California Survey of AIDS Knowledge, Attitudes & Behavior 1987

Investigators: State of California, Dept. of Health Services, Office of AIDS

The California Survey of AIDS Knowledge, Attitudes and Behavior: 1987 gathered data through a survey of California adults for the purpose of forecasting the course of the AIDS epidemic and planning risk reduction programs in the State of California. Augmented data collection was employed for three risk-groups: (1) gay-identifying men, (2) multiple/high-risk partner heterosexuals, and (3) recreational drug users. Interviews were conducted from October 4, 1987 through December 20, 1987. The 1988 follow-up study to the California Survey of AIDS Knowledge, Attitudes and Behavior: 1987 has been archived as Sociometrics AIDS/STI Data Archive Dataset 02. The 1987 data collection program had eight major objectives: To gather population-based data bearing on the size of the three primary AIDS risk groups in the State of California: homosexual/bisexual men, IV drug users, and multiple/high-risk partner heterosexuals; To determine the basic socioeconomic and other demographic characteristics of these risk groups in order to both enhance general understanding and allow for sufficient audience analysis to develop effective risk reduction interventions; To ascertain AIDS awareness and information levels among risk groups, as well as determining the impact of the epidemic to date on sexual and other risk behaviors; To determine the incidence of specific risk behaviors among the risk groups, including unsafe sex practices, IV drug usage, and needle-sharing; and collect baseline information that would enable behavior change over time to be monitored; To measure the degree to which existing risk reduction programs have penetrated risk group audiences in the State of California, which will be useful in evaluating the effectiveness of such programs; To collect data bearing on the design of future risk reduction programs, including questions related to message definition and the selection of appropriate communication channels; To determine AIDS awareness and knowledge levels among the general (low-risk) population of the state of California; and To gather population based data on utilization of the health care delivery system in California. Interviews were conducted from October 4, 1987 through December 20, 1987. The completion rate for interviews was 71%. Interviews were conducted in two stages. An initial 15-minute interview determined whether a respondent was a member of one or more of three AIDS high-risk groups: gay-identifying men, multiple/high-risk partner heterosexuals, or recreational drug users (not limited to intravenous drug use). If a respondent qualified as high-risk, an additional battery of questions, lasting about 20 minutes, was administered.

California Survey of AIDS Knowledge, Attitudes & Behavior: 1988

Investigators: State of California, Dept. of Health Services, Office of AIDS

The California Survey of AIDS Knowledge, Attitudes and Behavior: 1988 gathered data on 311 variables through a telephone survey of California adults for the purpose of forecasting the course of the AIDS epidemic and planning risk reduction programs in the State of California. The study consisted of 4,661 telephone interviews with a household probability sample of California adults aged 18 and over. Data collection employed stratified random sampling with over-sampling in geographic areas with identified high risk-group populations. Augmented data collection was employed for three risk-groups: (1) gay-identifying men, (2) multiple/high-risk partner heterosexuals, and (3) recreational drug users. Interviews were conducted from September 30, 1988 through December 13, 1988. Data collected in this survey permit comparisons to the California Survey of AIDS Knowledge, Attitudes and Behavior, (KABB), conducted in 1987, which has been archived as Sociometrics AIDS/STI Data Archive Dataset 01. However, the population stratification design employed in 1987 differed from that utilized in 1988, and some differences in results between the surveys may be attributable to this variation in methodology. The 1988 data collection program had four major objectives: To increase the number of risk group cases on whom reliable survey data existed in order to facilitate more detailed analysis of attitudinal and behavioral trends; To assess change or continuity in the incidence and distribution of AIDS risk behaviors over the year between the 1987 KABB survey and the 1988 KABB survey; To assess change or continuity in knowledge levels and attitudes of high-risk individuals between the two surveys; To measure the effectiveness of recent educational initiatives in California, including the national household mailing conducted by the Surgeon General of the United States.

Community-based Directly Observed Therapy (C-DOT) Program

Investigators: Maribel Muñoz, RN, Karen Finnegan, MPH, Jhon Zeladita, RN, Adolfo Caldas, MSW, Eduardo Sanchez, MD, Miriam Callacna, RN, Christian Rojas, MD, Jorge Arevalo, MD, Jose Luis Sebastian, MD, Cesar Bonilla, MD, Jaime Bayona, MPH, MD, & Sonya Shin, MPH, MD

