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Warning:
This site is being maintained for historical purposes, but has had no new entries since October 1998. To find more recent articles, please visit the following:
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Guidelines for AIDS Prevention Program Operations
U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Prevention Services, Division of Sexually Transmitted Diseases, Program Services Branch
Publication date: 10/01/1987
Table of Contents
AIDS Prevention - A Perspective
Defining The Problems and Resources Available
Target Populations
The Public
1. The Public
2. School and College-Aged Youth
3. Persons at Increased Risk or Infected
4Health Workers
Appendix A Examples of AIDS Prevention Outcome, Impact, and Process Objectives
Outcome Objectives
Impact Objectives
Process Objectives
Appendix B Selected Educational Methodologies
Appendix C Summary of Guideline Standards Guidelines for AIDS Prevention Program Operations
Defining The Problems and Resources Available
Target Populations
Objectives
Methodology
Coalition Building
Evaluation
Where to obtain a copy of this document:
POINT OF CONTACT FOR THIS DOCUMENT:
Tables
Assessment Of Selected Educational Methodologies
Foreword
Acquired immunodeficiency syndrome (AIDS) is emerging as one of the most significant public health problems of this century. AIDS presents public health agencies with unique and important challenges. At present, no therapy exists to eliminate the human immunodeficiency virus (HIV) or restore an immune system damaged by it. Currently, no vaccine exists to protect susceptible persons from infection.Many more people are infected with HIV than have AIDS. We have made estimates of the number of infected persons but need a better database than is currently available. Perhaps upwards of one and one-half million Americans and millions more worldwide are infected. These people are at risk of developing clinical AIDS; tragically, many eventually will. Meanwhile, infected individuals have the capability to transmit the virus to others during sex, when sharing drug needles, or during pregnancy.
AIDS is a severe clinical disease and is getting worse as a public health problem. For some populations of men who engage in sex with other men or who use intravenous (IV) drugs, the current prevalence of HIV infection has already magnified the statistical probability of infection from a single high-risk exposure. We cannot afford to wait until other populations at risk are similarly situated.
Transmission has most often occurred during sex and when people share needles and syringes to inject controlled substances like heroin, cocaine, and "speed." The term "syringes" includes "works" or paraphernalia that are used to cut, mix, or otherwise prepare a narcotic for injection and that may be factors in parenteral spread of HIV. Most events that facilitate HIV transmission involve behavior that individuals have some ability to control. If persons are informed, motivated to act, and encouraged to maintain risk-eliminating behavior changes, spread of HIV can be slowed or stopped.
Preventing spread of the HIV requires an education strategy effective in modifying risk-associated behaviors. This strategy has two main components. The first component involves directing pertinent AIDS information to the general public and to selected subsets of the general public based on specific needs identified for each. This component is designed to reach people at a nonpersonal level (as members of various populations, including the general public via the mass media, written materials, speakers bureaus or peer group presentations, educational outreaching using "street people"/former IV drug users, etc.) with messages that they must then individually process for personal relevance. It is expected that messages aimed at high-risk populations will find many individuals who are receptive to acknowledging their personal risk. The Centers for Disease Control (CDC) initiated the AIDS Health Education/Risk Reduction (HE/RR) Program which was designed in part to carry out this component of the AIDS prevention strategy.
The second component of the AIDS prevention strategy is designed to reach high risk people at a personal level, as individuals. A great many people with risk factors for AIDS misperceive their personal risk or deny that risk in spite of targeted educational campaigns. The focus of program services at the personal level is to provide high-risk individuals with education tailored to their unique situations and particular needs for assistance. Services also offer specific guidance and arrange referrals to help high-risk persons eliminate the risk of further transmission. This component of the strategy is carried out through the CDC funded Counseling and Testing Site (CTS) Program, voluntary counseling and testing which occurs in other settings, and the voluntary referral for counseling and testing of the sex and needle-sharing partners of infected individuals. The AIDS HE/RR and CTS cooperative agreements are the components of the AIDS Prevention Program discussed in these guidelines.
For health education efforts to be most effective, segments of the community most likely to be affected by AIDS should be involved in planning, implementing, and evaluating ongoing AIDS prevention efforts. Special attention should be paid to the need for involving minorities. On a national basis, blacks and Hispanics are disproportionately affected by AIDS, particularly perinatal AIDS. Local variations aside, these data are raising concerns in minority communities across the country and each AIDS Prevention Program is advised to be sensitive to the need for concentrated program involvement.
In addition, educational priority must be given to medical and dental health professionals. Increasingly, their numbers and the services they can offer are needed to provide accessible quality care for persons with AIDS and those infected with HIV. Furthermore, an AIDS Prevention Program must seek to involve mental health professionals in the effort to limit spread of HIV. Their participation is needed to provide psychosocial support to assist patients with HIV infection in adjusting to their condition and in developing coping and negotiating skills to help them make permanent risk-reducing behavior changes. Finally, an AIDS Prevention Program should strive to keep State and community leaders abreast of the facts and latest developments about AIDS.
The guidelines in this document recognize that while communities will differ in their approach to an AIDS Prevention Program, certain basic program management requirements are common to all. This document includes standards that address these requirements. The standards set forth are intended criteria for measuring professional performance, management effectiveness, and program quality. These guidelines complement other documents published by the U.S. Department of Health and Human Services, Public Health Service. These include: "Information/Education Plan to Prevent and Control AIDS in the United States" (March 1987); "Guidelines for STD Control Program Operations" (October 1985); "Guidelines for STD Education" (June 1985); and "Quality Assurance Guidelines for Managing the Performance of Disease Intervention Specialists in STD Control" (April 1985).
Willard Cates, Jr., M.D., M.P.H.
Director
Division of Sexually Transmitted Diseases
Center for Prevention Services
AIDS Prevention - A Perspective
A working definition for health education has been described as "...any combination of learning experiences designed to facilitate voluntary adaptations of behavior conducive to health" (Green et al., 1980). Health education has always been an integral part of public health efforts to control infectious diseases. Until AIDS, however, its role has often been ancillary and supportive to biomedical interventions, such as a therapy or vaccine, rather than as a principal tool for intervention.Perhaps the greatest success for health education has come when the initiative was designed to influence both individuals and populations (the public consciousness). Creating a personal and social awareness that public health is best served by stimulating responsible action or curtailing irresponsible action can produce a change in attitude that supports recommended behavioral responses. For example, efforts to induce individuals to quit smoking have met with increasing success as it has become popular to support legal constraints on where it is permitted, e.g., banning smoking in public buildings and especially in the workplace.
