Individual action and community context: the Health Intervention Project

HIV risk-reduction efforts have traditionally focused on the individual. The need for including the role of the social context and community is being recognized. Social capital provides social relationships and potential resources that may hinder or trigger risk or protective health behaviors, especially for individuals with limited economic means.

Sixty-five adult inner-city female drug users, who were included in a woman-focused HIV risk-reduction intervention trial, participated in in-depth interviews in Atlanta, Georgia, between 2002 and 2004. The interviews focused on the women's individual behavioral changes during the 6 months since completion of the intervention as well as on the impact of community conditions. Topics discussed were sexual and drug use behaviors, social relationships, social capital, and community physical and social infrastructure. The data were analyzed using the constant comparison methods.

The respondents indicated that poor physical and social infrastructure led to alienation and negatively affected their behavioral change efforts. Social capital and social support mediated these negative influences. Drug-related violence was especially debilitating in their efforts to reduce HIV risk associated with crack cocaine or injection drug use and associated sexual behavior. Environmental conditions and opportunity structures played salient roles in the women's success.

Individual actions and community context must be considered simultaneously when facilitating and assessing behavioral interventions.