Safer Sex Efficacy Workshop

Investigators: Karen Basen-Engquist

This single session, three-hour workshop is designed to increase college students' self-efficacy, or belief in their own ability to act successfully to prevent HIV/AIDS and other sexually transmitted diseases. Drawing upon social learning theory, the program includes numerous role-play and skill-building exercises, and is led by peer educators who are trained to serve as persuasive models. To give students the knowledge necessary to practice preventive behaviors, the leaders begin by facilitating a group discussion about HIV/AIDS and STDs, including transmission and prevention. During the next section, participants discuss personal experiences of and feelings about AIDS and other STDs. Finally, the students role play safe-sex discussions and learn about correct condom use, gaining confidence in their abilities in the process. A field study of the workshop was conducted with 209 undergraduate students enrolled in a health education class at the University of Texas. Compared to comparison groups of their peers, program participants showed significant increases in self-efficacy at the two month follow-up assessment. Sexually active students also showed an increase in their frequency of condom use. Click here to view more detailed information on this program.

Safety Counts: A Cognitive-Behavioral Intervention to Reduce HIV/Hepatitis Risks among Drug Users Who Are Not in Drug Treatment

Investigators: Michele Wood, Jonny Andía, Gricel Arredondo, Nan Corby, Jason Farrell, Camilla Harshbarger, Gary MacDonald, Sharon Novey, Kevin O’Connor, Fen Rhodes, Paul Simons, James Testaverde, & the Centers for Disease Control and Prevention (CDC)

The Safety Counts program is a proven intervention for out-of-treatment drug-using persons that will enable them to reduce their risk of becoming infected with or transmitting the human immunodeficiency virus (HIV) and hepatitis viruses such as hepatitis C. The Safety Counts intervention is appropriate for HIV-positive as well as HIV-negative drug users. Safety Counts is based on research that found this intervention to be effective in reducing high-risk sex and drug-use behaviors among both injection and noninjection drug users. As such, it is recommended for implementation by community-based organizations (CBOs) serving drug users. Through structured group and individual activities, the intervention assists clients in setting personal risk reduction goals and developing specific steps for achieving them. In partnership with behavioral counselors and outreach workers, clients design and manage their personalized goals for reducing their risks of acquiring or transmitting HIV and viral hepatitis. Ongoing support for achieving risk reduction goals is provided through sustained contact with program staff, interactions with peers who are enrolled in the program, and exposure to the personal stories of other drug users in the local community who have been successful in reducing their own risks. Clients participate in the intervention for a period of 4 months. This client-centered intervention benefits the client and the community. The research showed that the intervention reduced HIV risks by reducing drug use, increasing condom use, and increasing self-reported entry into drug treatment. Clients benefit from the strong outreach component of Safety Counts and from referrals to medical and social services. For HIV-positive clients, Safety Counts may allow them to deal with issues beyond substance use and HIV, such as addressing risk behaviors that can lead to contracting hepatitis and other infections. All clients learn how to make positive changes in their lives through setting specific goals and developing action steps to achieve their goals. These skills empower clients to take charge of their own risk behaviors, thereby benefiting themselves, their partners, their families, and their communities.

Safety Point

Investigators: Fen Rhodes

This program is a community-based intervention that seeks to reduce sex- and drug-related HIV risk factors in populations of injection drug and crack cocaine users. The intervention consists of nine sessions conducted by indigenous outreach workers over a period of four to six months. Participants attend two sessions of NIDA (National Institute on Drug Abuse) standard HIV counseling and testing, two group workshop sessions, and one individual counseling session. In addition, all participants receive a minimum of two planned supportive visits from outreach staff, and are encouraged to attend a minimum of two risk-reduction social events. Monetary and non-monetary incentives are used to encourage attendance. This program's effectiveness was evaluated in comparison to the effectiveness of the NIDA standard HIV counseling and testing intervention for reducing risky behavior among IDUs. Participants were interviewed at enrollment and five to nine months after the intervention. Urine tests at enrollment and follow-up allowed researchers to collect information on opiate and cocaine use. In comparison with participants in the NIDA standard intervention, participants in the enhanced intervention were significantly more likely to increase their self-reported condom use, reduce or cease their self-reported drug use, seek drug-abuse treatment, and/or have a negative urine test for cocaine or opiates at follow-up. (Rhodes, Wood and Hershberger, 1999). Click here to view more detailed information on this program.