AIDS is unique to the public health experience because of its medical complexity and frequent severity, its capacity to spark extensive legal, ethical, moral, and political controversy, and its potential for inducing unnecessary fears. In addition, AIDS is a community problem that requires a community response to the companion goals of helping individuals avoid infection and reducing unnecessary fears. The leaders within each community must recognize that no single agency or outreach organization has the knowledge, understanding, resources, or capacities to carry out an effective AIDS Prevention Program that will help achieve both of these important goals.
Education is a valuable and effective public health tool, but is limited by human factors which are difficult to control. Hopefully the potential for education to impact on AIDS will be supplemented soon with reliable therapies and an effective vaccine. However, no biomedical intervention will replace the role of education in reducing spread of HIV. The "voluntary adaptation of behavior conducive to health" will be as necessary later on as currently, when education is the only intervention tool available. It is crucial from the outset to correctly develop, manage, and evaluate an education-based AIDS Prevention Program.
Defining The Problems and Resources Available
For many who are not health education professionals, a common perception holds that health education is intrinsically good but its results are difficult and expensive to measure; therefore, just get on with it and trust that whatever educational activities are carried out will produce some good, and that the activities themselves will be an acceptable justification for continued support. However, this perception is inaccurate and an AIDS Prevention Program should avoid it. Current thinking in health education generally, and in AIDS Prevention particularly, considers evaluation an integral part of the health education planning process. Health education efforts designed to address factors that do not need to be changed or influenced are wasteful. For this reason, each AIDS Prevention Program should begin with a thorough assessment of health education needs of the community, basically -- defining the problem.Communities begin an AIDS Prevention Program typically knowing how many AIDS cases have occurred; they also know something about the risk factors of persons with AIDS, the localities where they reside, and which health care providers diagnosed their condition. However, much more is needed to assist community leaders in planning their AIDS Prevention Program based on a thorough understanding of what is happening in their own communities. For instance, it is important to know: The prevalence of HIV infection among persons whose behavior places them at increased risk of HIV infection; the extent to which the community's IV drug abusers share needles and syringes; how widespread the belief is that HIV infection can be acquired through casual contact; the number of people who believe AIDS can be acquired from donating blood; the proportion of men and women engaging in high-risk behavior who are still having unprotected sex; to what extent sexually active people have begun to use condoms; the levels of understanding women have about the risk of perinatal transmission; how many dentists and dental hygienists are using gloves when providing patient care; the extent to which blacks and Hispanics perceive AIDS as a problem affecting their communities; and many others.
These and other questions must be asked so that limited educational resources are proactively committed to address specific targets rather than obligated reactively or on the basis of guesswork or stereotype. The answers provide a basis for making informed decisions, determining specific purposes, and allocating funds in a rational manner. Furthermore, they help in tracking progress toward program objectives, adjusting educational methods to improve effectiveness, and maintaining accountability for program performance.
At the outset, an AIDS Prevention Program must take stock of what is already being done by AIDS service groups and other community organizations to address various facets of the problem. Sound planning, effective program operations, and avoiding unnecessary duplication of efforts may depend on a careful assessment of a community's existing AIDS-related services.
Standards --
An AIDS Prevention Program is planned based on:
- Data describing the seroprevalence of HIV infection in the general population and among those persons whose behaviors place them at increased risk for AIDS.
- The best available estimates of: (1) the prevalence of behaviors which increase the risk of infection with HIV, and (2) the levels of knowledge, beliefs, attitudes, values, skills support, and services associated with influencing such behaviors among members of the general population, including minority communities, health care providers, and individuals at increased risk of HIV infection.
- A thorough inventory of available and potential services and resources within the community.
Target Populations
To have a maximum impact on reducing HIV transmission, an AIDS Prevention Program must include a variety of educational efforts focused on different target populations. Some efforts may be broad and directed at all newspaper readers; others may be very specific and directed, for instance, at the residents of certain neighborhoods or the customers of certain bars. An effective AIDS Prevention Program will simultaneously include both types of approaches within a community.Baseline data help to focus educational efforts for any target population. Such data allow program managers from public agencies, AIDS service groups, and other community organizations to establish priorities, undertake complementary efforts, and make more efficient use of limited resources. Target populations for AIDS Prevention must be locally defined and may include:
1. The Public
This population includes both the uninfected and the possibly infected members of the community at large. Also included are lawmakers, State and municipal managers, public health administrators, health care institution directors, insurance industry policy makers, corporate executives, and other community leaders who need current information about AIDS because they may confront decisions affecting the ability of the AIDS Prevention Program to reduce transmission of the virus. On a national basis, members of the black and Hispanic communities are disproportionately affected by AIDS, especially perinatal AIDS.
2. School and College Aged Youth
This population includes young persons in and outside of academic institutions, school and college personnel, and persons involved in educating youth (school board members, counselors, etc.).
3. Persons at Increased Risk or Infected
This population includes individuals now infected with HIV who are capable of transmitting it to others and people who are not currently infected but whose behaviors continue to place them at risk for infection.
4. Health Workers
This population includes medical, dental, and mental health care providers whose practices may involve serving a person with AIDS, AIDS- related symptoms, HIV infection, or at risk for HIV infection.
The Public
The general public needs AIDS education to increase understanding of the problem and support for prevention efforts. Myths and fears surrounding AIDS often drive public policy and affect the welfare of a community. Responding to controversy associated with these myths and fears can also consume valuable program time, energy and staff. For instance, a mistaken belief that transmission occurs through casual contact can result in potentially discriminating policies affecting people's job status, housing, and educational opportunities. Similarly, the misconception about a risk of AIDS through blood donation can reduce a community's blood supplies to dangerous levels. The prevalence of these myths and fears in a community needs to be assessed and those which dominate should be the targets of education designed to counteract them.Many persons who are at increased risk for contracting HIV infection because of their sexual or drug abusing behaviors, maintain a covert lifestyle and cannot be reached through community organizations or AIDS service groups. Through education for the general population, many of these persons can receive needed information about AIDS. Information can be provided to make people aware of counseling and testing services, hospitals or hospices assisting persons with AIDS, support groups available for persons with AIDS, or current scientific developments that can affect their care.
AIDS has taken particularly harsh tolls in some black and Hispanic communities and IV drug abuse has often been an important factor of risk. Members of such minority communities who are not gay and do not use IV drugs may also be at increased risk because of the potential for heterosexual and perinatal transmission.
AIDS reports have tended to stress the prevalence of disease among gay, white males and may have obscured the disproportionate risk faced in some black and Hispanic communities. A necessary mission of an AIDS Prevention Program should be to ensure that implications of the epidemiology of AIDS is correctly perceived by all persons who may be at increased risk. These persons should receive appropriate educational services to help them reduce their particular risk of infection; however, any AIDS risk-reduction educational message is unlikely to have much impact as long as such persons mistakenly minimize the seriousness of their situation. When planning an AIDS Prevention Program initiative for minority populations, program managers should involve influential members of those communities. This involvement is to ensure that culturally sensitive decisions are made in all phases of the initiative and to improve its chances for success.
