A Peer Education Program for Taxicab/Tricycle Drivers and Other Bridge Populations

Investigators: Donald E. Morisky, ScD, ScM, MSPH, Chrystene Nguyen, MPH, Alfonso Ang, PhD, & Teodora V. Tiglao, EdD, MPH

The Peer Education Program aims to decrease sexual risk behaviors (such as unprotected sex) among members of a .bridge. population who are at risk of spreading STIs including HIV between high-risk groups (e.g., commercial sex workers) and the general population (e.g., other sexual partners). The Peer Education Program demonstrated increases in knowledge of HIV/AIDS transmission, positive attitudes toward condom use, and condom use frequency. The program includes a one-day needs assessment, a half-day peer educator information session and recruitment seminar, and a two-day peer educator training. For a year or more, peer educators share HIV prevention knowledge, distribute and promote condoms, and share educator-created prevention materials with coworkers and clients during normal work routines. Peer educators meet with program staff once a week throughout the program implementation to address questions or to problem solve ways to most effectively share safer sex messages with others. The Peer Education Program was originally implemented in the Philippines among drivers in the transportation industry but can readily be adapted to .bridge. populations in other settings and industries. The program.s peer education approach may also be useful in supporting HIV prevention behaviors among peers in many different types of communities and populations. 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.

Los Angeles Women's Health Risk Study, 1990

Investigators: David Kanouse

Investigators interviewed a stratified probability sample of 1,024 female street prostitutes in Los Angeles County between May 1990 and February 1991 to study behavior that is linked to transmission of HIV and other STDs. Although the study also collected blood samples from a subsample of 638 women to examine markers for HIV infection, as well as past syphilis and hepatitis B infection, the original investigator did not include blood sample data in this public use dataset. The specific aims of this study were to: develop numerical estimates of the size of the prostitute population in Los Angeles County and its distribution by predominant mode of solicitation of customers; characterize prostitute career patterns; perform HIV antibody testing to determine the prevalence of HIV infection in this population and its subgroups; measure the prevalence and incidence of specific sexual and drug-related risk behaviors and prevention behaviors and determine how these are related to prostitute characteristics and risk and prevention behaviors; and compare the characteristics of the population of prostitutes with those subgroups most likely to be recruited in convenience samples (e.g., from jails or STD clinics). The present study is unique in describing the characteristics, risk behavior and serological status of a probability sample of street prostitutes from a major metropolitan area of the U.S., which is also in AIDS epicenter.

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.

National AIDS Behavioral Surveys (NABS), NABS I, Complete Sample, 1990-92

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

The National AIDS Behavioral Surveys (NABS) were designed to identify AIDS-relevant risk behaviors and their correlates in a population based sample of adults aged 18-75 residing in the contiguous United States. The overall study design allows for the description of sexual practices, drug use, HIV antibody test seeking, and levels of AIDS-related knowledge, beliefs and social skills over the adult life-span both for the U.S. as a whole and for the major high AIDS prevalence areas. Emphasis was placed on oversampling black and Hispanic populations with the major AIDS epicenters. The specific aims of the survey included: Estimating the prevalence of AIDS-relevant sexual practices in the United States as a whole and in different segments of the population (blacks, Hispanics, and whites; men and women; married and unmarried; age groups). Estimating the prevalence of HIV antibody test-seeking and levels AIDS-related knowledge, beliefs, attitudes, and social skills among various segments of the population (blacks, Hispanics, and whites; men and women; married and unmarried, age groups. Testing the three stages of the proposed AIDS Risk Reduction Model: (a) Labeling: To determine the effects of HIV transmission knowledge, AIDS anxiety, HIV susceptibility beliefs, and AIDS ethnocentrism on "labeling" high risk behavior (i.e. the belief that "unsafe" sex practices put one at risk for HIV infection). (b) Commitment: To examine the effects of response efficacy (i.e. beliefs that safe sex behaviors are enjoyable and decrease the risk of HIV infection) and self-efficacy (i.e. beliefs in one's ability to perform safe sex behaviors) on behavior intentions to buy condoms, to increase condom use, and to reduce multiple-partnered sex. (c) Enactment: To assess the effects of sexual communication, risk behavior labeling (stage 1 outcome) and commitment to change (stage 2 outcome) on buying condoms, condom use and multiple partnered sex. PETRA Dataset #06 is comprised of data from three samples: A nationally-representative, random-digit-dialed (RDD) telephone survey of adults; A partially overlapping RDD Central City Sample (separately weighted), and A sample of Hispanic surnamed households screened for race (Hispanic and African American only) and age (18-49 only)

