HEALTH EDUCATION RESEARCH
Theory & Practice
Vol.17 no.4 2002
Pages 389–403
The protective effects of community involvement for
HIV risk behavior: a conceptual framework
J. Ramirez-Valles
Abstract
This paper presents a conceptual framework of
the protective effects of community involvement
in HIV/AIDS-related groups and organizations
for HIV sexual risk behavior among gay and
bisexual men. The framework delineates hypotheses for future research, and provides a guide
for prevention programs based on the active and
direct involvement of participants, particularly
communities of color. The framework (1) argues
that community involvement moderates the
association between three socio-structural risk
factors (i.e. poverty, homophobia and racism)
and sexual risk behavior; (2) posits that community involvement in HIV/AIDS reduces
sexual risk behavior via its effects on four
mediating factors (i.e. peer norms, self-efficacy,
positive self-identity and alienation); (3) proposes five socio-cultural barriers to and facilitators of community involvement in HIV/AIDS
(i.e. motives for participation, poverty, acculturation, stigma and perceived opportunities);
and (4) addresses burnout as one potential
negative consequence of community involvement in HIV/AIDS-related organizations and
groups. The conceptual framework advances
the understanding of HIV sexual risk behavior
by integrating both its socio-structural risk
and protective factors. It contributes to health
education by specifying how interventions based
on collective action (e.g. community involve-
School of Public Health, University of Illinois–Chicago,
1603 W. Taylor (m/c 923), Chicago, IL 60612-4394, USA
© Oxford University Press 2002. All rights reserved
ment) for social change may be effective in
generating healthy behaviors at individual and
community levels.
Introduction
Community involvement has played a central role
in the fight against HIV/AIDS since the beginning
of the epidemic in generating individual and
social change. Volunteers and activists led the first
educational, prevention and care activities, and
created community-based organizations in the most
affected populations (Arno, 1986; Kobasa, 1990;
Perrow and Guillen, 1990; Chambre, 1991). They
created a culture of safer sex in their communities.
Furthermore, in the process of mobilizing, volunteers and activists transformed themselves. They
became educated about the risks and prevention
measures for HIV/AIDS; developed a sense of
community and a positive self-identity in spite
of the stigma associated with being gay men in
the times of AIDS; and mobilized their social
networks and social support to cope with their
individual and community stressors. Thus, individuals’ community involvement may have critical
public health implications. First, through their
involvement in HIV/AIDS-related organizations
and efforts, individuals develop and maintain a
positive sense of themselves, and become educated
and conscious of HIV/AIDS risks and preventive
behaviors. Second, via this involvement individuals
affect change in their communities and make health
interventions culturally appropriate and sustainable
(Snyder and Omoto, 1992; Omoto et al., 1993;
Coates et al., 1995; Zimmerman et al., 1997; Kelly,
1999). Yet, research and prevention programs
389
J. Ramirez-Valles
have overlooked community involvement as a
mechanism to reduce HIV sexual risk behavior,
particularly among minority gay and bisexual men.
The aim of this paper is to present a conceptual
framework of the protective effects of community
involvement in HIV/AIDS-related groups and
organizations for HIV/AIDS sexual risk behavior
among gay or bisexual men. This is the first attempt
to integrate research from several fields and the
specific variables affecting minority gay and
bisexual men’s HIV risk behavior and community
involvement in HIV/AIDS. Although there is a
rich literature on activism and volunteerism [e.g.
(McAdam, 1989; Abrahams, 1996; Putnman,
2000)], and particularly around other health-related
issues [e.g. (Brown and Mikkelsen, 1990; Boehmer,
2000)], it does not speak directly to the HIV/AIDS
context and the lives of gay and bisexual men.
Furthermore, this literature cannot be easily translated into prevention programs. The major premise
of this conceptual framework is that the promotion
of community involvement, such as activism and
volunteering, is an effective prevention strategy
because individuals learn by doing while generating social change (Freire, 1970). The framework
delineates hypotheses for future research and provides a guide for prevention programs based on
the active and direct involvement of participants,
particularly communities of color.
In the following sections, I start by discussing
the state of research on community involvement
in HIV/AIDS and define the concept of community
involvement. Next, I present the framework of the
protective effects of community involvement in
HIV/AIDS among gay and bisexual men. First, I
argue that community involvement moderates the
association between three socio-structural risk
factors (i.e. poverty, homophobia and racism) and
sexual risk behavior. Second, I propose that community involvement in HIV/AIDS reduces sexual
risk behavior via its effects on four mediating
factors (i.e. peer norms, self-efficacy, positive selfidentity and alienation). Third, I discuss five sociocultural barriers to and facilitators of community
involvement in HIV/AIDS (i.e. motives for participation, poverty, acculturation, stigma and per-
390
ceived opportunities). Finally, I address burnout as
one of the potential negative consequences of
community involvement in HIV/AIDS-related
organizations and groups.