AIDS is a serious public health problem. For many in the public eye, however, AIDS is also an issue they have to face. Moreover, AIDS portends political consequences regardless of how public officials decide questions or what stand they take on various aspects of the problem. Therefore, elected officials, lawmakers, State and municipal managers, public health administrators, health care institution directors, corporate executives, and community leaders all need timely and accurate information about AIDS on an ongoing basis and in times of crisis. These individuals can make or influence decisions which may affect the ability of an AIDS Prevention Program to accomplish its mission. Education is often necessary to inform community decision makers. It is also often necessary for enlisting their support, either to promote some effective course of action or to avert some measure that could negatively effect the AIDS prevention effort. One example is to ensure that law makers have access to supportive legislative initiatives such as shielding AIDS and STD records from violations of confidentiality by disclosures through litigation. Another valuable initiative would be to promote a joint effort by corporate executives to provide education about AIDS (plus STD and drug abuse), both in the workplace and beyond, for workers and young adults who are no longer in school. Another is to educate local decision makers concerning public efforts to control drug abuse. Issues of particular relevance include support for HIV antibody counseling, testing, and partner referral in drug abuse treatment clinics and the availability of treatment "slots" to help reduce the risk of HIV transmission among IV drug abusers in the community.
Standards --
An AIDS Prevention Program:
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to reach the general public with information shown to most influence attitudes, beliefs, knowledge, and high-risk behaviors.
- Wherever population and/or problems indicate, develops efforts that address the specifically identified AIDS Prevention needs of the black and Hispanic communities and, when feasible, are designed with the assistance of minority community representatives and conducted with the participation and/or support of organizations and individuals within those communities.
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to keep community decision makers informed of the AIDS problem and to enlist their ongoing practical support for specific efforts to reduce transmission of HIV throughout the community.
1. The Public
The general public needs AIDS education to increase understanding of the problem and support for prevention efforts. Myths and fears surrounding AIDS often drive public policy and affect the welfare of a community. Responding to controversy associated with these myths and fears can also consume valuable program time, energy and staff. For instance, a mistaken belief that transmission occurs through casual contact can result in potentially discriminating policies affecting people's job status, housing, and educational opportunities. Similarly, the misconception about a risk of AIDS through blood donation can reduce a community's blood supplies to dangerous levels. The prevalence of these myths and fears in a community needs to be assessed and those which dominate should be the targets of education designed to counteract them.Many persons who are at increased risk for contracting HIV infection because of their sexual or drug abusing behaviors, maintain a covert lifestyle and cannot be reached through community organizations or AIDS service groups. Through education for the general population, many of these persons can receive needed information about AIDS. Information can be provided to make people aware of counseling and testing services, hospitals or hospices assisting persons with AIDS, support groups available for persons with AIDS, or current scientific developments that can affect their care.
AIDS has taken particularly harsh tolls in some black and Hispanic communities and IV drug abuse has often been an important factor of risk. Members of such minority communities who are not gay and do not use IV drugs may also be at increased risk because of the potential for heterosexual and perinatal transmission.
AIDS reports have tended to stress the prevalence of disease among gay, white males and may have obscured the disproportionate risk faced in some black and Hispanic communities. A necessary mission of an AIDS Prevention Program should be to ensure that implications of the epidemiology of AIDS is correctly perceived by all persons who may be at increased risk. These persons should receive appropriate educational services to help them reduce their particular risk of infection; however, any AIDS risk-reduction educational message is unlikely to have much impact as long as such persons mistakenly minimize the seriousness of their situation. When planning an AIDS Prevention Program initiative for minority populations, program managers should involve influential members of those communities. This involvement is to ensure that culturally sensitive decisions are made in all phases of the initiative and to improve its chances for success.
AIDS is a serious public health problem. For many in the public eye, however, AIDS is also an issue they have to face. Moreover, AIDS portends political consequences regardless of how public officials decide questions or what stand they take on various aspects of the problem. Therefore, elected officials, lawmakers, State and municipal managers, public health administrators, health care institution directors, corporate executives, and community leaders all need timely and accurate information about AIDS on an ongoing basis and in times of crisis. These individuals can make or influence decisions which may affect the ability of an AIDS Prevention Program to accomplish its mission. Education is often necessary to inform community decision makers. It is also often necessary for enlisting their support, either to promote some effective course of action or to avert some measure that could negatively effect the AIDS prevention effort. One example is to ensure that law makers have access to supportive legislative initiatives such as shielding AIDS and STD records from violations of confidentiality by disclosures through litigation. Another valuable initiative would be to promote a joint effort by corporate executives to provide education about AIDS (plus STD and drug abuse), both in the workplace and beyond, for workers and young adults who are no longer in school. Another is to educate local decision makers concerning public efforts to control drug abuse. Issues of particular relevance include support for HIV antibody counseling, testing, and partner referral in drug abuse treatment clinics and the availability of treatment "slots" to help reduce the risk of HIV transmission among IV drug abusers in the community.
Standards --
An AIDS Prevention Program:
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to reach the general public with information shown to most influence attitudes, beliefs, knowledge, and high-risk behaviors.
- Wherever population and/or problems indicate, develops efforts that address the specifically identified AIDS Prevention needs of the black and Hispanic communities and, when feasible, are designed with the assistance of minority community representatives and conducted with the participation and/or support of organizations and individuals within those communities.
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to keep community decision makers informed of the AIDS problem and to enlist their ongoing practical support for specific efforts to reduce transmission of HIV throughout the community.
2. School and College-Aged Youth
The promotion of sexually transmitted disease (STD) education in the schools is one of the objectives listed in the Public Health Service document, "Promoting Health/Preventing Disease: Objectives for the Nation." AIDS is a "sexually transmissible" disease about which young people should have access to timely and accurate information.AIDS information should be taught as a part of a comprehensive health curriculum covering both STD and drug abuse education. AIDS information, which is included in an STD and drug abuse continuum of instruction, should also be made available to students in all types of academic institutions beyond the high school level. Young adults who are not in school also need information to help them reduce their risk of AIDS and other STD and to avoid IV drug use. Young people can be reached as part of the general public; however, an AIDS Prevention Program should implement a special initiative to ensure that youth receive quality AIDS education through organizations which serve them and facilities which they use.
To be effective in helping young people avoid infection with HIV, AIDS education must focus on behaviors rather than on biomedical details. Information should be straightforward and appropriate to the students' level of development. AIDS education initiatives for youth should also include learning experiences that will help them develop skills they need to act on AIDS information and to comply with recommendations to avoid risk behaviors. For instance, young people may need skills in decision making and withstanding peer pressure. Such skills may be very useful to young people who decide to say "No" to sex or IV drug use.