School-Linked Reproductive Health Services (The Self Center)

Investigators: Laurie Schwab-Zabin, Janet B. Hardy, & Rosalie Streett

Originally launched as a partnership between junior and senior high schools and a neighborhood clinic, this program combines education, counseling, and reproductive services into a comprehensive intervention for youth. Services are provided by a team of nurses and social workers who divide their time between the schools and clinic. School-based components include: (1) at least one presentation to each homeroom class per semester to introduce the program and begin discussing values clarification, decision making, and reproductive health; ( 2) informal discussion groups that arise as students seek advice and information from staff on such themes as pubertal development, drug use, and parenting; and (3) individual counseling sessions, available as needed, with a social worker. At the clinic, reproductive and extended counseling services are provided, and referrals are given for teens requiring medical care. Staff encourage students waiting for appointments to participate in discussion groups and examine educational videos and pamphlets. A three-year field test of the intervention was conducted in a low-income neighborhood in Baltimore, Maryland, where elevated rates of sexual activity and teen pregnancy had been recorded. Compared to their peers attending comparable schools, students in the target schools showed reduced levels of sexual activity and (among the sexually active) more effective use of contraception. These effects were greatest among the younger, sexually active girls and boys whose use of contraception was minimal at the start of the program. A delay in the onset of sexual activity was also recorded among abstinent youth. Click here to view more detailed information on this program.

Sexual Health and Adolescent Risk Prevention (SHARP)

Investigators: Angela D. Bryan, PhD, Sarah J. Schmiege, PhD, & Michelle R. Broaddus, PhD

Adolescents in general are at high risk for sexually transmitted infections (STIs), including HIV. Even higher rates of STIs have been observed among youth involved with the criminal justice system. Typically, these adolescents are younger at first intercourse, have a higher number of sexual partners, and report lower rates of condom use than their peers. Despite the fact that these adolescents are at greater risk for HIV/STIs, few prevention interventions have been developed for them. In addition, few interventions for adolescents target both substance use and sexual risk reduction. SEXUAL HEALTH AND ADOLESCENT RISK PREVENTION (SHARP) aims to fill these gaps. SHARP is an intensive, interactive single-session (divided into five sections) intervention lasting 3-4 hours that incorporates videos, lecture, group discussion and activities. The groups are organized by gender, either all male or all female, with no more than 10 per session (but on average, the ideal number per session is between 3-5 participants per session). Overall SHARP program goals are to deepen STI/HIV knowledge, improve correct condom use, reduce sexual risks and alcohol use and set long-term goals to utilize knowledge and skills learned during the session. SHARP was evaluated using a randomized controlled trial with three group-based conditions. These three conditions were HIV information only (control group); SHARP program (intervention group) and SHARP + motivational enhancement therapy (enhanced intervention group). The study was conducted over a 12 month period, with data collected in 5 waves (baseline, 3, 6, 9 and 12 months). The enhanced intervention condition (SHARP + Motivational Enhancement Therapy) was statistically different and more significant than the control condition (HIV Information only). Any decrease in alcohol problems over time was statistically significant in the SHARP condition and the SHARP + Motivational Enhancement Therapy, when compared to HIV Information only. SHARP is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

SiHLE: Health Workshops for Young Black Women

Investigators: Ralph DiClemente, Gina Wingood, Kathy Harrington, Delia Lang, Susan Davies, Edward Hook III, M. Kim Oh, Richard Crosby, Vicki Stover Hertzberg, Angelita Gordon, James Hardin, Shan Parker, & Alyssa Robillard

SiHLE (Sistas, Informing, Healing, Living, Empowering) was developed to address the STI/HIV/AIDS prevention needs of African-American adolescent girls. Research has shown that this subgroup of the general population is at higher risk than their White or Hispanic peers. SiHLE was originally implemented in the South, where adolescent HIV prevalence was higher than any other geographic region in the U.S. Participants were girls seeking health services at community health agencies. Eliglible participants were African American between the ages of 14 and 18 who had engaged in vaginal intercourse within the previous six months. At baseline, 522 girls, aged 14-18, completed the baseline survey and were randomized into either the HIV-prevention intervention (n=251) or the general health control group (n=271). The HIV-prevention intervention was grounded in social cognitive theory and the theory of gender and power. Participants explored issues related to ethnic and gender pride, risk reduction strategies (including correct and consistent condom use), negotiating safer sex, and healthy relationships as they relate to practicing safer sex. At the six-month follow-up, intervention girls reported using condoms more consistently in the previous 30 days than did their control group counterparts (intervention, 75.3% vs. control, 58.2%). At the 12-month follow-up, intervention girls reported more consistent condom use both in the previous 30 days (intervention, 73.3% vs. control, 56.5%) and during the entire 12-month review period (adjusted odds ratio, 2.30; 95% CI, 1.51-3.5; Phere to view more detailed information on this program.