Community involvement in HIV/AIDS
What we know about the antecedents, processes
and consequences of community involvement in
HIV/AIDS has come from anecdotal data,
testimonials and a handful of studies among white
volunteers and activists, mainly gay and bisexual
men [e.g. (Kobasa, 1990; Valentgas et al., 1990;
Chambre, 1991; Bebbington and Gatter, 1994;
Omoto and Snyder, 1995; Ouellette et al., 1995;
Stewart and Weinstein, 1997; Boehmer, 2000)].
The value of these studies has been in documenting
the grassroots efforts of gay and bisexual men,
and in suggesting that community involvement in
HIV/AIDS has positive effects on participants’
safer sex practices, social acceptance and selfidentity. There is, however, no systematic research
or theory to support those observations and to
explicate how community involvement affects safer
sex behavior.
One of the limitations of those studies is their
reliance on the concepts of volunteerism and
activism to describe gay and bisexual men’s participation in HIV/AIDS-related organizations.
Volunteerism, activism or community involvement
are rarely defined in the literature and they are
usually measured by a single dichotomous variable
(e.g. volunteer, yes/no) or a list of volunteeringrelated activities, overlooking other dimensions,
such as the frequency and length of involvement
and the meaning (or importance) individuals attach
to their participation. Furthermore, concepts such
as volunteering and activism (or even organizational membership) fall short in capturing the ways
and extent to which minority gay and bisexual
men work (unpaid) for others in HIV/AIDS-related
issues. Among Latino gay and bisexual men, for
instance, community involvement takes different
modalities, which include informal helping
behaviors and activism in non-gay/bisexual
organizations. Also, for some of these men,
Protective effects of community involvement
particularly those of working class origin, volunteering may be a foreign idea because it denotes
the middle and upper class notion of ‘giving back’
(Abrahams, 1996; Boehmer, 2000). Thus, I propose
the concept of community involvement and define
it as a construct indicating individuals’ unpaid
work on behalf of others or a collective good
and in the context of a formal or semi-formal
organization and social networks, i.e. outside the
home and the family (Schondel et al., 1992; Smith,
1997; Wilson and Musik, 1997). The concept also
has several dimensions including type and number
of activities, frequency, length of involvement and
participation and perceived importance. It implies
that community involvement is not a dichotomous
variable but a continuous construct, and that
variations along that continuum (or along the above
dimensions) may have varying positive effects on
individuals’ behaviors. The modalities and dimensions of community involvement, however, need
further exploration to fully develop the concept of
community involvement in the context of HIV/
AIDS. A construct such as this one may be a
point of departure because it captures better the
complexity of unpaid work on behalf of a public
good such as HIV/AIDS prevention and care.
A second limitation of the existing literature is
the lack of inclusion of minority gay and bisexual
men (Ouellette et al., 1995). The findings and
models put forward in the literature, hence, may
not be applicable to minority gay and bisexual
men. This is particularly relevant because they
constitute the group most affected in the second
decade of the HIV/AIDS epidemic (Marin, 1995;
Klevens, 1999; Centers for Disease Control, 2000).
As Arno has noted, while HIV/AIDS continues to
be a pressing problem among minority communities and as treatments become available extending
life expectancy, our society will need to provide
more services to these communities (Arno, 1988).
A considerable proportion of these services will
be provided by community members and their
organizations. Yet, the current pools of community
volunteers and activists may not be able to
adequately meet the needs of individuals of color,
for they are comprised of mostly white, middle-
class gay and bisexual men. The existing
community-based organizations may have little
knowledge and experience with the needs and
resources of minority gay and bisexual men. In
addition, the few minority HIV/AIDS communitybased organizations have sparse resources and
experience to generate and maintain community
involvement. These organizations need to develop
broader and stronger community-based efforts to
address HIV/AIDS in a social class and culturally
appropriate ways. Thus, it is necessary to build
culturally sensitive knowledge about the processes
of community involvement in HIV/AIDS among
minority gay and bisexual men.
A related shortcoming is that this line of
research, while focusing on psychological antecedents of community involvement, has overlooked
the effects of social class, acculturation and stigma
of homosexuality and AIDS on the levels of
community involvement, specifically among communities of color. Finally, most of the research on
community involvement in HIV/AIDS has been
conducted among participants (e.g. volunteers and
activists) only. The lack of inclusion of nonparticipants has hindered conclusions regarding the
effects of community involvement on individuals’
behaviors.
