Posts classified under: HIV -

Masihambisane – Pregnant Women: KZN

There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Since clinics are the typical sites for treating each of these health problems, the NIMH-funded Masihambisane study is examining a clinic-based prevention program delivered by neighborhood Mentor Mothers (MM) to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

Targeted Risk Group: 

Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

Published Journal Articles :

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Interventions, Training Manuals, etc. :  

Surveys and Scales Used: 

Intervention model:  
In the intervention arm, participants will receive the Department of Health-delivered Prevention of Mother to Child Transmission (PMTCT) program plus the Project Masihambisane mentor mothers support program, delivered by HIV-positive mentor mothers. HIV-positive mentor mothers are women who are thriving in the community and who have been through the PMTCT program. They have been recruited and trained to deliver the intervention to pregnant mothers living with HIV.

Research Methods: 

Eight clinics were randomly assigned to the intervention (4 clinics) or control condition (4 clinics). There are two levels of nesting in the study. Mothers and their infants are nested within clinics, and repeated observations over time are nested within individuals. Longitudinal random effect regression models will be used to account for the nesting and examine the efficacy of the intervention at improving the health of infants and their mothers over time.

Local Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention and the local significance.

International Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention and the local significance.

Guys Understanding Your Situation (G.U.Y.S. Program)

Interventions, Training Manuals, etc. : 

The G.U.Y.S. Program offers a multi-tier health education/risk reduction (HE/RR) intervention – utilizing both individual and group-level interventions – designed to reduce high-risk sexual and drug behaviors among homeless, substance-using gay men and non-gay identified men who have sex with other men, and with women, and with transgender women. Most specifically the intervention targets sexual risk behaviors that are most likely to occur while using methamphetamine, particularly unprotected anal intercourse, as well as exchange sex risks and injection drug risks.

The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach, individual-level interventions (ILI), skills building group-level interventions (GLI) and art support GLIs. Follow-up ILI assessments are conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood and West Hollywood and in the natural settings where homeless, substance-using men congregate. The program has successfully worked with these populations in highly charged sexual arenas and developed non-invasive outreach and intervention strategies for these venues, which vary based on the safety and atmosphere of each public or commercial sex environment. The skills building GLI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors. Concurrently, the art support GLI component of the intervention serves to increase social support and self-esteem. Art is used as a harm reduction strategy by offering an opportunity for participants to closely identify their feelings and work towards understanding many of their high-risk behaviors. The art support GLI provides a space to cultivate their voice and express their experiences through art. Both the skills building GLI and art support GLI – working concomitantly with the outreach encounters and ILI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

 

Street Smart Uganda; UYDEL

Targeted Risk Group: 

Urban Ugandan youth (UYDEL)

Street Smart was an intensive HIV/AIDS program for slum youths whose behaviors place them at risk of becoming HIV infected. It was implemented in collaboration with Uganda Youth Development Link.

Based on the fact that adolescence is a time of experimentation and developmental change in behavior, thoughts and emotions, Street Smart linked feelings, thoughts, emotions and attitudes to behavior change.

In 2007, nearly 1 million young people became infected with HIV in sub-Saharan Africa. Existing prevention programs have not been effective, prompting more attention toward the social determinants of HIV, such as unemployment. Without hope for the future, it is unlikely that young people will be motivated to remain free of HIV, as poverty creates vulnerability to survival sex or sex without condoms. The Street Smart intervention was developed in the United States to eliminate or reduce HIV risk behaviors among young people. Despite its success, it does not address the problems of economic vulnerability and investment in the future. The aim of this study was to test the added value of vocational training provided to urban Ugandan youth, in addition to the Street Smart HIV prevention program.

