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. 1999 Mar;89(3):336–345. doi: 10.2105/ajph.89.3.336

Community-level HIV intervention in 5 cities: final outcome data from the CDC AIDS Community Demonstration Projects.

PMCID: PMC1508588  PMID: 10076482

Abstract

OBJECTIVES: This study evaluated a theory-based community-level intervention to promote progress toward consistent condom and bleach use among selected populations at increased risk for HIV infection in 5 US cities. METHODS: Role-model stories were distributed, along with condoms and bleach, by community members who encouraged behavior change among injection drug users, their female sex partners, sex workers, non-gay-identified men who have sex with men, high-risk youth, and residents in areas with high sexually transmitted disease rates. Over a 3-year period, cross-sectional interviews (n = 15,205) were conducted in 10 intervention and comparison community pairs. Outcomes were measured on a stage-of-change scale. Observed condom carrying and intervention exposure were also measured. RESULTS: At the community level, movement toward consistent condom use with main (P < .05) and nonmain (P < .05) partners, as well as increased condom carrying (P < .0001), was greater in intervention than in comparison communities. At the individual level, respondents recently exposed to the intervention were more likely to carry condoms and to have higher stage-of-change scores for condom and bleach use. CONCLUSIONS: The intervention led to significant communitywide progress toward consistent HIV risk reduction.

