A study by the Centers for Disease Control and Prevention provides further support for the use of community-level interventions to prevent HIV infection. The AIDS Community Demonstration Projects Research Group found that recruiting volunteers from populations at increased risk of HIV infection and training them to endorse HIV prevention and give theory-based prevention messages to their peers can motivate these populations to adopt risk-reduction behaviors.

Community-level interventions represent a promising approach to prevention of HIV infection.

These interventions complement individual-level interventions in their emphasis on changing the attitudes, norms and behaviors of entire communities. Community-level strategies, including street outreach, peer opinion leaders, and mass media campaigns have had some success in prevention of HIV infection. To the extent that such interventions are able to change community norms, they should provide an opportunity for the diffusion and ongoing support of reduced risk behaviors.

The AIDS Community Demonstration Projects promoted risk reduction among populations at increased risk of HIV infection.

The AIDS Community Demonstration Projects evaluated the impact of a community-level intervention designed to promote progress toward consistent condom and bleach use among injection drug users, female partners of injection drug users, female commercial sex workers, at-risk youth, and non-gay-identified men who have sex with men. The study was conducted from 1989-1994 in five cities: Dallas, Texas; Denver, Colorado; Long Beach, California; New York, New York; and Seattle, Washington.

Behavioral theory provided the basis for intervention design and evaluation.

All sites used a common intervention and evaluation protocol that was based upon behavior change theories, ethnographic research, and strategies used in other community-level studies. The ACDP intervention was based on the stages-of-change model, which suggests that behavior change is a process and takes time. The stages-of-change perspective is important because it recognizes that people are at different stages of readiness when it comes to using condoms or making other behavior changes, and thus may be receptive to different types of intervention messages. The intervention was also based on an integrated model of behavior change featuring the Theory of Reasoned Action and the Health Belief Model.

Intervention activities included three key components.

First, community members were recruited into peer volunteer networks and trained to distribute and verbally reinforce prevention materials among their peers. The participation of community members in delivering the intervention made it possible to reach many more persons than could have been reached by paid staff alone. Second, small media materials were produced that featured theory-based prevention messages drawn from the real-life experiences of community members. These "role model stories" were distributed by the peer volunteers. The use of role-model stories allowed community-specific, culturally relevant, explicit messages about risk reduction to be delivered. Finally, condoms and bleach kits were distributed with the small media in order to provide community members with the tools they needed to practice safer behaviors .

Findings from the five cities show positive effects.

The ACDP intervention was evaluated over a 3-year period using a quasi-experimental design with 10 matched intervention and comparison communities. A total of 15,205 field interviews were conducted in these communities in order to assess sexual and drug injection practices. Near the end of the intervention, 54% of target population members had received ACDP role model stories and/or spoken with a peer volunteer.

Overall, individuals in the intervention communities were significantly more likely to carry condoms than individuals in the comparison communities. Individuals in the intervention communities were also significantly more likely to report intentions to use condoms consistently with main partners and to report always using condoms with their non-main or casual partners. Those individuals who were directly exposed to the intervention were more likely to carry condoms and to report the following when compared with those who were not directly exposed to the intervention: using condoms at least sometimes with their main partner, always using condoms with their non-main partners, and using bleach to clean injecting equipment.

For more information:

Additional information about this study is presented in the article "Community-level HIV intervention in 5 cities: Final outcome data from the CDC AIDS Community Demonstration Projects" are published in the March 1999 issue of the American Journal of Public Health (Volume 89). Information can also be obtained at the ACDP website. Staff of community-based organizations and health departments are encouraged to evaluate whether the ACDP intervention would be a useful addition to their local prevention efforts.