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Galai N, Sirirojn B, Aramrattana A, Srichan K, Thomson N, Golozar A, Flores JM, Willard N, Ellen JM, Sherman SG, Celentano DD. A cluster randomized trial of community mobilization to reduce methamphetamine use and HIV risk among youth in Thailand: Design, implementation and results. Soc Sci Med 2018; 211:216-223. [PMID: 29966816 DOI: 10.1016/j.socscimed.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Use of methamphetamines (MA) and other stimulants have consistently been associated with HIV/STI risk globally. We evaluated a community mobilization intervention (Connect to Protect, C2P®) to prevent MA use among youth and reduce HIV risk behaviors through community structural changes. DESIGN A community-randomized trial in northern Thailand with matched districts randomized to C2P intervention or a standard voluntary counseling and testing (VCT) control. Intervention districts formed stakeholders' coalitions to plan tailored local prevention programs. Two independent random household samples of youth aged 14-24 were surveyed in 2009 and 2012. Lifetime and recent MA use was modeled with multilevel logistic regression. RESULTS Intervention initiatives included family-strengthening programs, school-based programs and opening a community drug treatment center. Control communities applied the government-led "war on drugs" approach in addition to youth and family programs. Baseline (N = 1077) and follow-up (N = 1225) samples included 47.5% females and 21.7% aged ≤16. Lifetime MA use in intervention districts reduced from 13.4% to 11.7% compared to reduction from 16.2% to 10.4% in the control districts (non-significant). In models, lifetime MA use was associated with: time (aOR = 0.6, 95%CI: 0.38-0.83), females (aOR = 0.2, 95%CI: 0.15-0.29), increasing age (aOR = 2.4, 95%CI: 1.40-4.20, ages 16-19; aOR = 3.5, 95%CI: 2.00-6.12, ages ≥20), and not being full-time students (aOR = 5.3, 95%CI: 3.77-7.37). Recent MA use showed similar results. Additionally, lifetime MA use was significantly associated with alcohol use, risky sexual behaviors and elevated depressive symptoms. CONCLUSIONS Delay in developing and implementing specific prevention programs in the intervention districts slowed diffusion of the effect into the communities. Secular trends with contentious civil unrest and active drug-enforcement efforts in the control communities also contributed to the null intervention effect. Longer time and intensified efforts stressing a public health approach are needed to demonstrate the effectiveness of community mobilization in reducing substance use and HIV risk in this rural Thai community.
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Affiliation(s)
- Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Statistics, Haifa University, Haifa, Israel.
| | - Bangorn Sirirojn
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Kamolrawee Srichan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
| | - Nicholas Thomson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jose M Flores
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nancy Willard
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Pediatrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Susan G Sherman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Willard N, Chutuape K, Stewart-Campbell R, Boyer CB, Ellen J. Targeting Structural Change for HIV Prevention: A Process and Tool for Community Application. Health Promot Pract 2015; 16:837-48. [PMID: 25776019 DOI: 10.1177/1524839915574831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To address the persistent HIV epidemic in the United States, prevention efforts are focusing on social determinants related to HIV risk by targeting systems and structures, such as organizational and institutional policies, practices and programs, and legislative and regulatory approaches to modify features of the environment that influence HIV risk. With limited evidenced-based examples, communities can benefit from strategic planning resources that help them consider developing structural-level changes that target root causes of HIV risk. In this article, we present the Connect to Protect® project that outlines a process and a tool to move from general ideas to specific structural changes. Examples from 14 coalitions are also provided. Using the process and tools presented here can provide a launching pad for other coalitions seeking to build an HIV prevention agenda and for practitioners seeking to incorporate structural changes for community health promotion.
