Many HIV prevention funding agencies require the use of evidence-based behavioral interventions (EBIs) previously shown to be effective through rigorous outcome evaluation. Often, the implementing agency's setting or target population is different than those in the original implementation and evaluation. The Centers for Disease Control and Prevention Division of HIV/AIDS Prevention, in collaboration with internal and external partners, developed draft guidance to adapt an EBI to fit the cultural context, risk determinants, risk behaviors, and unique circumstances of the agency without competing with or contradicting the core elements and internal logic. The guidance described in this article provides a systematic approach to help agencies identify the most appropriate intervention for their target population and agency capacity, monitor the process, and evaluate the outcomes of the adapted intervention. This guidance, currently being piloted with five community-based organizations, will be revised and disseminated at the conclusion of project activities.

Implementation of evidence-based HIV/STD prevention interventions can play an important role in reducing HIV and sexually transmitted diseases. This article describes the development, implementation, and lessons learned of the Diffusion of Effective Behavioral Interventions (DEBI) project, a strategy funded by the Centers for Disease Control and Prevention to diffuse evidence-based, group- and community-level HIV/STD prevention interventions to health departments and community-based organizations nationwide. The article specifically provides an overview of the rationale, description, and theoretical foundation of the project; a review of marketing efforts, including assessment of interests, needs, and capacities relative to the project; a description of project products, their purpose, approach employed to develop them, and their use by implementers; a description of the project's training coordination functions and activities; technical assistance issues; an overview of process and outcome evaluation components; new developments in response to feedback; and a discussion of future directions for DEBI. Project successes and challenges are addressed to inform future efforts to diffuse prevention interventions.

This study assessed HIV testing among 2,621 urban young men who have sex with men (YMSM). Of these, 77% were men of colour, 30% reported recent unprotected anal intercourse (UAI), 22% had never tested for HIV and 71% had not tested recently. Ever testing was associated with older age (OR=1.28), being employed (OR=1.34), exposure to more types of HIV preventions (linear trend p=0.02), sex with a main partner (OR=1.92), sex with a non-main partner (OR=1.36), UAI with a non-main partner (OR=0.53), UAI in the last three months (OR=1.32), knowing a comfortable place for testing (OR=5.44) and social support (OR=1.47). Rates of ever testing increased with behavioural risk with main partners; rates were lowest for men reporting high-risk with non-main partners. Recent testing was associated with greater numbers of HIV-prevention exposures (linear trend p =<0.001), sex with a main partner (OR=1.30), knowing a comfortable place for testing (OR=2.31) and social support (OR=1.23). Findings underscore the urgency of promoting testing among YMSM, point to components for the recruitment and retention of young MSM of colour in testing programmes and highlight the need for a theory-based approach to intervention development.

The Centers for Disease Control and Prevention (CDC), through its Diffusion of Effective Behavioral Interventions (DEBI) program, trained over 260 agencies on VOICES/VOCES between August 2003 and April 2005. ORC Macro conducted interviews with agency staff 3 months after receiving VOICES/VOCES training. This article discusses the diffusion of VOICES/VOCES; agencies' adoption, adaptation, and implementation of this intervention; and needs for ongoing proactive technical assistance (TA) for agencies to successfully integrate behavioral interventions into their programs. The vastmajority of agencies implemented VOICES/VOCES with fidelity to the core elements, and agencies successfully adapted the intervention to make it more appealing to target populations. TA is needed for interventions to be successfully adapted and implemented with fidelity to the core elements, and to ensure program sustainability. More effective interventions of short duration and minimum complexity to easily match with existing resources and conditions of agency capacity among HIV prevention providers in the community are needed.

The aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an African-American community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol (n=201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age=37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol < =15 days and = > 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use self-efficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices.