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França M, Dourado I, Grangeiro A, Greco D, Magno L. Racial HIV Testing Inequalities in Adolescent Men who have Sex with Men and Transgender Women in Three Brazilian Cities. AIDS Behav 2024:10.1007/s10461-024-04297-z. [PMID: 38526640 DOI: 10.1007/s10461-024-04297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/27/2024]
Abstract
Many barriers to human immunodeficiency virus (HIV) testing among Black people exist. This study analysed the association between race/skin colour and lifetime HIV testing among adolescent men who have sex with men (AMSM) and transgender women (ATGW) in three Brazilian cities. This cross-sectional study was nested within the PrEP1519 cohort, a multicentre study of AMSM and ATGW aged 15-19 years in Belo Horizonte, Salvador, and São Paulo, Brazil. The outcome variable was the lifetime HIV testing (no or yes). The main exposure variable was self-reported race/skin colour as White and a unique Black group (composed of Pardo-mixed colour and Black, according to the Brazilian classification). Descriptive statistics and bivariate and multiple logistic regression analyses were conducted to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) to determine the association between the main exposure and outcome, adjusted for covariates. White adolescents were tested more frequently than the unique Black group (64.0% vs. 53.7%, respectively; Ρ = 0.001). Multiple logistic regression analysis showed that the unique Black group of AMSM and ATGW had 26% (adjusted OR [aOR], 0.74; 95% CI, 0.55-0.98) and 38% (aOR, 0.62; 95% CI, 0.45-0.87) lower odds of being tested for HIV in a lifetime than Whites in model 1 and 2, respectively. Our findings highlight the role of racism in lifetime HIV testing among AMSM and ATGW. Therefore, an urgent need for advances exists in public policies to combat racism in Brazil.
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Affiliation(s)
- Marcus França
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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Kerr J, Smith A, Nzama N, Bullock NAA, Chandler C, Osezua V, Johnson K, Rozema I, Metzger IW, Harris LM, Bond K, LaPreze D, Rice BM. Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States. J Urban Health 2024; 101:31-63. [PMID: 38093034 PMCID: PMC10897076 DOI: 10.1007/s11524-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/07/2024]
Abstract
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
| | - Adrienne Smith
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nqobile Nzama
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nana Ama Aya Bullock
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Cristian Chandler
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victory Osezua
- Public Health Program, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Isabel Rozema
- University of Louisville Health, Louisville, KY, USA
| | - Isha W Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lesley M Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Dani LaPreze
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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3
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Chiaramonte D, Miller RL, Lee K, Santiago Rivera OJ, Acevedo-Polakovich ID, McGirr S, Porter JL, Ellen JM, Boyer CB. Gendered powerlessness in at-risk adolescent and young women: an empirical model. AIDS Care 2020; 32:1333-1342. [PMID: 32008352 DOI: 10.1080/09540121.2020.1724252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connell's Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young women's health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.
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Affiliation(s)
| | - Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - KyungSook Lee
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | | | | | - Sara McGirr
- Michigan Public Health Institute, Okemos, MI, USA
| | | | - Jonathan M Ellen
- All Children's Hospital Johns Hopkins Medicine, Baltimore, MD, USA
| | - Cherrie B Boyer
- School of Medicine, University of California, San Francisco, CA, USA
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- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Boyer CB, Greenberg L, Korelitz J, Harper GW, Stewart-Campbell R, Straub D, Sanders R, Reid LH, Futterman D, Lee S, Ellen JM. Sexual Partner Characteristics, Relationship Type, and HIV Risk Among a Community Venue-based Sample of Urban Adolescent and Young Adult Men Who Have Sex with Men. YOUTH & SOCIETY 2019; 51:219-246. [PMID: 30983642 PMCID: PMC6456077 DOI: 10.1177/0044118x16669259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Few studies have examined sexual partnerships and HIV risk in diverse samples of African American/black and Hispanic/Latino adolescent and young adult men who have sex with men (YMSM), a group that have a high burden of HIV in the U.S. A community-venue recruitment approach was used, which identified significant differences in HIV risk by sexual partner type among 1215 YMSM. Those with casual partners had a higher number of sexual partners, had more STIs, and were more likely to engage in transactional sex, to use alcohol, marijuana, or other substances compared with those with main partners only. Among those with female sexual partners, many used condoms "every time" when engaging in vaginal sex with casual partners, but a sizeable proportion "never/rarely" used condoms with their main partners. Our findings demonstrate a need for tailored HIV prevention education and counseling with necessary skills regarding consistent and correct condom use with all sexual partnerships.
