Connect to Protect® and the Creation of AIDS-Competent Communities

Abstract

The development of community capacity is integral to reducing the burden of HIV in high-risk populations (Kippax, 2012). This study examines how coalitions addressing structural level determinants of HIV among youth are generating community capacity and creating AIDS-competent communities. AIDS-competent communities are defined as communities that can facilitate sexual behavior change, reduce HIV/AIDS–related stigma, support people living with HIV/AIDS, and cooperate in HIV–related prevention practices. This study shows how the coalitions are fostering the resources indicative of AIDS-competent communities: knowledge and skills, enhanced dialogue among relevant sectors of the community, local ownership of a problem, confidence in local strengths, solidarity or bonding social capital, and bridging partnerships. These data show that the coalitions catalyzed several outcomes aside from the completion of their structural changes. Coalition members are developing the skills, resources, and relationships that can ostensibly build a heightened community response to HIV prevention.

Creating Youth-Supportive Communities: Outcomes from the Connect-to-Protect® (C2P) Structural Change Approach to Youth HIV Prevention

“…However, the findings are generally consistent with other studies of structural change which show evidence of effects on community perceptions (Allen et al 2013; Javdani and Allen 2011). Moreover, our findings correspond with the prevailing view in the extant literature that it is especially difficult to make changes that will benefit sexual minority youth and are also consistent with the process data suggesting that the YMSM coalitions faced significant political obstacles during their start-up period (Miller et al 2012; Reed et al 2013), providing us some confidence in our findings, despite the limitations of a descriptive study design for drawing causal inferences. Additionally, our ongoing evaluation data including key informant interviews conducted annually in each city and data on youth access to key services affirm C2P’s impacts are multiple and salient to local youth in ways that might plausibly effect their community perceptions related to HIV.…”

“…Although an 8-city study is limited in what it can demonstrate about the value of mobilizing communities to pursue structural change, we believe examining adolescents’ perceptions of how their communities change over time early in the life of this collaborative effort adds useful information to the growing base of evidence on the effects of these initiatives within the context of HIV. Our results aid in understanding whether structural changes can shift adolescents’ perceptions of their communities as AIDS-competent settings (Campbell et al 2007; Reed et al 2013). …”

“…The coalitions focused on other at-risk youth succeeded in impacting schools, faith-based organizations, legal and criminal justice systems, as well as parents during these early years. YMSM-focused coalitions’ achievements were largely confined to the social service sectors that were already engaged in issues concerning HIV and YMSM (Miller et al 2012; Reed et al 2013). For these reasons, achievements by the coalitions focused on other at-risk youth may have been more likely to have an impact on perceived resources and community support.…”

“…Although other studies using a theory-driven evaluation approach find similar support for the promise of community mobilization efforts to create structural change, within the domestic United States public health literature, the bulk of the evaluations identifying successful structural change coalitions examine health issues that are not heavily stigmatized, such as childhood asthma, cancers, diabetes, and heart disease. Whether community mobilization approaches to pursue structural changes will achieve similar success within the context of highly stigmatized diseases such as HIV remains a key area for research, especially given evidence that HIV-related structural change efforts at the local level may be politicized, resisted, and undermined (Campbell 2010; Miller et al 2012; Reed et al 2013, 2014). …”

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

“…Other analyses have shown how C2P coalitions have been successful in supporting AIDS-competent communities for HIV-prevention among youth ( 35 ). A central focus of C2P is the identification of local social and structural factors that impede HIV prevention in youth, such as poor shelter options for displaced youth and inadequate access to youth and lesbian, gay, bisexual and transgender (LGBT)-competent health care providers.…”