|
Individual-Level - MSM |
|
Dilley JW, Woods WJ,
Sabatino, J, et al. (2002). Changing Sexual Behavior Among Gay
Male Repeat Testers for HIV: A Randomized, Controlled Trial of a
Single-Session Intervention. JAIDS 30: 177-186. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Repeat testers |
Randomized, controlled counseling
intervention. Conducted at anonymous testing site in San
Francisco. N=248 MSM with history of at least one previous
negative HIV test result and self-reported UAI in last 12 months
with partners of unknown or discordant status. Intervention
component focused on self-justifications (thoughts, attitudes,
or beliefs that allow the participant to engage in high-risk
behaviors) at most recent UAI. Two intervention groups received
standard HIV test counseling plus the intervention (one group
also had sexual diary). Two control groups received only
standard HIV test counseling (one group also had sexual diary).
Counselors in intervention arm were licensed mental health
professionals. Intervention counseling occurred between pre-test
and post-test session. Intervention session lasted about 1 hour.
|
Compared to control participants,
intervention participants reported decreased UAI with
non-primary partners of unknown or discordant HIV status at 6
and 12 months (from 66% to 21% at 6 months and to 26% at 12
months). Overall retention at 6 and 12 months was 87% and 83%,
respectively. |
|
Prevention Case Management
- MSM
Back to Top |
|
The CDC has endorsed
Prevention Case Management (PCM) as an effective intervention to
reach HIV positive and/or very high-risk HIV negative persons.
PCM is a client-centered HIV prevention activity with the
fundamental goal of promoting the adoption and maintenance of
HIV risk reduction behaviors by clients with multiple, complex
problems and risk reduction needs. PCM provides
client-centered, multiple-session HIV risk reduction counseling
while using the service brokerage of traditional case management
to address competing needs that may make HIV prevention a lower
priority. This HIV prevention activity addresses the
relationship between HIV risk and other issues such as substance
use, mental health, adherence issues, social and cultural
factors, and physical health problems. While PCM has yet
to be rigorously evaluated, intensive case management
interventions for clients with multiple, complex problems have
been shown to be effective in other health fields.
CDC HIV Prevention Case Management – Guidance September
1997
CDC HIV Prevention Case Management – Literature Review and Current
Practice September 1997
CDC Abbreviations and Acronyms |
|
Group-Level - MSM
Back to Top |
|
Choi K-H, Lew S,
Vittinghoff E, et al. (1996). The efficacy of brief group
counseling in HIV risk reduction among homosexual Asian and
Pacific Islander men. AIDS 10: 81-87. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
POC
(API) |
Brief group counseling for
self-identified gay API in SF. N = 329 (208 intervention, 121
control). Randomized in single-session, 3-hr skills training
group or wait-list control. 4 components: development of
positive identity and social support, safer sex education,
eroticizing safer sex, negotiation. |
Baseline and 3-month follow-up. 46%
reduction in expected number of partners at follow-up for
intervention group. Chinese and Filipino men reduced UAI by more
than 50%. |
|
Rotheram-Borus, MJ,
Reid H et al. (1994) Factors mediating changes in sexual HIV
risk behaviors among gay and bisexual male adolescents. American Journal of Public Health 84:1938-1946. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Youth/ Street |
136 participated, age range 14-19.
20-session intervention, 90-120 min/session, offered 2-3
times/week after school. Non-peer led with HIV information,
coping, skills training, access to health care, social support,
private counseling. 20 session intervention, 90-120 min. each,
10 youth per session. No control group. |
Follow-up at 3, 6, & 12 months.
Protected anal intercourse (PAI) increased from 60% to 78%. Less risk in past, no
commercial sex work, and attending more sessions = more risk
reduction. Of racial/ethnic groups African-Am reduced risk most
(PAI increased from 36% to 84%). |
|
Huerts M (2001)
Hermonas de Luna y Sol: The Building of an Empowered Community.
