Capacity-Building Assistance and Structural Challenges in Hiv Prevention Services

Friedman et al. produced a thoughtful essay that presented theoretical and practical considerations of underlying reasons for social and behavioral actions of African Americans. Their work revealed a higher order of social structures that can impact HIV transmission. These higher-order structures included themes of survival, struggle, and propriety found in African American communities.1 While we applaud them in their analyses of myriad higher-order oppressive realities that can affect African Americans, we also were pleased that the authors made reference to practical community- and faith-based organizational challenges that affect deliverance of HIV prevention information and services. Often, organizations that are empowered to deliver prevention interventions encounter obstacles that inhibit their service. These obstacles can structurally threaten the feasibility and sustainability of the organizations. Through assessments of organizational capacity to deliver services, public health agencies have identified the need to provide capacity-building assistance to organizations to assist them in delivering interventions with fidelity.2 For example, the authors noted that a major deterrence to service can be found in untrained staff who adhere to the “propriety theme” and thus the inadvertent stigmatization of clients.1 The fight to combat new transmission rates must be conducted not only at the individual level but also at the community level and through organizations that are culturally sensitive to the clients that they serve. Building the capacity of the community- and faith-based organizations is a necessity when considering the practical assessment of HIV prevention in the context of communities of color. For many of the reasons mentioned in the Friedman et al. article, particularly given histories of oppression and funding shortages, many organizations have been inhibited in their work. Therefore, to assist in overcoming structural inadequacies, public health agencies and others have instituted capacity-building services for organizations. There has been such a need for this assistance that, according to a July 2009 report by the National Alliance of State and Territorial AIDS Directors and the Kaiser Family Foundation, helping organizations to reach target populations and to build capacity were the second and third challenges facing health departments, just behind the primary issue of funding.3 Public health agencies realize that the environmental and structural forces that enable HIV transmission to continue at epidemic rates in minority communities can only change with community involvement. Notwithstanding errant situations, it may be possible, through organizational capacity building, to alter some structural problems at the community and individual level

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• Structural and Social Contexts of HIV Risk Among African Americans

  R Friedman, Samuel R Friedman et al.•American Journal of Public Health•2009

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