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Affiliation(s)
- Cherrie B Boyer
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, CA
| | | | | | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Diane Straub
- Department of Pediatrics, University of South Florida, Tampa, FL
| | - Renata Sanders
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Donna Futterman
- Adolescent AIDS Program, Children's Hospital at Montefiore Einstein College of Medicine, Bronx, NY
| | - Sonia Lee
- Eunice Kennedy Shriver National Institute on Child Health and Human Development/Maternal and Pediatric Infectious Disease Branch, Bethesda, MD
| | - Jonathan M Ellen
- Johns Hopkins Children's Center, Johns Hopkins University, Baltimore, MD
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5
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Gamarel KE, Nelson KM, Stephenson R, Santiago Rivera OJ, Chiaramonte D, Miller RL. Anticipated HIV Stigma and Delays in Regular HIV Testing Behaviors Among Sexually-Active Young Gay, Bisexual, and Other Men Who Have Sex with Men and Transgender Women. AIDS Behav 2018; 22:522-530. [PMID: 29214408 PMCID: PMC5820119 DOI: 10.1007/s10461-017-2005-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Young gay, bisexual and other men who have sex with men (YGBMSM) and young transgender women are disproportionately affected by HIV/AIDS. The success of biomedical prevention strategies is predicated on regular HIV testing; however, there has been limited uptake of testing among YGBMSM and young transgender women. Anticipated HIV stigma-expecting rejection as a result of seroconversion- may serve as a significant barrier to testing. A cross-sectional sample of YGBMSM (n = 719, 95.5%) and young transgender women (n = 33, 4.4%) ages 15-24 were recruited to participate in a one-time survey. Approximately one-third of youth had not tested within the last 6 months. In a multivariable model, anticipated HIV stigma and reporting a non-gay identity were associated with an increased odds of delaying regular HIV testing. Future research and interventions are warranted to address HIV stigma, in order to increase regular HIV testing among YGBMSM and transgender women.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Kimberly M Nelson
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Rob Stephenson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
- The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Boyer CB, Greenberg L, Chutuape K, Walker B, Monte D, Kirk J, Ellen JM. Exchange of Sex for Drugs or Money in Adolescents and Young Adults: An Examination of Sociodemographic Factors, HIV-Related Risk, and Community Context. J Community Health 2018; 42:90-100. [PMID: 27498094 DOI: 10.1007/s10900-016-0234-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The goal of this research was to examine associations among sociodemographic factors, HIV risk, and community context (e.g., economic insecurity, job training, housing instability, crime victimization, and perceived community norms) in adolescents and young adults who ever exchanged sex for drugs or money. Anonymous survey data were collected using ACASIs at community venues where adolescents and young adults congregate in resource-challenged, STI prevalent, urban, US neighborhoods. Conventional descriptive statistics, Fisher's exact tests, and generalized estimating equations approaches were used to examine associations. Participants (1818, 95.5 % of those screened eligible) were, on average, aged 21.0 years; 42.2 % were males, and 4.6 % were transgender. Almost one-third (32.1 %) identified as gay or lesbian, 18.1 % identified as bisexual; 66.2 % were Black and 21.0 % were Hispanic; 1.3 % was 'living on the street'. A sizeable proportion reported HIV-related risk: 16.3 % exchanged sex, 12.6 % had sex with someone they knew to be HIV-infected, 7.8 % had sex with someone who injected drugs, and 1.3 % injected drugs. Multivariate comparisons identified a number of variables (e.g., being male or transgender, homelessness, sex with a partner who has HIV, STI history, unemployment, job training access, housing instability, crime victimization, perceived community norms) that were significantly associated with exchange of sex (p < 0.05). This research contributes to the knowledge-base regarding exchange of sex among adolescents and young adults, particularly as it relates to community context. Longitudinal studies to describe the trajectory of social, health, and physical risks and consequences are needed for development of effective evidence-based prevention strategies.