First Annual CAPS Conference, April 2001. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Latino |
Intervention for Latino MSM
engaging in UAI, mostly self-identified as gay or bisexual and
born abroad. Program includes: 1) six-week discussion workshop
with HIV prevention curriculum promoting social connectedness,
critical thinking and exploration of factors and barriers that
compete with safer sex intentions; 2) weekly discussion/support
group for graduates of main program; and 3) individual, client
–centered risk-reduction counseling to address individual
prevention needs. Ethnically, culturally, and linguistically
appropriate. Sessions addressed main issues Latino gay men face,
exploring strategies for survival, sharing the role sex has in
their lives, emotional challenges, exploring AIDS impact on
their lives, and exploring diversity. |
Preliminary evaluation data show
increased condom use for anal sex,
self-esteem, and social networks. |
|
Peterson JL, Coates,
TL et al. (1992). High-risk sexual behavior and condom use among
gay and bisexual African-American men. American Journal of
Public Health 82: 1490-4. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
POC (African-Am) |
318 African-American MSM in SF from
1989-1991. Randomly assigned to 1- session, 3-session, or
wait-list control group. 3-session non-peer mediated counseling
consisted of 3-hour group sessions one week apart with 10
participants in each group. Components: self-identity and
development of social support, AIDS risk education,
assertiveness training, and behavioral commitment. Attendance
problems: 53% of men in 3-session attended at least 1 session
(at least 12% attend one session, 16% attended at least two
sessions, and 25% attended all three sessions). 45% of men
assigned to the 1-session group, actually attended the session |
Participants in 3-session
intervention showed significant reduction in UAI at both 12 and
18-month follow-ups. Reduction from baseline was 45% to 20%.
Risk behavior in control group remained constant and declined
only slightly in 1-session group.
Comment: In spite of blocked randomization, control group was
much less risky at baseline. |
|
Rosser SBR, Bockting
WO, Rugg DL, et al. (2002). A Randomized Controlled Intervention
Trial of a Sexual Health Approach to Long-Term HIV Risk
Reduction for Men Who Have Sex with Men: Effects of the
Intervention on Unsafe Sexual Behavior. AIDS Education and
Prevention 14, Supplement A: 59-71. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
| |
Sexual Health approach ("an
approach to sexuality founded in accurate knowledge, personal
awareness and self-acceptance and in which one’s behavior,
values, and emotions are congruent and integrated into one’s
personality and self-definition"). N=422 Midwestern MSM. Random
assignment to either 1) 2-day comprehensive human sexuality
seminar designed to contextually address long-term risk factors
and cofactors or 2) control group who watched 3 hours of HIV
prevention videos. (Only 17% attrition at 12-month follow-up,
but ultimately only 40% completed all questions necessary for
inclusion in analysis. Prevalence of unsafe sex at baseline only
14.2%) |
Risk behaviors in preceding 3
months measured at baseline, 3 months, and 12 months. Measured
any UAI outside of long-term seroconcordant relationship. At 12
months, control group reported 29% decrease in use of condoms
during anal intercourse;
intervention group reported 8% increase in condom use. Both
groups appear to be making contextual decisions about risk
(engaging in UAI when they have estimated the risk is low). |
|
Valdiseri RO, Lyter DW
et al. (1989). AIDS Prevention in homosexual and bisexual men:
results of a randomized trial evaluating two risk-reduction
interventions. AIDS 3:21-6. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Caucasian |
584 participants randomly assigned
to 2 peer-led interventions: 1) a 1-session, 60-90 min small
group lecture on HIV transmission, clinical manifestations of
HIV infection, condom use, and meaning of HIV antibody test
results or 2) small group lecture plus 50 min. skills training
on safer sex negotiation. |
Condom use during insertive AI
higher among skills training (36% at baseline, 69% at 6-month
follow-up, and 80% at 12 months than among single lecture group
(44% at baseline, 43% at 6 months and 55% at 12 months). No
difference in condom use during receptive AI at both follow-ups. |
|
Community-Level - MSM
Back to Top |
|
Kelly JA, St. Lawrence
JS et al. (1992). Community AIDS/HIV risk reduction: The effects
of endorsements by popular people in three cities. American
Journal of Public Health 82: 1483-9. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
"Popular Opinion
Leader" |
Trained 924 opinion
leaders (POLs) in an intervention city. Lagged implementation
into 2 other cities. Surveyed bar patrons in all 3 cities at
same time points. POLs received 4 sessions, 90 minutes each,
covered HIV education and communication strategies. POLs then
agreed to have 14 peer conversations about AIDS risk reduction
(personal endorsement). Study conducted from 1989-1991.
