Mobilizing toward structural interventions for HIV prevention

Background: HIV/AIDS Prevention efforts continue to focus predominantly on modifying individual behavior, although public health research strongly suggests that changes to community's structural elements, such as their programs, practices, and laws or policies may result in more effective and sustainable outcomes. A 6-year, multi-site community mobilization intervention focused on altering or creating structural elements within a community in ways that will ultimately reduce HIV risk among youth. The intervention is being carried out by coalitions acting as catalysts for change in the intervention communities. Lead by partnerships of researchers and community members, the Washington, DC Coalition is one of 15 implementing this intervention across the continental United States and Puerto Rico. Design/Methods: In 2006, the Washington, DC Coalition engaged in a strategic planning process to identify structural changes that partners believed to be associated with youth HIV acquisition and transmission. Coalition capacity building, ongoing review and development of the strategic plan, and expansion of the coalition to include new key community members were core elements of the intervention, as community partners began working to integrate structural-level changes (e.g., New policy mandating HIV Risk Reduction curriculum be taught in public schools) into communities that once focused solely on individual-level prevention. Results/Outcome: The coalition's strategic plan expanded to 28 accomplished structural changes. The Coalition's membership has grown to include seven Director/Deputy Director/Bureau Chief(s), and 6-8 Executive Directors. Conclusion: This study shows that community mobilization can result in increasing levels of structural changes targeting HIV risk among youth.