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Affiliation(s)
- Cherrie B Boyer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118, USA.
| | | | - Kate Chutuape
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Bendu Walker
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jonathan M Ellen
- All Children's Hospital Johns Hopkins Medicine, St. Petersburg, FL, USA
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7
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Miller RL, Lee KS, Chiaramonte D, Santiago-Rivera OJ, Acevedo-Polakovich I, Boyer CB, Ellen JM. Youth health outcomes from the Connect-to-Protect Coalitions to prevent adolescent HIV infections. VULNERABLE CHILDREN AND YOUTH STUDIES 2017; 13:142-157. [PMID: 29623100 PMCID: PMC5880542 DOI: 10.1080/17450128.2017.1371818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.
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Miller RL, Reed SJ, Chiaramonte D, Strzyzykowski T, Spring H, Acevedo-Polakovich ID, Chutuape K, Cooper-Walker B, Boyer CB, Ellen JM. Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 60:199-214. [PMID: 28851064 PMCID: PMC5678968 DOI: 10.1002/ajcp.12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.
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Affiliation(s)
| | - Sarah J. Reed
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine
| | | | | | | | | | - Kate Chutuape
- Johns Hopkins University School of Medicine, Department of Pediatrics
| | | | - Cherrie B. Boyer
- University of California, San Francisco, Department of Pediatrics
| | - Jonathan M. Ellen
- Johns Hopkins University School of Medicine, Department of Pediatrics
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A Tailored Approach to Launch Community Coalitions Focused on Achieving Structural Changes: Lessons Learned From a HIV Prevention Mobilization Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21:546-55. [PMID: 26785397 DOI: 10.1097/phh.0000000000000182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition.
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Boyer CB, Walker BC, Chutuape KS, Roy J, Fortenberry JD. Creating Systems Change to Support Goals for HIV Continuum of Care: The Role of Community Coalitions to Reduce Structural Barriers for Adolescents and Young Adults. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2016; 15:158-179. [PMID: 27239165 PMCID: PMC4880364 DOI: 10.1080/15381501.2015.1074977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Routine population-wide HIV screening, early linkage and long-term retention in healthcare for HIV-infected individuals are key nodes of the HIV continuum of care and are essential elements of the National HIV/AIDS Strategy. Despite this, up to 80% of youth are unaware of their HIV infection status and only 29% are linked to HIV healthcare; less than half are engaged in long-term HIV healthcare, and far fewer maintain viral suppression. To fill this gap and to address the national call to action to establish a seamless system for immediate linkage to continuous and coordinated quality healthcare after diagnosis, this paper describes the processes and mechanisms by which the SMILE Program worked within the infrastructure of the ATN-affiliated Connect to Protect® (C2P) community coalitions to address structural barriers that hindered youth in their communities from being tested for HIV infection or linked and engaged in healthcare after an HIV positive diagnosis.
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Affiliation(s)
- Cherrie B. Boyer
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, CA
| | - Bendu C. Walker
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Kate S. Chutuape
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Jessica Roy
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - J. Dennis Fortenberry
- Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Miller RL, Janulis PF, Reed SJ, Harper GW, Ellen J, Boyer CB. Creating Youth-Supportive Communities: Outcomes from the Connect-to-Protect® (C2P) Structural Change Approach to Youth HIV Prevention. J Youth Adolesc 2016; 45:301-15. [PMID: 26534775 PMCID: PMC4714586 DOI: 10.1007/s10964-015-0379-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/25/2015] [Indexed: 12/01/2022]
Abstract
Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.
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Affiliation(s)
| | | | - Sarah J Reed
- Michigan State University, East Lansing, MI, USA.