Conceptual framework of the
protective effects of community
involvement for HIV risk behavior
The proposed conceptual framework is depicted in
Figure 1 and its presentation is organized according
to the major paths (1–4).
Community involvement, poverty,
homophobia and racism
Experiences of poverty, homophobia and racism
are underlying socio-structural factors associated
with sexual risk behavior among gay and bisexual
men, particularly gay men of color (CarballoDieguez and Dolezal, 1996; Ramirez-Valles et al.,
1998a; Stokes and Peterson, 1998; Diaz et al.,
1999a; Kraft et al., 2000; Williamson, 2000). For
instance, in the largest HIV/AIDS study conducted
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J. Ramirez-Valles
Fig. 1. Conceptual framework of the protective effects of community involvement for HIV risk behavior. Major paths of the model
are numbered 1–4.
among Latino gay and bisexual men in the US,
Diaz et al. found that poverty, homophobia and
racism were significantly associated with higher
sexual risk and substance use (Diaz et al., 1999b).
These findings concur with previous research on
discrimination [e.g. (Krieger, 1990; Meyer, 1995;
Kessler et al., 1999)] and further support the
hypothesis that discrimination, e.g. gender or race
based, has negative health effects.
Poverty and racism have been identified as risk
factors for sexual risk behavior, substance use and
other health outcomes among ethnic minorities
(Williams et al., 1994; Allen and Mitchell, 1996;
Krieger, 1999). Homophobia (e.g. negative feelings
and reactions towards homosexuality) has been
found to be associated with sexual risk behavior
and psychological well-being among white gay
and bisexual men (Turner et al., 1993; Meyer,
1995; Frabel, 1997; Williamson, 2000). Previous
studies, however, have not explained why some
392
individuals initiate and maintain safer sex
behaviors despite facing poverty, homophobia
and racism.
Research among white and African-American
groups suggests that involvement in social service,
neighborhood and community-based organizations
buffers the negative effects of poverty, homophobia
and racism on individuals’ well-being (Chambre,
1991; Weitz, 1991; Wilson, 1991; Brown et al.,
1992; Brown, 1997; Smith, 1997). Here I propose
that community involvement in HIV/AIDS-related
organizations and groups may operate as one
protective factor on the association between
poverty, homophobia and racism and HIV/AIDS
sexual risk behavior (see Path 1 in Figure 1).
The theoretical and empirical work of Garmezy
et al., Rutter and Brook et al. on protective
factors (also known as risk/protective factors) and
resiliency, provide the theoretical foundation to
hypothesize the protective effects of community
Protective effects of community involvement
involvement (Garmezy et al., 1984; Rutter, 1987;
Brook et al., 1990, 1991, 1992). These authors
posit that there are social and psychological factors
that help individuals cope favorably with adverse
circumstances. These factors work by moderating
the relationship between two other constructs (e.g.
poverty and sexual risk behavior), i.e. they function
as protective variables. This thesis, applied to gay
and bisexual men’s sexual risk behavior, suggests
that community involvement in HIV/AIDS may
compensate for the negative effects that poverty,
homophobia and racism have on HIV/AIDS sexual
behavior.
The model in Figure 1 also assumes that community involvement encompasses type of activity
(e.g. organizing meetings, providing support),
frequency (e.g. weekly, monthly), length (e.g. 1
year, 3 years) and importance (e.g. very important
to me, not important to me). To understand further
how community involvement in HIV/AIDS works
and to translate it into interventions; however, it
is necessary to consider the mediating mechanisms
between community involvement and sexual risk
behavior.
Mediating mechanisms of community
involvement
Although it has not been empirically and
systematically tested, researchers, HIV/AIDS
workers and volunteers/activists suggest that
involvement in HIV/AIDS organizations provides
individuals with a sense of personal growth and
community and increases knowledge about HIV/
AIDS and safer sex behavior, at the same time that
it provides invaluable public health and financial
benefits for their communities (Snyder and Omoto,
1992; Omoto et al., 1993). A study on New York
City’s Gay Men’s Health Crisis notes, ‘Participation in AIDS voluntary associations offers an
opportunity for empowerment and personal
development through social action. Volunteering
encourages people to respond successfully to the
serious stressors...’ [(Kobasa, 1991, pp. 173–174);
my italics]. Building from psychosocial theories
and research findings, Path 2 postulates the
mediating mechanisms by which community
involvement in HIV/AIDS may reduce sexual risk
behavior for HIV.
