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Compendium of Evidence-Based HIV Behavioral Interventions

Real AIDS Prevention Project (RAPP)

GOOD-EVIDENCE

Intervention Description

Target Population
Sexually active, low-income women of reproductive age in inner city communities

Goals of Intervention

  • Increase positive community norms and attitudes concerning condom use
  • Increase women’s condom use behaviors with main partners and other sex partners

Brief Description

Real AIDS Prevention Project (RAPP) is a community-level intervention that mobilizes the networks of community volunteers, organizations, and business. The intervention consists of 5 main components: conducting community outreach using peer networkers; having one-on-one, safer sex discussions based on the participants’ stage of readiness to change; distributing printed stories about community members and safer sex decisions (role model stories); obtaining program support from community organizations and businesses (community networking); and sponsoring small group activities in communities, such as safer-sex discussion parties and workshops conducted by outreach specialists. The role model stories describe how women in the local community overcome barriers or have learned from experience about the need to use condoms, and how they have progressed to more consistent condom use. The role model stories are distributed through flyers, brochures, posters, and newsletters.  The community contacts, activities, and materials provide tailored prevention messages and encourage behavior change to increase condom use among women.

Theoretic Basis

  • Transtheoretical Model of Behavior Change
  • Social Learning Theory
  • Diffusion of Innovation Model

Intervention Duration
Ongoing

Intervention Settings
Small businesses, neighborhood organizations, social agencies, on the street, and in other community settings

Deliverer
Trained outreach specialists, a network of peer community volunteers, and a full-time coordinator supervising the peer network

Delivery Methods

  • Discussions
  • Outreach
  • Printed materials
  • Role-model stories
  • Risk reduction supplies (condoms)
  • Safer-sex parties
  • Workshops

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Intervention Package Information

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.

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Evaluation Study and Results

The original evaluation was conducted in Pittsburgh, PA, West Philadelphia, PA, and Portland, OR between 1993 and 1996.

Key Intervention Effects

  • Reduced proportion of participants who reported never using condoms with main partner

Study Sample
The total study sample of 3,722 women is characterized by the following:

  • 73% African American, 28% Other
  • 100% Female
  • Mean age of 25
  • 37% completed less than a high school education

Recruitment Settings
Restaurants, shops, bars, community agencies, bus stops, residential areas, and parks

Eligibility Criteria

  • The eligible communities were ones with high rates of drug use and STDs, containing 1000 to 4000 eligible women (see below), with few or no HIV prevention activities. Intervention communities were first identified and then matched communities were selected.
  • Women were eligible for assessment if they were aged 15 through 34 years who have been sexually active in the past 30 days.

Assignment Method
Four pairs of communities were assigned to 1 of 2 groups: RAPP Intervention (4 communities) or Comparison (4 communities). Matched comparison communities were selected based on the same criteria used for selecting intervention communities and geographical distance to limit possible contamination. Census data were also used to ensure the pairs of communities were comparable in age distribution, racial composition, and economic status.

Comparison Group
Comparison communities received HIV prevention activities that were already in place, which were few if any.

Relevant Outcomes Measured and Follow-up Time

  • Sex behaviors by partner type (including condom use during most recent sex, frequency of condom use, and consistent condom use in past 30 days) were measured yearly during the 2-year intervention period.

Participant Retention
Not applicable due to cross-sectional samples1

Significant Findings

  • Intervention communities showed a significant decrease in the proportion of women who reported never using condoms with main partners relative to the comparison communities (p = .03).

Considerations

  • This intervention fails to meet the best-evidence criteria because the significant intervention effect was based on an exposure analysis. The analysis was restricted to 64% of women in the intervention communities who reported exposure to the intervention and 79% of women in the comparison communities who reported no intervention exposure.  Additionally, a one-tailed test was used.

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References and Contact Information

  • Lauby, J.L., Smith, P.J., Stark, M., Person, B., and Adams, J. (2000). A community-level HIV prevention intervention for inner-city women: Results of the women and infants demonstration projects. American Journal of Public Health, 90(2), 216-222.

    Researcher: Jennifer L. Lauby
    Philadelphia Health Management Corporation
    260 S. Broad Street, Suite 1800
    Philadelphia, PA 19102
    email: jennifer@phmc.org

1The evaluation did not follow a cohort of participants across time, but selected a different representative sample of community members at each assessment.

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