Download the UYDEL 2010 brochure here:  Uganda Youth Development Link (UYDEL) (2010) - Brochure

Interventions, Training Manuals, etc. : 

  1. Street Smart Introduction
  2. Street Smart Session 1: Language of HIV and STDs
  3. Street Smart Session 2: Personalized Risk
  4. Street Smart Session 3: How to Use Condoms
  5. Street Smart Session 4: Drugs and Alcohol
  6. Street Smart Session 5: Recognizing and Coping with Feelings
  7. Street Smart Session 6: Negotiating Effectively
  8. Street Smart Session 7: Self Talk
  9. Street Smart Session 8: Safer Sex
  10. Street Smart Session 9: Personal Counseling
  11. Street Smart: Table of Contents - Sessions 1-10

Intervention model: 

Street Smart consists of a total of 10 sessions (eight two- hour group sessions, one individual session and a group visits to a community health resource), exposes youth to information regarding HIV/AIDS, drug abuse, condom use, personalized risks, negotiating safer sex, recognizing and coping with feelings and self talk. Intervention sessions included participatory discussions, role-plays & use of tokens. Participants were divided into groups consisting of 8 to 9 members per group. Each group attended 3 sessions a week, each session lasting an average of 2hrs and 30 minutes.

Research Methods:

The project included a total of 50 street and slum youth from two slum centers in Kampala. Participants completed a behavioral assessment at baseline and at 4-months. Twenty-five participants from one slum center initially served as the control group and received the intervention after their 4-month follow-up assessment. Twenty-five participants from the second slum center received the 10-session HIV prevention intervention immediately following their Baseline assessment.

Local Significance: 

A total of 24 participants (96%) completed the entire 10 session intervention. The youth were also linked to important support services available to them. Given the small sample size and limited statistical power, longitudinal hierarchical linear models to examine the efficacy of the intervention were not appropriate. However, feedback gathered from both the youth participants and research staff, the intervention was very well-received. The youth’s engagement in the intervention is also apparent in the extremely high completion rate of the intervention.

International Significance: 

There were two primary objectives to the collaboration with Uganda Youth Development. The first objective was to build the research capacity and skills among the team of Uganda collaborators. During the course of the project, the UCLA team conducted non-formal and formal training activities in Uganda. The second objective was to adapt, implement, and evaluate the efficacy of the adapted HIV prevention intervention with street and slum urban youth in Kampala, Uganda. This was accomplished through the collaborative effort of the UCLA researchers and the Uganda research team.

The Street Smart intervention continues to be implemented by the staff at UYDEL, demonstrating the staff support and commitment to the intervention and the work completed through the research. Mr. Rogers Kasirye has consulted with other Ugandan agencies regarding the development of interventions and research with street and slum youth in Uganda.

Despite some study limitations, the results suggest that at 4 months the vocational training program improved employment, satisfaction with life, and social support; and reduced delinquent behaviors. Vocational training plus Street Smart improved social support and reduced sexual risk-taking, delinquent behavior, and substance use at 2 years. Fewer than half had ever worked prior to the program, but over 80% were employed at 2 years. Larger trials of HIV interventions addressing social determinants are warranted.

The TransAction Program

Many male-to-female transgender women are at high-risk of HIV infection as a result of several socio-cultural conditions, such as low income, high unemployment, lower levels of education, and unstable housing. Economic necessity, as a result of severe unemployment and housing discrimination, results in a reliance on sex work to secure food, shelter, and money.

The TransAction Program provides culturally appropriate, evidence based HIV prevention services that address both individual and socio-cultural risk factors. The program offers a multi-tier health education and risk reduction (HE/RR) intervention – utilizing both individual and group-delivered interventions – designed to reduce high-risk sexual and drug behaviors among transgender women. Most specifically the intervention target risk behaviors that are specific to the socio-cultural circumstances of high-risk transgenders, particularly exchange sex, hormone misuse, injection and non-injection drug risks. The program consists of a comprehensive, culturally appropriate, continuum of services that includes outreach encounters, individual-delivered interventions (IDI), skills building group-delivered interventions (GDI) and support groups.