This intervention was outlined in CDC’s
Procedural Guidance
for selected strategies and interventions for CBOs under Program
Announcement 04064 |
Significant reductions
in the mean % of men who practiced UAI in Biloxi (24% at 3 month
follow-up) and Monroe (21%) but the 15% decline observed in
Hattiesburg insignificant. Also, significant change in the % of
men with multiple sexual partners. At 3-year follow-up,
reductions in UAI and increases in condom use continued to occur
(St Lawrence JS, Brasfield TL, Diaz YE, et al. (1994) Three-year
follow-up of an HIV risk-reduction intervention that used
popular peers [letter]. American Journal of Public Health
84: 2027-2028.). |
|
AIDS Community
Demonstration Projects Research Group (1999). Community-Level
HIV Intervention in 5 cities: Final Outcome Data From the CDC
AIDS Community Demonstration Projects. American Journal of
Public Health: 89, 336-345. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Non-Gay-Identified
"Community
Promise" |
Community Promise (Peers
Reaching Out and Modeling Intervention Strategies) is included
on CDC’s Replicating Effective Programs web page (http://www.cdc.gov/hiv/projects/rep/promise.htm).
Populations that intervention used with: 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 rates of sexually transmitted
disease. Persons from the at-risk communities are recruited
and trained to be community advocates and to distribute role
model stories and risk reduction supplies on the streets of
their communities. Role model stories are personal accounts from
individuals in the target population explaining how and why they
took steps to practice HIV risk-reduction behaviors and the
positive effects the choice has had on their lives. The messages
in the role model stories are reinforced by interpersonal
communication with the community advocates. Each week, community
advocates distribute stories and supplies to 10 to 20 of their
peers. This intervention was outlined in CDC’s
Procedural Guidance for selected strategies and
interventions for CBOs under Program Announcement 04064 |
Communities where Community PROMISE
was conducted showed increased consistent condom use by
community members with their main and non-main partners and
increased condom carrying among members of the communities. |
|
Kelly JA, Winett RA et
al. (1993). Social diffusion models can produce population-level
HIV risk-behavior reduction: field trial results and mechanisms
underlying change. IX International Conference on AIDS/IV STD
World Conference Berlin, Germany (Abstract POC23-3167). |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
| |
For a 5-week period, trained
opinion leader in four experimental cities engaged in peer
conversations about the benefits and appropriateness of risk
behavior and change, strategies to implement change, and risk
misconception at local gay bars. Four matched cities were
selected as control. 701 participants. (See also Kelly JA,
Murphy DA, Sikkema KJ, et al. (1997) Community HIV Prevention
Research Collaborative: randomized, controlled community-level
intervention for sexual risk behavior among homosexual men in US
cities. Lancet 350: 1500-1505.) |
The community intervention led to
decreased proportions of men who engaged in any UAI (from 33% at
baseline to 25% at 9 month follow-up), unprotected insertive anal sex (27% to 17%), and unprotected receptive anal sex (22%
to 16%) in the experimental relative to control cities (little
change observed at the follow-up). |
|
Kegeles SM, Hays RB et
al. (1996) The Mpowerment Project: A community-level HIV
prevention intervention for young gay and bisexual men. American Journal of Public Health 86: 1129-36. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Young Gay men (18-29)
"Mpowerment Project" |
Peer-led program with three
components: outreach (formal and informal), small group, and
publicity campaign. Program run by Core Group and community
advisory board of "elders". Groups were one-time 3-hour small
group meetings (8-10 people), which focused on safer sex and HIV
information, communication and interpersonal skills.
Independently from the prevention program, a cohort of young gay
men (n=300) surveyed in intervention and comparison community.
Wait-list control design.