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Willard N, Chutuape K, Stewart-Campbell R, Boyer CB, Ellen J. Targeting Structural Change for HIV Prevention: A Process and Tool for Community Application. Health Promot Pract 2015; 16:837-48. [PMID: 25776019 DOI: 10.1177/1524839915574831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To address the persistent HIV epidemic in the United States, prevention efforts are focusing on social determinants related to HIV risk by targeting systems and structures, such as organizational and institutional policies, practices and programs, and legislative and regulatory approaches to modify features of the environment that influence HIV risk. With limited evidenced-based examples, communities can benefit from strategic planning resources that help them consider developing structural-level changes that target root causes of HIV risk. In this article, we present the Connect to Protect® project that outlines a process and a tool to move from general ideas to specific structural changes. Examples from 14 coalitions are also provided. Using the process and tools presented here can provide a launching pad for other coalitions seeking to build an HIV prevention agenda and for practitioners seeking to incorporate structural changes for community health promotion.
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Affiliation(s)
- Nancy Willard
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kate Chutuape
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Ellen JM, Greenberg L, Willard N, Korelitz J, Kapogiannis BG, Monte D, Boyer CB, Harper GW, Henry-Reid LM, Friedman LB, Gonin R. Evaluation of the effect of human immunodeficiency virus-related structural interventions: the connect to protect project. JAMA Pediatr 2015; 169:256-63. [PMID: 25580593 PMCID: PMC4346420 DOI: 10.1001/jamapediatrics.2014.3010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes. OBJECTIVE To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV. DESIGN, SETTING, AND PARTICIPANTS In this serial cross-sectional survey design, data were collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate. INTERVENTIONS Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV. MAIN OUTCOMES AND MEASURES Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing. RESULTS Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95% CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P = .39] for using a condom half the time or less with a casual partner). CONCLUSIONS AND RELEVANCE This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.
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Affiliation(s)
- Jonathan M. Ellen
- Department of Pediatrics, School of Medicine, All Children’s Hospital, Johns Hopkins Medicine, St Petersburg, Florida
| | | | - Nancy Willard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Bill G. Kapogiannis
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Dina Monte
- Health Studies Sector, Westat, Rockville, Maryland
| | - Cherrie B. Boyer
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Lisa M. Henry-Reid
- Department of Pediatrics, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Lawrence B. Friedman
- Division of Adolescent Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - René Gonin
- Health Studies Sector, Westat, Rockville, Maryland
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14
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Chutuape KS, Muyeed AZ, Willard N, Greenberg L, Ellen JM. Adding to the HIV Prevention Portfolio - the Achievement of Structural Changes by 13 Connect to Protect ® Coalitions. GLOBAL JOURNAL OF COMMUNITY PSYCHOLOGY PRACTICE 2015; 5:1-8. [PMID: 25632407 PMCID: PMC4306189 DOI: 10.7728/0502201404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Opportunities to control risk factors that contribute to HIV transmission and acquisition extend far beyond individuals and include addressing social and structural determinants of HIV risk, such as inadequate housing, poor access to healthcare and economic insecurity. The infrastructure within communities, including the policies and practices that guide institutions and organizations, should be considered crucial targets for change. This paper examines the extent to which 13 community coalitions across the U.S. and Puerto Rico were able to achieve "structural change" objectives (i.e., new or modified practices or policies) as an intermediate step toward the long-term goal of reducing HIV risk among adolescents and young adults (12-24 years old). The study resulted in the completion of 245 objectives with 70% categorized as structural in nature. Coalitions targeted social services, education and government as primary community sectors to adopt structural changes. A median of 12 key actors and six new key actors contributed to accomplishing structural changes. Structural change objectives required a median of seven months to complete. The structural changes achieved offer new ideas for community health educators and practitioners seeking to bolster their HIV prevention agenda.