Follow-up IDI assessments are conducted at 30, 60 and 90 days. Face-to-face street outreach is conducted in identified high-risk areas of Hollywood, West Hollywood and downtown Los Angeles and in the natural settings where high-risk transgender women congregate. The skills building GDI component of the intervention serves to increase knowledge and awareness of HIV risk behaviors and develop skills to decrease HIV risk behaviors. Concurrently, the support GDI component of the intervention serves to increase social support and self-esteem. Both the skills building GDI and support GDI – working concomitantly with the outreach encounters and IDI – motivate ongoing and maintained HIV risk reductions and gear participants’ towards HIV testing to identify their HIV status and, finally, develop skills for disclosing HIV status.

The TransAction Skills Building Groups

HIV Counseling & Texting Program

The HIV Counseling and Texting (HCT) program utilizes social networks testing methodology, specifically designed to work with HIV infected and high-risk gay and bisexual men of color and transgender women. HIV infected or high-risk negative participants who either come to the Friends Community Center site for services or are contacted through street outreach and meet eligibility are invited to serve as recruiters. The engagement of new recruiters will be an active and ongoing part of the program. Potential recruiters attend a group orientation, which explains the social network methodology and informs potential recruiters that they will be requested to recruit individuals from their social, sexual or drug-using networks whom they believe to be at high-risk of HIV infection. Following the training period (brief identification, group orientation, individual interview), the recruiter begins to locate network associates to be referred to our testing site. Confirmatory HIV tests and STI testing (syphilis, Chlamydia, gonorrhea) are also available at the Friends Community Center site. Participants (both those who test HIV negative and positive) are then linked to appropriate medical, social, psychological, CRCS and other needed services. Network associates who wish to become recruiters are be assessed for eligibility and appropriateness.

This program is funded by the Los Angeles County, Department of Health Services, Office of AIDS Programs and Policy (OAPP).

Support To Reunite, Involve and Value Each Other (STRIVE)

The STRIVE program aimed to improve residential stability and the quality of residential life, reduce the number of runaway episodes, as well as reduce HIV-related sexual and substance use risk acts. Family conflict is found to cause runaway episodes for youth. Targeting newly homeless youth, this study developed and implemented a 5-session family-based intervention. STRIVE sessions take place with families while youth are still in shelters and/or being served by community agencies, and as they transition back to the home.

Surveys and Scales Used: 

  1. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  2. AIDS Knowledge and Attitude - Survey
  3. Adult Attachment Scale (AAS)
  4. Educational (Academic) Experience Assessment
  5. Family Interdependence - Scale
  6. Family Functioning - Scale
  7. Family Assessment Measure III - Scale
  8. Employment and Labor Experience Assessment - Survey
  9. University of Rhode Island Change Assessment (URICA)
  10. Teaming African American Parents with Survival Skills (TAAPSS) - Survey
  11. Spiritual Intuition Inventory (Religion) - Survey
  12. Self Harm: Suicide History - Survey
  13. Social Support Microsystem Scale (SOC)
  14. Health Belief Model: Intentions for Safer Sex (HBMI) - Scale
  15. Michigan Alcoholism Screening Test (MAST) - Survey
  16. Alcohol/Drug: Drug Abuse Screening Test (DAST) - Adolescent Version
  17. Alcohol/Drug: Drug Abuse Screening Test (DAST) - Parent Version
  18. Runaway Episodes - Survey
  19. Residential Stability (RS) - Survey
  20. Reasons for Leaving Home (RLH) - Survey
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  22. Proactive Attitude Scale (PAS)
  23. Health Belief Model: Perceived Susceptibility (HMBP) - Scale
  24. Parental Monitoring Assessment (PMA)
  25. Parker Parental Bonding Instrument
  26. Parent Involvement & Supervision - Scale
  27. NSBA Religious Involvement - Survey
  28. Multiple Problem Behavior: Sex Work - Survey
  29. The Mini-Mental State Exam (MMSE) - Scale
  30. McMaster Family Assessment Device (FAD) - Scale
  31. Inventory of Parent and Peer Attachment (IPPA)
  32. House Rules - Scale
  33. Getting Services Assessment - Survey
  34. Difficulties in Emotion Regulation Scale (DERS)
  35. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  36. Conflict Resolution - Conflict Tactics Scale (CTS)
  37. Autonomy Self Report: Adolescent Autonomy - Scale
  38. AIDS Risk Behavior Assessment (ARBA) - Scale
  39. PTSD Index for DSM IV (Adolescent version) - UCLA
  40. Positive Attitudes Toward Living at Home - Survey