The official State or local education agency is responsible for health education in the schools. The AIDS Prevention Program can assist these agencies by providing technical assistance about AIDS, STD, and drug abuse that such an educational effort will require. In addition, the organizational structure of State and local health departments places the STD Control and AIDS Prevention Programs in unique positions to assist the implementation of AIDS (plus STD and drug abuse) instruction in the schools. Health departments are or should be in a position to assist with such necessary activities as planning for an AIDS education initiative, teacher training workshops, the selection of curriculum and materials, and generating the support of local school boards and parent groups for AIDS education in the schools.
Standards --
An AIDS Prevention Program:
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to reach young adults with information that will help them avoid infection with HIV (as well as other STD) and IV drug abuse.
- Works to ensure that AIDS curriculum and related materials emphasize prevention behaviors and minimize teaching biological details about the virus or exclusively clinical information concerning AIDS.
- Works closely with the necessary agencies to ensure widespread implementation of AIDS (plus STD and drug abuse) education in the schools.
- Works to ensure that students attending trade schools and junior and 4-year colleges have access to factual information about AIDS, STD and drug abuse.
- Establishes AIDS education activities through organizations and facilities that serve youth who are no longer in school.
3. Persons at Increased Risk or Infected
Uninfected persons whose behavior or circumstances place them at continuing risk for AIDS need program attention. They need help to minimize their risk of infection and to avoid transmitting the virus to others. Similarly, the possibilities need to be addressed that infected persons may transmit the virus and develop full blown AIDS. The AIDS Prevention Program must reach out to high-risk people as group members, but also educate them at a personal level through counseling tailored to their individual circumstances. The latter is pursued by providing well publicized counseling and testing services and by promoting referral of the sex and needle-sharing partners of infected persons. Individualized counseling for an infected person should emphasize risk-eliminating behavior that prevents transmission of the virus to others. The counseling should also stress that this same behavior can reduce their own exposure to diseases, a factor which some laboratory studies suggest may be of help in slowing replication of HIV and further damage to their immune system.Specifically, counseling messages targeted to those at increased risk and those who are infected should stress the following:
AIDS educational efforts should emphasize the factors and behaviors that incur risk rather than the personal characteristics. The latter only stereotypes AIDS patients or those considered to be at increased risk and detracts from the vital message that "unsafe" sex and needle-sharing behaviors increase the risk of HIV transmission. Hostility, fear, and discrimination toward individuals who appear to be associated with a particular population at risk can be a result.
- Do not donate blood, organs, or any other body tissues.
- Do not share IV drug needles and syringes.
- Do not share blood and semen, or any body fluid which may contain blood.
- Use condoms from start to finish during sex.
- Never engage in anal sex, regardless of condom use.
- Establish a mutually monogamous relationship or minimize sex with different people.
- If infected, postpone pregnancy until more is known about how to prevent perinatal transmission of HIV infection.
- Learn sexual negotiation skills in order to enhance risk-reduction.
Uninfected persons at increased risk, and particularly individuals already infected with HIV, may need services which an AIDS Prevention Program should ensure are made available. These include specific referrals for medical evaluation, professional counseling, and peer-group support; tuberculosis testing; and assistance in confidentially referring sex and needle-sharing partners for counseling and testing. Individual AIDS patients and their families or significant others should be provided with referrals to community social services, hospitals, physicians, hospices, counseling services, and other community agencies that can help with housing and insurance issues.
Persons with hemophilia, their sexual partners, and their offspring are at increased risk for HIV infection A high percentage of persons with hemophilia are now infected and may need specialized and intensive counseling and support to help them avoid infecting others. They receive this counseling and support largely through Comprehensive Hemophilia Treatment Centers (CHTC). Health departments which encounter persons with hemophilia who want testing for HIV antibody are urged to refer them to a CHTC whenever possible. CHTC staff are trained to serve the special needs of these patients. Most centers are prepared to deal with the difficult problem of AIDS risk in this population of patients and their families or significant others.
Persons who abuse IV drugs can be among the most difficult to reach effectively and influence to make risk-reducing behavior change. Such people risk HIV transmission both through sex and the sharing of needles and syringes. Enrolling these people and their spouses or significant others in a drug abuse treatment program is the most effective way of reducing this avenue of HIV transmission. An AIDS Prevention Program should work closely with drug abuse treatment organizations by collaborating on setting objectives and developing plans, coordinating AIDS educational messages, and helping to train drug treatment counselors about risk-reduction methods. In this process, AIDS Prevention Program staff should learn as much as possible about drug abuse and programs to control it as well as factors which may affect a working relationship, such as if there are sufficient drug abuse treatment "slots" locally to accommodate all high-risk IV drug abusers who can be motivated to enroll.
Standards --
An AIDS Prevention Program:
(Note *) For a description of such a system, refer to the CDC document, "Quality Assurance Guidelines for Managing the Performance of Disease Intervention Specialists in STD Control," April 1985, page 5-7.
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to educate uninfected persons at high risk and those who are infected. The information/education should be directed toward specific target populations as audiences and delivered at a personal level through individualized counseling to reduce the risk of HIV transmission.
- Provides personalized AIDS risk-reduction education for those who practice specific behaviors which place them at risk, including (1) men who have "unsafe sex" with other men; (2) people who share needles and syringes when using IV drugs; (3) people who engage in sex for money or drugs; (4) the sex and needle-sharing partners of the above; (5) individuals exposed to an STD other than HIV infection; and (6) others who are defined epidemiologically to be at increased risk of infection.
- Focuses on behaviors that increase the risk of HIV transmission rather than characteristics which stereotype individuals.
- Takes all reasonable steps to ensure that staff provide HIV antibody test counseling that is nonjudgemental, sensitive to the difficult human circumstances involved, and effectively communicates individualized behavioral information and guidelines both to people who are infected and to uninfected persons at increased risk.
- Takes all reasonable steps to promote with staff that they consistently exhibit:
- tact when encouraging infected persons to refer their sex and needle- sharing partners;
- competence in coaching patients to carry out their own referrals; and
- promptness, skill, and sensitivity in making any referrals requested by a patient.
- Establishes and maintains performance accountability through a system (Note *) which "quality-assures" the competence of staff in providing individualized counseling for people with an HIV infection, in consistently and accurately delivering counseling messages, and in confidentially referring their sex and needle-sharing partners.
- Where the State or locality cannot shield AIDS-related records, including those concerning partner referral, from disclosures through litigation (e.g., subpoena, court order), avoid maintaining formal name-identified records concerning such referrals.
- Works to help develop and maintain a system of referral that is convenient for patients, helps to meet their medical and psychosocial support requirements, assists them in maintaining risk-reducing behavior changes that reduce spread of HIV, and has the capacity to accommodate the numbers of patients who will need such services.