This intervention was outlined in CDC’s
Procedural
Guidance for selected strategies and interventions for CBOs
under Program Announcement 04064 |
Reduction in all UAI from 41% to
30%, from 20.2% to 11.2% with non-primary partners and from
58.9% to 44.7% with boyfriends. No significant changes in
comparison community. Reductions sustained 1 year later with
non-primary partners, mixed results for sex with boyfriends (Kegeles
SM, Hays RB, Pollack LM, Coates TJ (1999) Mobilizing young gay
and bisexual men for HIV prevention: a two-community study.
AIDS 13: 1753-1762.). 87% of intervention community
respondents had heard of project and 77% had experienced at
least two project activities. High risk-taking men less likely
to attend small groups, volunteer for outreach, or be Core Group
member. Cost-effectiveness data: Kahn JG, Kegeles SM, Hays R,
Beltzer N (2001). Cost-effectiveness of the Mpowerment Project,
a community-level intervention for young gay men. JAIDS 27(5):
482-91. |
|
Street and Community
Outreach - MSM
Back to Top |
|
Hospers HJ, Debets W,
Ross MW, and Kok G (1999). Evaluation of an HIV prevention
intervention for men who have sex with men at cruising areas in
the Netherlands. Aids and Behavior 3: 359-366. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
| |
Program in the Netherlands that
trains volunteers to go into cruising areas (CA) to talk with CA
visitors about importance of safer sex. Give risk information,
explain why safer sex important, brochure, condom and lube. No
conversations with visitors that didn’t want to talk. |
Post-intervention survey of people
who said had at least one conversation with a volunteer
(conversation group, n=172) and those who hadn’t been
approached but would have had a conversation (no conversation
control group, n=190). Conversation group had significantly
higher condom use for insertive and receptive AI. MSM increased
condom use more than MSMW. |
|
HIV Antibody
Counseling & Testing - MSM
Back to Top |
|
Higgins DL, C
Galavotti et al. (1991) Evidence for the Effects of HIV Antibody
Counseling and Testing on Risk Behaviors. Journal of American
Medical Association 266(17): 2419-2429. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
| |
Overall review of 50 C&T studies.
17 of these look at effect of C&T on behavior change (condom
use, reduction of sexual partners) of MSM. |
For MSM: All studies reported risk
reduction among tested and untested men, a few reported greater
decreases in seropositive than seronegative. States that it is
hard to draw firm conclusions about impact of C&T on MSM risk
behavior. |
|
Higginbotham, S., Holmes, R., Stone, H., Beil, J., Datu, Costa,
S., G.B., Paul, S., (2000) Adoption of Protective Behaviors
Among Persons With Recent HIV Infection and Diagnosis---
Alabama, New Jersey, and Tennessee, 1997--1998. MMWR June 16,
2000/49(23); 512-515 |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
|
To examine risk behaviors (e.g., condom use and number of sex
partners) after HIV diagnosis, CDC analyzed data on HIV Testing
history and sexual behavior of persons who may have recently
acquired HIV infection as part of a CDC sponsored study in
Alabama, New Jersey, and Tennessee. For purpose of the study,
criteria for recent HIV infection included persons with
diagnosed and reported HIV infection with CD4 T-lymphocyte
counts >700 cells/ul or percentage>36, documented HIV
seroconversion within 18 months of confirmed HIV infection
diagnosis, or persons aged 13-24 years when diagnosed. During
January 1997 through September 1998, 615 persons with HIV
infection diagnosed and reported met the criteria for the
study. These persons represented 15% of all persons reported
with HIV in the three states. Prior to diagnosis, the females
reporting having vaginal sex with males and males reporting anal
sex with males 25% reported never using a condom, 69% reported
sometimes using a condom, and 6% reported always using condoms. |
Of the 543 persons eligible after follow-up, 180 persons
completed the interview within 12 months of the self-reported
date learning they were HIV infected (median: 6 months). Among
those, 99 (55%) were female; 96 (53%) were <25 years old; and
105 were non-Hispanic blacks, 49 were non-Hispanic white, 24
were Hispanic, and two self reported as “other”. 162 (90%)
responded that they had changed their behavior since learning of
their HIV infection. After diagnosis, the females reporting
having vaginal sex with males and males reporting anal sex with
males, 30% reported not having sex, 6% reported never using a
