Compendium of Evidence-Based HIV Behavioral Interventions
Underserved populations at risk for HIV infection, including intravenous drug users (IDUs), female sex partners of male IDUs, non–gay-identified men who have sex with men (MSM), high-risk youth, female sex workers, and residents in areas with high rates of sexually transmitted diseases
Goals of Intervention
- Increase consistent condom use
- Increase disinfecting of injection equipment
Community Promise is a community-level intervention to promote progress toward consistent HIV prevention practices through community mobilization and distribution of small-media materials and risk reduction supplies, such as condoms and bleach. The intervention consists of 4 main components: community identification process to collect information about the community, including HIV/STD risk behaviors and influencing factors; creating role model stories based on personal accounts from individuals in the targeted populations; recruiting and training peer advocates from the target population to distribute prevention materials and role model stories that are appropriate to the participants’ stage of behavioral change; and continuous formative evaluation to capture behavior change within the target population. New role model stories that appeal to the target populations and reflect their culture and languages are produced approximately once a month. On-going feedback from collected data guides the selection and development of new role model stories. Trained peers distribute the role model stories, along with condoms and bleach kits, to their social networks. Peer network members who have tried to reduce their high-risk behavior are encouraged to share their personal stories and experience with other community members.
- Transtheoretical Model of behavioral change
- Health Belief Model
- Theory of Reasoned Action
- Social Cognitive Theory
Public areas, businesses, and other areas in the community
Outreach workers, peers, and area business people who had regular contact with the target population
- Printed materials (brochures, pamphlets, flyers, trading cards)
- Risk Reduction Supplies (condoms, bleach)
An intervention package was developed with funding from CDC’s Replicating Effective Programs (REP) Project. The intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.
The original evaluation study was conducted in Dallas, Texas; Denver, Colorado; Long Beach, California; New York City, New York; and Seattle, Washington between 1991 and 1994.
Key Intervention Effects
- Increased condom use
The baseline study sample of 15,205 participants in 20 communities is characterized by the following:
- 54% African American, 22% White, 19% Hispanic, 5% Other
- 55% Female, 45% Male
- 6% non-gay identified MSM
Community service organizations, local businesses, and other areas in the community
- The eligibility of communities was based on in-depth formative research conducted in each participating city. The geographic areas where at-risk target populations congregated were assessed to determine where the intervention and evaluation could be conducted. Intervention communities were first identified and then matched communities were selected.
- Men and women were eligible for assessment if they had vaginal or anal intercourse in the 30 days before the interview or shared needles for drug injection in the 60 days before the interview and were members in one of the at-risk communities targeted by the local site.
Ten pairs of communities were assigned to 1 of 2 groups: Community Promise Intervention (10 communities) or Comparison (10 communities). Two pairs of communities in Dallas were randomly assigned to intervention or comparison arms. In the other eight pairs of communities, assignment to the intervention arm was determined by resources (e.g., office space for intervention activities) and the comparison communities were matched by accessibility and density of targeted community members, demographics, and physical characteristics of interview locations.
Previously existing HIV prevention activities, if any
Relevant Outcomes Measured and Follow-up Time
- Stage of change for condom use with main and non-main partners during past month (including precontemplation, contemplation, preparation, action and maintenance) were measured in 10 cross-sectional waves: 2 prior to the intervention and 8 during the 32-month intervention period.
- Stage of change for bleach use to disinfect injection equipment during past two months (including precontemplation, contemplation, preparation, action and maintenance) were measured in 10 cross-sectional waves: 2 prior to the intervention and 8 during the 32-month intervention period.
Not applicable due to cross-sectional samples1
- Over the 32-month intervention period, there was a significantly greater increase in the mean stage-of-change scores for condom use with main partner and for condom use with non-main partners in the intervention communities than in the comparison communities (p’s < .05).
- For condom use with non-main partners over the 32-month intervention period, there was a significantly greater increase in the percentage of participants in the action stage (i.e., used condoms every time for less than 6 months) or higher stage in the intervention communities than in the comparison communities (p < .05).
- For condom use with non-main partners over the 32-month intervention period, there was a significantly greater increase in the percentage of participants in the maintenance stage (i.e., has used condoms every time for 6 or more months) in the intervention communities than in the comparison communities (p < .05).
- The intervention did not meet best-evidence criteria because of dropping communities due to contamination or logistic/implementation issues.
- CDC AIDS Community Demonstration Projects Research Group. (1999). Community-level HIV intervention in 5 cities: Final outcome data from the CDC AIDS Community Demonstration Projects. American Journal of Public Health. 89(3), 336-345.
- Centers for Disease Control and Prevention (1996). Community-level prevention of human immunodeficiency virus infection among high-risk populations: The AIDS Community Demonstration Projects. MMWR Recommendations and Report, 45, 1-24.
Richard Wolitski, National Center for HIV, STD, and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road, MS E-37
Atlanta, GA, 30333