- Works together with local Comprehensive Hemophilia Treatment Centers in the area to extend meaningful AIDS prevention services to persons with hemophilia and their families and sex partners.
- Works together with the State or local drug abuse control agency and all local drug abuse treatment facilities to design and implement initiatives that have a reasonable chance of reducing HIV transmission to, among, and by IV drug abusers.
4Health Workers
Three general groups of health workers are influenced by AIDS. Each AIDS Prevention Program needs an active program of professional outreach and education for health workers in these groups. The first group includes those, such as family practitioners and other primary care physicians, who see uninfected patients who are worried about the disease and want information, advice, and answers to their questions. Physicians in particular need information and encouragement to become more active in educating their patients, assessing risk, and providing or arranging necessary counseling related to testing those at risk.The second group are those health professionals situated to serve persons with AIDS or with an HIV infection but who are yet to become involved. As more infected people are stimulated to volunteer for counseling and testing, the need expands for professionals who will accept referrals for medical evaluation, psychosocial support, and mental health services. A clear program responsibility is to identify sources of such services. Where they don't exist or are inadequate, an AIDS Prevention Program should stimulate appropriate community action and participation by providers of care. Meeting this need is crucial to reducing transmission of HIV. Infected persons are infectious indefinitely; behavior change to reduce their risk of transmission must be for at least an equal period. This means that patients may need ongoing access to professional or social support services to help them cope with the profound realities of their infection and continue maintaining a permanent behavior change.
The third group are those who need specific education about AIDS in the workplace because their practice or duties involve possible HIV exposure. This would include, for instance, people who work in the dental profession, in fire and rescue, and in emergency medical services.
Standards --
An AIDS Prevention Program has objectives that meet the standards appearing in the "Objectives" section of these guidelines and coherent and realistic written plans of operation and evaluation to:
- Provide primary care physicians with sufficient information to respond to patient concerns about AIDS, assess risk, and provide or arrange necessary counseling related to testing those at risk.
- Work to ensure that health professionals accept referrals and meet the medical, psychosocial, and mental health needs of all patients identified with HIV infection.
- Educate health workers in practices that involve some risk of exposure about AIDS and the CDC guidelines for preventing HIV transmission in the health care setting.
Objectives
An AIDS Prevention Program should include three different types of objectives (See Appendix A for examples). This particular typology may depart or semantically differ from that used in other disciplines; however, it is consistent with that developed for STD control (Note *) and has been adopted for use in the AIDS Prevention Program. The outcome objective, also known as a long-range objective, expresses an expected level of program accomplishment at some future point, often by the end of a project period. For an AIDS Prevention Program, an appropriate subject of outcome objectives is the expected HIV seroprevalence in various populations with specific risk factors and the general public at a future point in time. Setting realistic outcome objectives depends on having current baseline data. Reducing seroprevalence may not be attainable; but slowing or containing the rate of increase would be a logical product of an effective AIDS Prevention Program to influence risk behaviors and the attitudes, knowledge, beliefs, skills, supports, and services related to effecting and maintaining change in such behavior.Impact objectives are the core of an AIDS Prevention Program plan. Everything should relate back to them and the expectations they hold forth.
Impact objectives are set using data from surveys determining the prevalence of attitudes, knowledge, beliefs, and risk behaviors. Each impact objective should trigger specific action and resource commitments; but selectivity is important. Impact objectives should be set for risk behaviors and the most significant factors that are thought to influence those behaviors. For example, assume that 95% of a high-risk population surveyed has heard about AIDS, but only 40% currently take recommended precautions to eliminate risk in all applicable situations. An impact objective to increase the latter would be appropriate, whereas addressing the former by setting an objective and carrying out educational activities would be redundant and a waste of resources. Individually, impact objectives should be realistic; taken collectively, they should be reasonable in light of resources and constraints.
Last are process objectives. In an AIDS Prevention Program, process objectives describe key activities essential to achieving the impact objectives and that management should track. As with outcome and impact objectives, process objectives are specific, realistic, time phased, and measurable. Unlike the other types, however, process objectives in an AIDS Prevention Program do not have to be numerically measurable; however, they should be tracked.
In a newly formed AIDS Prevention Program, process objectives are crucial because in the short run they are the only objectives. Remember, outcome and impact objectives cannot even be set until process objectives are achieved to gather and analyze baseline data which will define the problem.
Thus, conducting the surveys to amass these data and taking a resource inventory are appropriate subjects of a new AIDS Prevention Program's process objectives and prerequisite to setting either outcome or impact objectives. In a more developed AIDS Prevention Program which has set outcome and impact objectives that meet the standards appearing in the "Objectives" section of these guidelines, process objectives play a less dominant role. They generally appear in the plan of operation and involve milestones to assist program management in tracking their implementation.
Standards --
An AIDS Prevention Program:
- Establishes outcome (long-range) objectives that are specific, realistic, time phased, and numerically measurable in setting target levels of seroprevalence as the anticipated result of overall educational efforts conducted in the community.
- Establishes impact (short-range or budget period) objectives that are specific, realistic, time phased, and numerically measurable in setting forth the expected changes that program efforts will produce in relation to the baseline levels of risk behaviors and the attitudes, knowledge, beliefs, skills, supports, and services relevant to such behaviors.
- Establishes process objectives that are specific, realistic, time phased, and measurable in describing key program activities monitored by management to achieve program impact objectives.
(Note *) For a description of this typology of objectives as it relates to STD control, see the CDC publication, "Guidelines for STD Control Program Management," October 1985, Chapter II.
Methodology
Planning effective AIDS educational initiatives will require program management to select and implement a variety of educational methods. Changing high risk behavior is the primary focus of any comprehensive AIDS Prevention Program. Yet influencing behavior change is complicated and difficult. Current health education theory suggests the use of multiple, coordinated strategies to change behavior by: (1) increasing knowledge; (2) changing attitudes; (3) enhancing or building skills; (4) influencing the norms of risk populations to support and reinforce behavior change; and (5) establishing services that affect the behavior to be changed, reinforce a commitment to behavior change, and follow up over a long period of time. Such strategies use a combination of methods which include one-on-one discussion, role playing, lectures, print media, electronic media, audiovisual aids, and community action. These methods should be considered in AIDS prevention. The specific methods selected will depend on the program objectives and the cost. Remember, choosing a strategy simply because staff members are familiar with it, is not an adequate justification for method selection.Appendix B, Table 1 summarizes selected educational methods for consideration in an AIDS Prevention Program and assesses the advantages and disadvantages of each.
Standards --
An AIDS Prevention Program:
- Chooses methods for achieving the educational objectives that are feasible to implement and reasonably based on the availability of resources, and that have a realistic potential to succeed.