The C-DOT Program aims to increase adherence of individuals living with HIV beginning highly active antiretroviral therapy (HAART). The program includes 4-day training for DOT workers. After training, DOT workers provide support to participants for a total of 11 months. For eight months DOT workers monitor all HAART doses (and doses of other medications for indications other than HIV) in participants' homes while providing social, emotional, and informational support to participants and their families and reporting missed doses, adverse events, and psychosocial crises to nurses. During the last three months DOT workers visit participants less frequently to prepare the participant for self-administration. Supervisors act as an intermediary between participants and the medical organization, coordinating other aspects of participants. medical care. Nurses supervise C-DOT Program staff and monitor follow-up care of participants. The C-DOT Program was shown to increase adherence, suppress viral load, and be associated with better tuberculosis outcomes. Additionally, the program has been shown to improve stigma, social support, self-efficacy, and health service acquisition. The C-DOT Program was originally implemented throughout the community as DOT workers conducted home visits to participants and monitored medication doses in homes or other community locations. This program may also be applicable to clinic settings and feasible to implement in clinics or hospitals serving individuals living with HIV. Click here to view more detailed information on this program.

CyberSenga

Investigators: Michelle Ybarra, Tonya Prescott, Josephine Korchmaros, Julius Kiwanuka, Sheana Bull, David Bangsberg, Norma Ware, & Ruth Birungi

CyberSenga is part of an effort to increase technology-based HIV prevention research in resource-limited settings such as Uganda. The purpose of CyberSenga is to prevent more people from getting HIV and to help those who have HIV live healthy lives by taking advantage of Internet technology to give young people both honest and truthful information, and the tools they need to make good decisions. CyberSenga consists of five one-hour modules conducted through the online CyberSenga software, along with a four-month post-intervention booster session. At the beginning of the program, participants answer two questions to sort them into four groups: abstinent boys, abstinent girls, sexually active boys, and sexually active girls. Based on their responses, participants are directed to intervention content tailored for saliency based upon their biological sex and sexual experience, although all versions include the same concepts. Content discusses relevant topics to provide youth with the information and skills they need to make healthy decisions in the future. An evaluation of CyberSenga has demonstrated that receiving the five CyberSenga sessions improves youths’ HIV preventive information as well as motivation to use condoms, and the booster session delivered four months after the initial intervention enhances the learning effect. Click here to view more detailed information on this program.

Demographic, Behavioral & Health Characteristics of Injection Drug Users in San Francisco 1985-86

Investigators: John K. Watters

The study, Demographic, Behavioral, and Health Characteristics of Injection Drug Users in San Francisco, 1985- 86, was conducted in late 1985 and early 1986 as part of a larger investigation of health characteristics and risk factors for HIV transmission in intravenous drug users. The purpose of the study was to obtain data on demographic characteristics, sexual and other risk behavior, and general health characteristics from a group of intravenous drug users (IVDUs) in San Francisco. The San Francisco research team first conducted a two-pronged approach among the city's IVDUs during late 1985 and early 1986. The first element consisted of intensive ethnographic study in the two San Francisco neighborhoods with the highest concentrations of IVDUs.The other direction of research, which proceeded simultaneously with the ethnographic study, consisted of lengthy interviews with 438 IVDUs.

Doing Something Different: Group Counseling at STD Clinics to Promote Condom Use

Investigators: Deborah A. Cohen

Doing Something Different, a single-session, one-hour intervention, was designed for use in an inner-city public health clinic, but is appropriate for use in any community setting that provides education or services to at-risk populations. The intervention is led by a health educator, who presents a video on the social acceptability of condom use, demonstrates proper condom-use techniques, and directs a role-playing session in which participants practice negotiating condom use with sexual partners. Click here to view more detailed information on this program.

Entre Nous Jeunes

Investigators: Simon-Pierre Tegang, M.Sc., Jean Paul Tchupo, M.A., Gdon Yomi, M.Sc., & Blanche Djofang, B.A.

During the 18-month program, Entre Nous Jeunes utilizes a peer-education strategy to increase contraceptive prevalence and reduce the prevalence of STI/HIV and unintended pregnancies. Young adult peer educators in the community educate youth about HIV prevention and safer sex. Peer educators are trained during a one week-long session for the program. For two years, peer educators engage youth in the community by leading discussion groups, creating and using promotional materials, and referring peers to social and health services. The main objective of the program is for young people who have been exposed to a peer-educator to gain greater knowledge and practice more protective behaviors than those not exposed. The findings indicate the important contribution of the ENJ peer-educator program to the promotion of protective reproductive health behaviors to reduce unintended pregnancies and STIs among adolescents. In particular, the program was significantly associated with greater spontaneous knowledge of modern contraceptives and STI symptoms. Findings also suggest positive intervention effects on contraceptive knowledge for males, and virginity and contraceptive use at last intercourse for sexually active females. Click here to view more detailed information on this program.

