The Future is Ours (FIO)

Investigators: Anke A. Ehrhardt, Heidi Arner, Pam Farquhar, Laura Frye, Jeff Natt, Inez Sieben, Imelda Walavalkar, Susie Hoffman, Jessica Adams-Skinner, & Teresa Exner

The Future Is Ours (FIO) is an eight-session HIV prevention intervention delivered to high-risk heterosexual women in a group setting. FIO is guided by three major theories, Modified AIDS Risk Reduction Model (MARRM), Social Learning Theory, and Gender Theory. The goal of FIO is to empower women to reduce unsafe sexual encounters by increasing the use of male and female condoms and alternate protection strategies including sex without penetration, getting tested for HIV jointly with a partner along with mutual monogamy and a safety agreement, deciding to be celibate, and refusing unsafe sex or deciding to not get involved with a partner who will not use condoms. FIO is a gender-specific HIV/STD risk reduction intervention designed for heterosexually active, at-risk women of diverse ethnicities (African-American/Black, Caribbean, Latina, White), ages 18 to 30, who are not injection drug users, are HIV-negative or of unknown status, are not pregnant or trying to become pregnant, and who live in communities where rates of HIV and other STDs are high.

The SISTA Project

Investigators: Ralph DiClemente & Gina Wingood

SISTA, a gender-relevant, culturally sensitive group program for African-American women, is designed to be implemented in a community setting. Based on social cognitive theory and the theory of gender and power, SISTA seeks to prevent HIV transmission by promoting consistent condom use. Peer Health Educators lead five two-hour sessions, focusing first on ethnic and gender pride, then moving on to provide knowledge about HIV/AIDS and skills training to promote sexual safety. Each session employs group discussion, lecture, role play activities and written homework to increase retention of risk reduction strategies. Click here to view more detailed information on this program.

Tools for Building Culturally Competent HIV Prevention Programs (CC)

Investigators: Julie Solomon, Jacqueline Berman, Laura Lessard, Diana Dull Akers, Angela Amarillas, Megan Bunch, & Josefina J. Card

In the fight to reduce the spread of HIV, addressing the specific HIV-related needs of diverse cultural groups is becoming increasingly important. Tools for Building Culturally Competent Prevention Programs is designed to help HIV prevention professionals who are planning, implementing, or evaluating programs to increase the cultural competence and effectiveness of HIV prevention efforts in their local communities. The Tools website is divided into Planning, Implementation, and Evaluation Toolkits. Each Toolkit comprises a set of research-based, practitioner-friendly resources, including: Key Concepts, which summarize in plain language the important concepts and practices in effective, culturally competent HIV prevention programming. Interactive elements within the Key Concept webpages help reinforce the concepts with concrete examples. Tools, which are user-friendly MSWord checklists and worksheets that facilitate culturally competent programming. The user can type directly into each document and save it for future use. Other Resources, which include "tales from the field"--true stories of how the key concepts have been put into practice in real-world prevention settings--and links to additional relevant resources available through the Internet. The web site also contains an introductory section that provides an overview of the concepts of culture and cultural competence, and their relevance for HIV prevention programming. The site also offers a glossary of all the terms used in the site.

Turning Point

Investigators: Russel S. Falck, Robert G. Carlson, & Harvey A. Siegal

Turning Point includes two separate interventions designed to reduce the frequency and probability of injection-risk behavior among IDUs not participating in drug abuse treatment programs. The basic intervention consists of two sessions. In the first session, participants undergo HIV antibody tests and receive pre-test counseling. In the second session, a counselor-educator provides detailed information about HIV and HIV transmission and guides the participant group through activities intended to teach behavioral strategies for avoiding exposure to HIV. Participants in the enhanced intervention complete the basic intervention and attend three additional sessions, in which they address HIV/AIDS pathology, drug addiction, and safer sex practices. Both interventions employ videotape presentations, role-play, hands-on demonstrations, and print materials. The enhanced intervention also employs slide presentations, self-assessment tests, and lecture/discussion. The program's effectiveness was evaluated in Dayton and Columbus, OH. Participants were randomly assigned to one of the two interventions. Surveys were administered to both groups at enrollment and six months after the intervention. A majority of participants in both the standard and enhanced interventions reported safer needle practices at follow-up. Although no difference in needle risk was observed between intervention groups when all subjects were included in analyses, participants in the enhanced intervention who reported unsafe needle practices at enrollment were significantly more likely to report safer needle practices at follow-up than similar participants in the standard intervention (Siegal, Falck, Carlson and Wang, 1995). Click here to view more detailed information on this program.

