Miller Robin Lin, Janulis Patrick F, Reed Sarah J, Harper Gary W, Ellen Jonathan, Boyer Cherrie B
Michigan State University, East Lansing, MI, USA.
University of Michigan, Ann Arbor, MI, USA.
J Youth Adolesc. 2016 Feb;45(2):301-15. doi: 10.1007/s10964-015-0379-9. Epub 2015 Nov 3.
Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.
降低青少年中的艾滋病毒感染率是一项紧迫的全球优先事项。通过解决导致艾滋病毒感染风险上升的经济、社会、文化和政治因素，采用结构性变革方法预防艾滋病毒可降低年轻人的风险。我们评估了八个“连接保护”（C2P）联盟所实现的结构性变革是否与联盟动员的头四年中年轻人对其社区看法的改善相关。我们从每个C2P社区招募了有针对性的青年年度横断面样本。我们在社区场所对青年进行抽样。在四年时间里，我们共采访了2461名青年。接受采访的大多数人是男性（66%）和有色人种青年（52%为西班牙裔/拉丁裔；41%为非裔美国人）。到第4年，青年报告对其社区作为一个支持青年的环境更满意。与第1年相比，他们报告现有社区资源能更好地满足他们的需求。然而，这些结果因风险人群而异，即来自C2P关注男男性行为者（YMSM）的社区的青年报告随时间没有变化，而来自关注其他高危青年的社区的青年报告在满意度和资源需求满足方面随时间有显著改善。在为其他高危青年服务的社区中，内化的艾滋病毒污名随时间增加，而在YMSM社区中则没有变化。我们观察到，随着时间推移，关注YMSM的社区与关注其他高危青年的社区之间存在非常不同的结果，这可能表明，假设在与艾滋病毒有如此不同历史关系且在其社区中面临非常不同类型根深蒂固歧视的青年人群中存在相同的结构性因果关系链是不合理的。