Path 2 in Figure 1 hypothesizes that community
involvement reduces instances of sexual risk
behavior because it (1) increases peer norms
towards safer sex, (2) increases self-efficacy
towards condom use, (3) increases positive selfidentity and (4) decreases social alienation. The
four constructs are not only the most salient and
proximal factors that may put gay and bisexual
men at risk for HIV/AIDS (Carballo-Dieguez and
Dolezal, 1996; National Institutes of Health, 1997;
Diaz, 1998; Stokes and Peterson, 1998), but they
also are theoretically and culturally relevant.
Peer norms towards safer sex
The positive effects of community involvement
are partly deduced from Social Control Theory.
This theory posits that individuals’ behaviors, such
as sex practices and substance use, are regulated
through participation and bonding to organizations
and groups, such as community-based organizations, religious groups and those with cultural and
political ends, i.e. through groups promoting norms
and actions against those behaviors (Hirschi, 1969;
Catalano et al., 1996). Individuals who participate
in an organization become socialized in its norms
and develop a social bonding with the organization
and its members; hence, they tend to act in conformity with the organization’s norms. The
organization’s agenda and culture, as well as the
bonding the participant feels, create a pressure to
act according to the group or organization’s norms
and expectations (Fine and Holyfield, 1996). The
organization’s or group’s norms are used as a point
of reference by members to monitor each others’
behaviors (Smith, 1994), so that social control is
exercised through the peers that the individual
comes in contact, and interacts, with in the
organization. Thus, community involvement in
HIV/AIDS-related organizations may reduce risk
behaviors for HIV/AIDS because it provides a set
of peer norms linked to the good the organization
promotes (e.g. safer sex) and because the individual
feels bonded to those peers (Barbour, 1994;
Hodgkinson, 1995; Omoto and Snyder, 1995;
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J. Ramirez-Valles
Wilson and Musick, 1997). Individuals who do not
participate or feel any bonding to these organizations may not feel compelled to act according to
organizations’ and members’ norms (Smith, 1997).
They may have little reason to commit to safer sex.
Social Control Theory has been extensively
tested on youth sexual risk behavior and substance
use. Research done with white and AfricanAmerican youth has found that involvement in
community-based organizations, youth programs
and church-related activities is negatively correlated to sexual risk behavior and drug use
(Donovan and Jessor, 1978; Jessor et al., 1983;
Wilson, 1987; Bingham et al., 1990; Maton, 1990;
Zimmerman and Maton, 1992; Catalano et al.,
1996). A study by Ramirez-Valles et al. among
African-American and white youth, for instance,
found that involvement in community-based organizations and extra-curricular activities is associated
with less sexual risk behavior, while controlling
for race, gender, family structure, social class,
parental involvement and neighborhood poverty
(Ramirez-Valles et al., 1998b). This line of
research, therefore, indicates that sexual behavior
is influenced by involvement in positive socializing
agents (e.g. service organizations).
Self-efficacy towards condom use
Community involvement has been found to be
positively associated with self-efficacy in general
(Moen and Fields, 1999). Theories of actionoriented learning (also referred to as adult, popular
or empowerment education) (Freire, 1970; Minkler
and Cox, 1980; Minkler, 1985; Wilson, 1987;
Wallerstein and Bernstein, 1988; Wallerstein, 1992;
Zimmerman et al., 1997) and Social Cognitive
Theory (Bandura, 1986) predict that involvement
in HIV/AIDS-related organizations increases selfefficacy towards condom use, hence reducing
instances of risk behavior. Learning and behavioral
change may occur through community involvement
in HIV/AIDS-related organizations because participants acquire knowledge and awareness while
conducting actions directed to HIV/AIDS (Freire,
1970; Smith, 1997; Stewart and Weinstein, 1997;
Zimmerman, et al., 1997). Action-oriented learning
394
theories propose that individuals increase their
self-efficacy and change their behaviors if learning
takes place in a group and is based on the interconnection between development of awareness and
action (Freire, 1970; Rappaport, 1984; Cornell
Empowerment Group, 1989; Zimmerman et al.,
1992). Through involvement in collective action,
individuals increase their understanding of the
agents that facilitate or inhibit the capacity to be
proactive in their efforts to change their own health
and the health of their community (Zimmerman,
1995). In addition, individuals produce their own
knowledge and incorporate it into their own
realities.