Coalition Building
Health departments are not in a strategic or a resource position to single-handedly carry out an entire AIDS Prevention Program, nor does it make sense that they should try. To be effective, an AIDS Prevention Program should be a community-wide effort involving the significant participation of others. Therefore, the health department AIDS Prevention Program is responsible for building a coalition of civic leaders, community organizations, and AIDS service groups to define priority problems and help in working toward program objectives. Program management's responsibility is to work with members of this coalition to encourage the involvement of those who can reach various target groups and help coordinate their individual and collective efforts toward reaching program objectives. Program management should be prepared to provide technical and financial support as needed. Finally, AIDS Prevention Program management should closely track the performance of all people and organizations involved because it will be held accountable for whether the overall strategy is effectively implemented and achieving its intended purpose.Standards --
An AIDS Prevention Program:
- Methodically builds, and changes as necessary, a coalition of community groups to participate in the effective and efficient implementation of activities designed to meet program objectives.
- Provides technical assistance and feasible financial support for effective implementation and evaluation of AIDS prevention strategies.
Evaluation
Evaluation is a process whereby the performance of a program or program element is compared to a standard of acceptability. Using this definition to assess the effects of an AIDS education effort implies that some acceptable standards, or evaluation criteria, exist which can be used in a comparison. In practice, the establishment of AIDS Prevention objectives that meet the standards appearing in the "Objectives" section of these guidelines and of program evaluation criteria is a simultaneous process. Once baseline data are obtained on attitudes, knowledge, beliefs, or risk behaviors, the evaluation criteria are easily established. Similarly, the methods for evaluating program results are clear and merely involve using again the measurement procedures, e.g., surveys, opportunity samples, etc., used in obtaining baseline data in the first place.Evaluating the quality of process (i.e., "how well" people, organizations, and systems consistently carry out their assigned duties and responsibilities) is an issue of significant concern to program management. However, it is a somewhat different matter than evaluating results. An AIDS Prevention Program depends upon many diverse groups and individuals to deliver very precise messages consistently and accurately. A program responsibility is to apply its technical expertise to assess the quality of this performance using a combination of data analysis, assessing reports, and direct observation to make appropriate decisions and effect necessary changes.
Standards --
An AIDS Prevention Program:
- Evaluation plan is realistic, feasible, and appropriately addresses all of the outcome, impact, and process objectives.
- Evaluation plan provides for routine gathering of information about the quality of performance by program employees and collaborating groups and individuals by using, as appropriate, activity data, written or verbal accounts of how activities were carried out and received, and especially the direct observation of performance.
Appendix A Examples of AIDS Prevention Outcome, Impact, and Process Objectives
Outcome Objectives
- By April 30, 1991, (Note *) no more than (Percent Projected from Baseline Seroprevalence)% of the general population who donate blood will be positive for HIV antibody.
- By April 30, 1991, no more than (Percent Projected from Baseline Seroprevalence)% of new patients attending STD clinics in the three largest cities will be positive for HIV antibody.
- By April 30, 1991, no more than (Percent Projected from Baseline Seroprevalence)% of gay men tested from bars, baths, and community organizations in the three largest cities will be positive for HIV antibody.
- By April 30, 1991, no more than (Percent Projected from Baseline Seroprevalence)% of IV drug abusers attending drug treatment centers in the three largest cities will be positive for HIV antibody.
- By April 30, 1991, no more than (Percent Projected from Baseline Seroprevalence)% of women seeking health care in publicly funded prenatal clinics, family planning clinics, or outpatient hospital gynecology clinics in the three largest cities will be positive for HIV antibody.
(Note *) The last day of the project period for current CDC cooperative agreements that support the AIDS Prevention Program.Impact Objectives
1. The Public
2. School and College-Aged Youth
- By the end of the current budget period, reduce from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of those polled through random digit dialing who express a refusal to donate blood because of fear of acquiring HIV.
- By the end of the current budget period, reduce from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of parents polled at PTA meetings who would not allow their children to attend school if a child infected with HIV was enrolled.
- By the end of the current budget period, reduce from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of those polled through random digit dialing who express a belief that HIV can be transmitted by casual contact.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of those polled who will be able to state three ways HIV is most commonly transmitted and at least three ways that risk of transmission can be reduced.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of those responding to a survey questionnaire administered to young adults (18-25) who claim to use condoms for each act of sexual intercourse with a partner in the previous 3 months.
- By the end of the current budget period, have introduced legislation to strengthen statutes protecting the confidentiality of HIV antibody results.
- By the end of the current budget period, increase from (Baseline Number) to (Projected Number Due to Program Impact) the number of major businesses and corporations actively assisting in promoting AIDS education within and beyond the workplace.
3. Persons at Increased Risk or Infected
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the high schools in the three largest cities which provide a quality unit of education on AIDS, STD, and drug abuse which emphasizes positive health behaviors rather than biomedical details.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the trade schools, junior colleges, colleges, and universities which provide a quality unit of education on AIDS, STD, and drug abuse which emphasizes positive health behaviors rather than biomedical details.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the neighborhood recreation centers in the three largest cities which provide a quality unit of education on AIDS, STD, and drug abuse which emphasizes positive health behaviors rather than biomedical details.
4. Health Workers
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of men who engage in sex with men responding to a survey questionnaire who claim to use condoms for each act of sexual intercourse with a partner in the previous 3 months.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of men whose sexual preference is other men responding to a survey questionnaire who claim to be abstaining from sex or to have acquired an exclusive sex partner in the previous 6 months.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of prostitutes responding to a survey questionnaire who claim to use condoms for each act of sexual intercourse with both steady and non- steady partners in the previous 3 months.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of prostitutes responding to a survey questionnaire who use IV drugs and claim not to have shared needles and syringes in the previous 3 months.
- By the end of the current budget period, reduce from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of IV drug users attending drug treatment centers who claim to have shared IV drug needles and syringes in the previous 3 months.
- By the end of the current budget period, decrease from (Baseline Percent)% to below (Projected Percent Due to Program Impact)% the number of self-identified sexually active heterosexuals surveyed who report having had anal sex, either with or without a condom, in the previous 9-month period.
- By the end of the current budget period, increase from (Baseline Number) reported in the previous budget period to at least (Projected Number Due to Program Impact) the number of IV drug users who seek counseling and HIV antibody testing at either drug abuse treatment facilities, STD clinics, the Maternal and the Infant Care Project, or Counseling and Testing sites.
- By the end of the current budget period, increase from (Baseline Number) seen in the previous budget period to at least (Projected Number Due to Program Impact) the number of men who engage in sex with men who seek HIV antibody testing at the STD clinic and at Counseling and Testing sites.