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Affiliation(s)
- Nancy Willard
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kate Chutuape
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Ellen JM, Greenberg L, Willard N, Korelitz J, Kapogiannis BG, Monte D, Boyer CB, Harper GW, Henry-Reid LM, Friedman LB, Gonin R. Evaluation of the effect of human immunodeficiency virus-related structural interventions: the connect to protect project. JAMA Pediatr 2015; 169:256-63. [PMID: 25580593 PMCID: PMC4346420 DOI: 10.1001/jamapediatrics.2014.3010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE With the emphasis on structural-level interventions that target social determinants of human immunodeficiency virus (HIV) transmission to curb the HIV epidemic, there is a need to develop evaluation models that can detect changes in individual factors associated with HIV-related structural changes. OBJECTIVE To describe whether structural changes developed and achieved by community coalitions are associated with an effect on individual factors associated with the risk of contracting HIV. DESIGN, SETTING, AND PARTICIPANTS In this serial cross-sectional survey design, data were collected from 8 cities during 4 rounds of annual surveys from March 13, 2007, through July 29, 2010. Study recruitment took place at venues where the population of focus was known to congregate, such as clubs, bars, community centers, and low-income housing. The convenience sample of at-risk youth (persons aged 12-24 years) included 5337 individuals approached about the survey and 3142 (58.9%) who were screened for eligibility. Of the 2607 eligible participants, 2559 (98.2%) ultimately agreed to participate. INTERVENTIONS Achievement of locally identified structural changes that targeted public and private entities (eg, federal agencies, homeless shelters, and school systems) with the goal of fostering changes in policy and practice to ultimately facilitate positive behavioral changes aimed at preventing HIV. MAIN OUTCOMES AND MEASURES Number of sexual partners, partner characteristics, condom use, and history of sexually transmitted infections and HIV testing. RESULTS Exposure to structural changes was not statistically significantly associated with any of the outcome measures, although some results were in the direction of a positive structural change effect (eg, a 10-unit increase in a structural change score had an odds ratio of 0.88 [95% CI, 0.76-1.03; P = .11] for having an older sexual partner and an odds ratio of 0.91 [95% CI, 0.60-1.39; P = .39] for using a condom half the time or less with a casual partner). CONCLUSIONS AND RELEVANCE This study evaluated a broad representation of at-risk individuals and assessed the effect of numerous structural changes related to various HIV risk factors. No structural changes as measured in this study were associated with a statistically significant reduction in risk behaviors. These null findings underscore the need for a long-term approach in evaluating structural interventions and the development of more nuanced methods of quantifying and comparing structural-change initiatives and determining the appropriate strategies for evaluating effect.
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Affiliation(s)
- Jonathan M. Ellen
- Department of Pediatrics, School of Medicine, All Children’s Hospital, Johns Hopkins Medicine, St Petersburg, Florida
| | | | - Nancy Willard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Bill G. Kapogiannis
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Dina Monte
- Health Studies Sector, Westat, Rockville, Maryland
| | - Cherrie B. Boyer
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Lisa M. Henry-Reid
- Department of Pediatrics, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Lawrence B. Friedman
- Division of Adolescent Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - René Gonin
- Health Studies Sector, Westat, Rockville, Maryland
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Chutuape KS, Muyeed AZ, Willard N, Greenberg L, Ellen JM. Adding to the HIV Prevention Portfolio - the Achievement of Structural Changes by 13 Connect to Protect ® Coalitions. Glob J Community Psychol Pract 2015; 5:1-8. [PMID: 25632407 PMCID: PMC4306189 DOI: 10.7728/0502201404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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.
