Point for Point

Investigators: San Francisco AIDS Foundation HIV Prevention Project & The Prevention Point Research Group

Point for Point is a needle exchange intervention designed for implementation in street settings. Needle exchange operates on the premise that increased availability of sterile syringes can reduce the prevalence of needle-sharing among injection drug users (IDUs). Needle sharing, the use of the same syringe by more than one person, is associated with high rates of transmission of infectious diseases, including HIV/AIDS. Point for Point relies on trained volunteers to operate exchange sites at which sterile hypodermic syringes are exchanged for used syringes on a one-for-one basis. Volunteers also distribute condoms and provide exchangers with bleach, alcohol swabs, sterile cotton, and other materials associated with safer drug-injection techniques. Point for Point was evaluated under the name Prevention Point in connection with the Urban Health Study (UHS), a long-term study of the IDU community in San Francisco, CA. Data collected through UHS surveys revealed that Point for Point quickly became the principal source of sterile syringes for San Francisco IDUs, and that IDUs who reported regular use of the needle exchange were significantly less likely to report needle-sharing than IDUs who did not use the needle exchange. Participants also reported a significant drop in the median number of daily injections, and the proportion of respondents who reported their first injection behavior in the previous year dropped significantly. An overall decline in reported needle sharing was also observed (Watters, 1996; Watters, Estillo, Clark and Lorvick, 1994). Click here to view more detailed information on this program.

Portland Women's Health Program

Investigators: Brian W. Weir, MPH, Rosemary Breger, MPH, Kerth O'Brien, PhD, Carol J. Casciato, Ronda S. Bard, PhD, John A. Dougherty, PhD, Michael J. Stark, PhD

Portland Women's Health Program, a one-to-one behavioral intervention, aims to reduce HIV risk behaviors and increase life stability among women who were recently incarcerated. A community health specialist extensively trained in motivational interviewing (MI) techniques meets individually with women during 10 sessions delivered over three months. During program sessions, the health specialist uses MI techniques to empower and encourage women to explore potential positive changes they can make in their lives. The sessions are both directive, since the health specialist guides the conversation toward particular topics, and participant-centered, since the participant's experiences, views, and reluctance or readiness to change are central topics of discussion. All ten of the Portland Women's Health Program sessions address HIV-prevention in addition to life stability issues. Click here to view more detailed information on this program.

Project MARS: Motivating Adolescents to Reduce Sexual Risk

Investigators: Angela D. Bryan, Renee E. Magnan, Arielle S. Gillman, Elizabeth A. Yeater, Sarah W. Feldstein Ewing, Alberta S. Kong, & Sarah J. Schmiege

MARS (Motivating Adolescents to Reduce Sexual risk) is an intervention targeted at reducing adolescent risky sexual behavior, particularly in contexts where alcohol or marijuana use may be involved. An evaluation of the MARS intervention showed that it resulted in decreased incident sexually transmitted infections one year after delivery. This one-session, two-hour intervention is appropriate for community based settings including juvenile justice centers for use with high risk adolescents. The MARS intervention is delivered in a motivational enhancement therapy format. The approach for this intervention is grounded in the assumption that the responsibility and capability for change exist within the participant. The role of the intervention leader is to create an environment that will enhance the participant’s inherent motivation for, commitment to, and movement towards behavior change. The intervention involves group discussion and exercises focused on establishing a condom language, talking about condom use, provision of norms, self-affirmation, high risk situations, and how one might change, along with video review, interactive games, and skills building. The intervention is led by a Masters or PhD level therapist. Groups should be kept small and capped at 6 to 8 participants, and the age range of participants in the group should be restricted to two years (for example, 14-16 or 16-18) in order to keep the range of experiences similar. Although MARS is appropriate for all genders, if possible adolescent groups should be kept single-sex. MARS has been evaluated in a cluster randomized controlled trial. Data was collected at pre-test and immediate post-test as well as 3, 6, 9, and 12 months post-intervention. The intervention was effective at reducing STI incidence. Participants had lower incidence of STI at follow-up than participants who received comparison interventions with only sexual risk or sexual risk and alcohol content, as opposed to sexual risk, alcohol, and cannabis content. Click here to view more detailed information on this program.

Project SMART: AIDS Education for Drug Users in Short-Term Treatment

Investigators: Benjamin Lewis

Developed for use in short-term in-patient drug treatment programs, Project SMART includes two distinct interventions: a two-session informational intervention and a six-session enhanced intervention that includes both informational and behavioral skills training. A trained health educator delivers both interventions. In the informational intervention, participants receive an overview presentation about AIDS, complete homework, and watch condom-use and works-cleaning demonstrations. In the enhanced intervention, participants also participate in role-plays, watch video presentations, and practice condom-use and works-cleaning skills. Click here to view more detailed information on this program.

Real Men Are Safe (REMAS)

Investigators: Donald A. Calsyn, PhD, Mary Hatch-Maillette, PhD, Susan Tross, PhD, Suzanne R. Doyle, PhD, Yong S. Song, PhD, Judy M. Harrer, PhD, Genise Lalos, MA, Sara B. Berns, PhD

REMAS is a group-level, clinic-based behavioral intervention designed to reduce HIV/STI risk among male substance abuse treatment center attendees. More specifically, the program aims to reduce the number of times that men engage in unprotected vaginal and anal sexual intercourse, or have sex while under the influence of drugs or alcohol. Two trained male health counselors teach participants information, help participants develop risk-reduction skills, and motivate behavior change through group discussion, role-play, and condom use skill training. REMAS is comprised of five 90-minute sessions where participants learn about HIV risky-behaviors, HIV prevention planning, and methods for communicating about safer sex and discussing sex without drugs. Click here to view more detailed information on this program.

Rikers Health Advocacy Program (RHAP)

Investigators: Stephen Magura, Janet Shapiro, & Sung-Yeon Kang

This program, originally developed for use with incarcerated male adolescent drug users between 16 and 18 years of age, consists of four one hour small group sessions focusing on health education issues, particularly HIV/AIDS. Adapting techniques of Problem Solving Therapy, the facilitator guides eight-person groups in discussing the following topics: general health, HIV and AIDS, drug abuse and its consequences, sexual behavior, health and AIDS-risk behaviors, and strategies for seeking health and social services. Active learning is emphasized, with opportunities for youths to define high-risk attitudes and behaviors, suggest alternative actions, and engage in role play and rehearsal activities. A field study of the curriculum compared the attitudes and behaviors of RHAP participants with those of a control group of teens, selected from a waiting list for the program. Both samples were predominantly African-American and Hispanic. Following the intervention, program participants were more likely to use condoms during intercourse, compared to the comparison group of teens. RHAP 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.

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.

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.

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.

State-Wide Indian Drug Prevention Program

Investigators: Steven P. Schinke

The program is a drug prevention program, designed to combine a social learning based intervention with bicultural competence theory. Bicultural competence encompasses skills that can enable American-Indian people to adapt the roles in which they were raised with the culture in which they are surrounded. The three subgoals of bicultural competence, knowledge and practice in communication, coping, and discrimination skills, provide the theoretical foundation for intervention to prevent substance abuse with American-Indian youth. The original program was designed primarily for fourth and fifth grade Native American/Alaskan Native students in s classroom setting, but it can easily be modified for higher-grade levels and other adolescents. The curriculum can be implemented in a wide variety of settings, including public schools, tribal schools, tribal community centers, and student retreats. The intervention is administered in 15 one-hour sessions. Click here to view more detailed information on this program.