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Compendium of Evidence-Based HIV Behavioral Interventions

Self-Help in Eliminating Life-Threatening Diseases (SHIELD)

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Intervention Description

Target Population
Low-income, African American drug users

Goal of Intervention
To reduce drug and sex risk behaviors

Brief Description

SHIELD is a small-group, interactive intervention that relies on peer networks to reduce drug and sex risk behaviors. Participants are asked to make public commitments to increase their own health behaviors and to promote HIV prevention among their networks and community contacts. The intervention includes multiple training and skill building sessions that involve setting goals, role plays, demonstrations, and group discussions. In addition, one session occurred in the community and provided a “street outreach” practice session. These sessions teach participants techniques for personal risk reduction and the development of correct condom use and safer sex negotiation skills. The intervention also addresses injection drug use risk and the avoidance of risky situations. To present HIV risk within a broader community context, the intervention emphasizes the interrelatedness of HIV risk among individuals, their risk partners, and their community. Participants are also provided tools and strategies for effective community outreach, and are encouraged to conduct HIV education and become advocates of risk reduction among their sex and drug partners, family and friends, and other community members.

Theoretic basis
  • Active Learning Theory
  • Cognitive Consistency Theory
  • Social Identity Theory
  • Social Influence Theory
  • Social Cognitive Theory

Intervention Duration
Ten 90-minute sessions

Intervention Setting
The setting for the 10-session training is a community-based research clinic; but the participant-delivered outreach is conducted throughout the community.

Deliverer
Male and female indigenous paraprofessional facilitators

Delivery Methods
  • Community mobilization
  • Demonstrations
  • Exercises
  • Goal setting
  • Group discussions
  • Outreach
  • Printed materials
  • Role plays and practice
  • Supplies

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Intervention Package Information

An intervention package is currently being developed with funding from CDC’s Replicating Effective Programs (REP) Project. Contact Dr. Carl A. Latkin, Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Faculty of Social and Behavioral Sciences, Johns Hopkins University, 624 North Broadway, Baltimore, Maryland 21205, e-mail: clatkin@jhsph.edu, for details on intervention materials.

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Evaluation Study and Results

The original evaluation study was conducted in Baltimore, Maryland, between 1997 and 1999. The study included a predominantly African American sample of 250 drug-using men and women.

Key Intervention Effects

  • Reduced needle sharing
  • Reduced injection drug use frequency
  • Increased cessation of injection drug use
  • Increased condom use with casual partners

Study Sample

  • 94% African American, 6% unspecified
  • 61% Male, 39% Female
  • Mean and median age of 39 years

Recruitment Settings
Recruitment of participants in high risk areas identified through observations, focus groups, and geographical coding of drug-related arrests in Baltimore City

Eligibility Criteria
Eligible participants had to be at least 18 years or older, had at least weekly contact with drug users, were willing to conduct AIDS outreach education and bring in 2 network members for assessment, and not enrolled in a recent behavioral HIV prevention or network study.

Assignment Method
Participants were randomly assigned in a ratio of 2:1 to the intervention (n=172) or control (n=78) groups.

Comparison Group
The control group was designed to be equivalent to the intervention group in number of sessions (10), duration (90 minutes each), and interest level. The control intervention involved basic HIV prevention education focusing on the prevention of HIV transmission through needle sharing and unprotected sex. Intervention sessions also included videotapes of the Public Broadcasting System series Focus on the Family. The program focused on addiction and family psychodynamics, and group discussions were delivered by indigenous peer paraprofessional facilitators.

Relevant Outcomes Measured and Follow-up Time

  • Injection drug outcomes during the previous 6 months (including frequency of injection drug use and needle sharing) were assessed at the 6-month post-intervention follow-up
  • Sexual risk behaviors during the previous 6 months (including frequency of condom use with main and casual sex partners, number of casual partners) were assessed at the 6-month follow-up

Participant Retention

  • SHIELD Intervention:
    91% retained at 6 months
  • Control Intervention:
    94% retained at 6 months

Significant Findings

  • At 6-month follow-up, injection drug users receiving the SHIELD intervention reported significantly greater reductions in needle sharing (p < 0.05) and injection drug use frequency (p < 0.05) and were more likely to stop injecting drugs (p < 0.05) than those in the control group.
  • Among sexually active drug users, those receiving the SHIELD intervention reported significantly greater increases in condom use with casual sex partners (p < 0.05) than those in the control group.

Considerations

  • The participation rate in the evaluation was low because 59% of participants who completed the baseline assessment did not bring in network members, and an additional 13% did not return for the intervention.

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References and Contact Information

  • Latkin, C.A., Sherman, S., & Knowlton, A. (2003). HIV prevention among drug users: Outcome of a network-oriented peer outreach intervention. Health Psychology, 22(4), 332–39.

Researcher: Dr. Carl A. Latkin
Department of Health, Behavior, & Society
Johns Hopkins Bloomberg School of Public Health
Faculty of Social and Behavioral Sciences, Johns Hopkins University
624 North Broadway
Baltimore, Maryland 21205
E-mail: clatkin@jhsph.edu

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