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HIV Prevention: A Review of Interventions
Prevention Column ARTICLE JANAC Vol. 14, No. 1, January/February 2003 10.1177/1055329002239193 Porche, Swayzer / HIV Prevention
HIV Prevention: A Review of Interventions Demetrius J. Porche, DNS, RN, CS Robert Swayzer III, MPH
T
he determination of behaviors that predispose individuals and populations to HIV has been the center of behavioral research since the emergence of the HIV/ AIDS epidemic. Throughout this epidemic, researchers have studied the relationships and attempted to determine the levels of risk that exist between behaviors and HIV transmission. On the basis of research that proposes different levels of risk for HIV transmission with specific behaviors, behavioral interventions have been developed to decrease or eliminate the risk of HIV transmission. Behavioral research continues to study the antecedents to behaviors that increase the risk of HIV infection and the effectiveness of behavioral interventions among at-risk populations. A plethora of behavioral interventions have been proposed as strategies to decrease or eliminate the risk of HIV transmission. Some of these interventions have been developed on the basis of behavioral or social science theories; some have evolved from research; and others have evolved from a combination of behavioral and social science, research, and grassroots community engagement. A weakness of HIV prevention behavioral interventions is the lack of research or evaluation data that support the effectiveness of these interventions. The purpose of this column is to provide a review of multilevel HIV prevention interventions (individual-, group-, and community-level interventions) used to decrease or eliminate the risk of HIV transmission. This column is not intended to be an exhaustive list, nor does it provide a critical analysis of the effectiveness of these interventions. Future columns will present information on HIV prevention programs.
The following are descriptive definitions of the multiple HIV prevention interventions being implemented. AIDS risk reduction education. AIDS risk reduction education consists of disseminating information in a didactic format. This information typically consists of information regarding HIV transmission, HIV antibody testing, correcting misconceptions about HIV transmission, safer sex practices, safer injecting drug use (IDU) practices, and an overview of HIV disease. Skills building. Skills building consists of interventions that provide participants with the necessary skills that support the practice of safe sex (inclusive of condom use and safer sex negotiation). Skills building includes an educational and behavioral component. Condom skills building. Condom skills building provides instructions on correct condom use. These interventions typically consist of condom demonstrations and participant return demonstrations of condom use. Community awareness sessions. Community awareness sessions serve to increase awareness of Demetrius J. Porche, DNS, RN, CS, is an associate professor and acting associate dean of nursing research and evaluation at the Louisiana State University Health Sciences Center, School of Nursing, Office of Nursing Research and Evaluation. Robert Swayzer III, MPH, is director of prevention programs at Brotherhood Incorporated.
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 14, No. 1, January/February 2003, 79-81 DOI: 10.1177/1055329002239193 Copyright © 2003 Association of Nurses in AIDS Care
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JANAC Vol. 14, No. 1, January/February 2003
HIV/AIDS among at-risk populations. There is a basic need to be aware of the risk factors for HIV infection before protective behaviors are adopted. For populations among which there are low levels of awareness of HIV/AIDS and HIV risk behaviors, community awareness sessions may increase perceptions of susceptibility and the seriousness of the disease. Drop-in centers. Drop-in centers are communitybased organizations that are not shelters nor emergency rooms but provide a multitude of health-related services to target populations. These are designed as neutral settings that provide health-related services such as HIV testing and risk reduction education. Popular opinion leaders. Popular individuals within a target community are trained to serve as proponents, educators, and interventionists to change behaviors among their peers in the community. Small print media. Small print media consist of brochures and pamphlets that contain information regarding HIV disease, HIV antibody testing, safer sex and IDU practices, and/or community resources. These are frequently distributed within targeted communities. Mass media and advertisements. Mass media interventions are informational and/or educational announcements that use media channels such as radio, television, billboards, and newspapers. Public service announcements are considered mass media interventions. Safer sex house parties. Safer sex house parties are hosted by a community volunteer who invites several friends or acquaintances to his or her home. The attendees are presented with educational information and/ or skills-building exercises in a nonthreatening environment. HIV antibody testing and counseling. HIV antibody testing and counseling provide individuals with opportunities to learn their HIV statuses. HIV testing is usually accompanied by counseling regarding HIV transmission, the meaning of an HIV antibody test, safer sex and IDU practices, and individual risk reduction plans.
Partner counseling and referrals. Partner counseling and referrals provide counseling to HIV-infected individuals’sexual or IDU partners and offer HIV testing while maintaining confidentiality. Individual risk reduction plans. Individual risk reduction plans are developed through mutual goal setting between individuals and HIV prevention interventionists. Risk reduction plans assist individual clients in identifying realistic goals that are targeted with their risk behaviors and the actions necessary to achieve the planned goals to reduce or eliminate their risk behaviors. Condom distribution. Condom distribution consists of providing condoms in places that are accessible to target populations. Common sites of condom distribution are restrooms, bars, spas, bathhouses, barber shops, and hair salons. Needle and syringe distribution. Needle and syringe distribution prevention programs provide individuals with access to sterile needles and syringes. Needle and syringe exchange. Needle and syringe exchange programs provide individuals with access to sterile needles and syringes with the return of used needles and syringes. Needle and syringe skills building. Needle and syringe skills building provides individuals with information on the proper techniques for cleaning needles, syringes, and other IDU works. This intervention consists of needle and syringe cleaning demonstrations, with participants performing return demonstrations. Sexual assertiveness training. Sexual assertiveness training assists individuals in learning to assert their own positions and requests regarding safer sex or IDU practices. Sexual assertiveness training includes instruction, role modeling, behavior rehearsal, reinforcement and corrective feedback, and continual practice. This training teaches individuals how to behave; allows them to gain confidence through role playing assertive responses; and teaches them how to assert their feelings and skills in genuine, real-life situations.