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Affiliation(s)
- Kate S Chutuape
- Project Director for Connect to Protect at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Adaline Z Muyeed
- Senior Epidemiologist and Project Director at Westat in Rockville, MD, USA
| | - Nancy Willard
- public health researcher at Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - Jonathan M Ellen
- Protocol Chair and President of All Children's Hospital in St. Petersburg, FL, USA
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Ellen JM, Greenberg L, Willard N, Stines S, Korelitz J, Boyer CB. Cross-sectional survey comparing HIV risk behaviours of adolescent and young adult men who have sex with men only and men who have sex with men and women in the U.S. and Puerto Rico. Sex Transm Infect 2015; 91:458-61. [PMID: 25587181 DOI: 10.1136/sextrans-2014-051712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/28/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the HIV risk behaviours of men who have sex with men only (MSMO) and men who have sex with men and women (MSMW), aged 12-24 years, in five US cities and in San Juan, Puerto Rico. METHODS Data were collected through four annual cross-sectional anonymous surveys at community venues and included questions about sexual partnerships, sexual practices including condom use and substance use. Demographic and risk profiles were summarised for both groups. RESULTS A total of 1198 men were included in this analysis, including 565 MSMO and 633 MSMW. There were statistically significant differences between the two groups for many risk factors examined in multivariable models. MSMW were more likely to identify as bisexual, be in a long-term relationship, have a history of homelessness, have ever used marijuana, have ever been tested for HIV and to have been tested for HIV within the past 6 months. MSMW may be more likely to ever exchange sex for money and ever have a sexually transmitted infection than MSMO. CONCLUSIONS MSMW were more likely to report several markers of socioeconomic vulnerability or behaviours associated with increased risk for HIV than MSMO. MSMW contribute to HIV prevalence in the USA, and better understanding of the risk profile of this group is essential to understand heterosexual HIV transmission. MSMW, particularly those who identify as bisexual or questioning, may feel uncomfortable participating in programmes that are designed for gay-identified men. Therefore, prevention strategies need to target distinct subgroups that compose the population of MSM.
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Affiliation(s)
- Jonathan M Ellen
- Department of Pediatrics, All Children's Hospital Johns Hopkins Medicine, St Petersburg, Florida, USA
| | | | - Nancy Willard
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Cherrie B Boyer
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Willard N, Chutuape K, Stines S, Ellen JM. Bridging the gap between individual-level risk for HIV and structural determinants: using root cause analysis in strategic planning. J Prev Interv Community 2014; 40:103-17. [PMID: 24188352 DOI: 10.1080/10852352.2012.660122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV prevention efforts have expanded beyond individual-level interventions to address structural determinants of risk. Coalitions have been an important vehicle for addressing similar intractable and deeply rooted health-related issues. A root cause analysis process may aid coalitions in identifying fundamental, structural-level contributors to risk and in identifying appropriate solutions. For this article, strategic plans for 13 coalitions were analyzed both before and after a root cause analysis approach was applied to determine the coalitions' strategic plans potential impact and comprehensiveness. After root cause analysis, strategic plans trended toward targeting policies and practices rather than on single agency programmatic changes. Plans expanded to target multiple sectors and several changes within sectors to penetrate deeply into a sector or system. Findings suggest that root cause analysis may be a viable tool to assist coalitions in identifying structural determinants and possible solutions for HIV risk.
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Affiliation(s)
- Nancy Willard
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Harper GW, Willard N, Ellen JM. Connect to Protect®: utilizing community mobilization and structural change to prevent HIV infection among youth. J Prev Interv Community 2014; 40:81-6. [PMID: 24188350 DOI: 10.1080/10852352.2012.660119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gary W Harper
- Department of Psychology and Master of Public Health Program, DePaul University, Chicago, Illinois, USA
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Willard N, Srirojn B, Thomson N, Aramrattana A, Sherman S, Galai N, Celentano DD, Ellen JM. Coalition formation to address structural determinants of methamphetamine use in Thailand. Health Promot Int 2014; 30:782-92. [PMID: 24493782 DOI: 10.1093/heapro/dau001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite two recent government-sponsored 'wars on drugs', methamphetamine use continues to be a pervasive problem in Thailand. Out of concern for reported human rights abuses, there has been a call from the international community to take a different approach from the government's 'zero tolerance'. This paper describes the adaptation of the Connect to Protect® coalition formation process from urban U.S. cities to three districts in northern Thailand's Chiang Mai province, aimed to reduce methamphetamine use by altering the risk environment. Project materials, including manuals and materials (e.g. key actor maps and research staff memos), were reviewed to describe partnering procedures and selection criteria. Potential community partners were identified from various government and community sectors with a focus on including representatives from health, police, district and sub-district government officials. Of the 64 potential partners approached, 59 agreed to join one of three district-level coalitions. Partner makeup included 25% from the health sector, 22% who were sub-district government officials and 10% were representatives from the police sector. Key partners necessary for endorsement of and commitment to the coalition work included district-level governors, police chiefs and hospital directors for each district. Initial coalition strategic planning has resulted in policies and programs to address school retention, youth development initiatives and establishment of a new drug treatment and rehabilitation clinic in addition to other developing interventions. Similarities in building coalitions, such as the need to strategically develop buy-in with key constituencies, as well as differences of whom and how partners were identified are explored.