Urban Mens Health Survey (UMHS), 1997-98

Investigators: Center for AIDS Prevention Studies (CAPS); University of California, San Francisco

The Urban Men's Health Study (UMHS) is a telephone interview of a probability sample of men who have sex with men (MSMs) living in four cities – San Francisco, New York, Los Angeles, and Chicago. An MSM was defined as any male who reported same sex contact since age 14 or who self-identified as gay or bisexual. The dataset contains 855 variables and 2881 cases. Data were collected between November 1996 and February 1998 on the respondent's sexual behaviors in the preceding 12 months, information on up to four (4) male or female partners, sexual development, anti-gay victimization, sexual coercion, access to medical care, sexual problems, depression, alcohol and drug use, STD assessment, HIV antibody test, attitudes about being HIV positive, and well-being. A total of 2,881 interviews were obtained between November 1996 and February 1998. Data were collected on the respondent's sexual behaviors in the preceding 12 months, information on up to four (4) male or female partners, sexual development, anti-gay victimization, sexual coercion, access to medical care, sexual problems, depression, alcohol and drug use, STD assessment, HIV antibody test, attitudes about being HIV positive, and well-being. Interviews were conducted in English and Spanish (n=17) at a time of the respondents' choosing and lasted an average of 75 minutes. Only male interviewers were employed for the MSM screening and questionnaire portions of the interview.

Voluntary Counseling and Testing for Female Sex Workers (VCT Program)

Investigators: Xiaoming Li, PhD, Bo Wang, PhD, Xiaoyi Fang, PhD, Ran Zhao, MD, Bonita Stanton,MD, Yan Hong, MA, Baiqing Dong, MD, Wei Liu, MD, Yuejiao Zhou, MD, Shaoling Liang, MD, & Hongmei Yang, PhD

The VCT Program aims to increase STI/HIV testing, awareness of infection, STI/HIV knowledge, and consistent use of condoms among female sex workers in China in order to ultimately reduce rates of STI infections. The VCT Program demonstrated increases in knowledge of STI/HIV knowledge and consistent condom use, and decreases in STI incidence. The VCT Program is composed of a pre-test counseling session, STI/HIV testing, and a post-test counseling session. During the first 25-minute VCT counseling session, the counselor works with the participant to: complete a risk assessment; identify challenges related to risk reduction; create a risk reduction plan; and practice condom use skills. After the first counseling session, the participant completes STI/HIV testing. During the 20-minute post-test counseling session, the counselor shares test results and reviews treatment options and risk reduction plans. The VCT Program was originally implemented in a suburban area of Nanning in southern China with female sex workers recruited from entertainment establishments. This program's voluntary counseling and testing content and approach may be useful in increasing testing and safer sex behaviors in many different types of communities and populations. Click here to view more detailed information on this program.

WILLOW: HIV Transmission Reduction Among Women Living with HIV

Investigators: Wingood, GM, DiClemente, RJ, MikHail, I, Lang, DL, Hubbard McCree, D, Davies, SL, Hardin, JW, Hook, EW & Saag, M

Traditional methods of preventing the transmission of STIs and HIV/AIDS focus on decreasing risk behaviors while increasing condom usage among individuals who are HIV negative. Included in those methods are individual counseling and group interventions. Few risk reduction interventions are developed specifically for women who have tested positive for HIV, despite data that indicate that a growing number of women acquired their infections through heterosexual contact. WILLOW was designed as a group intervention for African American women. The intervention incorporates elements of sexual risk reduction and social networking to reduce STI/HIV sexual transmission and to enhance psychosocial mediators and structural factors associated with preventive behaviors over a one-year period. The evaluation of WILLOW was a randomized controlled study including 366 women who were assigned to either the intervention (n=190) or comparison (n=176) conditions. Criteria for eligibility included: HIV+ serostatus; aged 18-50; and sexually active during the past six months. Following a baseline assessment, women were randomly assigned to one of two conditions. Follow-up assessments were conducted at six and twelve months post intervention. Over the 12-month follow-up period, women in the intervention group, as compared to their comparison group counterparts, reported fewer incidents of unprotected vaginal intercourse (1.8 vs. 2.5; P=0.022); were less likely to report never using condoms (OR=0.27; P=0.008); had a lower rate of bacterial infections (OR=0.19, P=0.006); reported greater HIV knowledge and condom use self-efficacy, more network members, fewer beliefs that condoms interfere with sex, and fewer partner-related barriers to condom use; and demonstrated greater skill in using condoms. Click here to view more detailed information on this program.