Porche, Swayzer / HIV Prevention
Self-management skills. Self-management skills interventions assist individuals in developing both cognitive and behavioral skills that are needed to avoid or reduce risk, including environmental changes that may be needed to reduce high-risk behaviors. Selfmanagement skills consist of obtaining and buying condoms, keeping and practicing condom use, and avoiding situations that place individuals in risky positions. Sexually transmitted disease (STD) screening and treatment. STD screening and treatment involve the screening and treatment of STDs, including HIV. The Centers for Disease Control and Prevention strongly recommend that the early detection and treatment of STDs be a central and explicit component of national, state, and local strategies to prevent HIV infection and AIDS. STD screening may be offered in various locations, including public health clinics, school-based clinics, and community-based organizations. HIV prevention case management. HIV prevention case management is a hybrid intervention that combines individual HIV risk reduction interventions with case management principles for both HIV-positive and HIV-negative individuals. This intervention focuses on initiating and/or sustaining practices that limit the potential transmission of HIV. Prevention case
81
management consists of intensive, individualized, supportive prevention counseling. Street outreaches. Street outreaches consist of faceto-face interactions with individuals with the goal of providing education and/or skills to reduce their risk of HIV transmission. Venue-based community outreaches. Venue-based community outreaches are educational and skillsbuilding programs that target high-risk populations in specific venues to eliminate or reduce their HIV transmission risks. Train-the-trainer prevention programs. Train-thetrainer prevention programs are designed to train individual community members or professionals on HIV prevention strategies. These trainees are provided with information and skills to train other community members or professionals on HIV prevention strategies.
Bibliography Kelly, J. (1995). Changing HIV risk behavior: Practical strategies. New York: Guilford. Porche, D. (2000). Principles of HIV/AIDS case management. In J. Durham & F. Lashley (Eds.), The person with HIV/AIDS: Nursing perspectives (3rd ed., pp. 387-400). New York: Springer.
HIV Prevention: A Review of Interventions Demetrius J. Porche, DNS, RN, CS Robert Swayzer III, MPH
T
he determination of behaviors that predispose individuals and populations to HIV has been the center of behavioral research since the emergence of the HIV/ AIDS epidemic. Throughout this epidemic, researchers have studied the relationships and attempted to determine the levels of risk that exist between behaviors and HIV transmission. On the basis of research that proposes different levels of risk for HIV transmission with specific behaviors, behavioral interventions have been developed to decrease or eliminate the risk of HIV transmission. Behavioral research continues to study the antecedents to behaviors that increase the risk of HIV infection and the effectiveness of behavioral interventions among at-risk populations. A plethora of behavioral interventions have been proposed as strategies to decrease or eliminate the risk of HIV transmission. Some of these interventions have been developed on the basis of behavioral or social science theories; some have evolved from research; and others have evolved from a combination of behavioral and social science, research, and grassroots community engagement. A weakness of HIV prevention behavioral interventions is the lack of research or evaluation data that support the effectiveness of these interventions. The purpose of this column is to provide a review of multilevel HIV prevention interventions (individual-, group-, and community-level interventions) used to decrease or eliminate the risk of HIV transmission. This column is not intended to be an exhaustive list, nor does it provide a critical analysis of the effectiveness of these interventions. Future columns will present information on HIV prevention programs.
The following are descriptive definitions of the multiple HIV prevention interventions being implemented. AIDS risk reduction education. AIDS risk reduction education consists of disseminating information in a didactic format. This information typically consists of information regarding HIV transmission, HIV antibody testing, correcting misconceptions about HIV transmission, safer sex practices, safer injecting drug use (IDU) practices, and an overview of HIV disease. Skills building. Skills building consists of interventions that provide participants with the necessary skills that support the practice of safe sex (inclusive of condom use and safer sex negotiation). Skills building includes an educational and behavioral component. Condom skills building. Condom skills building provides instructions on correct condom use. These interventions typically consist of condom demonstrations and participant return demonstrations of condom use. Community awareness sessions. Community awareness sessions serve to increase awareness of Demetrius J. Porche, DNS, RN, CS, is an associate professor and acting associate dean of nursing research and evaluation at the Louisiana State University Health Sciences Center, School of Nursing, Office of Nursing Research and Evaluation. Robert Swayzer III, MPH, is director of prevention programs at Brotherhood Incorporated.
