese Immigrant Religious Institutions’ Variability in Views on Preventing Sexual Transmission of HIV

John J Chin, PhD

Torsten B Neilands, PhD

Abstract

RELIGIOUS INSTITUTIONS AND HEALTH PROMOTION

RELIGIOUS INSTITUTION INVOLVEMENT IN HIV PROGRAMS

BEST PRACTICES AND VIEWS ON ACCEPTABLE APPROACHES

METHODS

Data Management

Analysis

RESULTS

TABLE 1—

Bivariate Correlations

Multivariable Analysis Results

TABLE 2—

Teaching adolescents about condoms.

FIGURE 1—

Nonjudgmental approach to discussing homosexuality.

Disagreement with an abstinence-only approach to HIV education.

DISCUSSION

ACKNOWLEDGMENTS

HUMAN PARTICIPANT PROTECTION

REFERENCES

ACTIONS

PERMALINK

RESOURCES

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