Sniffer

Investigators: Don C. Des Jarlais, Cathy Casriel, Ray Rodriguez, Andrew Rosenblum, Samuel Friedman, Bruce Stepherson & Elizabeth Khuri

Sniffer is designed to prevent intranasal heroin users from making the transition to injection drug use, and to prevent those who have used injection drugs in the past from returning to that mode of use. Participants attend four 90-120 minute sessions in which didactic materials, group discussions, and situational role play scenarios are employed to communicate information about AIDS, drug use, sexual risk behavior, and drug abuse treatment options. The intervention also seeks to reduce non-injection use of illicit drugs, but advocates harm reduction practices and treatment rather than condemning the behavior of group members who use illicit non-injection drugs. The program's effectiveness was evaluated in a study of 104 intranasal drug users in New York City, each of whom had injected heroin less than 60 times in the previous two years and was HIV and/or hepatitis B negative. Participants were recruited and assigned to test and control groups. All subjects received information about AIDS prior to enrollment. Follow-up interviews at roughly nine months after enrollment collected information about drug use and sexual behavior as well as attitudes towards AIDS. Participation in the intervention was associated with a significantly lower probability of self-reported injection drug use and increased condom use during the follow-up period. (Des Jarlais, Casriel, Friedman and Rosenblum, 1995; Casriel et al., 1990). Click here to view more detailed information on this program.

Study to Reduce Intravenous Exposures (STRIVE)

Investigators: Steffanie Strathdee, Ph.D., Sebastian Booner, Ph.D., Elizabeth Golub, Ph.D., Mary Latka, M.P.H., Ph.D., Farzana Kapadia, Ph.D., Holly Hagan, M.P.H., Ph.D., Jennifer Campbell, & Richard Garfein, Ph.D., M.P.H

STRIVE is a group-level, clinic-based, behavioral intervention that aims to reduce risky distributive injection practices (e.g., syringe lending and unsafe drug preparation) among young injection drug users who are HCV positive. During six 2-hour sessions, two trained health advisors promote group cohesion and support peer education within the STRIVE group. The health advisors encourage behavior change by teaching peer-education tactics and risk reduction skills. The STRIVE program increases participants. HCV knowledge and risk awareness, problem-solving and risk-reduction skills, and supports sustained behavior change. The effectiveness of the STRIVE program was evaluated using a randomized trial design with a time-equivalent attention-control group. Participants included 418 HCV-positive injection drug users aged 18 to 35 years in three US cities. Participants reported their injection-related behaviors at baseline, and at three- and six-month follow-ups. Compared with the control group, intervention group participants reported a 26% relative reduction of distributive risk behaviors at three months and six months, but were no more likely to cite their HIV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention group participants who had known their HCV-positive status for at least six months. Peer mentoring and self-efficacy were significantly increased among intervention group participants, and intervention effects were mediated through self-efficacy. Click here to view more detailed information on this program.

Teen Health Project (THP): Community-Level HIV Prevention Intervention for Adolescents in Low Income Housing Development

Investigators: Kathleen J. Sikkema, Jeffrey A. Kelly & the Teen Health Project Team

TEEN HEALTH PROJECT was developed for adolescents ages 12 to 17 living in low-income housing developments. The purpose of the evaluation study was to determine whether the effects of a community-level HIV risk reduction intervention would be stronger when the intervention targeted change in individual-level risk reduction as well as change in the social and peer normative environment. Participants (n = 1,172) were recruited from 15 housing developments. Developments were randomly assigned to the community-level intervention (5 developments), workshop-only (5 developments), or a control condition (5 developments). Assessments were conducted at baseline, approximately 3 months after completion of the educational sessions, and again approximately 18 months after baseline. At long-term follow-up, adolescents living in the community-level developments were more likely to have remained abstinent than their control group peers (t(1, 10) = 2.22, Phere to view more detailed information on this program.

The Abstinence and Contraception Education Storehouse (ACES)

Investigators: Josefina J. Card, Shobana Raghupathy & Charles Klein

ACES is an online library of multimedia activities and exercises that can be used to enhance behavioral skills training in teen sexual risk reduction interventions. The goal is to enable teachers and practitioners to improve program delivery by using these activities to supplement existing interventions, and consequently promote active youth engagement and involvement. ACES has two components: (1) The Youth Activities Library (YAL) (2) The Teacher Training Library (TTL) The activities in the Youth Activities Library are aimed at youth and include multimedia audio-visual presentations, role-play demonstrations, group discussion activities, video clips, quizzes and polls, as well as traditional classroom exercises, handouts, and homework assignments. The library also includes classroom presentation materials that provide factual information on HIV/AIDS and STD awareness (incidence, prevalence, modes of STI transmission etc.). These activities in the YAL are arranged into 40 separate modules, with each module focusing on the following themes in the area of teen HIV/AIDS/STDS and pregnancy prevention: Refusal skills and resistance to peer pressure Assessing risks/using safety skills Stress management/ conflict resolution Dating and relationship decisions Negotiation skills/contraception use HIV/AIDS/STD awareness Safe sex practices Abstinence/delaying sexual activity Sexual orientation Buying contraception Condom demonstration Parent-child communication To help teachers use these modules, ACES also includes tutorials for teacher training. The ACES Teacher Training Library (TTL) is aimed at teachers and will train teachers and practitioners by offering video demonstrations in conducting role plays, group discussions and general classroom management strategies.