FOCUS: Preventing Sexually Transmitted Infections and Unwanted Pregnancies among Young Women

Investigators: Cherrie Boyer, Mary-Ann Shafer, Lance Pollack, Kelli Betsinger, Y. Jason Yang, Julius Schachter, Richard Shaffer, Stephanie Brodine, Heidi Kraft

The FOCUS program, a four-session cognitive-behavioral group intervention addressing prevention of sexually transmitted infections (STIs) and unintended pregnancies, was originally delivered to young women US Marine Corps recruits. Following a baseline survey, 2,157 women were randomized into either the experimental group (n=1,062) or the control group (n=1,095). Both groups received interventions of four two-hour sessions. Follow-up surveys were conducted with both groups at approximately four months post-baseline and approximately 14 months post-baseline. The evaluation results revealed that a higher proportion of the control group had a post-intervention STI or unintended pregnancy than the intervention group (Odds Ratio = 1.41, 95% Confidence Interval = 1.01-1.98). Among study participants who had no pre-intervention history of STIs or pregnancy, but who engaged in risky sexual behaviors just before recruit training, the control group was significantly more likely to acquire a post-intervention STI than the intervention group (OR = 2.05, CI = 1.74-4.08). Among study participants who reported not being sexually experienced at baseline, control group participants were significantly more likely to have had multiple sexual partners post-intervention than intervention group participants (OR = 1.87, CI = 1.01-3.47). FOCUS 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 been proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

Focus on Youth (FOY) with ImPACT

Investigators: Bonita Stanton, MD, PhD, Jennifer Galbraith, PhD, Cherri Gardner, MA, Pam Drake, PhD, James Walker, Scott Martin, Teree Jerome, Suzanne Schrag, Sarah Stevens, Charlene Foster, & the CDC Division of HIV/AIDS Prevention

Focus on Youth with Informed Parents and Children Together (ImPACT) is an HIV, STD and pregnancy prevention intervention for African-American youth ages 12–15. The intervention was updated from Focus on Kids, a community-university linked research and intervention program. The goal of Focus on Youth with ImPACT is to reduce the risk of HIV infection among youth. The researchers, led by principle investigator Bonita Stanton, M.D., worked with community members from recreation centers, housing developments, schools and government agencies in settings throughout the U.S. to reach this goal. The evaluation of the combined Focus on Kids and ImPACT interventions met the necessary criteria for the interventions identified as interventions with best evidence of efficacy by the Centers for Disease Control and Prevention’s (CDC) HIV/AIDS Prevention Research Synthesis (PRS) Project. Focus on Kids alone was identified as an intervention with promising evidence. This Focus on Youth with ImPACT edition provides updated information and more tools to facilitate implementation and increase the relevance of the program for African-American youth between ages 12 and 15 who are at risk for HIV infection. ImPACT is a 90-minute HIV prevention program for parents of African-American adolescents used in combination with Focus on Youth. ImPACT is delivered to parents/guardians and youth, one family at a time, by a health educator. It consists of basic HIV information, a culturally appropriate video documentary that stresses parental monitoring and communication, a discussion with the health educator, two guided roleplays, a parent/guardian resource guide, and a condom demonstration. It was guided by parental monitoring theory and theory of parenting (passive, authoritarian and authoritative).

Focus on the Future

Investigators: Richard Crosby, PhD, Ralph J. DiClemente, PhD, Richard Charnigo, PhD, Gregory Snow, Adewale Troutman, MD

FOCUS ON THE FUTURE, a one-to-one, single session intervention, administered by a lay health advisor, is culturally appropriate for use among young (aged 18-29 years) heterosexual African American men newly diagnosed with a sexually transmitted infection (STI). Based on the behavioral skills model, this one hour long program consists of a personalized discussion, presentation of basic STI/HIV/AIDS and safer sex information, and condom use skills practice. For each individual participant, the FOCUS ON THE FUTURE health facilitator initiates a discussion about the disproportionate HIV/AIDS burden experienced by African American men (illustrated using large posters); condom negotiation skills; and any questions, problems, and concerns the men may have regarding safer sex with their partners. The health facilitator also conducts a demonstration of available condom and lubricant varieties and correct condom and lubrication use. Throughout the session, the advisor encourages the individual to feel good about using condoms, to experience condoms as being compatible with sexual pleasure, to equate condom use with an investment in his future, and to actively protect himself from obtaining a future STI. Men are encouraged to use condoms that they feel fit them well and provide them with a sense of security. Participants receive pocketsize vials of water-based lubricants as well as 12 or more condoms of their choice from a broad selection of brands and sizes. Click here to view more detailed information on this program.