- By the end of the current budget period, overall AIDS Prevention Program educational and outreach efforts will increase the monthly average number of people who volunteer for services at Counseling and Testing sites from (Baseline Number) to at least (Projected Number Due to Program Impact), while maintaining those with risk factors for AIDS at (Target Percent or Percentage Range)% of the total.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of those individuals with positive HIV antibody tests participating in support groups who claim to be correctly following recommended guidelines to prevent transmission of infection.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of people volunteering to Counseling and Testing sites who give "partner referral" as their reason for requesting services.
- By the end of the current budget period, increase the number of dentists from (Baseline Number) to (Projected Number Due to Program Impact) and the number of physicians from (Baseline Number) to (Projected Number Due to Program Impact) who are willing to provide care for persons infected with HIV.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the proportion of the dentists following CDC infection control guidelines for the dental office.
- By the end of the current budget period, increase from (Baseline Percent)% to (Projected Percent Due to Program Impact)% the number of emergency medical technicians who are willing to provide care for a person infected with HIV.
Process Objectives
1. The Public
2. School and College-Aged Youth
- Within (A Projected Number) months of the beginning of the budget period, complete an inventory of AIDS-related materials, resources, and services.
- Within (A Projected Number) months of the beginning of the budget period, gather baseline data, including demographic variables, on the knowledge, attitudes, and beliefs of the general public and set impact objectives for the rest of the budget period that are specific and numerically measurable.
- Within (A Projected Number) months of the beginning of the budget period, gather baseline data, including demographic variables, on the seroprevalence of HIV infection among the general public and set outcome objectives for the project period that are specific, realistic, and numerically measurable.
- Within (A Projected Number) months of the beginning of the budget period, specify the basic elements of information about AIDS to be communicated to the general public.
- Within (A Projected Number) months of the current budget period, develop a written plan of operation that specifies dates of initiation, the responsibilities of participating organizations and individuals, and methods selected to deliver the basic elements of information on AIDS to the general public.
- Within (A Projected Number) months of the current budget period, recruit and train individuals to participate in an AIDS speakers bureau.
- Within (A Projected Number) months of the beginning of the budget period, form an AIDS Task Force.
- Within (A Projected Number) months of the beginning of the budget period, convene a meeting with key business leaders to enlist their support in providing community AIDS education.
3. Persons at Increased Risk or Infected
- Within (A Projected Number) months of the current budget period, meet with key personnel from the State and local school systems and representatives of the health department to plan a curriculum unit on AIDS, STD, and drug abuse.
- Within (A Projected Number) months of the current budget period, select or prepare curricular materials for AIDS, STD, and drug abuse health education.
- Within (A Projected Number) months of the current budget period, deliver training on providing AIDS, STD, and drug abuse education to at least (A Projected Number) teachers.
4. Health Workers
- Within (A Projected Number) months of the beginning of the budget period, identify community organizations best suited to provide AIDS education to specific groups of those at increased risk/infected, involve them in baseline data collection, program planning, and setting objectives, and make arrangements for technical and/or financial support.
- Within (A Projected Number) months of the beginning of the budget period, gather baseline data, summarized by demographic variables and specific risk factors, on the knowledge, attitudes, beliefs and risk behaviors of men who engage in sex with men and set impact objectives for the remainder of the budget period that are specific and numerically measurable.
- Within (A Projected Number) months of the beginning of the budget period, gather baseline data, summarized by demographic variables and specific risk factors, on the seroprevalence of HIV infection among populations at increased risk and set outcome objectives for the project period that are specific, realistic, and numerically measurable.
- Within (A Projected Number) months of the beginning of the budget period, open five additional counseling and testing sites.
- Within (A Projected Number) months of the beginning of the budget period, enroll (A Projected Number) female and (A Projected Number) male prostitutes in a program to encourage "safer" sex practices.
- Within (A Projected Number) months of the beginning of the budget period, train drug treatment staff from (A Projected Percent)% of treatment centers to provide counseling on AIDS risk reduction.
- Within (A Projected Number) months of the beginning of the budget period, gather baseline data from dentists on the AIDS-related knowledge, attitudes, beliefs, infection control practices, and policies for providing care to individuals infected with HIV and set impact objectives for the remainder of the budget period that are specific and numerically measurable.
- Within (A Projected Number) months of the beginning of the budget period, ensure that each physician and dentist receive copies of CDC guideline document, "Preventing the Transmission of hepatitis B, AIDS, and Herpes in Dentistry."
- Within (A Projected Number) months of the beginning of the budget period, train (A Projected Number) emergency medical technicians to provide care for individuals who may be infected with HIV.
- By the end of the current budget period, increase from (Baseline Number) to (Projected Number Due to Program Impact) the number of individuals trained to provide HIV antibody counseling.
Appendix B Selected Educational Methodologies
Table 1
Appendix C Summary of Guideline Standards Guidelines for AIDS Prevention Program Operations
Defining The Problems and Resources Available
An AIDS Prevention Program is planned based on:
- Data describing the seroprevalence of HIV infection in the general population and among those persons whose behaviors place them at increased risk for AIDS.
- The best available estimates of: (1) the prevalence of behaviors which increase the risk of infection with HIV, and (2) the levels of knowledge, beliefs, attitudes, values, skills support, and services associated with influencing such behaviors among members of the general population, including minority communities, health care providers, and individuals at increased risk of HIV infection.
- A thorough inventory of available and potential services and resources within the community.
Target Populations
1. The Public
An AIDS Prevention Program:
2. School and College-Aged Youth
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to reach the general public with information shown to most influence attitudes, beliefs, knowledge, and high-risk behaviors.
- Wherever population and/or problems indicate, develops efforts that address the specifically identified AIDS Prevention needs of the black and Hispanic communities and, when feasible, are designed with the assistance of minority community representatives and conducted with the participation and/or support of organizations and individuals within those communities.
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to keep community decision makers informed of the AIDS problem and to enlist their ongoing practical support for specific efforts to reduce transmission of HIV throughout the community.
An AIDS Prevention Program:
3. Persons at Increased Risk or Infected
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to reach young adults with information that will help them avoid infection with HIV (as well as other STD) and IV drug abuse.
- Works to ensure that AIDS curriculum and related materials emphasize prevention behaviors and minimize teaching biological details about the virus or exclusively clinical information concerning AIDS.
- Works closely with the necessary agencies to ensure widespread implementation of AIDS (plus STD and drug abuse) education in the schools.
- Works to ensure that students attending trade schools and junior and 4-year colleges have access to factual information about AIDS, STD and drug abuse.
- Establishes AIDS education activities through organizations and facilities that serve youth who are no longer in school.
An AIDS Prevention Program:
4. Health Workers
- Sets objectives that meet the standards appearing in the "Objectives" section of these guidelines and develops coherent and realistic written plans of operation and evaluation to educate uninfected persons at high risk and those who are infected. The information/education should be directed toward specific target populations as audiences and delivered at a personal level through individualized counseling to reduce the risk of HIV transmission.