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Affiliation(s)
- Nancy Willard
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 4200, 5200 Eastern Avenue, Baltimore, MD 21224-2780, USA
| | - Bangorn Srirojn
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Nicholas Thomson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Susan Sherman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Ellen
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Freeman P, Walker BC, Harris DR, Garofalo R, Willard N, Ellen JM. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. ACTA ACUST UNITED AC 2011; 165:736-40. [PMID: 21810635 DOI: 10.1001/archpediatrics.2011.118] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To examine methamphetamine use and its association with sexual behavior among young men who have sex with men. DESIGN Cross-sectional observational analysis. SETTING Eight US cities. PARTICIPANTS As part of the Adolescent Trials Network for HIV/AIDS Interventions, adolescent boys and young men who have sex with men, aged 12 to 24 years, were recruited from social venues (e.g., clubs, parks, and street corners) between January 3, 2005, and August 21, 2006, to complete a study survey. MAIN OUTCOME MEASURES Reported methamphetamine use in the past 90 days and reported sexual risk behavior compared with individuals reporting no hard drug use and individuals reporting hard drug use in the past 90 days. RESULTS Among 595 adolescent boys and young men, 64 reported recent methamphetamine use, and 444 reported no recent hard drug use (87 reported use of hard drugs other than methamphetamine). Recent methamphetamine use was associated with a history of sexually transmitted diseases (51.6%), 2 or more sex partners in the past 90 days (85.7%), sex with an injection drug user (51.6%), and sex with someone who has human immunodeficiency virus (32.8%) compared with individuals reporting no recent hard drug use (21.1%, 63.1%, 10.7%, and 11.1%, respectively; P < .05 for all [n = 441]). Recent users of methamphetamine were more likely to have a history of homelessness (71.9%) and were less likely to be currently attending school (35.9%) compared with individuals reporting no recent hard drug use (28.4% and 60.4%, respectively; P < .001 for both). CONCLUSIONS Adolescent boys and young men who have sex with men and use methamphetamine seem to be at high risk for human immunodeficiency virus. Prevention programs among this age group should address issues like housing, polydrug use, and educational needs.
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Affiliation(s)
- Peter Freeman
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The Johns Hopkins School of Medicine, 5200 Eastern Ave., Baltimore, MD 21224-2780, USA
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Straub DM, Arrington-Sanders R, Harris DR, Willard N, Kapogiannis B, Emmanuel P, Futterman D, Ellen JM. Correlates of HIV testing history among urban youth recruited through venue-based testing in 15 US cities. Sex Transm Dis 2011; 38:691-6. [PMID: 21758020 PMCID: PMC3155007 DOI: 10.1097/olq.0b013e318214bb70] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adolescents and young adults comprise disproportionately high percentages of individuals living with human immunodeficiency virus (HIV) and those with undiagnosed HIV. Our objective was to determine factors associated with history of HIV testing and receipt of results among a sample of urban, high-risk, sexually active adolescents in 15 US cities. METHODS A total of 20 to 30 sexually active youths, aged 12 to 24 years, were recruited to participate in an anonymous survey and HIV antibody testing at 2 to 3 venues per city identified by young men who have sex with men, young women of color, or intravenous drug users. RESULTS Of the 1457 participants, 72% reported having been previously tested for HIV (89% of whom were aware of their test results). Our sample was diverse in terms of gender, race/ethnicity, and sexual orientation. Factors found to be predictive of testing typically reflect high risk for HIV, except for some high-risk partner characteristics, including having had a partner that made the youth have sex without a condom or had a partner with unknown HIV status. Factors associated with knowledge of serostatus are reported. HIV testing seems to be more associated with sexually transmitted infection testing services than with primary care. CONCLUSIONS More strategies are needed that increase testing, including targeting partners of high-risk individuals, insuring receipt of test results, and increasing testing in primary care settings.