Youth AIDS Prevention Project (YAPP)

Investigators: Susan Levy, Brian Flay, & Arden Handler

Originally designed for African-American youth, YAPP aims to prevent STDs, HIV/AIDS, and substance abuse among high-risk junior high school students. Guiding the program is the social influence model of behavioral change, which targets teens' knowledge, attitudes, intentions, and behaviors regarding high-risk activities. The intervention includes ten sessions for 7th grade students, delivered in regularly scheduled health or science classes, and a five-part booster session offered one year later, when the teens have entered 8th grade. Classes cover transmission and prevention of STDs and HIV/AIDS, the importance of using condoms for those who choose to have sex, and the development of decision-making and resistance/negotiation skills. In addition to lectures and class discussions, active learning is emphasized, with opportunities for students to participate in small group exercises and role plays. There are also homework activities and opportunities for parental involvement. A field study of the intervention was conducted in fifteen high-risk school districts in Chicago. Research focused on the group of students who first became sexually active during the study period. Following the booster session, these students were more likely than a control group of peers to report using condoms with foam; they also expressed greater intention to use condoms with foam in the future. Click here to view more detailed information on this program.

Youth and AIDS Project's HIV Prevention Program

Investigators: Gary Remafedi, Susan Reynolds, John Yoakam, & Kevin Cwayna

A community and university partnership launched this program to provide education, peer support, counseling, and case management to gay and bisexual male adolescents between 13 and 21 years of age, who are at high risk for HIV/AIDS. The program begins with an initial two-hour interview for individualized HIV/AIDS risk assessment and risk reduction counseling. Youth then participate in a 90-minute interactive peer education program designed to provide clear, factual information in an atmosphere of mutual support. The program's lessons are reinforced in an educational video. Optional peer support groups meet weekly, if youth wish to attend. Finally, there is a one-hour follow-up visit for reassessment and referrals, as needed, to medical and social services. A field study of the program was conducted with a predominantly white sample of males, ages 13-21, who identified themselves as gay or bisexual. Following the intervention, the 139 participants reported less frequent unprotected anal intercourse and more frequent use of condoms. A reduction in substance abuse, particularly amphetamines and amyl nitrate, was also recorded. Click here to view more detailed information on this program.

mDOT Program: For Individuals Receiving Highly Active Antiretroviral Therapy (HAART)

Investigators: Cynthia R. Pearson, PhD, Mark Micek, MD, Jane M. Simoni, PhD, Eduardo Matediana, MD, Diane P. Martin, PhD, & Stephen Gloyd, MD, MPH

The mDOT Program aims to increase adherence to highly active antiretroviral therapy (HAART) for individuals living with HIV/AIDS through peer-provided directly observed therapy. The program significantly increased adherence to HAART at 6-week, 6-month, and 1-year follow ups and significantly increased the number of program participants achieving more than 90% adherence after 6 months. Peer educators are trained during a 2-day workshop to deliver directly observed therapy and support HAART adherence. After training, peer educators monitor morning HAART doses during the 6-week program period. Peer educators provide social support, adherence advice and health information to participants throughout the program. Peer educators complete refresher training every three months throughout the program. The mDOT Program was originally implemented in Beira, Mozambique, at a large-volume public institution providing free specialized HIV care and antiretroviral medications. Although this program was designed to operate in an HIV clinic or hospital, it may be feasible for other community-based organizations serving individuals living with HIV to implement the mDOT program. Click here to view more detailed information on this program.