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Selected References

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  1. Asamoah-Adu A., Weir S., Pappoe M., Kanlisi N., Neequaye A., Lamptey P. Evaluation of a targeted AIDS prevention intervention to increase condom use among prostitutes in Ghana. AIDS. 1994 Feb;8(2):239–246. doi: 10.1097/00002030-199402000-00012. [DOI] [PubMed] [Google Scholar]
  2. Booth R. E., Watters J. K. How effective are risk-reduction interventions targeting injecting drug users? AIDS. 1994 Nov;8(11):1515–1524. doi: 10.1097/00002030-199411000-00001. [DOI] [PubMed] [Google Scholar]
  3. Choi K. H., Coates T. J. Prevention of HIV infection. AIDS. 1994 Oct;8(10):1371–1389. doi: 10.1097/00002030-199410000-00003. [DOI] [PubMed] [Google Scholar]
  4. Community Intervention Trial for Smoking Cessation (COMMIT): I. cohort results from a four-year community intervention. Am J Public Health. 1995 Feb;85(2):183–192. doi: 10.2105/ajph.85.2.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Community intervention trial for smoking cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. Am J Public Health. 1995 Feb;85(2):193–200. doi: 10.2105/ajph.85.2.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Corby N. H., Enguídanos S. M., Kay L. S. Development and use of role model stories in a community level HIV risk reduction intervention. Public Health Rep. 1996;111 (Suppl 1):54–58. [PMC free article] [PubMed] [Google Scholar]
  7. Corby N. H., Wolitski R. J. Condom use with main and other sex partners among high-risk women: intervention outcomes and correlates of reduced risk. Drugs Soc (New York) 1996;9(1-2):75–96. doi: 10.1300/J023v09n01_05. [DOI] [PubMed] [Google Scholar]
  8. Dubois-Arber F., Jeannin A., Konings E., Paccaud F. Increased condom use without other major changes in sexual behavior among the general population in Switzerland. Am J Public Health. 1997 Apr;87(4):558–566. doi: 10.2105/ajph.87.4.558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Farquhar J. W. The community-based model of life style intervention trials. Am J Epidemiol. 1978 Aug;108(2):103–111. doi: 10.1093/oxfordjournals.aje.a112593. [DOI] [PubMed] [Google Scholar]
  10. Fishbein M. Great expectations, or do we ask too much from community-level interventions? Am J Public Health. 1996 Aug;86(8):1075–1076. doi: 10.2105/ajph.86.8_pt_1.1075. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fortmann S. P., Flora J. A., Winkleby M. A., Schooler C., Taylor C. B., Farquhar J. W. Community intervention trials: reflections on the Stanford Five-City Project Experience. Am J Epidemiol. 1995 Sep 15;142(6):576–586. doi: 10.1093/oxfordjournals.aje.a117678. [DOI] [PubMed] [Google Scholar]
  12. Gostin L. O., Lazzarini Z., Jones T. S., Flaherty K. Prevention of HIV/AIDS and other blood-borne diseases among injection drug users. A national survey on the regulation of syringes and needles. JAMA. 1997 Jan 1;277(1):53–62. [PubMed] [Google Scholar]
  13. Groseclose S. L., Weinstein B., Jones T. S., Valleroy L. A., Fehrs L. J., Kassler W. J. Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992-1993. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Sep 1;10(1):82–89. [PubMed] [Google Scholar]
  14. Guenther-Grey C., Noroian D., Fonseka J., Higgins D. Developing community networks to deliver HIV prevention interventions. Public Health Rep. 1996;111 (Suppl 1):41–49. [PMC free article] [PubMed] [Google Scholar]
  15. Higgins D. L., O'Reilly K., Tashima N., Crain C., Beeker C., Goldbaum G., Elifson C. S., Galavotti C., Guenther-Grey C. Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects. Public Health Rep. 1996;111 (Suppl 1):28–35. [PMC free article] [PubMed] [Google Scholar]
  16. Holtgrave D. R., Qualls N. L., Curran J. W., Valdiserri R. O., Guinan M. E., Parra W. C. An overview of the effectiveness and efficiency of HIV prevention programs. Public Health Rep. 1995 Mar-Apr;110(2):134–146. [PMC free article] [PubMed] [Google Scholar]
  17. Jamner M. S., Corby N. H., Wolitski R. J. Bleaching injection equipment: influencing factors among IDUs who share. Subst Use Misuse. 1996 Dec;31(14):1973–1993. doi: 10.3109/10826089609066447. [DOI] [PubMed] [Google Scholar]
  18. Kegeles S. M., Hays R. B., Coates T. J. The Mpowerment Project: a community-level HIV prevention intervention for young gay men. Am J Public Health. 1996 Aug;86(8):1129–1136. doi: 10.2105/ajph.86.8_pt_1.1129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kelly J. A., Murphy D. A., Sikkema K. J., McAuliffe T. L., Roffman R. A., Solomon L. J., Winett R. A., Kalichman S. C. Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet. 1997 Nov 22;350(9090):1500–1505. doi: 10.1016/s0140-6736(97)07439-4. [DOI] [PubMed] [Google Scholar]
  20. Kelly J. A., St Lawrence J. S., Stevenson L. Y., Hauth A. C., Kalichman S. C., Diaz Y. E., Brasfield T. L., Koob J. J., Morgan M. G. Community AIDS/HIV risk reduction: the effects of endorsements by popular people in three cities. Am J Public Health. 1992 Nov;82(11):1483–1489. doi: 10.2105/ajph.82.11.1483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Koepsell T. D., Diehr P. H., Cheadle A., Kristal A. Invited commentary: symposium on community intervention trials. Am J Epidemiol. 1995 Sep 15;142(6):594–599. doi: 10.1093/oxfordjournals.aje.a117680. [DOI] [PubMed] [Google Scholar]
