HIV Prevention Among Drug Users:
A Resource Book for Community Planners & Program Managers

Using the Results of Evaluation Research

The purpose of this section is to provide HIV prevention planners and program managers with results of evaluation research on the general characteristics of effective HIV prevention programs and, more specifically, on interventions that have been shown to be effective at reducing sexual and drug-use risk behaviors among drug-using populations. A mounting body of scientific evidence generated from evaluation research has shown that lasting changes in risky behavior can occur as a result of well-designed interventions.

General Characteristics of Effective Prevention Programs

Behavioral science research has been used to design effective prevention programs in areas such as teen pregnancy, smoking cessation, and substance abuse, as well as in HIV prevention. The results of this research, including that of HIV researchers, (Holtgrave et al., 1995; Choi et al., 1994; Kelly, 1992; Stryker et al., 1995; Janz et al., 1996) has helped identify some general characteristics of effective HIV prevention programs to consider during program design. The more characteristics an intervention integrates into a program, the stronger the chance for effectiveness. Exhibit I below presents these characteristics.

Exhibit I: Effective HIV Prevention Programs

• are designed according to the results of a comprehensive needs assessment, including an identification of target group members' level of motivation to change risk behaviors
• are affordable and easy to access by the target population served and are able to respond to other expressed needs of the community
• are culturally competent, relevant to the targeted population (i.e., consistent with norms, attitudes, and beliefs), and include members of the target population in program planning and implementation
• have clearly defined target group(s), interventions and program components, and objectives
• focus on behavioral skills, which include how to carry out low-risk, safer behaviors as well as how to avoid and cope with high-risk situations
• do not provide messages that are judgmental, moralistic, or attempt to instill fear
• have ample duration and intensity to achieve lasting behavior change, and provide support and skills necessary to cope with lapses and setbacks in maintaining safe behaviors
• address the social and community norms of the target population so that program participants receive consistent messages and reinforcement for the prescribed behavior change
• are offered to the target group as part of a continuum of health care (e.g., drug and alcohol treatment, STD treatment, family planning, other health services)
• address other basic needs of the targeted population (e.g., housing, food) in order for HIV prevention to be considered a priority
• are regularly monitored to assure implementation is according to plan and that outcomes are being met

Studies That Evaluate the Effectiveness of HIV Prevention Interventions for Drug Users

In addition to findings about the general characteristics of effective programs, a body of research exists that examines the effectiveness of specific interventions conducted with drug users and their partners. This section provides an overview of selected evaluation studies from the peer-reviewed literature and more general resource materials (books, monographs, journal articles) chosen for their focus on effectiveness and their usefulness to community planners and program managers. More complete descriptions of the materials are contained in Appendices A and B of this document.

Appendix A contains summaries of 13 evaluation studies of interventions selected from the peer-reviewed journal literature. Each has been summarized using a standard Evaluation Study Summary Form designed to address the needs of prevention planners. Nine of the summaries are also included in the document, What Intervention Studies Say About Effectiveness: A Resource for HIV Prevention Community Planning Groups (AED, 1996). Four more have been added to take advantage of new findings and ensure a variety of settings and drug-using populations. These summaries do not represent all studies on intervention effectiveness with drug users. Rather, they are intended to provide a range of current and quality research relevant to the needs of HIV prevention planners and program managers.

Below, Table 3.4 provides a guide to the Evaluation Study Summaries included in Appendix A. The table lists the citation, target populations, and type of intervention for each article included.

Appendix B contains descriptions of additional resources with a focus on effectiveness, including books, book chapters, monographs, and journal articles. These materials offer a broad range of comprehensive information on interventions for drug users and their partners. For example, one book discusses the effectiveness of a range of interventions conducted with drug users and their sex partners (Sorensen, 1991). A chapter in another book addresses interventions conducted with drug users in natural settings (as opposed to drug treatment settings) and their effectiveness (Watters, in DiClemente et al., 1994). A second chapter discusses the effectiveness of interventions for sex partners of HIV-infected or high-risk individuals, with special attention given to partner notification and HIV antibody testing and counseling programs (Padian, in DiClemente et al., 1994). Another important resource is the National Research Council's Congressionally-commissioned national study on the effectiveness of needle exchange and bleach distribution programs (Normand et al., 1995).

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