Community involvement may have a direct
positive effect on self-efficacy because it provides
opportunities for vicarious learning and verbal
persuasion. Social Cognitive Theory proposes that
behavioral change and maintenance is a function
of (1) expectations that one’s actions can lead to
a desired outcome (outcome expectations) and (2)
expectations about one’s ability to enact a behavior
to produce the desired outcome (self-efficacy)
(Bandura, 1986; Strecher et al., 1986; Rosentock
et al., 1988). These expectations may be enhanced
through vicarious learning, which involves observing others’ actions, and verbal persuasion, which
entails exhortations from others. Through community involvement in HIV/AIDS, individuals vicariously learn about safer sex and its negotiation
from other participants and from individuals the
organization works for; and they may also be
exhorted by other members to maintain safer sex
practises (Riessman, 1965; Schondel et al., 1992).
Moreover, involvement may increase self-efficacy
because individuals develop a greater commitment
to the program or agenda of the organization; they
are exposed to diverse opportunities to acquire and
maintain behaviors and skills; and they may make
public commitments to behavioral change and
maintenance (Wandersman, 1981; Stewart and
Weinstein, 1997; Altman et al., 1998).
Positive self-identity
Community involvement may create a positive
self-identity because participants interact with
Protective effects of community involvement
supporting peers, and because working toward
the good of others provides participants with an
identity of a caring and good person, and with
feelings of self-worth (Hunter and Linn, 1981;
Cutler, 1982; Holland and Andre, 1987; Marsh,
1992; Bellah et al., 1996; Wilson and Musick,
1997; Youniss and Yates, 1997; Moen and Fields,
1999). Peers provide information, feedback, and a
point of reference to evaluate the self and construct
and maintain a self-identity (Frable et al., 1997).
Although research on community involvement in
HIV/AIDS is scarce (particularly among gay and
bisexual men), the available studies show that
participation is associated with self-acceptance
and positive self-identity (Kobasa, 1990; Ouellette
et al., 1995). For instance, Schondel et al. found
that AIDS volunteers reported higher personal
satisfaction and self-esteem than non-volunteers
(Schondel et al., 1992). Among ACT UP members,
Wolfe observed that some gay members ‘came
out of the closet’ and acquired a sense of selfaffirmation through their participation (Wolfe,
1994). Community involvement has unique positive effects on psychological well-being, beyond
the effects of social support and mastery that may
be gained through participating (Rietschlin, 1998).
Findings from this body of research may also be
true for HIV-positive individuals and those with
AIDS. Weitz found that people living with AIDS
cope with social stigma, create a positive selfidentity and find a positive meaning for their
lives through participating in community-based
organizations (Weitz, 1991).
Among gay men, it has been suggested that
community involvement reduces sexual risk
behavior through its positive effects on self-acceptance (Waldo et al., 1998). Association with a
network of gay men has positive effects on gay
identity and self-perceptions (Turner et al., 1993;
Frable et al., 1997). In minority groups, participation in organizations furnishes opportunities for
self-expression and validation (Chambre, 1991;
Brown et al., 1992; Brown, 1997; Smith, 1997). For
minority gay and bisexual men this is particularly
relevant because their ethnic and sexual identities
are frequently conflicting (Stokes and Peterson,
1998; Kraft et al., 2000). They experience difficulty
in developing and maintaining a positive ethnic
and gay identity. Individuals who do not accept
their gay and bisexual identity or feel shame about
their homosexual desires are at risk of HIV/AIDS
because they have difficulty talking about their
own sexuality, and tend to engage in sex under the
influence of alcohol and with anonymous partners
(Diaz, 1998). Thus, to the extent that community
involvement of gay and bisexual men entails interaction with both ethnic (in the case of men of
color) and gay men and working with their communities, it may positively affect self-identity, which
in turn may reduce episodes of sexual risk behavior.
Alienation
Community involvement also may decrease sexual
risk behavior because it reduces feelings of alienation, especially among minority gay and bisexual
men. In their classic work, ‘Habits of the Heart’,
Bellah et al. argue that participation, volunteering
and activism in religious, civic associations and
local organizations are the means for individuals
to connect to their larger society (Bellah et al.,
1996). Several studies suggest that involvement in
community-based organizations increases social
interactions and face-to-face communication,
creates social networks, and develops a sense of
community, hence reducing alienation (McAdam,
1989; Smith, 1994, 1997; Stewart and Weinstein,
1997; Wilson and Musick, 1997; Younis and Yates,
1997; Rietschlin, 1998; Ramirez-Valles, 1999).
Among gay men, community involvement has been
found to be associated with greater social support
(Waldo et al., 1998). In addition, taking action to
address individual and community-level problems
is associated with greater sense of community
(Altman et al., 1998).
Gay and bisexual men of color frequently experience alienation because of racism, poverty and low
levels of acculturation (Diaz, 1998; Kraft et al.,
2000). Mainstream gay and bisexual groups typically exclude non-English speakers and gay and
bisexual men of color. Alienation can lead to
sexual risk behavior because it creates feelings of
low self-worth. This can be counterbalanced by
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J. Ramirez-Valles
involvement in HIV/AIDS-related organizations if
this involvement provides face-to-face interactions,
a network of peers and opportunities to work for
their communities.
