Youth health outcomes from the Connect-to-Protect coalitions to prevent adolescent HIV infections

ABSTRACT

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect-to-Protect coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.

KEYWORDS:

• HIV/AIDS
• coalitions
• structural change
• HIV testing
• HIV risk behavior
• adolescents

Acknowledgements

The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) is funded by Grants Nos. 5 U01 HD040533 and 5 U01 HD 40474 from the National Institutes of Health through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (B. Kapogiannis, MD), with supplemental funding from the National Institute on Drug Abuse (K. Davenny, PhD), National Institute of Mental Health (P. Brouwers, PhD) and National Institute on Minority Health and Health Disparities (R. Berzon, PhD). The study was scientifically reviewed by the ATN’s Community and Prevention Leadership Group. Network scientific and logistical support was provided by the ATN Coordinating Center (C. Wilson, C. Partlow, J. Merchant) at the University of Alabama at Birmingham. Network operations support was provided by the ATN Data and Operations Center at Westat, Inc. (B. Harris, B. Driver). We would like to thank and acknowledge the contribution of the investigators and staff at the following ATN sites that participated in Connect to Protect: Children’s Diagnostic and Treatment Center (Ana Puga, MD, Jessica Roy, MSW, Jamie Blood, MSW); Children’s Hospital of Los Angeles (Marvin Belzer, MD, Miguel Martinez, MSW/MPH, Veronica Montenegro, MPH); John H. Stroger Jr. Hospital of Cook County and the CORE Center (Lisa Henry-Reid, MD, Jaime Martinez, MD, Ciuinal Lewis, MS, Antionette McFadden, BA); Children’s Hospital National Medical Center (Lawrence D’Angelo, MD, William Barnes, PhD, Stephanie Stines, MPH); Montefiore Medical Center (Donna Futterman, MD, Michelle Lyle, MPH, Bianca Lopez, MPH); Mount Sinai Medical Center (Linda Levin-Carmine, MD, Meg Jones, MPH, Michael Camacho, BA); Tulane University Health Sciences Center (Sue Ellen Abdalian, MD, Sybil Schroeder, PhD); University of Maryland (Ligia Peralta, MD, Bethany Griffin-Deeds, PhD, Kalima Young, BA); University of Miami School of Medicine (Lawrence Friedman, MD, Kenia Sanchez, MSW); Children’s Hospital of Philadelphia (Bret Rudy, MD, Marne Castillo, PhD, Alison Lin, MPH); University of Puerto Rico (Irma Febo, MD, Carmen Rivera RN, MPH), University of California at San Francisco (Barbara Moscicki, MD, Johanna Breyer, MSW, Kevin Sniecinski, MPH) and University of South Florida (Patricia Emmanuel, MD, Amanda Schall, MA, Rachel Stewart-Campbell, BA). The investigators are grateful to the members of the local youth Community Advisory Boards for their insight and counsel and are indebted to the youth who participated in this study. We acknowledge the feedback and assistance of Trevor Stzyrzykowski, Chelsea Schmidt, Hannah Spring and Alexandra Watson. The comments and views of the authors do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) is funded by Grants Nos. 5 U01 HD040533 and 5 U01 HD 40474 from the National Institutes of Health through the National Institute of Child Health and Human Development (B. Kapogiannis, MD), with supplemental funding from the National Institute on Drug Abuse (K. Davenny, PhD), National Institute of Mental Health (P. Brouwers, PhD) and National Institute on Minority Health and Health Disparities (R. Berzon, PhD). Eunice Kennedy Shriver National Institute of Child Health and Human Development in the identified location(s).