National AIDS Behavioral Surveys (NABS); NABS I, Poststratified separately to selected U.S. metropolitan cities: Chicago, Detroit, Houston, Los Angeles, Miami, New York, Philadelphia, 1990-92

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

The National AIDS Behavioral Surveys (NABS) were designed to identify AIDS-relevant risk behaviors and their correlates in a population based sample of adults aged 18-75 residing in the contiguous United States. The overall study design allows for the description of sexual practices, drug use, HIV antibody test seeking, and levels of AIDS-related knowledge, beliefs and social skills over the adult life-span both for the U.S. as a whole and for the major high AIDS prevalence areas. Emphasis was placed on oversampling black and Hispanic populations with the major AIDS epicenters. The specific aims of the survey included: Estimating the prevalence of AIDS-relevant sexual practices in the United States as a whole and in different segments of the population (blacks, Hispanics, and whites; men and women; married and unmarried; age groups). Estimating the prevalence of HIV antibody test-seeking and levels AIDS-related knowledge, beliefs, attitudes, and social skills among various segments of the population (blacks, Hispanics, and whites; men and women; married and unmarried, age groups. Testing the three stages of the proposed AIDS Risk Reduction Model: (a) Labeling: To determine the effects of HIV transmission knowledge, AIDS anxiety, HIV susceptibility beliefs, and AIDS ethnocentrism on "labeling" high risk behavior (i.e. the belief that "unsafe" sex practices put one at risk for HIV infection). (b) Commitment: To examine the effects of response efficacy (i.e. beliefs that safe sex behaviors are enjoyable and decrease the risk of HIV infection) and self-efficacy (i.e. beliefs in one's ability to perform safe sex behaviors) on behavior intentions to buy condoms, to increase condom use, and to reduce multiple-partnered sex. (c) Enactment: To assess the effects of sexual communication, risk behavior labeling (stage 1 outcome) and commitment to change (stage 2 outcome) on buying condoms, condom use and multiple partnered sex. PETRA Dataset #01 is comprised of a subset of the RDD Central City Sample (a partially overlapping, separately weighted RDD Central City Sample) divided into seven non-combinable subsamples from the following high risk urban areas: Chicago (n=951), Detroit (n=566), Houston (n=526), Los Angeles (n=839), Miami (n=494), New York (n=555), and Philadelphia (n=549). These samples, when properly weighted, may be used to make separate, individual estimates for large, high-risk metropolitan areas.

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.

