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.

Prime Time: A Positive Youth Development Program

Investigators: Renee Sieving, Jenny Oliphant, Kayci Rush, Bethany Divakaran, Jill Farris, and Glynis Shea

Prime Time is an 18-month multicomponent program that seeks to reduce sexual risk behaviors, violence involvement, and school disconnection among sexually active female adolescents at increased risk for early pregnancy and sexually transmitted diseases. The program is grounded in a Positive Youth Development framework that views young people as resources to be developed, not problems to be fixed. Prime Time aims to build adolescents’ skills and competencies, confidence, character, connections, and contributions through program activites. Prime Time consists of two core components. The first is one-on-one case management, which addresses social and emotional skills, responsible behaviors, healthy relationships, and positive involvement with family, school and the community. The second core component is a 16-session peer educator program called Just In Time, which addresses communication, stress management and conflict resolution skills, responsible sexual behaviors, sexual decision-making, and contraceptive use. Through a combination of case management and the peer educator program, Prime Time targets outcomes including fewer sexual partners; consistent condom and hormonal contraceptive use; reduced interpersonal aggression and violence; and reduced school misbehavior and dropout. An evaluation of Prime Time showed that receiving the intervention increased abstinence, as well as more consistent use of condoms, hormonal contraception, and dual-method contraception. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. 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 SAFE (P-SAFE)

Investigators: Tamara Kuhn, Charles Klein, Alejandra Moreno, and Carmela Lomonaco

Project SAFE is a computer-delivered HIV/STI prevention program specifically designed for Latinas available in both English and Spanish. P-SAFE includes videos of individual women speaking candidly about HIV/STI-related topics in their lives and communities, skills instruction by the health educator, groups of women practicing condom skills, and role-play and novela vignettes demonstrating intervention themes.

Project SAFE: Sexual Awareness For Everyone An Intervention to Prevent STDs Among Minority Women

Investigators: Rochelle N. Shain, Reyes Ramos, Sondra T. Perdue, & Edward R. Newton

Developed for use in public health clinics, PROJECT S.A.F.E. is a three session cognitive-behavioral intervention designed to reduce STD infections among Hispanic and African American women. Sessions are designed to facilitate skill development to avoid infections while increasing awareness that STDs (including AIDS) disproportionately affect minority women. The intervention also helps build decision-making and communication skills, and encourages participants to set risk reduction goals. Participants gain mastery through role-play, group discussion, and behavioral skills exercises. The original evaluation, conducted in metropolitan San Antonio, TX, between 1993 and 1994, included 617 Hispanic and African American women. Participants were randomly assigned to either the intervention group (n=313) or the control group (n=304). Intervention group participants took part in three small-group sessions while their control group counterparts received standard STD counseling. Program participants showed a lower rate of infection as well as a better understanding of risky sexual behavior as compared to the control group. 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.

Protect and Respect

Investigators: Michelle Teti, Linda Lloyd, Susan Rubinstein, Lisa Bowleg, Mary Ann Nkansa, Russell Cole, Zekarias Berhane, Erika Aaron, Ann Ricksecker, Marla Gold, Susan Spencer, Rhonda Ferguson, Dianne Rorie

PROTECT AND RESPECT, a clinic-based, behavioral intervention, aims to reduce the sexual transmission of HIV by decreasing high-risk behaviors among women living with HIV/AIDS. The intervention delivers HIV prevention messages in the following three ways: (1) a primary care provider counsels participants during health care visits; (2) an Intervention Specialist leads five group skills building sessions that teach skills to reduce sexual risk behaviors; and (3) Peer Educators conduct weekly discussion groups, which support participants. attempts to implement behaviors learned in the group skills building sessions. The program provider delivers a one-time, brief prevention message lasting 3 . 5 minutes, while the group skills building sessions consist of five 2-hour weekly educational sessions delivered over a 5-week period. The peer-led support groups meet weekly for 1-hour, beginning after the group skills building sessions have concluded, and may extend for as long as the program is in effect. During support group sessions, women are provided with an opportunity to discuss specific topics such as HIV risk reduction strategies, how to disclose, handling stress, or communicating with partners. Click here to view more detailed information on this program.

Queens Hospital Center's Teenage Program

Investigators: Jill M. Rabin & Vicki Seltzer

Based upon the premise that a teen's first pregnancy may stem from underlying, unmet needs, this clinic-based program provides medical care, psychosocial support, and education to the adolescent, her partner, and her family. The comprehensive approach to service emphasizes early intervention, beginning during pregnancy. For the duration of the intervention, each patient and her infant remain with a team of providers: an obstetrician-gynecologist, pediatrician, social worker, and health educator. The program also includes a physician/ practitioner 24 hour "on call" system and a reproductive health and family life education program, featuring bi-weekly classes for the patient, her partner, and family. In an effort to prevent repeat pregnancy and STDs, the teen's partner is encouraged to participate in education, support, and counseling activities. A field study of the intervention was conducted in Queens, New York, with 498 adolescents and their infants. Compared to a control group of teen mothers, program participants were more likely to attend and graduate from school and (for those who were sexually active) use regular contraception; additionally, both they and their infants experienced significantly better health. Moreover, the repeat pregnancy rate was significantly lower for program participants compared to the control group. Click here to view more detailed information on this program.

Reach for Health: A School-Sponsored Community Youth Service Intervention for Middle School Students

Investigators: Lydia O'Donnell, Alexi San Doval, Richard Duran, Deborah Haber, Rebecca Atnafou, Patricia Piessens, & Renee F. Wilson-Simmons, Ann Stueve, Joseph H. Pleck, Norma Johnson, Uda Grant, Helen Murray

The REACH FOR HEALTH COMMUNITY YOUTH SERVICES PROGRAM (RFH-CYS) targets African-American and Hispanic youth living in urban areas. REACH FOR HEALTH combines a classroom teaching component with community service work. The intervention, as implemented, provides opportunities for middle school students to participate in service activities within their communities while simultaneously reducing early and unprotected sexual activity. The intervention was initially delivered in 1994 to two large middle schools in Brooklyn, NY; one school was designated as the intervention school, the other as the control. A total of 68 classrooms participated in the initial implementation. In the control school, 33 classrooms (584 students) received the standard New York City health education program, which includes some mandated lessons on drugs and AIDS. Within the intervention school, 22 classrooms (222 students) were randomly assigned to receive core RFH curriculum (classroom component only). The remaining 13 intervention classrooms (255 students) received the enhanced RFH plus Community Youth Services program (RFH-CYS). Bi-lingual and special education classes were included from both school sites. At follow-up six months later, reports of sexual activity were higher across the sample. However, students in the control condition showed greater increases in risk behavior (ever had sex, recent sex, recent sex without condom, recent sex without birth control) than did their peers in the treatment conditions. In contrast, students in both intervention conditions showed increases in their use of STD protection and birth control. Also noteworthy are the findings that eighth graders and special education students showed the greatest improvement. Click here to view more detailed information on this program.