Targeted Risk Group: 

Newly homeless youth in Los Angeles

Intervention model: 

A behavioral family-based intervention model was used to address family conflict and promote positive family-child interactions.

Research Methods: 

This study consisted of two phases Phase 1 was focus groups and key informant interviews to develop research design, measures, an intervention activities. Phase 2 implemented family intervention sessions with baseline and 3, 6, 12, 18, 24 month follow ups.

Local Significance: 

Positive outcomes for reducing HIV risk behaviors and improving mental health.

International Significance: 

N/A
 

Street Smart (US)

Runaway and homeless youth have a national seroprevalence rate of 2.3%, a rate about six times higher than adolescents in the major AIDS epicenters.

Links to Interventions, Training Manuals, etc. :
  1. Street Smart Cover
  2. Street Smart: Table of Contents - Sessions 1-10
  3. Street Smart Introduction
  4. Street Smart Session 1: Language of HIV and STDs
  5. Street Smart Session 2: Personalized Risk
  6. Street Smart Session 3: How to Use Condoms
  7. Street Smart Session 4: Drugs and Alcohol
  8. Street Smart Session 5: Recognizing and Coping with Feelings
  9. Street Smart Session 6: Negotiating Effectively
  10. Street Smart Session 7: Self Talk
  11. Street Smart Session 8: Safer Sex
  12. Street Smart Session 9: Personal Counseling
  13. Street Smart Session 10: Community Resource

Targeted at homeless and runaway youth, the Street Smart intervention was designed to reduce high-risk sex and drug using behaviors that can lead to HIV infection. However, 12 months after the original intervention, relapse occurred in approximately 15% of those who had previously changed their behavior, and long-term effects were only found in girls. Street Smart: Skills Maintenance addressed the problem of relapse by delivering an additional intervention post-Street Smart, Stayin’ Street Smart. Stayin’ Street Smart was a website that provided skill training, social support, informational updates, and access to an expert for consultation, including problem solving for emerging crises.

In addition to measuring the effectiveness of the maintenance intervention, Street Smart: Skills Maintenance examined the program’s effect over time on multiple problem behaviors (sex work, conduct problems, delinquency, school/employment, violence, chronic homelessness), examined the acceptability of the strategies by youth, and documented patterns of maintenance over time.

Participants:

Approximately 474 homeless and runaway youth between the ages of 12-24 were recruited through community-based agencies and homeless shelters in Los Angeles, CA.

Targeted Risk Group:
Homeless and runaway youth between the ages of 12-24

Local Significance: 

Research on the use of Street Smart documented positive outcomes in reducing sexual risk behaviors among females and substance use among both male and female runaways over 2 years (Rotheram-Borus et al. 2003). Outcomes from Street Smart: Maintenance have not been published.