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 14, No. 1, January/February 2003, 79-81 DOI: 10.1177/1055329002239193 Copyright © 2003 Association of Nurses in AIDS Care
80
JANAC Vol. 14, No. 1, January/February 2003
HIV/AIDS among at-risk populations. There is a basic need to be aware of the risk factors for HIV infection before protective behaviors are adopted. For populations among which there are low levels of awareness of HIV/AIDS and HIV risk behaviors, community awareness sessions may increase perceptions of susceptibility and the seriousness of the disease. Drop-in centers. Drop-in centers are communitybased organizations that are not shelters nor emergency rooms but provide a multitude of health-related services to target populations. These are designed as neutral settings that provide health-related services such as HIV testing and risk reduction education. Popular opinion leaders. Popular individuals within a target community are trained to serve as proponents, educators, and interventionists to change behaviors among their peers in the community. Small print media. Small print media consist of brochures and pamphlets that contain information regarding HIV disease, HIV antibody testing, safer sex and IDU practices, and/or community resources. These are frequently distributed within targeted communities. Mass media and advertisements. Mass media interventions are informational and/or educational announcements that use media channels such as radio, television, billboards, and newspapers. Public service announcements are considered mass media interventions. Safer sex house parties. Safer sex house parties are hosted by a community volunteer who invites several friends or acquaintances to his or her home. The attendees are presented with educational information and/ or skills-building exercises in a nonthreatening environment. HIV antibody testing and counseling. HIV antibody testing and counseling provide individuals with opportunities to learn their HIV statuses. HIV testing is usually accompanied by counseling regarding HIV transmission, the meaning of an HIV antibody test, safer sex and IDU practices, and individual risk reduction plans.
Partner counseling and referrals. Partner counseling and referrals provide counseling to HIV-infected individuals’sexual or IDU partners and offer HIV testing while maintaining confidentiality. Individual risk reduction plans. Individual risk reduction plans are developed through mutual goal setting between individuals and HIV prevention interventionists. Risk reduction plans assist individual clients in identifying realistic goals that are targeted with their risk behaviors and the actions necessary to achieve the planned goals to reduce or eliminate their risk behaviors. Condom distribution. Condom distribution consists of providing condoms in places that are accessible to target populations. Common sites of condom distribution are restrooms, bars, spas, bathhouses, barber shops, and hair salons. Needle and syringe distribution. Needle and syringe distribution prevention programs provide individuals with access to sterile needles and syringes. Needle and syringe exchange. Needle and syringe exchange programs provide individuals with access to sterile needles and syringes with the return of used needles and syringes. Needle and syringe skills building. Needle and syringe skills building provides individuals with information on the proper techniques for cleaning needles, syringes, and other IDU works. This intervention consists of needle and syringe cleaning demonstrations, with participants performing return demonstrations. Sexual assertiveness training. Sexual assertiveness training assists individuals in learning to assert their own positions and requests regarding safer sex or IDU practices. Sexual assertiveness training includes instruction, role modeling, behavior rehearsal, reinforcement and corrective feedback, and continual practice. This training teaches individuals how to behave; allows them to gain confidence through role playing assertive responses; and teaches them how to assert their feelings and skills in genuine, real-life situations.
Porche, Swayzer / HIV Prevention
Self-management skills. Self-management skills interventions assist individuals in developing both cognitive and behavioral skills that are needed to avoid or reduce risk, including environmental changes that may be needed to reduce high-risk behaviors. Selfmanagement skills consist of obtaining and buying condoms, keeping and practicing condom use, and avoiding situations that place individuals in risky positions. Sexually transmitted disease (STD) screening and treatment. STD screening and treatment involve the screening and treatment of STDs, including HIV. The Centers for Disease Control and Prevention strongly recommend that the early detection and treatment of STDs be a central and explicit component of national, state, and local strategies to prevent HIV infection and AIDS. STD screening may be offered in various locations, including public health clinics, school-based clinics, and community-based organizations. HIV prevention case management. HIV prevention case management is a hybrid intervention that combines individual HIV risk reduction interventions with case management principles for both HIV-positive and HIV-negative individuals. This intervention focuses on initiating and/or sustaining practices that limit the potential transmission of HIV. Prevention case
81
management consists of intensive, individualized, supportive prevention counseling. Street outreaches. Street outreaches consist of faceto-face interactions with individuals with the goal of providing education and/or skills to reduce their risk of HIV transmission. Venue-based community outreaches. Venue-based community outreaches are educational and skillsbuilding programs that target high-risk populations in specific venues to eliminate or reduce their HIV transmission risks. Train-the-trainer prevention programs. Train-thetrainer prevention programs are designed to train individual community members or professionals on HIV prevention strategies. These trainees are provided with information and skills to train other community members or professionals on HIV prevention strategies.
Bibliography Kelly, J. (1995). Changing HIV risk behavior: Practical strategies. New York: Guilford. Porche, D. (2000). Principles of HIV/AIDS case management. In J. Durham & F. Lashley (Eds.), The person with HIV/AIDS: Nursing perspectives (3rd ed., pp. 387-400). New York: Springer.