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The Research
The Intervention

The Research

The Science Behind the Package
RAPP is a community mobilization program designed to reduce risk for HIV and unintended pregnancy among women in high-risk communities by increasing condom use. The program is based on the multi-site HIV Prevention in Women and Infants Demonstrations Project. RAPP is based on the transtheoretical model of behavior change, which states that people move through a series of stages in the process of changing their behavior. The program also is supported by theories of social learning and diffusion of innovation, which suggest that people are more likely to adopt new behaviors that have already been accepted by others who are similar to them and whom they respect.

Target Population
Sexually active women of reproductive age and their male partners

Intervention
The RAPP II intervention relies on a set of peer-led integrated activities:

Outreach: Peer network volunteers contact their neighbors on the street, at businesses and community organizations, and in residential areas. During brief, one-on-one encounters, they deliver informational brochures, referrals, and condoms. They may also engage in longer discussions in which they determine the woman's stage of change and motivate her with stage-appropriate messages and “role model” stories (project-produced brochures containing stories of community women in different stages of readiness to use condoms and describing their experiences and decisions).

Small groups: Peer network leaders supplement street outreach by conducting small group activities, such as safer sex parties and presentations to organized community groups. The peer networkers also represent the project in community activities promoting women's health.

Community mobilization: Peer networkers recruit businesses to provide in-kind services for project activities and to participate in a media campaign. The businesses display posters and distribute “role model” stories and brochures and newsletters containing information on HIV prevention, women's health and well-being, and referral sources.

Research Results
After the RAPP intervention, women living in high risk intervention communities were more likely to have:

• Initiated condom use with their steady partner
• Negotiated condom use with steady and casual partners

Women at very high risk (sex workers) were more likely to use condoms consistently with both steady and casual partners.

For Details on the Research Design
Lauby, J. L., Smith, P. J., Stark, M., Person, B., and Adams, J. (2000). A community-level prevention intervention for inner city women: Results of the Women and Infants Demonstration Projects. American Journal of Public Health 90(2), 216-222.

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The Intervention

A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that identifies HIV/AIDS prevention interventions with demonstrated evidence of effectiveness. REP supports the original researchers in developing a user-friendly package of materials designed for prevention providers. RAPP is one of the REP interventions. The RAPP intervention package was developed by researchers and representatives from the health department, community-based HIV prevention organizations (CBOs), and public housing communities. The package has been field tested in two public housing communities by non-research staff.

Core Elements
Core elements are intervention components that must be maintained without alteration to ensure program effectiveness. The core elements of RAPP include:

• Conducting community outreach using peer volunteers
• Having one-on-one, safer sex discussions based on the client's stage of readiness to change
• Using printed stories about community members' safer sex decisions (“role model” stories)
• Soliciting program support from community organizations and business
• Sponsoring small group activities, such as safer sex parties and presentations

Package Contents

• Overview of program for agency and community leaders
• Training manual for agency staff and peer network volunteers from the community
• Video introducing the program and demonstrating each of its components
• Materials for reproduction, such as training modules, tracking forms, and “role model” stories

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Intervention Orientation
Agency staff and community volunteers attend a 1-day session that includes an introduction to the intervention and training on basic community street outreach. Peer networkers and project staff attend a 2-day training on conducting stage-based encounters and a 1-day training on developing community “role model” stories.

Technical Assistance
RAPP staff and adopting agencies collaboratively solve problems to achieve an effective balance between maintaining core elements and tailoring to local needs. Staff address implementation concerns, answer questions, and offer advice. This assistance is provided through telephone calls and on-site visits. RAPP staff also are available to conduct booster sessions for agency program staff to refine their ability to deliver the intervention.

Timeline for Availability
The package is available with training and technical assistance from the Family Health Council.

For More Information on the RAPP Package
Roberta Mattheis at Adagio Health. 960 Penn Avenue, Suite 600, Pittsburgh, PA 15222. Phone: 412-288-2130. Fax: 412-288-9036. E-mail: rmattheis@adagiohealth.org. Or, to find out more about future trainings, please visit http://effectiveinterventions.org, e-mail interventions@aed.org, or telephone 1-800-462-9521 or 1-202-884-8712.

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