title: Adding to the HIV Prevention Portfolio - the Achievement of Structural Changes by 13 Connect to Protect®Coalitions.
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.
authors: Project Director for Connect to Protect at Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
authors: Kate S
authors: KS
authors: Chutuape
authors: Senior Epidemiologist and Project Director at Westat in Rockville, MD, USA.
authors: Adaline Z
authors: AZ
authors: Muyeed
authors: public health researcher at Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
authors: Nancy
authors: N
authors: Willard
authors: Epidemiologist at Westat in Rockville, MD, USA.
authors: Lauren
authors: L
authors: Greenberg
authors: Protocol Chair and President of All Children's Hospital in St. Petersburg, FL, USA.
authors: Jonathan M
authors: JM
authors: Ellen
keywords: HIV prevention; adolescents; coalition; community mobilization; structural change
references: AIDS Behav. 2013 Nov;17(9):2878-92
references: 23975473
references: AIDS Educ Prev. 2006 Jun;18(3):187-203
references: 16774462
references: Annu Rev Public Health. 2000;21:369-402
references: 10884958
references: MMWR Morb Mortal Wkly Rep. 2012 Nov 30;61(47):971-6
references: 23190571
references: J Prev Interv Community. 2012;40(2):103-17
references: 24188352
references: Nature. 1987 Mar 12-18;326(6109):137-42
references: 3821890
references: J Adolesc Health. 2007 Jun;40(6):489-98
references: 17531754
references: Am J Community Psychol. 2001 Apr;29(2):173-91; discussion 205-11
references: 11446275
references: Am J Public Health. 2007 Nov;97(11):1974-81
references: 17901452
references: Public Health Rep. 2010 Jul-Aug;125 Suppl 4:1-5
references: 20629250
references: Arch Pediatr Adolesc Med. 2011 Jan;165(1):77-84
references: 21199984
references: Int J STD AIDS. 1997 Jan;8(1):40-3
references: 9043980
references: Am J Public Health. 2010 Apr;100(4):590-5
references: 20167880
references: J Urban Health. 2006 May;83(3):506-22
references: 16739051
references: Lancet. 2008 Aug 30;372(9640):764-75
references: 18687460
references: AIDS. 2000 Jun;14 Suppl 1:S11-21
references: 10981470
references: Am Psychol. 2013 May-Jun;68(4):286-99
references: 23688095
references: Public Health Rep. 2000 Mar-Jun;115(2-3):174-9
references: 10968751
references: AIDS Care. 2009 Dec;21(12):1499-507
references: 20024729
references: AIDS. 2000 Jun;14 Suppl 1:S3-10
references: 10981469