TY - JOUR
T1 - Structural Effects on HIV Risk Among Youth
T2 - A Multi-level Analysis
AU - Miller, Robin Lin
AU - Strzyzykowski, Trevor
AU - Lee, Kyung Sook
AU - Chiaramonte, Danielle
AU - Acevedo-Polakovich, Ignacio
AU - Spring, Hannah
AU - Santiago-Rivera, Olga
AU - Boyer, Cherrie B.
AU - Ellen, Jonathan M.
N1 - Funding Information:
Acknowledgements This work was supported by The Adolescent Trials Network for HIV/AIDS Interventions (ATN) with funding from the National Institutes of Health [U01 HD 040533 and U01 HD 040474] through the National Institute of Child Health and Human Development (B. Kapogiannis), with supplemental funding from the National Institutes on Drug Abuse (S. Kahana) and Mental Health (P. Brouwers, S. Allison). We acknowledge the contribution of the investigators and staff at the following Adolescent Medicine Trials Units (AMTUs) that participated in this research: Children’s Hospital of Los Angeles (Marvin Belzer, MD, Miguel Martinez, MSW/MPH, Julia Dudek, MPH, Milton Smith, BA); John H. Stroger Jr. Hospital of Cook County and the CORE Center (Lisa Henry-Reid, MD, Jaime Martinez, MD, Ciuinal Lewis, MS, Atara Young, MS, Jolietta Holliman, Antoinette McFad-den, BA); Children’s Hospital National Medical Center (Lawrence D’Angelo, MD, William Barnes, Ph.D., Stephanie Stines, MPH, Jen-nifer Sinkfield, MPH) Montefiore Medical Center (Donna Futterman, MD, Bianca Lopez, MPH, Elizabeth Spurrell, MPH, LCSW, Rebecca Shore, MPH); Tulane University Health Sciences Center (Sue Ellen Abdalian, MD, Nadrine Hayden, BS; St. Jude Children’s Research Hospital (Patricia Flynn, MD, Aditya Guar, MD, Andrea Stubbs, MPH);
Funding Information:
Funding This study was funded by the National Institute of Child Health and Human Development, with supplemental funding from the National Institutes on Drug Abuse and the National Institute of Mental Health (U01 HD 040533 and U01 HD 040474).
PY - 2018/11/1
Y1 - 2018/11/1
N2 - We proposed a multilevel model of structural influences on HIV-risky sexual partnerships in a diverse sample of 1793 youth residing in 23 states and the District of Columbia. We examined the influence of concentrated disadvantage, HIV stigma, and sexual and gender minority stigma on engagement in HIV risky sexual partnerships and whether youth’s participation in opportunity structures, anticipation of HIV stigma, and perceptions of their community as youth-supportive settings mediated structural effects. After controlling for age, HIV status, and race, we found structural HIV stigma had deleterious indirect effects on youth’s participation in HIV-risky sexual partnerships. Concentrated disadvantage and structural sexual and gender minority stigma had direct negative effects on youth’s perceptions of their communities as supportive and on their participation in prosocial activity. Support perceptions had direct, protective effects on avoidance of HIV-risky sexual partnerships. Structural stigma undermines youth’s belief that their communities invest in their safety and well-being.
AB - We proposed a multilevel model of structural influences on HIV-risky sexual partnerships in a diverse sample of 1793 youth residing in 23 states and the District of Columbia. We examined the influence of concentrated disadvantage, HIV stigma, and sexual and gender minority stigma on engagement in HIV risky sexual partnerships and whether youth’s participation in opportunity structures, anticipation of HIV stigma, and perceptions of their community as youth-supportive settings mediated structural effects. After controlling for age, HIV status, and race, we found structural HIV stigma had deleterious indirect effects on youth’s participation in HIV-risky sexual partnerships. Concentrated disadvantage and structural sexual and gender minority stigma had direct negative effects on youth’s perceptions of their communities as supportive and on their participation in prosocial activity. Support perceptions had direct, protective effects on avoidance of HIV-risky sexual partnerships. Structural stigma undermines youth’s belief that their communities invest in their safety and well-being.
KW - Concentrated disadvantage
KW - HIV risk behavior
KW - High-risk youth
KW - Structural stigma
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U2 - 10.1007/s10461-018-2031-7
DO - 10.1007/s10461-018-2031-7
M3 - Article
C2 - 29340914
AN - SCOPUS:85040560828
VL - 22
SP - 3451
EP - 3467
JO - AIDS and Behavior
JF - AIDS and Behavior
SN - 1090-7165
IS - 11
ER -