Mobilizing Communities Around HIV Prevention for Youth: How Three Coalitions Applied Key Strategies to Bring About Structural Changes

Abstract

Increasingly, HIV prevention efforts must focus on altering features of the social and physical environment to reduce risks associated with HIV acquisition and transmission. Community coalitions provide a vehicle for bringing about sustainable structural changes. This article shares lessons and key strategies regarding how three community coalitions located in Miami and Tampa, Florida, and San Juan, Puerto Rico engaged their respective communities in bringing about structural changes affecting policies, practices and programs related to HIV prevention for 12–24-year-olds. Outcomes of this work include increased access to HIV testing and counseling in the juvenile correctional system (Miami), increased monitoring of sexual abuse between young women and older men within public housing, and support services to deter age discordant relationships (Tampa) and increased access to community-based HIV testing (San Juan).

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

“…Action plans delineate structural change objectives (SCOs) that C2P coalition members strive to accomplish. Structural changes “create opportunities or remove barriers to promote HIV prevention” and may consist of changes to programs, policies, or institutions (Chutuape et al, 2010, p. 2). During the time period under analysis, members of these coalitions completed 133 structural changes (see Table 2 for examples).…”

“…During the time period under analysis, members of these coalitions completed 133 structural changes (see Table 2 for examples). Elsewhere, C2P’s mobilization approach (Chutuape et al, 2010; Straub et al, 2007; Ziff et al, 2006) is described in more detail.…”

The Benefits of Youth Engagement in HIV-Preventive Structural Change Interventions

“…Connect to Protect ® (C2P) is an Adolescent Medicine Trials Network–supported research initiative designed to institute structural changes that impact youth’s risk of exposure to HIV through the creation of community coalitions. To meet C2P’s goal, coalition members develop and carry out structural change objectives (SCOs), which they define as new or modified laws and policies meant “to create opportunities or remove barriers to promote HIV prevention” (Chutuape et al, 2010, p. 2). As an example, an objective implemented by the one coalition was as follows: “By school year 07–08, DC public schools will have a policy in place that mandates HIV risk reduction classes for all 9th grade and new DC public school students.” To identify locally relevant objectives, coalition members engage in root cause analysis to identify the community- and structural-level causes of a particular problem (Willard et al, in press).…”

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

“…We have described the processes and mechanisms by which the ATN-affiliated C2P community coalitions mobilized to address structural barriers that hindered youth in their communities from being tested for HIV infection or linked and engaged in healthcare when they receive an HIV positive diagnosis. Specifically, we have demonstrated that the C2P community coalitions that are comprised of a committed group of local volunteer stakeholders, decision makers, and content experts can effectively work together to bring about locally identified structural changes related to HIV prevention ( 33,44-47 ). Unique to this effort was the role of the LTC subcommittees within the C2P coalitions engaged in strategic planning leading to HIV CoC structural changes to remove barriers that hindered HIV-infected youth from linking to, remaining engaged in, and being retained in long-term HIV healthcare.…”