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Lesbian, gay, bisexual, transgender, queer, intersex, Two-Spirit, and other sexual and gender minority (LGBTQ+) individuals encounter numerous obstacles to equity across health and healthcare, education, housing, employment, and other domains. Such barriers are even greater for LGBTQ+ individuals who are also Black, Indigenous, and People of Color (BIPOC), as well as those who are disabled, and those who are working-class, poor, and otherwise economically disadvantaged, among other intersecting forms of oppression. Given this, an evaluation cannot be equitable for LGBTQ+ people without meaningfully including our experiences and voices. Unfortunately, all evidence indicates that evaluation has systematically failed to recognize the presence and value of LGBTQ+ populations. Thus, we propose critical action steps and the articulation of a new paradigm of LGBTQ+ Evaluation. Our recommendations are grounded in transformative, equitable, culturally responsive, and decolonial frameworks, as well as our own experiences as LGBTQ+ evaluators and accomplices. We conclude by inviting others to participate in the articulation and enactment of this new paradigm.

In 2003, Michigan implemented a reentry service to assist HIV-infected people incarcerated in state prisons in linking to HIV medical care immediately upon their release. We examined whether formerly incarcerated people were linked to care successfully, remained in care, and were in good health 3 years after their date of release. In all, 190 people used the service over the 5 years following its inception. Only a minority of those who were alive and not reincarcerated at the time of the evaluation engaged consistently with medical care. Unsurprisingly given low rates of engagement in care, 3 years after their release only 27% had achieved viral suppression. Concerted efforts to support formerly incarcerated HIV-infected individuals' engagement in care over the long term are urgently needed.

In the United States, youth aged 13-24 comprised approximately 21% of new HIV infections in 2017; 13% of these infections occurred among women, the majority of whom (86%) acquired HIV through heterosexual contact (Centers for Disease Control and Prevention. 2019a. HIV and youth. Retrieved from https://www.cdc.gov/hiv/group/age/youth/index.html, Centers for Disease Control and Prevention. 2019b. HIV among women. Retrieved from https://www.cdc.gov/hiv/group/gender/women/index.html). We fit and validated a developmentally appropriate empirical model of Connell's Theory of Gender and Power (Connell, R. W. 1987. Gender and power: Society, the person and sexual politics. Stanford, CA: Stanford University Press, Connell, R. W. 2013. Gender and power: Society, the person and sexual politics. Hoboken, NJ: John Wiley & Sons) in a sample of young women and assessed whether gendered powerlessness reflected a multidimensional higher-order latent factor, as the theory implies. Anonymous computer-assisted interviews were administered to at-risk, sexually active young women (N = 1,101). Factor analyses and structural equation modeling were used to determine the dimensionality of gendered powerlessness. Associations with condom use were examined to validate the model. We fit a three-component model of gendered powerlessness, but not a higher-order latent factor. We observed that high scores on two dimensions of gendered powerlessness - cathexis and sexual division of power - were associated with lower likelihood of condom use. Our three-component model helps elucidate the role that components of gendered powerlessness play in young women's health behaviors and underscores the need for measures tailored to young women at high risk of contracting HIV.

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.

Using an ecological perspective, we sought to elucidate the perceived barriers preventing HIV service access among two groups of U.S. youth (ages 12-24) disproportionately affected by HIV, men who have sex with men and high-risk women. We content analyzed interviews with 318 key informants to identify distinct service barriers. The 29 barriers informants named were organized into six categories (service-seeking demands, stigmas, knowledge and awareness, service quality, powerful opposition, and negative emotions). Findings suggest that barriers impacting access to HIV prevention, testing, and linkage-to-care services are remarkably similar and point to the need for comprehensive approaches to improving youth's access services that address both individual-level barriers and extra-individual barriers simultaneously. Findings can be used to guide future research, programming and interventions to reduce the disproportionate spread of HIV among US youth.

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect to Protect (C2P) coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2,248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking, and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.

Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.

