Objective 2-Among men who have sex with men (MSM), increase the proportion who consistently engage in behaviors that reduce risk for HIV acquisition or transmission.

Three of the 14 DEBI interventions are specifically targeted to MSM: Many Men, Many Voices; Mpowerment; and Popular Opinion Leader (POL). In response to an outbreak of HIV among males attending colleges in the Research Triangle area of North Carolina, the North Carolina Department of Health implemented the Men's Health Initiative to adapt and test the effectiveness of the POL intervention as a prevention strategy focusing on primarily African-American men who have sex with men and women (MSM/W), 18-30 years of age in three geographic areas and one college campus in North Carolina. The intervention was previously tested among primarily white gay men and African-American women living in subsidized housing. The goal of the POL is to identify, train and enlist the help of key opinion leaders to help change social norms through engaging in risk reduction conversations with friends. The reported outcomes of the North Carolina Men's Health Initiative using POL showed that a total of 264 POLs (15% of the target population) were trained for the intervention, 226 in the community and 38 on campus; 1302 conversations were held by POLs, 822 by community POLS and 480 by campus POLs; and eight booster sessions and four reunions were held. The North Carolina Department of Health heralded the POL as a successful intervention for the targeted population claiming that it created a safe, non-sexual environment for African-American MSM/W that did not exist previously, promoted sexual wellness for African-American men regardless of their sexual orientation, and created new community advocates and empowered POLs to do more for the community.

Objective 3- Among adolescents increase the proportion who consistently engage in behaviors that reduce risk for HIV acquisition or transmission.

The Youth Risk Behavior Surveillance System (YRBSS) is a key tool used by CDC to monitor adolescent HIV risk behaviors. From 1991-2003, YRBSS data showed that the proportion of high school students who have ever had sex, showed a significant decline from 54.1% to 46.7%. During the same time period, the percentage of high school students who had their first sexual intercourse before age 13 also declined significantly, from 10.2% to 7.4%, and the percentage of students who had four or more lifetime sex partners also declined significantly, from 18.7% to 14.4%. Finally, the percentage of students who used a condom during their last sexual intercourse increased significantly, from 46.2% in 1991 to 63% in 2003. The YRBSS data are collected every other year and allow CDC to monitor sexual activity among high school students and risk behavior mechanisms to reduce the acquisition and transmission of HIV in this population.

One of CDC's 14 DEBI interventions, “Street Smart: Reducing HIV Risk among Runaway and Homeless Youths,” is specifically targeted toward adolescents. Street Smart is a multi-session, skills-building program designed to help groups of runaway youth reduce unprotected sex, number of sex partners, and substance use.

Objective 4- Among injecting drug users (IDUs), increase the proportion who abstain from drug use or, for those who do not abstain, use harm reduction strategies to reduce risk for HIV acquisition or transmission.

In November 2005, CDC released the most recent HIV/AIDS surveillance data from the 33 states with longstanding confidential name-based HIV surveillance systems.

One of the notable findings in the data is a decline in HIV/AIDS diagnoses among IDUs from 2001-2004. During this 3-year period, there was an estimated annual percentage decline of 3.9% per year among IDUs, suggesting that prevention activities targeted toward this group are contributing to reduced HIV transmission rates.

One DEBI intervention targeted to female sex partners of male IDUs, MSM who do not self-identify as gay, and other populations at risk is “Community PROMISE: Peers Reaching Out and Modeling Intervention Strategies.” This is a community-level intervention that promotes progress toward consistent HIV prevention through community mobilization and distribution of small-media materials and risk-reduction supplies.

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