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.

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/Community Program for Sexual Risk Reduction among Teens

Investigators: Murray Vincent

This program is a community-wide public outreach campaign. It incorporates multiple forms of outreach and public education to engage the entire community in preventing pregnancy among unmarried adolescents. Public schools, universities, church groups and civic organizations are all targeted as sites for training and workshops concerning human physiology, sexual development, self-concept and sexual awareness, values clarification and communication skills. Abstinence is promoted as the preferred sexual health decision in all activities; contraceptive information is provided for teens who do choose to become sexually active. The intervention was developed and field tested in a rural, low-income and predominantly African-American community. A significant drop in the pregnancy rate was recorded during the full implementation period of the program. Click here to view more detailed information on this program.

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.

U.S.-Mexico Border Survey, 1979

Investigators: Jack C. Smith

Health officials have long recognized that special attention is required to identify and deal with health problems unique to people who live along the U.S.-Mexico border. The United States-Mexico Border Health Association conducted this survey on the utilization of family planning and maternal health services among households in the area in 1979. Its aim was to provide information that would be useful to local, state and regional health officials involved in planning and delivery of family planning and maternal health services in the border area. Data include information on fertility, family planning, maternal and child health, alcohol consumption, smoking, and knowledge of contraception. Some general desciptive information about the area surveyed is also included.

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.

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.