title: Resources and obstacles to developing and implementing a structural intervention to prevent HIV in San Salvador, El Salvador.
abstract: HIV prevention researchers have increasingly advocated structural interventions that address factors in the social, political and economic context to reduce disparities of HIV/AIDS among disadvantaged populations. This paper draws on data collected in three different types of low-income communities (n=6) in the San Salvador metropolitan area in El Salvador. Nine focus group discussions were conducted between January 2006 and July 2007, 6 with community leaders, and 3 with crack cocaine users, as well as in-depth interviews with 20 crack users and crack dealers. We explore opportunities and barriers to the implementation of a community-level, structural intervention. We first analyze the different forms of leadership, and other community resources including existing HIV prevention activities that could potentially be used to address the related problems of crack use and HIV in the communities, and the structural factors that may act as barriers to capitalizing on communities' strengths in interventions. Each of the communities studied demonstrated different resources that stem from each community's unique history and geographic location. HIV testing and prevention resources varied widely among the communities, with resources concentrated in one Older Central community despite a strong need in all communities. In many communities, fear of gang violence and non-responsiveness by government agencies to communities' needs have discouraged community organizing. In the discussion, we offer concrete suggestions for developing and implementing structural interventions to reduce HIV risks that use communities' different but complementary resources.
authors.affiliation: Pyshciatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI 53202, USA. Electronic address: jdickson@mcw.edu.
authors.forename: Julia
authors.initials: J
authors.lastname: Dickson-Gomez
authors.affiliation: Pyshciatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI 53202, USA.
authors.forename: A Michelle
authors.initials: AM
authors.lastname: Corbett
authors.affiliation: Fundacion Antidrogas de El Salvador, El Salvador.
authors.forename: Gloria
authors.initials: G
authors.lastname: Bodnar
authors.affiliation: Fundacion Antidrogas de El Salvador, El Salvador.
authors.forename: Karla
authors.initials: K
authors.lastname: Rodriguez
authors.affiliation: Fundacion Antidrogas de El Salvador, El Salvador.
authors.forename: Carmen E
authors.initials: CE
authors.lastname: Guevara
mesh_terms: D019970:Cocaine-Related Disorders; D003153:Community Health Services / Q000458:organization & administration*; D016578:Crack Cocaine; D004544:El Salvador; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D015276:Health Care Rationing; D006295:Health Resources / Q000600:supply & distribution*; D054624:Health Status Disparities; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D016730:Program Development; D012111:Residence Characteristics / Q000145:classification*; D012959:Socioeconomic Factors
chemical_list: D016578:Crack Cocaine