International Significance:

Globally, there are approximately 100 million homeless youth (UNICEF 1989). Strategies to maintain reductions in sexual risk behaviors and substance use found to be effective in homeless and runaway youth in the United Stated could be adapted to help homeless and runaway youth in other countries

 

Youth LIGHT

Youth LIGHT was a study to address critical gaps in research on HIV/AIDS prevention with high risk youth, offering an opportunity to shift patterns of sexual risk behaviors among delinquent youth at risk of becoming HIV seropositive adults. An intervention with established efficacy for high risk adults, Project LIGHT, was adapted for high risk adolescents. Youth LIGHT tested the hypothesis that a computerized version of Project LIGHT would be as efficacious as the interpersonal, small-group delivery of the intervention in reducing the sexual risk behaviors of delinquent youths. Youth LIGHT was intended to appeal to youth by changing the traditional methods for teaching and sharing information while getting them to think about their HIV and STI risk behaviors. The study was conducted in partnership with the Los Angeles County Office of Education, and the Juvenile Division of the Superior Court for the County of Los Angeles.

Targeted Risk Group: 

Male and female at-risk youth between 14-21 years old, attending LA County alternative education high schools located in the community and in juvenile hall camps.

Interventions, Training Manuals, etc. : 

Youth Light Workbook

 

Session 1: Introductory education/preparedness – basic information about HIV/AIDS; motivation for self-protection
  • Know one another, and begin to learn each other’s names.v  Learn about the project (schedule, ground rules, payment).
  • Begin to develop a sense of group cohesion, identity and ownership by participating in group activities and developing group rules and rituals.
  • Group activity to distinguish facts and myths about AIDS.
  • Identify personal values and positive reasons to stay healthy through group brainstorm.
  • Identify one personal risk factor for AIDS.
  • Identify positive changes they have already made in their lives.
  • Begin to learn about AIDS prevention strategies including condom use and HIV testing.
  • Meet the animated characters featured throughout the programv  Learn about the project
  • Introduce and explain the workbook
  • Identify personal values and positive reasons to stay healthy by computer activity and workbook
  • Play game to distinguish facts and myths about AIDS.
  • Complete computerized personal risk assessment and receive feedback regarding likely risk of contracting HIV or other STD.
  • Learn facts and statistics regarding HIV transmission and infection
  • Complete quiz regarding HIV transmission
Session 2: Identifying triggers – personal vulnerability; identifying personal antecedents to risk behavior
  • Relate one example of HIV/AIDS content encountered since the last session.v  Watch video of persons living HIV
  • Verbalize one personalizing comment indicating heightened vulnerability.
  • Learn to define and identify “trigger” through a group brainstorm.
  • Identify one past incident of personal risk behavior on worksheet.
  • Identify one personal risk trigger on worksheet.
  • Identify one personal goal for the coming session.
  • Read and seriously consider signing a Contract of Commitment given by facilitators.
  • Watch video of young people living with HIVv  Record in workbook one personalizing comment indicating heightened vulnerability.
  • Learn to define and identify “trigger” through computer interaction.
  • Record in workbook one past incident of personal risk behavior.
  • Record in workbook one personal risk trigger.
  • Choose one personal goal from a list to try before logging on again.
  • Read and seriously consider signing the Contract of Commitment contained in the workbook.
  • Complete quiz regarding triggers
Session 3: Controlling triggers – problem solving and cognitive self-instruction
  • Learn the basic steps of problem solving related to HIV risk reduction through a group exercise.
  • Apply the problem-solving steps to a variety of hypothetical situations generated by the group that require the handling of risk triggers.
  • Generate ask a group a personal list of self-statements to guide behavior change efforts.
  • Set personal goal for handling at least one personally relevant trigger for next session.
  • Learn the basic steps of problem solving related to HIV risk reduction through interacting with animated character.v  Apply the problem-solving steps through modeling from animated character and computer guided workbook exercise.
  • Play game about strength of self-statements to guide behavior and record personal list of self-statements in workbook.
  • Choose a goal related to handling a common and relevant trigger to try before logging on again.
  • Complete quiz regarding steps to problem solving
Session 4: Condom skills – practice use of male and female condom; needle cleaning skills
  • Sort sexual activities by their safety level as a group.v  Identify the safest condom and lubricant types available.
  • Demonstrate the proper way to place and remove a male condom.
  • Demonstrate the proper way to place and remove a female condom.
  • Describe the proper way to clean needles.
  • Sort sexual activities by their safety level in a game.v  Watch a demonstration of the proper way to place and remove a male condom
  • Watch a demonstration of the proper way to place and remove a female condom
  • Choose one personal goal from a list related to proper condom choice and use to try before logging on again
  • Complete quiz regarding steps to proper use of male and female condoms
Session 5/6: Protecting myself– assertive communication
  • Identify “unwritten rules” of social behavior that can influence people to be unsafe.v  Learn the three types of communication: assertive, aggressive, passive.
  • Apply the TALK tools for refusing unsafe sex and/or requesting safe sex through role-play with other group members.
  • Learn how “unwritten rules” of social behavior can influence people to be unsafe.v  Learn the three types of communication: assertive, aggressive, passive.
  • Watch video of youth negotiating for condom use
  • Apply the TALK tolls for requesting safe sex through interaction with avatar that is recorded and played back.
Session 6: Maintenance and relapse prevention – reinforcement of previous skills and advocacy
  • Identify situations that might lead to relapse.v  Learn to deal effectively with potential relapse situations.
  • Identify self-rewards for maintaining safer sex behavior
  • Identify ways to make safer sex more enjoyable.
  • Learn ways in which to “spread the word” about what was learned in the group
  • Learn how skills of problem solving and self talk can help one effectively deal with relapse through interacting with animated character.v  Watch as animated characters identify self-rewards maintaining safer sex behavior.
  • Watch as animated characters identify ways to make safer sex more enjoyable
  • Learn steps with modeling from animated characters about ways to “spread the word” about what was learned from the program