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Affiliation(s)
- Diane M Straub
- Department of Pediatrics, University of South Florida, Tampa, FL, USA.
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Deeds BG, Peralta L, Willard N, Ellen J, Straub DM, Castor J. The role of community resource assessments in the development of 15 adolescent health community-researcher partnerships. Prog Community Health Partnersh 2010; 2:31-9. [PMID: 20208189 DOI: 10.1353/cpr.2008.0010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Connect to Protect (C2P): Partnerships for Youth Prevention Interventions is an initiative that alters the community's structural elements to reduce youth HIV rates. OBJECTIVES This study details a community resource assessment and describes how resources were evaluated in the context of local needs. METHODS Fifteen sites developed a community resource list, conducted a brief survey, created a youth service directory, and mapped where disease prevalence and community resources intersected. Sites also completed a survey to review and verify local site findings. RESULTS On average, sites identified 267 potential community resources. Sites narrowed their resource list to conduct a brief survey with 1,162 agencies; the site average was 78. Final products of this process included maps comparing resources with risk data. CONCLUSIONS The evaluation of local resources is an important initial step in partnership development and is essential for the success of health promotion and disease prevention interventions that target adolescents.
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Chutuape KS, Willard N, Sanchez K, Straub DM, Ochoa TN, Howell K, Rivera C, Ramos I, Ellen JM. Mobilizing communities around HIV prevention for youth: how three coalitions applied key strategies to bring about structural changes. AIDS Educ Prev 2010; 22:15-27. [PMID: 20166784 PMCID: PMC2850206 DOI: 10.1521/aeap.2010.22.1.15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
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).
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Affiliation(s)
- Kate S Chutuape
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
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Ziff MA, Willard N, Harper GW, Bangi AK, Johnson J, Ellen JM. Connect to Protect Researcher-Community Partnerships: Assessing Change in Successful Collaboration Factors over Time. ACTA ACUST UNITED AC 2010; 1:32-39. [PMID: 21152354 DOI: 10.7728/0101201004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fifteen research sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions launched Connect to Protect community coalitions in urban areas across the United States and in Puerto Rico. Each coalition has the same overarching goal: Reducing local youth HIV rates by changing community structural elements such as programs, policies, and practices. These types of transformations can take significant amounts of time to achieve; thus, ongoing successful collaboration among coalition members is critical for success. As a first step toward building their coalitions, staff from each research site invited an initial group of community partners to take part in Connect to Protect activities. In this paper, we focus on these researcher-community partnerships and assess change in collaboration factors over the first year. Respondents completed the Wilder Collaboration Factors Inventory at five time points, approximately once every two to three months. Results across all fifteen coalitions show significant and positive shifts in ratings of process/structure (p<.05). This suggests that during the first year they worked together, Connect to Protect researcher-community partners strengthened their group infrastructures and operating procedures. The findings shed light on how collaboration factors evolve during coalition formation and highlight the need for future research to examine change throughout subsequent coalition phases.
