Predictors of Voting and Advocacy Engagement Among Clients of a Community-Based HIV Service Organization

Background and Purpose: Social and structural determinants of health have long proven to significantly contribute to HIV risk and health outcomes. Accordingly, structural interventions have increasingly been implemented to alter the HIV risk environment, addressing issues such as stigma, homelessness and health policy. Achieving structural change requires sustained civic engagement by people with HIV and allies. Community-based HIV service organizations (CBHSO) are well-positioned to foster civic engagement among the communities they serve. However, scant research has examined HIV advocacy engagement within CBHSOs or whether issue-based advocacy is related to broader forms of civic engagement, such as voting. This study examines predictors of advocacy and voting among clients of a large CBHSO in New York City with a history of policy advocacy and engagement in direct action.

Methods: Researchers developed and administered a survey about voting and advocacy participation to clients of a CBHSO (N=244) after the 2016 Presidential election. Descriptive statistics captured rates of voting and various advocacy activities. A multinomial logit model was used to identify predictors of advocacy level (no advocacy, low advocacy, high advocacy). Logistic regression was used to identify predictors of voting behavior. Significance was set to a p-value of 0.05 or less.

Results: Sixty-four percent of respondents reported participating in some form of advocacy. Low investment activities included signing a petition (37%) and attending a press conference, march, rally or demonstration (24%). High investment advocacy activities included travelling to the capitol to meet with a government official (18%) and speaking at a public meeting (9%). Clients were significantly more likely to engage in advocacy if they identified as non cisgender (odds ratio {OR} 4.8), were HIV positive (OR 1.81), or were over 50 years of age (OR 3.4).  Overall, high levels of voting were reported (60%, 87% of those registered).  Voting was significantly predicted by level of advocacy engagement (low advocacy OR 5.77, high advocacy OR 7.19, compared to no advocacy), identifying as lesbian, gay or bisexual (OR 2.52), and identifying as cis-female (OR 2.36).                   

Conclusions and Implications: For community-based agencies to meet social work goals of ‘achieving equal opportunity, equity, and justice’ clients must be engaged as citizens and self-advocates, not simply service recipients. Our study finds that a high level of advocacy engagement among clients is achievable when an organizational culture of social change is maintained. Voter mobilization is additionally critically important in an era of low voting rates and high barriers to voting for marginalized groups. We found that participation in CBHSO-initiated advocacy is strongly associated with voting, suggesting that issue-based advocacy may facilitate broader political efficacy and consciousness raising.  Within a political climate increasingly hostile to the needs of marginalized groups, social workers are called on to strengthen the political voice of the communities with whom we work.