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.

HIV/AIDS Warriors Program

Investigators: Eric G. Bing, MD, Daniel J. Ortiz, PhD, Ricardo E. Ovalle-Bahamn, C. Phil., Karen G. Cheng, PhD, Francisco Ernesto, MD, & Cherrie B. Boyer, PhD

The HIV/AIDS Warriors Program aims to enhance HIV risk reduction knowledge, motivation, and behaviors among soldiers or other at-risk populations. The program is composed of five, 4-hour sessions delivered on consecutive days to groups of soldiers by civilian facilitators. Optional monthly booster sessions last 1-hour and reinforce the information provided by the initial program and give participants an opportunity to discuss their experiences related to the program. Program participants significantly increased their HIV/AIDS knowledge, perceived vulnerability to HIV, and condom use. Program participants also engaged in fewer unprotected sex acts with girlfriends, occasional partners, and sex workers; reduced the number of unprotected anal sex acts with live-in partners; and reduced the overall number of occasional partners and sex workers. The HIV/AIDS Warriors Program was originally designed for and implemented with soldiers in the Angolan Armed Forces. The HIV prevention messages presented in the curriculum are applicable to other non-military populations at risk of acquiring and transmitting STIs/HIV. Click here to view more detailed information on this program.

Multimedia WiLLOW: HIV Transmission Reduction Among African American Women Living with HIV

Investigators: Josefina J. Card, Amie Ashcraft, John Wundes, Nikia Braxton, Gina Wingood, & Ralph DiClemente

Multimedia WILLOW in an interactive computer-based intervention designed for African American women living with HIV that is gender relevant and culturally sensitive, based on the effective group intervention WiLLOW. The intervention incorporates elements of sexual risk reduction to reduce STI/HIV sexual transmission and to enhance psychosocial mediators and structural factors associated with preventive behaviors. Designed for implementation in clinical or community-based settings, the two-session interactive, intervention emphasizes ethnic and gender pride, elements of sexual risk reduction, sexual negotiation skills, proper condom use, and development of partner norms supportive of consistent condom use. Each session offers multimedia learning, games and quizzes to help viewers increase and reinforce their risk-reduction awareness, knowledge, and skills. Women interact with the computer-based intervention individually and at their own speed. Only minimal staff participation is needed to implement Multimedia WiLLOW. A recent study demonstrated the efficacy of Multimedia WiLLOW. The evaluation study (N=168) used a randomized controlled design to examine Multimedia WILLOW.s efficacy by assessing participants. Multimedia WILLOW participants, compared to the control condition, had a significantly higher percentage of condom protected sex acts in the past 30 days (90% vs. 80%, p=.001). This greater condom use occurred with both HIV-negative (90% vs. 80%, p=.037) and HIV-positive (100% v. 70%, P=.011) partners. Women receiving Multimedia WILLOW were also more likely to report 100% condom use (OR = .10; p=.003) and had a lower adjusted mean number of unprotected vaginal and anal sex acts in the past 30 days (.31 vs. 2.33, P=.002). In comparison to women in the control condition, Multimedia WILLOW participants reported significantly higher levels of communication with their partners on HIV risk reduction practices (11.5 vs. 10.8, p=.052); greater sexual communication self-efficacy (36.1 vs. 34.0, p=.003); and less self-reported stress (32.3 vs. 34.3, p=.003). Participants rated the computer-delivered intervention more favorably than the standard of care condition in the four principal satisfaction categories -- enjoyment (4.69 v. 4.26, p

HIV/AIDS Prevention Practitioner Institute (HPPI)

