Special Issue: Community Coalitions and Structural Change: Innovative Approaches to HIV Prevention for Youth: Journal of Prevention & Intervention in the Community

"As HIV continues to proliferate in the adolescent and young adult populations, its impact is most predominate among young gay, bisexual, and other men who have sex with men (especially young men of color) and heterosexual young women of color....Such individuals may lack the social power and resources to access HIV prevention services, as well as primary medical care if they do become infected."


In order to increase the scope of current HIV prevention efforts for youth, Connect to Protect® (C2P), a multi-site intervention focused on addressing the HIV epidemic at a structural level by working with community coalitions to alter policies, practices, programmes, and/or physical environments that are associated with increased risk for HIV among youth, was initiated in 2002. "C2P is the primary prevention infrastructure of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), a National Institutes of Health funded network that conducts research related to youth (i.e., ages 12-24) who are living with or are at risk for HIV. Fifteen research centers in the mainland United States and Puerto Rico have been conducting C2P. The primary research objective of C2P is to determine whether structural changes achieved by C2P coalitions have an effect on individual risk factors associated with HIV transmission and acquisition among youth in intervention communities." [Footnotes removed by the editor.]

This special issue explores various aspects of C2P across multiple sites and offers recommendations for others who wish to use this type of community mobilisation approach to HIV prevention.

"Doll, Harper, Robles-Schrader, Johnson, Bangi, and Velagaleti begin the issue by exploring the organizational and contextual factors that impacted C2P coalition functioning at all sites during the first year of their existence using a longitudinal mixed-methods approach. Willard, Chutuape, Stines, and Ellen then describe the implementation and impact of a root cause analysis process that assisted coalitions in identifying fundamental structural-level contributors to risk, as well as appropriate solutions. Their methodology consisted of coding structural change objectives generated by coalitions. Reed, Miller, and Francisco also analyzed structural change objectives, as well as the progress made toward the objectives, across a 2-year time frame in order to assess how programmatic capacity affects coalitions' ability to achieve structural HIV prevention interventions.

The final three articles in this issue focus on specific populations that are addressed at various C2P sites, and how coalition activities were unique to the needs of these populations. Robles-Schrader, Harper, Purnell, Monarrez, and Ellen examine differential challenges in coalition processes that hindered or facilitated coalition building for coalitions focused on young gay/bisexual men versus young heterosexual women. Data for this study came from in-depth qualitative interviews with community partners involved in each coalition. Lin, Dudek, Francisco, Castillo, Freeman, Martinez, Sniecinski, Young, and Ellen conducted an analysis of data from C2P staff members who coordinate coalition activities in the seven communities that focus exclusively on young men who have sex with men of color, and explored the unique challenges they experienced with regard to forming community partnerships, maintaining the coalition, and facilitating structural-level coalition objectives. In the final article, Castillo, Palmer, Rudy, and Fernandez use multiple data sources to present a detailed case analysis of one C2P site in Philadelphia which is focused on providing HIV prevention and testing services to young men who have sex with men who are members of the House and Ball Community."

C2P phases are described as follows:

• Phase I consisted of assessing community assets and risks: "C2P staff compiled extant data including local health department disease surveillance data for STIs and HIV, crime data, and demographic data to generate a youth HIV/AIDS epidemiological profile for their urban area. Using the profiles, C2P staff determined high-risk geographic areas, and a youth subpopulation (i.e., young men who have sex with men, young heterosexual women of color, young drug users) on which to focus C2P efforts. Throughout this phase, C2P staff attended and hosted community events to promote C2P and youth HIV-related issues. They also met individually with community agency representatives to discuss interests in partnering with the C2P coalition. The initial coalition make-up ranged in size from 10-25 members from various community sectors (e.g., community-based health and social service organization, education, government, judicial services, law enforcement, faith-based, and business). Partnerships were formalized by signing a memorandum of understanding agreeing to contribute to the development of C2P community-based efforts."
• "Phase II advanced the project by (a) collecting data from at-risk youth on HIV risk behaviors and (b) initiating a series of meetings with community partners to begin to develop the coalition infrastructure and to build partner capacity. In order to collect youth data, 3-5 venues (e.g., clubs, parks, and shopping malls) were identified by each site where interviews and HIV sero-surveys, to determine HIV prevalence, were conducted. To build the capacity of coalitions, the NCC developed new and/or adapted existing materials on topics including the epidemiology of HIV, structural change as an intervention option, coalition infrastructure requirements, advocacy skills, and media/marketing, among other topics."
• "The primary objective of Phase III was for each coalition to develop a local strategic plan that included identification of structural changes determined to be relevant for reductions in HIV risk in their community. The C2P approach for strategic planning emphasizes development of objectives and action steps through the 'VMOSA' strategic planning process. The coalitions engaged in the VMOSA process by completing a series of activities that resulted in developing a vision and mission for their coalition and specific structural change objectives, strategies, and ultimately, action plans detailing specific steps to bring about the objectives. Structural changes are defined as new or modified programs, policies, and practices that were logically linked to HIV acquisition and transmission and could be sustained over time. Examples of structural changes include 'offering testing in juvenile correctional facilities' or 'requiring community organizations to demonstrate cultural competency as part of a grant application.' As structural changes were developed by the coalition, they were shared with the NCC to ensure they met the project definition of structural change. The C2P staff documented progress toward achieving their structural changes, allowing both the coalition and the NCC to monitor coalition progress. As Phase III progresses, the coalitions meet regularly to review their strategic plans, develop new structural change objectives, and continue the necessary capacity building to sustain the coalition effort."