ImportanceMost human immunodeficiency virus (HIV)-infected youths are unaware of their serostatus (approximately 60%) and therefore not linked to HIV medical or prevention services. The need to identify promising and scalable approaches to promote uptake of HIV testing among youths at risk is critical.ObjectiveTo evaluate a multisite HIV testing program designed to encourage localized HIV testing programs focused on self-identified sexual minority males and to link youths to appropriate prevention services after receipt of their test results.Design, setting, and participantsTesting strategies were evaluated using an observational design during a 9-month period (June 1, 2015, through February 28, 2016). Testing strategies were implemented by 12 adolescent medicine HIV primary care programs and included targeted testing, universal testing, or a combination. Data were collected from local youth at high risk of HIV infection and, specifically, sexual minority males of color.Main outcomes and measuresProportion of sexual minority males and sexual minority males of color tested, proportion of previously undiagnosed HIV-positive youths identified, and rates of linkage to prevention services.ResultsA total of 3301 youths underwent HIV testing. Overall, 35 (3.6%) of those who underwent universal testing in primary care clinical settings, such as emergency departments and community health centers, were sexual minority males (35 [3.6%] were males of color) compared with 236 (46.7%) (201 [39.8%] were males of color) who were tested through targeted testing and 693 (37.8%) (503 [27.4%] were males of color) through combination efforts. Identification of new HIV-positive cases varied by strategy: 1 (0.1%) via universal testing, 39 (2.1%) through combination testing, and 16 (3.2%) through targeted testing. However, when targeted tests were separated from universal testing results for sites using a combined strategy, the rate of newly identified HIV-positive cases identified through universal testing decreased to 1 (0.1%). Rates of new HIV-positive cases identified through targeted testing increased to 49 (6.3%). Youths who tested through targeted testing (416 [85.1%]) were more likely to link successfully to local HIV prevention services, including preexposure prophylaxis, compared with those who underwent universal testing (328 [34.1%]).Conclusions and relevanceThe findings suggest that community-based targeted approaches to HIV testing are more effective than universal screening for reaching young sexual minority males (especially males of color), identifying previously undiagnosed HIV-positive youths, and linking HIV-negative youths to relevant prevention services. Targeted, community-based HIV testing strategies hold promise as a scalable and effective means to identify high-risk youths who are unaware of their HIV status.

The purpose of this study was to examine one interpersonal relationship--natural mentoring relationships--that may promote healthy development among young Black men who have sex with men (YBMSM), a population at disproportionate risk of multiple psychosocial health issues. We analyzed data from interviews with 168 YBMSM. We used content analysis to identify who participants cited as mentors, their personal characteristics, and the functions they played in youths' lives. Participants frequently cited women and family members as mentors. Participants preferred as mentors people with whom they shared key attributes and who they considered successful and resilient. Mentors played roles in participant's identity construction, cognitive development, and emotional development. Findings suggest that mentors have significant influence in the development of YBMSM. Incorporating natural mentors into health promotion interventions may be one means of enhancing the cultural relevance of interventions for this population.

Introduction: Sickle cell disease is an inherited disorder characterized by hemoglobin S polymerization leading to vaso-occlusion and hemolytic anemia. These result in a variety of pathological events, causing both acute and chronic complications. Millions around the world are affected by sickle cell disease with predominance in sub-Saharan Africa. Hydroxyurea was the first drug approved for use in sickle cell disease to reduce the occurrence of painful crises and blood transfusions in patients with frequent, moderate to severe painful crises. Areas covered: With the development of new therapeutics, the role of hydroxyurea is evolving. This narrative review aims to provide clinical data, safety information, and supplementary evidence for the role of hydroxyurea in the current era of sickle cell disease. A comprehensive literature search of databases, including PubMed and Cochrane Library, was conducted from 1963 to 2024. Expert opinion: Even though new medications have been approved for sickle cell disease, hydroxyurea remains the gold standard. Hydroxyurea is not only a disease modifier but it has additional clinical benefits, it is affordable, and its longevity has prompted expanded research in areas such as underutilization and pharmacogenomics. As the treatment landscape evolves, hydroxyurea's long-standing record of efficacy and safety continues to support its role as a key agent in disease management. [ABSTRACT FROM AUTHOR]

Reducing HIV incidence among adolescents represents an urgent global priority. Structural change approaches to HIV prevention may reduce youth risk by addressing the economic, social, cultural, and political factors that elevate it. We assessed whether achievement of structural changes made by eight Connect-to-Protect (C2P) coalitions were associated with improvements in youth's views of their community over the first 4 years of coalitions' mobilization. We recruited annual cross-sectional samples of targeted youth from each C2P community. We sampled youth in neighborhood venues. We interviewed a total of 2461 youth over 4 years. Males (66 %) and youth of color comprised the majority (52 % Hispanic/Latinos; 41 % African Americans) of those interviewed. By year 4, youth reported greater satisfaction with their community as a youth-supportive setting. They reported their needs were better met by available community resources compared with year 1. However, these findings were moderated by risk population such that those from communities where C2P focused on young men who have sex with men (YMSM) reported no changes over time whereas those from communities focused on other at-risk youth reported significant improvements over time in satisfaction and resource needs being met. Internalized HIV stigma increased over time among those from communities serving other at-risk youth and was unchanged among those from YMSM communities. The very different results we observe over time between communities focused on YMSM versus other at-risk youth may suggest it is unreasonable to assume identical chains of structural causality across youth populations who have such different historical relationships to HIV and who encounter very different kinds of entrenched discrimination within their communities.

