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Changes to HIV-related interventions failed to reduce risk behaviors
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Structural changes to community coalitions whose goal was to decrease HIV infection rates among children in at-risk communities did not significantly reduce risk behaviors, according to study findings in JAMA Pediatrics.
“Structural interventions target public and private entities (eg, federal agencies, private homeless shelters, and public school systems) with the goal of fostering changes in policy and practice that will facilitate positive behavioral changes in individuals,” Jonathan M. Ellen, MD, of All Children’s Hospital, Johns Hopkins Medicine, in St. Petersburg, Fla., and colleagues wrote. “The objective of this study is to determine whether structural changes achieved through a project called Connect to Protect (C2P): Partnerships for Youth Prevention Interventions are associated with an effect on individual risk factors associated with HIV acquisition and transmission.”
Jonathan M. Ellen
The C2P coalitions were tasked to develop and implement structural changes, such as new or modified policies, programs and practices that address risk factors associated with HIV. To assess the effects structural changes had on HIV risk behaviors, researchers collected data through four anonymous cross-sectional surveys administered annually to eight US research sites from March 2007 to July 2010. The analyses included 2,392 participants, aged 12 to 24 years.
Structural changes were graded by researchers based on their perceived ability to influence behaviors. Changes were assigned one point for lower-effect traditional changes and two points for changes with higher effects.
Exposure to structural changes was not associated with any risk-related factors, according to researchers. A 10-unit increase in structural change score yielded an OR of 0.88 (95% CI, .76-1.03) for having a sexual partner aged 25 years or older. Although this implied a lower likelihood of engaging in risk behavior, it was not statistically significant.
Associations between structural change scores and variables related to condom use with casual sex partners indicated a link between higher scores and condom use no more than half the time (OR=0.91; 95% CI, 0.6-1.39), but the association also was not statistically significant.
“While there were some suggested associations between [structural change objective] scores and risk factors in the bivariate analysis (eg, condom use with casual partners), the outcome variables selected for this analysis were not statistically significantly associated with structural changes,” the researchers wrote. “These null findings highlight the challenges of evaluating interventions focused on making structural changes that span the spectrum of community sectors and target varying social-ecologic levels.”
Disclosure: The researchers report no relevant financial disclosures.
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