- Provides personalized AIDS risk-reduction education for those who practice specific behaviors which place them at risk, including (1) men who have "unsafe sex" with other men; (2) people who share needles and syringes when using IV drugs; (3) people who engage in sex for money or drugs; (4) the sex and needle-sharing partners of the above; (5) individuals exposed to an STD other than HIV infection; and (6) others who are defined epidemiologically to be at increased risk of infection.
- Focuses on behaviors that increase the risk of HIV transmission rather than characteristics which stereotype individuals.
- Takes all reasonable steps to ensure that staff provide HIV antibody test counseling that is nonjudgemental, sensitive to the difficult human circumstances involved, and effectively communicates individualized behavioral information and guidelines both to people who are infected and to uninfected persons at increased risk.
- Takes all reasonable steps to promote with staff that they consistently exhibit:
- tact when encouraging infected persons to refer their sex and needle- sharing partners;
- competence in coaching patients to carry out their own referrals; and
- promptness, skill, and sensitivity in making any referrals requested by a patient.
- Establishes and maintains performance accountability through a system (Note *) which "quality-assures" the competence of staff in providing individualized counseling for people with an HIV infection, in consistently and accurately delivering counseling messages, and in confidentially referring their sex and needle-sharing partners.
- Where the State or locality cannot shield AIDS-related records, including those concerning partner referral, from disclosures through litigation (e.g., subpoena, court order), avoid maintaining formal name-identified records concerning such referrals.
- Works to help develop and maintain a system of referral that is convenient for patients, helps to meet their medical and psychosocial support requirements, assists them in maintaining risk-reducing behavior changes that reduce spread of HIV, and has the capacity to accommodate the numbers of patients who will need such services.
- Works together with local Comprehensive Hemophilia Treatment Centers in the area to extend meaningful AIDS prevention services to persons with hemophilia and their families and sex partners.
- Works together with the State or local drug abuse control agency and all local drug abuse treatment facilities to design and implement initiatives that have a reasonable chance of reducing HIV transmission to, among, and by IV drug abusers.
(Note *) For a description of such a system, refer to the CDC document, Quality assurance Guidelines for Managing the Performance of Disease Intervention Specialists in STD Control, April 1985, page 5-7.
- An AIDS Prevention Program has objectives that meet the standards appearing in the "Objectives" section of these guidelines and coherent and realistic written plans of operation and evaluation to:
- Provide primary care physicians with sufficient information to respond to patient concerns about AIDS, assess risk, and provide or arrange necessary counseling related to testing those at risk.
- Work to ensure that health professionals accept referrals and meet the medical, psychosocial, and mental health needs of all patients identified with HIV infection.
- Educate health workers in practices that involve some risk of exposure about AIDS and the CDC guidelines for preventing HIV transmission in the health care setting.
Objectives
An AIDS Prevention Program:
- Establishes outcome (long-range) objectives that are specific, realistic, time phased, and numerically measurable in setting target levels of seroprevalence as the anticipated result of overall educational efforts conducted in the community.
- Establishes impact (short-range or budget period) objectives that are specific, realistic, time phased, and numerically measurable in setting forth the expected changes that program efforts will produce in relation to the baseline levels of risk behaviors and the attitudes, knowledge, beliefs, skills, supports, and services relevant to such behaviors.
- Establishes process objectives that are specific, realistic, time phased, and measurable in describing key program activities monitored by management to achieve program impact objectives.
Methodology
An AIDS Prevention Program:
- Chooses methods for achieving the educational objectives that are feasible to implement and reasonably based on the availability of resources, and that have a realistic potential to succeed.
Coalition Building
An AIDS Prevention Program:
- Methodically builds, and changes as necessary, a coalition of community groups to participate in the effective and efficient implementation of activities designed to meet program objectives.
- Provides technical assistance and feasible financial support for effective implementation and evaluation of AIDS prevention strategies.
Evaluation
An AIDS Prevention Program:
- Evaluation plan is realistic, feasible, and appropriately address all of the outcome, impact, and process objectives.
- Evaluation plan provides for routine gathering of information about the quality of performance by program employees and collaborating groups and individuals by using, as appropriate, activity data, written or verbal accounts of how activities were carried out and received, and especially the direct observation of performance.
Where to obtain a copy of this document:
October 1987, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Prevention Services, Division of Sexually Transmitted Diseases, Program Services Branch, Atlanta, Georgia 30333
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DIVISION OF HIV/AIDS PREVENTION
Table 1
Table 1. Selected Educational Methodologies ===================================================================================================================== Method Target Groups Advantages Disadvantages --------------------------------------------------------------------------------------------------------------------- -Television/radio All Reaches the broadest segment Information may be Public Service of the target population; can insufficiently detailed for Announcements direct audience to other; particular target groups. News coverage sources of information; radio Feature presentations messages can reach more specific target groups. -Newspaper All Provides greater detail than radio Does not reach as many persons Feature stories or TV; newspapers which serve in each target group. News coverage specific audiences permit targeted Advertisements messages. -Posters All Can reach specific target Provides only limited amount Billboards populations; can direct audience to information. Bus posters additional sources of information Public facilities and complement other methodologies by reinforcing various messages -Brochures/fliers All Messages can be appropriately May be less effective for some Inserts--utility bills individualized, detailed, and target groups like prostitutes Health care facilities graphic for each target group and IV drug abusers Workplace -Newsletters/journals Health workers Messages can be individualized, The longer the document, the Organization newsletters Community leaders detailed, and complex segments less likely it is to be read. AIDS update newsletter and risk popula- of the public. tions. -Resource materials Health workers Provides technical information The longer the document, the Guidelines Community leaders to specific target groups. less likely it is to be read. Curriculum materials Reprints Resource directories -Presentations The public Specific information tailored Labor intensive; primarily Community groups Health workers to the group addressed; can be information transfer only. Health care facilities Community leaders interactive. -Workshops Increased risk groups Provides detailed information Labor intensive Drug treatment centers Health workers and emphasizes skill development. Safer sex workshops -Outreach activities Persons at increased One-on-one/peer group counseling Very Labor intensive Bars risk, e.g. gay and to individuals at increased Baths bisexual men, IV drug risk who are most difficult Bookstores abusers, prostitutes to reach through other means. Streets -Counseling and testing Persons at increased One-on-one counseling to individuals Very labor intensive risk attempting to adopt or sustain positive health behaviors. -Referral of sex and Partners of those at Can offer counseling and testing Very labor intensive needle-sharing increased risk due for very high risk people who have partners to sexual activity shared needles and syringes or who or IV drug use have had "unsafe" sex with an infected person and may not otherwise become aware of their risk status. =====================================================================================================================
