Impact Data - Community Approaches to HIV/AIDS
Date
Initiated in 1989, the AIDS Community Demonstration Projects (ACDPs) were community level-human immunodeficiency virus (HIV)-prevention programmes addressing high-risk, hard-to-reach populations in 5 United States cities. For the intervention design, researchers developed a common study protocol based on behaviour-change theories and models. The goals of this research were to determine the efficacy of a specific community-level intervention for groups considered hard to reach and, if effective, to apply the strategies used in the intervention to subsequent HIV prevention programmes. This report describes the common study protocol used in the ACDPs, the preliminary findings, and some conclusions regarding design and implementation of interventions.
Methodologies
To determine if the intervention was reaching persons in the groups being addressed, project sites used the following process measures: a) records of monthly averages of the numbers of network members and distributed print materials; b) interviews with key observers and persons in the populations being addressed regarding changes in the community; c) records of daily outreach activities; and d) in the Dallas project, unobtrusive observations of discarded condoms, bleach bottles, or print materials. To collect data from the study populations, the project sites developed a street interview instrument containing questions linked to the behavioural theories underlying the intervention. Following a pilot period, periodic cross-sectional surveys were performed in 10 waves of data collection from February 1991 through June 1994.
Knowledge Shifts
Ratio of people who thought "you can avoid getting infected with AIDS by avoiding people who look sick" decreased from 56% to 42%. First named mode of AIDS prevention as condoms increased from 5 to 11% and increase of awareness that condoms existed grew by 11%. Knowledge differences between the study group and the control group was 11%.
Attitudes
The nature of the methodology of reporting of this study combines attitudinal and practice factors onto a single linear scale, using a 5-point system. Called the Stages of Change (SOC) continuum, 1 represented the state of Pre-contemplation while 5 is the Maintenance of a ideal behaviour. The study was designed to see how the populations under study moved as a mean along this scale after exposure to the interventions.
At baseline, the mean SOC value for condom use for vaginal intercourse with a main partner among intervention-area respondents (1.60) was similar to that among comparison-area respondents (1.57). These low values correspond to a high proportion of respondents in the pre-contemplation stage for this behaviour (72% in both the intervention and comparison areas). 10.6% of intervention area respondents reported exposure to the project intervention during the start-up phase and 40.7% at the early implementation phase. As of early implementation, the mean SOC value among intervention-area respondents (2.02) was higher than that among comparison-area respondents (1.87) though the change was found to not be satitically significant.
In comparison, at baseline, the mean SOC values for condom use for intercourse with non-main partners were similar: 2.78 for intervention-area respondents and 2.74 for comparison-area respondents. 9% reported project exposure during the start-up phase and 42.9% at early implementation. At early implementation, the mean SOC value for this behaviour had increased to 3.08 among intervention-area respondents, compared with 2.85 among comparison-area respondents, representing a statistically significant intervention effect for vaginal intercourse with non-main partners (p<0.05). These results correspond to a 43.9% increase (from 23.0% to 33.1%).
At the early implementation phase, 45.6% of the intervention-area IDU respondents recalled exposure to the intervention. The mean SOC value for this behaviour decreased from 2.65 to 2.51 among comparison-area respondents, but increased from 2.94 to 3.12 among respondents in the intervention areas (intervention effect, p=0.002). The mean SOC value among intervention-area respondents who recalled exposure to the project (3.33) was significantly higher than that for the unexposed group (2.95) (exposure effect, p=0.001).
At baseline, the mean SOC value for condom use for vaginal intercourse with a main partner among intervention-area respondents (1.60) was similar to that among comparison-area respondents (1.57). These low values correspond to a high proportion of respondents in the pre-contemplation stage for this behaviour (72% in both the intervention and comparison areas). 10.6% of intervention area respondents reported exposure to the project intervention during the start-up phase and 40.7% at the early implementation phase. As of early implementation, the mean SOC value among intervention-area respondents (2.02) was higher than that among comparison-area respondents (1.87) though the change was found to not be satitically significant.
In comparison, at baseline, the mean SOC values for condom use for intercourse with non-main partners were similar: 2.78 for intervention-area respondents and 2.74 for comparison-area respondents. 9% reported project exposure during the start-up phase and 42.9% at early implementation. At early implementation, the mean SOC value for this behaviour had increased to 3.08 among intervention-area respondents, compared with 2.85 among comparison-area respondents, representing a statistically significant intervention effect for vaginal intercourse with non-main partners (p<0.05). These results correspond to a 43.9% increase (from 23.0% to 33.1%).
At the early implementation phase, 45.6% of the intervention-area IDU respondents recalled exposure to the intervention. The mean SOC value for this behaviour decreased from 2.65 to 2.51 among comparison-area respondents, but increased from 2.94 to 3.12 among respondents in the intervention areas (intervention effect, p=0.002). The mean SOC value among intervention-area respondents who recalled exposure to the project (3.33) was significantly higher than that for the unexposed group (2.95) (exposure effect, p=0.001).
Increased Discussion of Development Issues
Over 50% of sample discussed issues raised in the television drama with friends or family.
Access
Exposure rates to the intervention material ranged from between 1% and 18% in the start up phase and from 22% to 68% in the early implementation exposure phase. At early implementation, female sex traders were overall the most likely to report exposure to project materials and staff, while non-homosexually identifying men who have sex with men (MSM) were the least likely to report exposure to the intervention activities or materials. The Long Beach project reported the greatest improvements in exposure rates. Vaginal intercourse with non-main partners was reported by 5,532 respondents. Respondents were almost evenly divided between women (n=2,770 [50%]) and men (n=2,762 [50%]). Most male respondents were intervenous drug users (IDUs) (n=1,410 [51%]), and most female respondents were sex traders (n=2,075 [75%]).
Other Impacts
In all cases the mean SOC value among persons in the intervention areas who reported exposure to the project intervention was greater than the mean SOC value among those who did not report exposure. While not all cases demonstrated a statistically significant shift, there is some evidence pointing to the positive effects derived from the intervention activities. The report concludes with a series of recommendations for further development of community interventions.
Source
Centers for Disease Control and Prevention. "Community-level prevention of human immunodeficiency virus infection among high-risk populations: the AIDS Community Demonstration Projects" [PDF], MMWR 1996; 45(RR-6).
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