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Affiliation(s)
- Kate S Chutuape
- Project Director for Connect to Protect at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Adaline Z Muyeed
- Senior Epidemiologist and Project Director at Westat in Rockville, MD, USA
| | - Nancy Willard
- public health researcher at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - Jonathan M Ellen
- Protocol Chair and President of All Children's Hospital in St. Petersburg, FL, USA
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15
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Reed SJ, Miller RL, Francisco VT. Programmatic capacity and HIV structural change interventions: influences on coalitions' success and efficiency in accomplishing intermediate outcomes. J Prev Interv Community 2014; 40:118-30. [PMID: 24188353 DOI: 10.1080/10852352.2012.660123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article assesses how programmatic capacity affects coalitions' ability to achieve structural HIV prevention interventions. The focus of the analysis was on the structural changes developed (n = 304) at all coalitions involved in Connect to Protect® between early 2006 through the end of 2008. Data included records of coalitions' structural change objectives and the progress made toward their accomplishment. For the current study, we divided objectives into two periods: those created before 2008 (n = 201) and those created from January 2008 through December 2008 (n = 103). In addition to becoming more structurally focused, C2P coalitions are becoming more efficient and most individual coalitions are becoming more successful. Findings highlight the benefit of creating high quality, strategic structural change objectives. Future research should investigate other influences that impede or facilitate the implementation of structural change HIV prevention interventions.
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Affiliation(s)
- Sarah J Reed
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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16
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Castillo M, Palmer BJ, Rudy BJ, Fernandez MI. Creating partnerships for HIV prevention among YMSM: the Connect Protect® Project and House and Ball Community in Philadelphia. J Prev Interv Community 2014; 40:165-75. [PMID: 24188356 DOI: 10.1080/10852352.2012.660126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Community participation in prevention research has emerged as an important resource for identifying and addressing HIV risk factors and populations that may be more susceptible to these risks. This article focuses on the coalition at the Philadelphia site of Connect to Protect®: Partnerships for Youth Prevention Interventions (C2P), and the partnerships developed to work with an understudied subgroup of young men who have sex with men (YMSM), the House and Ball Community (HBC). The authors describe the coalition's process of identifying HIV risk factors, developing objectives and prevention activities such as increased access to HIV counseling and testing, and building partnerships with the HBC community. Local HIV testing data from C2P affiliated events, additional outcomes, and future directions for the coalition to continue these efforts are presented.
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Affiliation(s)
- Marné Castillo
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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17
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Reed SJ, Miller RL. The Benefits of Youth Engagement in HIV-Preventive Structural Change Interventions. YOUTH & SOCIETY 2014; 46:529-547. [PMID: 25328252 PMCID: PMC4197976 DOI: 10.1177/0044118x12443372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Youth are infrequently included in planning the health promotion projects designed to benefit them as many of the factors infringing upon youth's health and well-being also limit their engagement in community-based public health promotion projects. This article explores youth engagement in 13 coalitions implementing structural changes meant to reduce HIV transmission among adolescents. There was wide variation of youth membership and involvement across coalitions. Using analytic induction, the authors show that youth engagement was associated with the successful completion of structural change efforts. The authors also describe how youth engagement indirectly facilitated coalitions' success. The authors suggest that youth engagement in planning and conducting structural interventions is itself a valuable structural change.
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18
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Willard N, Srirojn B, Thomson N, Aramrattana A, Sherman S, Galai N, Celentano DD, Ellen JM. Coalition formation to address structural determinants of methamphetamine use in Thailand. Health Promot Int 2014; 30:782-92. [PMID: 24493782 DOI: 10.1093/heapro/dau001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite two recent government-sponsored 'wars on drugs', methamphetamine use continues to be a pervasive problem in Thailand. Out of concern for reported human rights abuses, there has been a call from the international community to take a different approach from the government's 'zero tolerance'. This paper describes the adaptation of the Connect to Protect® coalition formation process from urban U.S. cities to three districts in northern Thailand's Chiang Mai province, aimed to reduce methamphetamine use by altering the risk environment. Project materials, including manuals and materials (e.g. key actor maps and research staff memos), were reviewed to describe partnering procedures and selection criteria. Potential community partners were identified from various government and community sectors with a focus on including representatives from health, police, district and sub-district government officials. Of the 64 potential partners approached, 59 agreed to join one of three district-level coalitions. Partner makeup included 25% from the health sector, 22% who were sub-district government officials and 10% were representatives from the police sector. Key partners necessary for endorsement of and commitment to the coalition work included district-level governors, police chiefs and hospital directors for each district. Initial coalition strategic planning has resulted in policies and programs to address school retention, youth development initiatives and establishment of a new drug treatment and rehabilitation clinic in addition to other developing interventions. Similarities in building coalitions, such as the need to strategically develop buy-in with key constituencies, as well as differences of whom and how partners were identified are explored.