Investigators: Josefina J. Card & Diana Dull Akers

The HIV/AIDS Prevention Practitioner Institute (HPPI) was created to empower HIV prevention professionals facing programmatic challenges and health disparities on the front line of the epidemic. HPPI consists of five interactive, multimedia, computer-delivered courses (and accompanying texts). The courses are designed to increase HIV health professionals' capacity to plan, evaluate, and sustain scientifically effective, culturally competent HIV prevention interventions. Each course in the multimedia HPPI series includes a video course guide, video segments with practitioners, quizzes, glossaries, workbook activities, and interactive learning exercises. Course 1: Developing a Program Model. defines and reviews the elements that make up a program model, explains how program models are used and what is involved in creating a program model, guides you through the specific steps for developing a program model and assessing its strength, and finally, explores strategies for assessing and improving the strength of your program model. Course 2: Program Replication and Adaptation. This course walks you through the steps required to select and adapt effective programs successfully. In particular, it addresses the following questions: 1. How do you identify effective programs? 2. How do you decide whether to replicate a program, and, if so, which one? 3. If necessary, how do you adapt a program to better meet the needs of your target population and setting? Course 3: Understanding Process Evaluation. This course focuses on strategies to assess an intervention program to see what is working and what is not, to determine what factors contribute to success or failure, and to refine the ways a program is im plemented. The course defines process evaluation, identifies key questions process evaluati on can answer, identifies uses of process evaluation findings, explains the steps necessary to conduct a process evaluation, and describes how a process evaluation can contribute to an outcome evaluation. Course 4: Understanding Outcome Evaluation. This course focuses on the most scientific way to determine if your program is having the desired positive impact on program participants' knowledge, attitudes, beliefs, skills, intentions, behaviors, or health status outcomes, such as prevention of HIV or sexually transmitted infection (STI). This course will help you: 1) Identify key research questions that can be answered by an outcome evaluation; 2) Understand the similarities and differences between outcome and process evaluations; 3) Understand the benefits of conducting outcome evaluations; 4) Implement the steps necessary to conduct a basic outcome evaluation; and 5) Understand why a comparison group is essential to outcome evaluation. Course 5: Creating Culturally Competent Programs. This course focuses on culture, cultural identity, and the importance of striving for cultural competence in your HIV prevention program. The course explores strategies for bringing cultural competence goals to bear on HIV/AIDS prevention program planning, implementation and evaluation processes.

Youth and AIDS Project's HIV Prevention Program

Investigators: Gary Remafedi, Susan Reynolds, John Yoakam, & Kevin Cwayna

A community and university partnership launched this program to provide education, peer support, counseling, and case management to gay and bisexual male adolescents between 13 and 21 years of age, who are at high risk for HIV/AIDS. The program begins with an initial two-hour interview for individualized HIV/AIDS risk assessment and risk reduction counseling. Youth then participate in a 90-minute interactive peer education program designed to provide clear, factual information in an atmosphere of mutual support. The program's lessons are reinforced in an educational video. Optional peer support groups meet weekly, if youth wish to attend. Finally, there is a one-hour follow-up visit for reassessment and referrals, as needed, to medical and social services. A field study of the program was conducted with a predominantly white sample of males, ages 13-21, who identified themselves as gay or bisexual. Following the intervention, the 139 participants reported less frequent unprotected anal intercourse and more frequent use of condoms. A reduction in substance abuse, particularly amphetamines and amyl nitrate, was also recorded. Click here to view more detailed information on this program.

Information-Motivation-Behavioral Skills HIV Prevention Program (IMB)

Investigators: Jeffrey Fisher, William A. Fisher, Stephen J. Misovich, & Angela D. Bryan

The goal of the Information-Motivation-Behavioral Skills HIV Prevention Program (IMB Program) is to reduce high school students' risk of HIV infection. Program objectives include positively influencing students' HIV prevention knowledge, attitudes and norms, increasing students' levels of HIV prevention behavioral skills, and increasing students' levels of HIV preventive behavior. The intervention involves a four-session classroom component to be conducted by trained high school teachers. The IMB Program is based on the Information, Motivation and Behavioral Skills (IMB) model of health behavior change, which assumes that information, motivation and behavioral skills are the fundamental determinants of HIV preventive behavior. An evaluation of the curriculum offered in three intervention formats (classroom-based only, peer-based only, and combination classroom and peer-based delivery) was conducted by the Center for Health/HIV Intervention and Prevention in 1999. Participants were 1,577 students in four inner-city high schools in Connecticut (61% African-American, 28% Hispanic-American, 11% Caucasian, mixed or "other.") The classroom-based HIV prevention education component effectively promoted risk reduction behavior change in these urban high school settings at one year post-intervention. Click here to view more detailed information on this program.