condom, 11% reported sometimes using a condom, and 47% reported
always using condoms. The number of sexual partners for the
males and females decreased as well. |
|
Further information can be found in
The Revised
Guidelines for HIV Counseling, Testing, and Referral (Adobe
Acrobat, 110 pages) published by the CDC. An
alternative
format of this publication is also available upon request. |
|
Drug Treatment - MSM
Back to Top |
|
Shoptaw S, Reback CJ,
Frosch DL, Rawson RA (1998). Stimulant Abuse Treatment as HIV
Prevention. Journal of Addictive Diseases 17(4): 19-32. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Non-IDU drug users |
Individuals who use illicit
stimulants, primarily cocaine and methamphetamine, engage in
substantial amounts of HIV–related sexual risk behaviors when
under the influence. This paper presents the idea that
reductions in stimulant use consequent to drug treatment makes
stimulant drug treatment an important HIV prevention tool for
this high–risk population. |
Presents data to describe
HIV–related sexual risks reported by out–of–treatment
methamphetamine users and by cocaine and methamphetamine abusers
at treatment entry and six months post treatment entry. Overall,
findings demonstrate that following initiation of a treatment
episode, stimulant abusers demonstrate significant reductions in
HIV–related sexual behaviors, primarily by reducing the number
of sexual partners. |
|
Stall R, Paul JP,
Barrett DC, Crosby GM, Bein E (1999). An Outcome Evaluation to
Measure Changes in Sexual Risk-Taking among Gay Men Undergoing
Substance Use Disorder Treatment. Journal of Studies on
Alcohol 60: 837-845. |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
|
Non-IDU drug users |
Men recruited as they entered
substance use treatment. Five waves of data collection, each
wave measuring the previous 90 days. 82 men assigned to the
experimental condition (treatment plus a safe sex intervention);
65 were assigned to the regular substance use treatment.
Conclusions: (1) substantial HIV risk reductions can occur after
initiation of treatment for substance use; (2) risk reductions
begin soon after treatment begins; (3) lapses to unsafe sex are
common; (4) continued UAI most likely among those men who are
riskier at intake, who continue to be more sexually active and
who combine substance use and sexual behavior; (5) AIDS
prevention activities conducted at treatment agencies cannot
reach all high-risk substance-using gay men. |
Although levels of risk within each
wave were never significantly different between the two
treatment groups, reductions in unprotected anal intercourse (UAI)
with a nonmonogamous partner for both groups from the baseline
Wave-1 levels were uniformly significant. Such high-risk sex in
the year-long follow-up period was correlated with UAI reported
at intake, enjoyment of UAI, relative youth, heavier concurrent
use of alcohol or amphetamines and greater numbers of sexual
partners. |
|
Partner Notification - MSM
Back to Top |
|
Partner Counseling and
Referral Services to Identified Persons with Undiagnosed
HIV---North Carolina. MMWR December 5, 2003/52 (48); 1181-1184 |
|
Subpopulation |
Researched Intervention Design |
Evaluated Outcome |
| |
In 1989, North Carolina Department
of Health and Human Services began offering PCRS to clients who
tested positive in confidential and anonymous testing venues.
HIV infection became reportable in 1990 and anonymous testing
was discontinued in 1997. A trained disease intervention
specialist (DIS) completed six important steps. All notified
partners received risk reduction counseling and appropriate
referrals. |
Data collected from 2001 revealed a
total of 1,603 persons were newly reported to have HIV
infections. DIS were assigned to conduct PCRS with 1,580 (99%)
index clients, 1,378 (87%) were located and PCRS identified
1,532 sex or needle sharing partners. 1,359 partners were
located and notified of their possible exposure to HIV. After
PCRS, from those who not previously testing positive for HIV,
108 newly tested partners were diagnosed HIV positive. |
|
CDC Technical Guidance for Partner Notification and Referral
Services
Procedural Guidance for Implementation of Partner Notification
and Referral Services (Adobe
Acrobat, 33 pages) An
alternative
format of this publication is also available upon request. |
|
No reviews on Mass & Other Media,
Social Marketing, Hotlines, Clearinghouse, or Partner
Notification for MSM |
HIV/AIDS
Prevention and Education Services