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Affiliation(s)
- Mauri A Ziff
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland
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Chutuape K, Willard N, Kapogiannis BG, Ellen JM. CREATIVE AND TAILORED STRATEGIES NEEDED TO FOSTER RESEARCHER-COMMUNITY PARTNERSHIPS. Am J Public Health 2009; 99:390. [DOI: 10.2105/ajph.2008.151993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kate Chutuape
- Kate Chutuape and Nancy Willard are with the Connect to Protect research study, and the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Bill G. Kapogiannis is with the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Jonathan M. Ellen is with the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns
| | - Nancy Willard
- Kate Chutuape and Nancy Willard are with the Connect to Protect research study, and the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Bill G. Kapogiannis is with the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Jonathan M. Ellen is with the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns
| | - Bill G. Kapogiannis
- Kate Chutuape and Nancy Willard are with the Connect to Protect research study, and the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Bill G. Kapogiannis is with the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Jonathan M. Ellen is with the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns
| | - Jonathan M. Ellen
- Kate Chutuape and Nancy Willard are with the Connect to Protect research study, and the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Bill G. Kapogiannis is with the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Jonathan M. Ellen is with the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns
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Straub DM, Deeds BG, Willard N, Castor J, Peralta L, Francisco VT, Ellen J. Partnership selection and formation: a case study of developing adolescent health community-researcher partnerships in fifteen U.S. communities. J Adolesc Health 2007; 40:489-98. [PMID: 17531754 PMCID: PMC1950847 DOI: 10.1016/j.jadohealth.2006.11.136] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 09/08/2006] [Accepted: 11/14/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE This study describes the partner selection process in 15 U.S. communities developing community-researcher partnerships for the Connect to Protect (C2P): Partnerships for Youth Prevention Interventions, an initiative of the Adolescent Trials Network for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Interventions. METHODS Each site generated an epidemiological profile of urban youth in their community, selected a focus population and geographic area of youth at risk for HIV, conducted a series of successive structured interviews, and engaged in a process of relationship-building efforts culminating in a collaborative network of community agencies. RESULTS Sites chose as their primary target population young women who have sex with men (n = 8 sites), young men who have sex with men (n = 6), and intravenous drug users (n = 1). Of 1162 agencies initially interviewed, 281 of 335 approached (84%) agreed to join the partnership (average 19/site). A diverse array of community agencies were represented in the final collaborative network; specific characteristics included: 93% served the sites' target population, 54% were predominantly youth oriented, 59% were located in the geographical area of focus, and 39% reported provision of HIV/STI (sexually transmitted infection) prevention services. Relationship-building activities, development of collaborative relationships, and lessons learned, including barriers and facilitators to partnership, are also described. CONCLUSIONS Study findings address a major gap in the community partner research literature. Health researchers and policymakers need an effective partner selection framework whereby community-researcher partnerships can develop a solid foundation to address public health concerns.
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Affiliation(s)
- Diane M Straub
- Department of Pediatrics, University of South Florida, Tampa, Florida 33606, USA.
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Ellen JM, Gaydos C, Chung SE, Willard N, Lloyd LV, Rietmeijer CA. Sex partner selection, social networks, and repeat sexually transmitted infections in young men: a preliminary report. Sex Transm Dis 2006; 33:18-21. [PMID: 16385217 DOI: 10.1097/01.olq.0000187213.07551.a6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL The goal of this study was to examine the risk for repeat sexually transmitted infections (STIs) associated with reducing the number of sex partners who come from within the social networks of males 13 to 25 years old in Baltimore, Maryland, and Denver, Colorado. STUDY Asymptomatic males diagnosed with chlamydia and/or gonorrhea as part of an asymptomatic chlamydia and gonorrhea male screening project were recruited and interviewed about their sexual behaviors and their perceptions of social characteristics and sexual behaviors of their sex partners. We characterized the sex partners of each participant as belonging to or not belonging to his social network. We examined whether a decrease in percentage of sex partners who were in the participant's social network was associated with repeat infection. RESULTS There were 47 participants in Baltimore and 92 in Denver. In both cities, there was a trend toward a finding that decreasing the percentage of sex partners belonging to a participant's social network was protective for repeat STI. CONCLUSION These data suggest that interventions may need to be designed to reduce the prevalence of infection in the social networks of infected men.
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Affiliation(s)
- Jonathan M Ellen
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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Willard N. Antibiotics: the resistance problem. Aust Nurses J 1985; 14:58-9. [PMID: 3844937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Willard N. Malaria: the fight goes on. J R Soc Health 1983; 103:242-3. [PMID: 6358493 DOI: 10.1177/146642408310300614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Willard N. [Tobacco: warning to the Third World]. WHO Chron 1983; 37:98-100. [PMID: 6681464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Willard N. The riddle of three landscapes--Iran. Aust Nurses J 1970; 68:111-3. [PMID: 5200097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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