Keepin' It R.E.A.L.! A Mother-Adolescent HIV Prevention Program

Investigators: Colleen DiIorio, Frances McCarty, Dongqing Terry Wang, Pamela Denzmore, Ken Resnicow, Anindya K. De, William N. Dudley, PhD

The KEEPIN. IT R.E.A.L.! (Responsible, Empowered, Aware, Living) evaluation tested the effectiveness of two HIV prevention interventions designed for mothers and their adolescents, as compared to a control group. Sites were randomly assigned to one of three conditions: the Social-Cognitive program (SCT--four sites, the focus of this replication kit); another program not included in this kit; or the control condition (four sites). The SCT program was designed to delay initiation of sexual intercourse for those adolescents who were not yet sexually active, and to increase condom use among sexually active participants. SCT involved seven 2-hour meetings conducted over 14 weeks. Participating adolescents (N = 582) were between the ages of 11 and 14 years, mostly male (60%), and African American (97.7%). The number of participating mothers was 470; 110 mothers had more than one adolescent in the study. Assessments were conducted at baseline, and at 4, 12 and 24 months after baseline. At the 24-month assessment, a higher percent of sexually active participants in the SCT groups reported condom use at last sex compared to their control group peers (96% and 85%, respectively), condom use intentions (100% and 94%, respectively), and cessation of sexual activity until they were older (43% and 24%, respectively). For the mothers, their levels of self-efficacy and comfort for talking with their adolescents about sex increased over time. Both mothers and adolescents demonstrated an increase in HIV knowledge. Click here to view more detailed information on this program.

Tools for Building Culturally Competent HIV Prevention Programs (CC)

Investigators: Julie Solomon, Jacqueline Berman, Laura Lessard, Diana Dull Akers, Angela Amarillas, Megan Bunch, & Josefina J. Card

In the fight to reduce the spread of HIV, addressing the specific HIV-related needs of diverse cultural groups is becoming increasingly important. Tools for Building Culturally Competent Prevention Programs is designed to help HIV prevention professionals who are planning, implementing, or evaluating programs to increase the cultural competence and effectiveness of HIV prevention efforts in their local communities. The Tools website is divided into Planning, Implementation, and Evaluation Toolkits. Each Toolkit comprises a set of research-based, practitioner-friendly resources, including: Key Concepts, which summarize in plain language the important concepts and practices in effective, culturally competent HIV prevention programming. Interactive elements within the Key Concept webpages help reinforce the concepts with concrete examples. Tools, which are user-friendly MSWord checklists and worksheets that facilitate culturally competent programming. The user can type directly into each document and save it for future use. Other Resources, which include "tales from the field"--true stories of how the key concepts have been put into practice in real-world prevention settings--and links to additional relevant resources available through the Internet. The web site also contains an introductory section that provides an overview of the concepts of culture and cultural competence, and their relevance for HIV prevention programming. The site also offers a glossary of all the terms used in the site.

HORIZONS: STI/HIV Sexual Risk Reduction Intervention for African American Girls

Investigators: Ralph J. DiClemente, Gina M. Wingood, Eve S. Rose, Jessica M Sales, Delia L. Lang, Angela M. Calienda, James W. Hardin & Richard A. Crosby

HORIZONS, a two-session STI-prevention program developed for small groups of sexually-active African American adolescent girls, was developed to address a broad range of risk factors, including personal, relational, sociocultural, and structural factors. The overall goals of the program are to reduce recurrent STIs and enhance STI/HIV preventive behaviors. The workshops are interactive, involving the participants in games, role playing, poetry readings, condom skills practice, and self-reflection activities. HORIZONS was evaluated with a randomized control trial that included two conditions (control and intervention). Data was collected from the subjects at baseline, 6-months and 12-months post-completion of the program. When the program participants were compared to their control group peers, the program participants had, on average, a 35% lower risk of having Chlamydia than the control participants (RR, 0.65; 95% CI, 0.42 to 0.98; P=.04). Overall, participants in the program condition had higher self-reported condom use during sexual activity in the previous 14 days (P=.004) and 60 days (Phere to view more detailed information on this program.

Teen Health Project (THP): Community-Level HIV Prevention Intervention for Adolescents in Low Income Housing Development

Investigators: Kathleen J. Sikkema, Jeffrey A. Kelly & the Teen Health Project Team

TEEN HEALTH PROJECT was developed for adolescents ages 12 to 17 living in low-income housing developments. The purpose of the evaluation study was to determine whether the effects of a community-level HIV risk reduction intervention would be stronger when the intervention targeted change in individual-level risk reduction as well as change in the social and peer normative environment. Participants (n = 1,172) were recruited from 15 housing developments. Developments were randomly assigned to the community-level intervention (5 developments), workshop-only (5 developments), or a control condition (5 developments). Assessments were conducted at baseline, approximately 3 months after completion of the educational sessions, and again approximately 18 months after baseline. At long-term follow-up, adolescents living in the community-level developments were more likely to have remained abstinent than their control group peers (t(1, 10) = 2.22, Phere to view more detailed information on this program.