National AIDS Behavioral Survey (NABS II), 1992

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

The National AIDS Behavioral Surveys (NABS) were designed to identify AIDS-relevant risk behaviors and their correlates in a population based sample of adults aged 18-75 residing in the contiguous United States. The overall study design allows for the description of sexual practices, drug use, HIV antibody test seeking, and levels of AIDS-related knowledge, beliefs and social skills over the adult life-span both for the U.S. as a whole and for the major high AIDS prevalence areas. Emphasis was placed on oversampling black and Hispanic populations with the major AIDS epicenters. The specific aims of the survey included: Estimating the prevalence of AIDS-relevant sexual practices in the United States as a whole and in different segments of the population (blacks, Hispanics, and whites; men and women; married and unmarried; age groups). Estimating the prevalence of HIV antibody test-seeking and levels AIDS-related knowledge, beliefs, attitudes, and social skills among various segments of the population (blacks, Hispanics, and whites; men and women; married and unmarried, age groups. Testing the three stages of the proposed AIDS Risk Reduction Model: (a) Labeling: To determine the effects of HIV transmission knowledge, AIDS anxiety, HIV susceptibility beliefs, and AIDS ethnocentrism on "labeling" high risk behavior (i.e. the belief that "unsafe" sex practices put one at risk for HIV infection). (b) Commitment: To examine the effects of response efficacy (i.e. beliefs that safe sex behaviors are enjoyable and decrease the risk of HIV infection) and self-efficacy (i.e. beliefs in one's ability to perform safe sex behaviors) on behavior intentions to buy condoms, to increase condom use, and to reduce multiple-partnered sex. (c) Enactment: To assess the effects of sexual communication, risk behavior labeling (stage 1 outcome) and commitment to change (stage 2 outcome) on buying condoms, condom use and multiple partnered sex. The National AIDS Behavioral Survey II (NABS II) is a telephone survey conducted as a follow-up to the National AIDS Behavioral Surveys I conducted in 1990-91. NABS II has the following specific aims: 1) Estimate changes from 1990/91 to 1992 in AIDS relevant sexual practices (number of sexual partners, unprotected vaginal/anal intercourse, condom use), HIV antibody test-seeking, injection drug use, and AIDS-relevant beliefs and social skills across gender and racial/ethnic groups in a national sample. 2) Estimate the extent to which various subgroups in the population mix sexually and thus are capable of spreading HIV or other sexually transmitted diseases out of established risk groups; such subgroups are defined by age, race/ethnicity, gender, sexual orientation, marital status, level of education, and geographic proximity. 3) Test the predictive power of the AIDS Risk Reduction Model (ARRM) in a longitudinal design. The dataset consists of 5,391 cases and 315 variables.

Brother to Brother

Investigators: John L. Peterson, Thomas J. Coates, Joseph Catania, Walter W. Hauck, Michael Acree, Dennis Daigle, Bobby Hillard, Lee Middleton, & Norman Hearst

Brother to Brother is a three-session behavioral intervention aimed at reducing HIV infection among African-American gay and bisexual men. Sessions are designed to foster positive identity development, educate participants about HIV/AIDS risk, teach assertiveness, and encourage the sharing of commitments and strategies for risk reduction among group members. Participants gain mastery through role-play, group discussion, and behavioral skills exercises. Click here to view more detailed information on this program.

SMART Couples

Investigators: Robert Remien, PhD, Michael Stirratt, PhD, Joanna Dognin, PsyD, Emily May, MA, Curtis Dolezal, PhD, Alex Carballo-Dieguez, PhD, Nabila El Bassel, DSW, Tiffany Jung, NP, Patricia Warne, PhD, & Glenn Wagner, PhD

SMART COUPLES is a four-session intervention delivered by a nurse practitioner to serodiscordant (mixed HIV status) couples. The program aims to increase antiretroviral therapy (ART) adherence in the partner living with HIV/AIDS by increasing knowledge about the importance of medical care adherence, increasing adherence motivation and self-monitoring, increasing problem solving skills to overcome adherence issues, increasing self-efficacy, and optimizing partner support. In addition, the program was designed to foster active support between partners and help couples address issues of sex, intimacy, and transmission risk behaviors. During four 45- to 60-minute sessions, the couples engage in structured discussion and instruction, as well as specific problem-solving and couple-communication exercises. The nurse practitioner helps participants learn the different components of medical care adherence, and how a partner can help prompt adherence. Participants are also given an opportunity to discuss barriers to adherence, and how to communicate with their partners about different health care concerns including sexual risk taking. Finally, couples determine what their .triggers. are for poor medication adherence, and how to avoid these triggers in the future. Click here to view more detailed information on this program.