Connect to Protect®: Utilizing Community Mobilization and Structural Change to Prevent HIV Infection Among Youth

Infection with HIV often results in myriad negative social, physical, and psychological consequences for adolescents and young adults. At the end of 2007, an estimated 25,036 adolescents and young adults 13 to 24 years of age were living with HIV in the 37 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting (CDC, 2010). HIV is not equally distributed among adolescents of all ethnic groups. In 2008, 50% of adolescents/young adults living with HIV were African American, 29% were White, 20% were Latino, and 1% each were Asian, American Indian/Alaska Native, and multi-ethnic (CDC, 2010). Although the primary route of HIV transmission among youth is sexual activity, differences exist across gender and sexual activity categories. In 2008, males accounted for approximately 71% of adolescents aged 13–19 years diagnosed with HIV, and 80% of young adults aged 20–24 years (CDC, 2010). HIV infections resulting from male-to-male sexual activity among adolescents/young adults increased from 57% in 2005 to 68% in 2008—the rates of HIV due to heterosexual contact decreased from 32% to 25% during this time (CDC, 2010). As HIV continues to proliferate in the adolescent and young adult populations, its impact is most predominate among young gay, bisexual, and other men who have sex with men (especially young men of color) and heterosexual young women of color. These are populations that experience varying degrees of social control and power in most societies, and experience oppression in the form of ageism, sexism, racism, and heterosexism (Diaz, Ayala, & Bein, 2004; Harper, 2007; Harper & Schneider, 2003). Such individuals may lack the social power and resources to access HIV prevention services, as well as primary medical care if they do become infected. In addition, the available HIV prevention approaches that are being implemented in communities where these young people live may be limited with regard to their cultural appropriateness (both ethnic culture and sexual orientation culture), and may not impact the larger social forces and structures that may place these youth at risk for HIV. Further, despite the disproportionately high rates of HIV infection among gay/bisexual male adolescents and other young men who have sex with men, prior reviews of rigorously evaluated HIV prevention programs for adolescents in peer-reviewed journals have almost exclusively been focused on heterosexual youth (Kim, Stanton, Li, Dickersin & Galbraith 1997; Pedlow & Carey, 2003, 2004; Robin, Dittus, Whitaker, Crosby, Ethier, et al., 2004; Rotheram-Borus, O’Keefe, Kracker & Foo, 2000; Stanton, Kim, Galbraith & Parrott, 1996).