The four potential mediating mechanisms (e.g.
peer norms, self-efficacy, self-identity and alienation) by which community involvement may
decrease instances of sexual risk behavior are
important for two reasons. First, they help
disentangle the documented association between
community involvement in HIV/AIDS-related
organizations and safer sex practises. Second, they
can be used to target specific areas to enhance
the experience of participants, such as proving
channels of communication among peers. Yet, to
extend the positive impact of community involvement to larger segments of the population and to
design interventions is necessary to identify the
barriers and facilitators for community
involvement.
Socio-cultural barriers to and facilitators
of community involvement
The process, extent and consequences of community involvement in HIV/AIDS-related organizations are linked to cultural and social-specific
factors that work as barriers and facilitators for
community involvement. Based on previous
research, I have identified five factors that may
influence community involvement in HIV/AIDS
(see Path 3 in Figure 1), motives for community
involvement, poverty, acculturation, the stigma
of homosexuality and HIV/AIDS, and perceived
opportunities to participate. These factors have
not been systematically studied in the context of
community involvement in HIV/AIDS among gay
and bisexual men. The understanding of how these
factors facilitate or inhibit community involvement
in HIV/AIDS is vital to inform future research and
interventions among gay and bisexual men and
HIV/AIDS-related organizations.
Motives for community involvement
Motives are psychosocial and cultural factors
which partly determine levels of community
involvement (Knoke and Woods, 1981; Omoto and
396
Snyder, 1995; Ramirez-Valles, 2002). The levels
and types of community involvement may
depend on the levels of motivation and the types
of motives individuals have for participation.
Research on participation in community-based,
neighborhood and service organizations has identified categories of motives for involvement (e.g.
concern for one’s community, moral values, understanding others, coping with one’s troubles and
helping others) (Knoke and Woods, 1981; Jenner,
1982; Wandersman and Alderman, 1986; Clary
et al., 1992; Snyder and Omoto, 1992; Bebbington
and Gatter, 1994; Smith, 1994; Gabard, 1995;
Hodgkinson, 1995; Omoto and Snyder, 1995; Ouellette et al., 1995; Stewart and Weinstein, 1997).
The types of motives found do not differ greatly
across studies. What appears to be different are
the types of motives identified as most salient
(Knoke and Woods, 1981; Jenner, 1982;
Hodgkinson, 1995; Omoto and Snyder, 1995; Stewart and Weinstein, 1997). For instance, Omoto
and Snyder found overall motivation positively
associated with length of time as an HIV/AIDS
volunteer, but self-oriented motives (e.g. personal
development) were better predictors of length of
service than community-oriented motives (e.g.
community concern) (Omoto and Snyder, 1995).
Research on motives, however, has been conducted primarily among participants who are white,
middle class and relatively well educated. This
limits its application to minority gay and bisexual
men, because motives are shaped by the social and
cultural context (Stewart and Weinstein, 1997;
Ramirez-Valles, 2001). Motives for participation
in HIV/AIDS-related organizations have not been
studied among gay and bisexual men of color, who
may have other motives or may express their
motivations with a different cultural vocabulary.
Future research, thus, is needed to identify motives
for community involvement in HIV/AIDS among
minority gay and bisexual men, and to examine
whether motivation levels are associated with
levels of community involvement and which
motives are associated with greater community
involvement.
Protective effects of community involvement
Poverty and acculturation
Compared to their white peers, gay and bisexual
men of color have been less involved in HIV/
AIDS-related organizations and other collective
prevention efforts (Perrow and Guillen, 1990;
Chambre, 1991). The vast majority of participants
in HIV/AIDS organizations are still white gay and
bisexual men (Valentgas et al., 1990; Omoto and
Snyder, 1995). Minority gay and bisexual men’s
low rate of participation in HIV/AIDS-related
organizations may be due to their overall
poverty levels and low acculturation (for recent
immigrants) into the mainstream culture. Generally,
ethnic minorities seem to participate at lower
rates in service, volunteer and community-based
organizations than white populations (Smith,
1997). The available evidence, however, is
inconclusive. In some studies, race participation
differences disappear when social class is
accounted for (Wilson and Musick, 1997),
suggesting that minority’s low participation may
be due to their higher poverty levels. National
surveys and local studies have consistently found
that individuals with higher education (e.g. college
degree) and income are more likely to be recruited
for volunteer positions (Wandersman and
Alderman, 1986; Smith, 1994, 1997; Hodgksinson,
1995; Wilson and Musick, 1997). This excludes
many minority gay and bisexual men, particularly
those recent immigrants who do not speak English
or who are less acculturated into the US mainstream
culture. Other studies indicate that ethnic minorities
do not participate less than white populations,
but participate in different types of organizations
(Portney et al., 1997). Communities of color may
not be as involved in issue-oriented organizations
(e.g. HIV/AIDS) as in neighborhood-level
organizations (Schondel et al., 1992; Portney
et al., 1997). Thus, poverty and low acculturation
levels (for recent immigrants) appear to be significant barriers for community involvement in HIV/
AIDS-related organizations.