  22. Lando H. A., Pechacek T. F., Pirie P. L., Murray D. M., Mittelmark M. B., Lichtenstein E., Nothwehr F., Gray C. Changes in adult cigarette smoking in the Minnesota Heart Health Program. Am J Public Health. 1995 Feb;85(2):201–208. [PMC free article] [PubMed] [Google Scholar]
  23. Luepker R. V., Murray D. M., Jacobs D. R., Jr, Mittelmark M. B., Bracht N., Carlaw R., Crow R., Elmer P., Finnegan J., Folsom A. R. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. Am J Public Health. 1994 Sep;84(9):1383–1393. doi: 10.2105/ajph.84.9.1383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McAlister A. L. Population behavior change: a theory-based approach. J Public Health Policy. 1991 Autumn;12(3):345–361. [PubMed] [Google Scholar]
  25. McAlister A., Puska P., Koskela K., Pallonen U., Maccoby N. Psychology in action. Mass communication and community organization for public health education. Am Psychol. 1980 Apr;35(4):375–379. doi: 10.1037//0003-066x.35.4.375. [DOI] [PubMed] [Google Scholar]
  26. Murray D. M., Hannan P. J., Jacobs D. R., McGovern P. J., Schmid L., Baker W. L., Gray C. Assessing intervention effects in the Minnesota Heart Health Program. Am J Epidemiol. 1994 Jan 1;139(1):91–103. doi: 10.1093/oxfordjournals.aje.a116938. [DOI] [PubMed] [Google Scholar]
  27. O'Reilly K. R., Higgins D. L. AIDS Community Demonstration Projects for HIV prevention among hard-to-reach groups. Public Health Rep. 1991 Nov-Dec;106(6):714–720. [PMC free article] [PubMed] [Google Scholar]
  28. Prochaska J. O., DiClemente C. C., Norcross J. C. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992 Sep;47(9):1102–1114. doi: 10.1037//0003-066x.47.9.1102. [DOI] [PubMed] [Google Scholar]
  29. Prochaska J. O., Velicer W. F. The transtheoretical model of health behavior change. Am J Health Promot. 1997 Sep-Oct;12(1):38–48. doi: 10.4278/0890-1171-12.1.38. [DOI] [PubMed] [Google Scholar]
  30. Puska P., Nissinen A., Tuomilehto J., Salonen J. T., Koskela K., McAlister A., Kottke T. E., Maccoby N., Farquhar J. W. The community-based strategy to prevent coronary heart disease: conclusions from the ten years of the North Karelia project. Annu Rev Public Health. 1985;6:147–193. doi: 10.1146/annurev.pu.06.050185.001051. [DOI] [PubMed] [Google Scholar]
  31. Rietmeijer C. A., Kane M. S., Simons P. Z., Corby N. H., Wolitski R. J., Higgins D. L., Judson F. N., Cohn D. L. Increasing the use of bleach and condoms among injecting drug users in Denver: outcomes of a targeted, community-level HIV prevention program. AIDS. 1996 Mar;10(3):291–298. [PubMed] [Google Scholar]
  32. Schnell D. J., Galavotti C., Fishbein M., Chan D. K. Measuring the adoption of consistent use of condoms using the stages of change model. AIDS Community Demonstration Projects. Public Health Rep. 1996;111 (Suppl 1):59–68. [PMC free article] [PubMed] [Google Scholar]
  33. Schnell D. J., Magee E., Sheridan J. R. A regression method for analysing ordinal data from intervention trials. Stat Med. 1995 Jun 15;14(11):1177–1189. doi: 10.1002/sim.4780141104. [DOI] [PubMed] [Google Scholar]
  34. Simons P. Z., Rietmeijer C. A., Kane M. S., Guenther-Grey C., Higgins D. L., Cohn D. L. Building a peer network for a community level HIV prevention program among injecting drug users in Denver. Public Health Rep. 1996;111 (Suppl 1):50–53. [PMC free article] [PubMed] [Google Scholar]
  35. St Lawrence J. S., Brasfield T. L., Diaz Y. E., Jefferson K. W., Reynolds M. T., Leonard M. O. Three-year follow-up of an HIV risk-reduction intervention that used popular peers. Am J Public Health. 1994 Dec;84(12):2027–2028. doi: 10.2105/ajph.84.12.2027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Susser M. The tribulations of trials--intervention in communities. Am J Public Health. 1995 Feb;85(2):156–158. doi: 10.2105/ajph.85.2.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Sweat M. D., Denison J. A. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS. 1995;9 (Suppl A):S251–S257. [PubMed] [Google Scholar]
  38. Tawil O., Verster A., O'Reilly K. R. Enabling approaches for HIV/AIDS prevention: can we modify the environment and minimize the risk? AIDS. 1995 Dec;9(12):1299–1306. [PubMed] [Google Scholar]
  39. Velicer W. F., Rossi J. S., Diclemente C. C., Prochaska J. O. A criterion measurement model for health behavior change. Addict Behav. 1996 Sep-Oct;21(5):555–584. doi: 10.1016/0306-4603(95)00083-6. [DOI] [PubMed] [Google Scholar]
  40. Williams E., Lamson N., Efem S., Weir S., Lamptey P. Implementation of an AIDS prevention program among prostitutes in the Cross River State of Nigeria. AIDS. 1992 Feb;6(2):229–230. [PubMed] [Google Scholar]
  41. Wolitski R. J., Bensley L., Corby N. H., Fishbein M., Galavotti C. Sources of AIDS information among low-risk and at-risk populations in five U.S. cities. AIDS Community Demonstration Projects. J Community Health. 1996 Aug;21(4):293–310. doi: 10.1007/BF01794879. [DOI] [PubMed] [Google Scholar]

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