Community-level HIV intervention in 5 cities: final outcome data from the CDC AIDS Community Demonstration Projects.

Abstract

The CDC AIDS Community Demonstration Projects Research Group Community-level interventions represent a promising approach to prevention of HIV infection. They aim to change communitywide norms and practices in order to support individuals' efforts to change.1'2 Since the 1970s, community-level interventions have addressed various health issues, including smoking cessation3-5 and the control and prevention of coronary heart disease. 1,6-10 However, "the size of effects has been meager in relation to the effort expended."'" In many studies, positive behavioral changes were seen in both the treatment and comparison areas, a result that seemed to be due in part to unexpectedly steep trends toward reducing unhealthy behaviors.4"''3Nevertheless, community-level interventions have had some success in prevention of HIV infection. Kelly and colleagues trained gay men to talk about prevention with their peers and to endorse behavior changes.'4 After the intervention, unprotected sexual intercourse decreased and condom use for anal intercourse increased. These trends continued for 3 years after the intervention,'5 and similar results were achieved when Kelly et al. replicated this study in 8 cities.'6 A community-level approach has also been used to reach young men who have sex with men.'7 Street outreach programs, mass media campaigns, and other forms of community-level interventions have been used extensively to reach injection drug users and other at-risk populations.2""20 Few studies have analyzed the degree to which community-level programs have led to behavioral changes at the community level. Rather, most have addressed changes among individuals. Here we describe the outcome evaluation results from the AIDS Community Demonstration Projects, an innovative 5-city trial to evaluate the effects of a community-level intervention for underserved populations at risk for HIV 21-23 infection. MethodsThe AIDS Community Demonstration Projects were conducted in Dallas, Tex; Denver, Colo; Long Beach, Calif; New York City; and Seattle, Wash. In each city, the project focused on members of 1 to 3 of the populations at increased risk for HIV infection: active injection drug users, female sex partners of male injection drug users, female commercial sex workers and other women who trade sex for money or drugs, youth in high-risk situations, non-gay-identified men who have sex with men, and residents of census tracts where rates of sexually transmitted diseases are high. A community was defined as an at-risk population in a specific geographic region. A total of 10 intervention-comparison community pairs were studied (Table 1).The study design, data collection methods, and intervention activities have been described in detail elsewhere.21-24 These activities were approved by human subjects review boards at each of the study sites. Intervention ActivitiesAll sites used a common intervention protocol that was based on behavioral theo-A complete list of the members of the CDC AIDS Community Demonstration Projects Research

Evaluation of a Peer Network-Based Sexual Risk Reduction Intervention for Men in Beer Halls in Zimbabwe: Results from a Randomized Controlled Trial

“…While several community-level, peer-oriented AIDS prevention interventions have proven effective in changing behavior [ 44 , 47 – 49 ], the negative results reported here are echoed in other behavioral RCTs. The most pertinent comparison is the Community Popular Opinion Leader Intervention which employed a community-POL approach to HIV prevention in five countries, including Zimbabwe and India [ 50 ].…”

Reducing HIV Risks Among Active Injection Drug and Crack Users: The Safety Counts Program

“…Outreach workers received extensive training prior to intervention delivery. First, there was educational training on HIV, transmission risks, and protective behaviors, as well as the theory of behavior change and the Prochaska theory of change [ 8 ]. Second, street outreach workers were provided scripts that demonstrated the intervention in role play and with mock clients.…”

“…However, despite multiple scientific reviews on its efficacy, most communities in the US do not have access to needle exchange and there are many parts of the world without such access. Given the political realities of acceptable treatments, this study examines an intervention strategy built concurrently with the street-outreach models of the AIDS Community Demonstration Projects [ 8 ].…”

Lessons Learned From Dissemination of Evidence-Based Interventions for HIV Prevention

“…29 For example, PROMISE, a community-level intervention originally designed to use printed role model stories to increase condom use, was updated to include social media role model stories around HIV medication adherence. 9…”

“…); Partnership for Health; Healthy Relationships; WILLOW (Women Involved in Life Learning from Other Women); CONNECT; START; Sister to Sister; Many Men, Many Voices; Personalized Cognitive Counseling; VOICES/ VOCES (Video Opportunities for Innovative Condom Education and Safer Sex); and Safe in the City interventions. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] A conservative estimate would be that $100 million ($500,000 on packaging, $2,000,000 on website resources, $22,000,000 on training and technical assistance, $75,500,000 in implementation) was devoted per year to dissemination and implementation of EBIs.…”