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Affiliation(s)
- Nancy Willard
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 4200, 5200 Eastern Avenue, Baltimore, MD 21224-2780, USA
| | - Bangorn Srirojn
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Nicholas Thomson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Susan Sherman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Ellen
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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19
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Reed SJ, Miller RL, Francisco VT. The influence of community context on how coalitions achieve HIV-preventive structural change. HEALTH EDUCATION & BEHAVIOR 2013; 41:100-7. [PMID: 23855017 DOI: 10.1177/1090198113492766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community coalition action theory (CCAT) depicts the processes and factors that affect coalition formation, maintenance, institutionalization, actions, and outcomes. CCAT proposes that community context affects coalitions at every phase of development and operation. We analyzed data from 12 Connect to Protect coalitions using inductive content analysis to examine how contextual factors (e.g., economics, collaboration, history, norms, and politics) enhance or impede coalitions' success in achieving outcomes. Consistent with CCAT, context affected the objectives that coalitions developed and those they completed. Results suggest that local prevention history and political support have particular impact on coalitions' success in creating structural changes. These data underscore the heuristic value of CCAT, yet also imply that the contextual constructs that affect outcomes are issue specific.
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Affiliation(s)
- Sarah J Reed
- 1Michigan State University, East Lansing, MI, USA
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20
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Miller RL, Reed SJ, Francisco V. Accomplishing structural change: identifying intermediate indicators of success. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 51:232-42. [PMID: 22875684 PMCID: PMC3495085 DOI: 10.1007/s10464-012-9544-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Coalitions are routinely employed across the United States as a method of mobilizing communities to improve local conditions that impact on citizens' well-being. Success in achieving specific objectives for environmental or structural community change may not quickly translate into improved population outcomes in the community, posing a dilemma for coalitions that pursue changes that focus on altering community conditions. Considerable effort by communities to plan for and pursue structural change objectives, without evidence of logical and appropriate intermediate markers of success could lead to wasted effort. Yet, the current literature provides little guidance on how coalitions might select intermediate indicators of achievement to judge their progress and the utility of their effort. The current paper explores the strengths and weaknesses of various indicators of intermediate success in creating structural changes among a sample of 13 coalitions organized to prevent exposure to HIV among high-risk adolescents in their local communities.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
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21
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Miller RL, Reed SJ, Francisco V. Accomplishing structural change: identifying intermediate indicators of success. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 51:232-242. [PMID: 22875684 DOI: 10.1007/s10464-012-9544-9554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Coalitions are routinely employed across the United States as a method of mobilizing communities to improve local conditions that impact on citizens' well-being. Success in achieving specific objectives for environmental or structural community change may not quickly translate into improved population outcomes in the community, posing a dilemma for coalitions that pursue changes that focus on altering community conditions. Considerable effort by communities to plan for and pursue structural change objectives, without evidence of logical and appropriate intermediate markers of success could lead to wasted effort. Yet, the current literature provides little guidance on how coalitions might select intermediate indicators of achievement to judge their progress and the utility of their effort. The current paper explores the strengths and weaknesses of various indicators of intermediate success in creating structural changes among a sample of 13 coalitions organized to prevent exposure to HIV among high-risk adolescents in their local communities.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
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22
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Miller RL, Reed SJ, Francisco VT, Ellen JM. Conflict transformation, stigma, and HIV-preventive structural change. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2012; 49:378-92. [PMID: 21805217 PMCID: PMC3348352 DOI: 10.1007/s10464-011-9465-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.
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Affiliation(s)
- Robin Lin Miller
- Department of Psychology, Michigan State University, East Lansing, 48824, USA.
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