Stigma of homosexuality and HIV/AIDS
Gay and bisexual men’s low rates of participation
in HIV/AIDS-related organizations may also be
due to the stigma of HIV/AIDS and homosexuality.
The fear of being identified as homosexual or a
‘person with AIDS’ (PWA) by family, co-workers
and friends may prevent individuals from becoming
actively involved in HIV/AIDS-related organizations (Kayal, 1994; Gabard, 1995). Synder et al.,
for example, found that individuals who believe
they will be stigmatized are less likely to become
AIDS volunteers than those who do not perceive
potential stigmatization (Synder et al., 1999).
Moreover, family stigma against homosexuality
has been found to be negatively associated with a
positive gay identity (Turner et al., 1993; Frabel,
1997; Diaz, 1998). The stigma of homosexuality
and HIV/AIDS is still widespread in many communities, organizations and families. Yet, the
stigma of homosexuality and HIV/AIDS among
gay and bisexual men has not been studied in the
context of community involvement and sexual risk
behavior, particularly among communities of color.
Future research needs to examine whether stigma
of homosexuality and HIV/AIDS is associated
with lower levels of community involvement in
HIV/AIDS.
Perceived opportunities
Studies on national and local civil and social
service organizations indicate that participation
may be largely determined by individuals’ perceptions of opportunities to participate (Snow et al.,
1980; Williams and Ortega, 1986; Smith, 1994;
Catalano et al., 1996). Individuals are likely to
get involved if they know of the existence of
organizations and opportunities to do so, and if
they perceive those organizations and opportunities
as accessible and accepting of them. There is,
however, a need in the field to examine whether
perceived opportunities to participate in HIV/
AIDS-related organizations and activities is
positively associated with actual community
involvement.
Community involvement burnout
Community involvement in HIV/AIDS, however,
may cause stress and burnout (see Path 4 in
Figure 1). Activists, volunteers and other HIV/
397
J. Ramirez-Valles
AIDS workers may experience physical and
emotional fatigue, and depersonalization as a result
of their work. Evidence of this effect is inconclusive, though (Guinan et al., 1991; Barbour, 1994).
For instance, some research on ‘PWAs’ buddies’
suggests that feelings of stress are related to the
time one works with a PWA (McKusick et al.,
1986), while other research indicates that time
helping a PWA is positively correlated with the
helper’s mental health (Gilhooly, 1984). Moreover,
it is not clear whether burnout is caused by the
activity itself or by organizational factors (e.g.
poor support and training). The available studies
suggest that burnout may be due to organizational
factors; that burnout associated with community
involvement in HIV/AIDS may be compensated
by its rewards (Guinan et al., 1991; Barbour,
1994); and that stress and burnout may not be
generalizable to all HIV/AIDS-related activities,
but to specific ones (e.g. being a PWA buddy).
Little is still known about community involvement in HIV/AIDS and burnout among gay and
bisexual men and ethnic minority groups. Burnout
effects among minority gay and bisexual men
may be small, because the levels of involvement
generally found in this population are not as high
as to cause burnout. It is possible, however, that
those gay and bisexual men of color who are
involved experience burnout due to the extensive
workload. Future research needs to explore whether
community involvement is associated with burnout
and what specific aspects of involvement (e.g.
frequency, type of activity) are associated with
greater burnout.
Conclusion
Community involvement is one of the most
important means for individuals to feel part of
their larger society (Bellah, et al., 1996). It also
has an instrumental value beyond the individual
level, as it provides a space for social action to
address community-wide problems, such as HIV/
AIDS (Patton, 1989; Smith, 1997). Through
involvement in community-based organizations
and action groups, individuals learn and create a
398
sense of themselves while promoting social change.
In this paper a conceptual framework was presented
to understand and disentangle the effects that
community involvement in HIV/AIDS-related
organizations and activities may have on individuals’ safer sex practices. The framework provides specific suggestions for future research to test
how and to what extent community involvement
affects individuals’ health, and to design health
prevention programs based on the direct and active
participation of affected communities.