William Dean Crano is the Stuart Oskamp Distinguished Professor of Psychology in the School of Behavioral and Organizational Sciences at Claremont Graduate University. A social psychologist, Crano received his MS and PhD degrees from Northwestern University, where Donald T. Campbell was his advisor and mentor. Dr. Crano has served on the faculties of Michigan State, Texas A&M, and the University of Arizona. At Michigan State, he founded and directed the Center for Evaluation and Assessment. At Texas A&M, he directed the Public Policy Resources Laboratory. At Arizona, he was Head of the Department of Communication. Dr. Crano has held several posts outside the academy. He served as the program director in social psychology for the National Science Foundation. He has been Liaison Scientist in the behavioral sciences for the Office of Naval Research, London. Dr. Crano also was a North Atlantic Treaty Organization Senior Scientist. He had served on numerous commissions, review panels, committees, and advisory positions. In the edited transcript that follows, Dr. Crano describes his training, especially his experience with and observations about Don Campbell. He also discusses his own work in evaluation, his ideas about formative research and program theory, and his assessment of the current status and future potential of evaluation. [Co-written with The Oral History Project Team.]

Since 2003, the Oral History Project Team has conducted interviews with individuals who have made particularly noteworthy contributions to the theory and practice of evaluation. In 2013, Mel Mark, Valerie Caracelli, and Miles McNall sat with Thomas Cook in Washington, D.C., during the American Evaluation Association (AEA) annual conference. The interview was taped and subsequently transcribed verbatim into a 37-page document. The authors edited the transcript for clarity and length. Cook reviewed and approved the final product prior to its submission to "American Journal of Evaluation." Thomas D. Cook was the Joan and Sarepta Harrison Chair of Ethics and Justice at Northwestern University, where he is professor emeritus of sociology, psychology, education, and social policy. Cook is well known for his work on social science methods, especially for his books on quasi-experiments with Donald Campbell and William R. Shadish. In this contribution to the oral history project, Cook describes how he went from working on a PhD in German literature to working in the Department of Psychology at Northwestern, where Donald Campbell provided his entrée to program evaluation. Cook describes his initial evaluation project, the early history of the Evaluation Research Society (ERS), the writing of the Cook and Campbell book on quasi-experimentation, Cronbach's alternative view of validity, mixed methods and critical multiplism, and more. [This article was written with the Oral History Project Team, which consists of Robin Lin Miller, Jean A. King, Melvin M. Mark, and Valerie Caracelli.]

PurposeHispanic/Latino adolescents and young adults are disproportionately impacted by the HIV/AIDS epidemic; yet little is known about the best strategies to increase HIV testing in this group. Network-based approaches are feasible and acceptable means for screening at-risk adults for HIV infection, but it is unknown whether these approaches are appropriate for at-risk young Hispanics/Latinos. Thus, we compared an alternative venue-based testing (AVT) strategy with a social and sexual network-based interviewing and HIV testing (SSNIT) strategy.MethodsAll participants were Hispanics/Latinos aged 13-24 years with self-reported HIV risk; they were recruited from 11 cities in the United States and Puerto Rico and completed an audio computer-assisted self-interview and underwent HIV screening.ResultsA total of 1,596 participants (94.5% of those approached) were enrolled: 784 (49.1%) through AVT and 812 (50.9%) through SSNIT. HIV infection was identified in three SSNIT (.37%) and four AVT (.51%) participants (p = .7213).ConclusionsDespite high levels of HIV risk, a low prevalence of HIV infection was identified with no differences by recruitment strategy. We found overwhelming support for the acceptability and feasibility of AVT and SSNIT for engaging and screening at-risk young Hispanics/Latinos. Further research is needed to better understand how to strategically implement such strategies to improve identification of undiagnosed HIV infection.

Third-sector organizations (TSOs) are recognized for having a unique and essential role in designing and delivering community-centred, sustainable health and well-being services. A World Café workshop at the 2023 International Conference on Integrated Care to explore perspectives on the questions explored the question: How do we characterize the role of the Third Sector in Integrated Care Systems? Are they Partners, Service Providers, Both or Neither? Attendees from Canada, England, Scotland, Wales, Ireland, Belgium, Denmark, and the Netherlands shared perspectives regarding facilitators and barriers to engaging TSOs in integrated care systems, drawing on experiences and practices from their communities and health systems. Building from participant perspectives, we posit that while cross-sectoral alliances between government and voluntary organizations are possible, and this engagement can contribute substantial health-promoting value to society, much work remains to be done. Meaningful collaboration requires attitudinal shifts, new working methods, rebalancing power within the relationships, and sufficient resources to support the collaboration. Creative approaches to facilitating positive engagement of TSOs within integrated care systems can address long-standing barriers and misunderstandings. Sharing and learning through research, evaluations, and networks is essential to achieve integrated care systems based on trust and committed collaboration. [ABSTRACT FROM AUTHOR]