Changing Risk While Changing Structures: The Potential of a University-Based HIV Prevention Intervention

Background

HIV rates continue to rise among youth and young adults: individuals ages 13-24 comprise a quarter of new HIV infections, over half of them are unaware that they are infected, and a disproportionate amount are African American or Latino. . Universities are unique sites for service implementation because they have the infrastructure to support services, offer access to an otherwise difficult to reach population, and prioritize knowledge sharing among all entities. Substance Use, Mental Health, and HIV/AIDS Risk Assessment and Testing (SMART Cougars) is a HIV intervention that provides HIV testing and education, mental health, and substance abuse services and referrals to minority young adults on a university campus campus. SMART Cougars aims to change the university environment and ideology, ultimately constructing a stigma-free atmosphere through service provision. However, little is known about the ways in which such interventions actually change the structural environment. Thus, the objective of this paper is to examine the ways in which SMART Cougars changed the structural environment of the university campus.

Methods

SMART Cougars, a partnership between university and community, provides a bundled intervention consisting of mental health and substance use screening; HIV Counseling, Testing, and Referral; and Prevention Counseling on a large university campus in the Southern US. Data were collected through participant observation, in-depth semi-structured interviews with SMART Cougars staff, and quantitative and qualitative data collected from study participants (n=80). Thematic analysis was utilized.

 

Results

SMART Cougars changed the structural environment of the university in three distinct yet interconnected ways:

a) Working within the university’s and community’s political environment by understanding multiple perspectives: Researchers utilized tactics rooted in social work to manage differing political ideologies in the university, ultimately resulting in getting individuals on board to promote HIV testing at the university.

b) Engaging in co-learning processes: A space for exchanging ideas, among university staff, students, community members, ultimately led to creative ideas for program implementation; Specifically, SMART Cougars has increased the conversation about mental health, substance use, and HIV/AIDS among UH students by participating in 80 UH campus and 50 community events, continuous appearance in the headlines of the UH newspaper, and distributed more than 3000 brochures on campus and the surrounding community;

c) Utilizing a strengths-based approach: Partners capitalized on their strengths to uniquely contribute to SMART Cougars. Strong university-community partnerships are essential to enhance public health and examination of key processes has implications for future university-based programs.

Discussion

This study adds to the current social work knowledge base by isolating the ways SMART Cougars changed the structural environment of the university in the context of HIV stigma: Working within the political environment, engaging in a co-learning process, and utilizing a strengths-based perspective. While individual sexual choices are important (i.e. condom use), structural factors are important because they have the potential be a barrier to HIV testing. These findings have the potential to inform other university-based interventions and thus, ensure a healthy development of all youth.