The proposed framework presents significant
contributions to HIV/AIDS, community involvement and health education literatures. It focuses
on community involvement as a protective factor
for HIV/AIDS risk behavior, while addressing
socio-structural risk factors. Previous research on
HIV/AIDS among gay and bisexual men has
centered on finding predictors of and risk factors
for HIV. While this has been important, little is
known about why some individuals practise safer
sex despite facing unfavorable circumstances, i.e.
about protective factors for HIV. These protective
factors may then be used to develop new interventions or to enhance existing ones that target risk
factors solely. In addition, this framework advances
the understanding of community involvement in
HIV/AIDS, as well as its definition and association
with sexual risk behavior. No previous research
has directly addressed community involvement in
HIV/AIDS and its effects on sexual risk behavior,
especially among minority gay and bisexual men.
Specifically, this framework argues for a comprehensive measure of community involvement in
HIV/AIDS. It defines community involvement as
a construct encompassing type of activities, length
and frequency of involvement, and the meaning
participants attach to their involvement. Moreover,
this construct could be used, adapted and tested in
other contexts, such as substance use, mental health
and empowerment. It could also be tailored to
other populations, such as Latino and AfricanAmerican youth.
Regarding research on community involvement,
several implications can be drawn from this framework. First, as mentioned above, community
Protective effects of community involvement
involvement must be treated as a continuous or
latent variable, instead of a dichotomous variable.
In addition, it is necessary to assess the unique
and combined effects of the various aspects of
community involvement (e.g. length, frequency,
type) on individuals’ behaviors. Second, studies
should collect data from individuals with a range
of levels of community involvement, not only from
individuals who are at one extreme of involvement
(e.g. volunteers and activists). Third, future
research may benefit by collecting qualitative data
(e.g. narratives, participant observation) from
individuals and organizations to document the
processes, trajectories and contexts of community involvement and further inform the models
presented here. Fourth, longitudinal or experimental research designs need to be employed to
assess causal effects and antecedents of community
involvement. Finally, studies need to address the
group-specific variables of non-white populations,
such as Latino, Asian-Pacific and AfricanAmerican gay and bisexual men, and modify this
conceptual framework accordingly.
This framework also advances health education
theory and practice by providing the basis for
future interventions at community, organizational
and individual levels. It delineates how interventions based on collective action (e.g. community
involvement) for social change may be effective
in generating healthy behaviors at individual and
community levels. These types of interventions
work as prevention strategies because individuals
learn by doing while creating social change. For
instance, if the hypotheses put forward here are
correct, an intervention with HIV/AIDS-related
organizations could be developed to (1) enhance
community members’ involvement with organizations (e.g. creating satisfying activities and more
interaction with peers) so that community involvement may affect participants’ peer norms, selfefficacy, positive self-identity and alienation; and
(2) increase and improve outreach efforts for gay
and bisexual men who live in poverty, are less
acculturated and who feel stigmatized. At the
community level, an educational intervention could
be aimed at reducing stigma and increasing know-
ledge of community involvement opportunities
among gay and bisexual men who are less likely
to get involved (e.g. those who are less acculturated
and live in poverty).
There are, however, some caveats that need to
be considered when interpreting the conceptual
framework presented here. The framework
presumes one way causal relationships, which have
not been empirically tested. For example, it is
possible that those individuals who are practising
safer sex are more likely to volunteer in HIV/AIDSrelated organizations. Nonetheless, the proposed
relationships are consistent with theoretical
expectations and previous research. Part of the
agenda of future studies should be to assess the
effects of community involvement on individual
behavior over time. Likewise, the framework does
not include variables that may have a significant
impact on community involvement, such as health
care and health policies. Access to health care, for
instance, may influence who and how participates
as volunteer or activist. Access to health care
may also be a significant outcome of community
involvement. Variables such as this one, however,
add complexity to the framework presented here
and deserve a detailed examination elsewhere.
Moreover, although an effort was made to take
into account the specific life experiences of
minority gay and bisexual men, the framework
does not fully represent the cultural diversity
within this group. Future research would benefit
by focusing only on a particular ethnic group
to investigate whether there are ethnic-specific
variations on community involvement and its precursors and consequences.
Acknowledgements
This research was partially funded by the National
Institute of Mental Health, grant 5P50MH4245914 to the Center for AIDS Prevention Studies,
University of California-San Francisco. The author
thanks the participants of the Collaborative HIV
Prevention Research in Minority Communities
Project for their comments and encouragement.
399
J. Ramirez-Valles
Rafael M. Diaz and Barbara Marin provided critical
support and feedback.
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