 

Intervention model: 

To illustrate the operations of the computer intervention, we have constructed a table which illustrates the parallel structure between the small group Project Light, and Project Light delivered via computer.

Research Methods: 

Students aged 14 to 18 years attending 22 alternative education high schools located in the community and in juvenile hall camps were assessed at baseline and 3, 6 and 12 months. The baseline and follow-up assessments required about 1.5-hour to complete. Each recruitment school was randomized into one of three study conditions: 1) Interpersonal Intervention, 2) Computerized Intervention or, 3) Control.  Students attending the same school received the same intervention condition.

Local Significance: 

Results from the pilot of this study support the use of computers as a tool for HIV prevention. Youths receiving the computerized intervention were successful in reducing their sexual risk behaviors.

International Significance: 

Computerized interventions, which are relatively easy to implement and sustain, appear to be a potentially effective means of promoting reductions in HIV-related sexual risk behaviors. Interactive computer programs may help youths learn skills to prevent HIV infection and instill in these youths the self-efficacy to apply these new skills. These attributes may be particularly useful in international settings where concerns of cost-effectiveness and ease in dissemination are of paramount importance.

Start of Project: 

January 1, 2002

 

China CPOL (Community Popular Opinion Leaders) Project

This 8-year study was part of the National Institute of Mental Health (NIMH) Collaborative HIV/Sexually Transmitted Disease (STD) Prevention Trial in international settings, including China, India, Peru, Russia, and Zimbabwe. The trial was designed to identify, recruit, train, and engage community popular opinion leaders (C-POL) in a defined population to convey HIV risk reduction messages. The primary objective was to reduce HIV/STD incidence and risky sexual behaviors.
Intervention model: 

Community Popular Opinion Leader (CPOL) HIV prevention intervention

Research Methods: 

• Ethnographic studies to identify social networks
• Pre-baseline assessment for risk estimates
• 4,510 market workers from 40 food markets participated in the baseline
• Behavioral and biological assessments
• Longitudinal analyses with 12 and 24 month follow-ups

Local Significance: 

The project has provided an opportunity to communicate with policy makers at all administrative levels in China about HIV prevention and intervention strategies. The POL model was adapted by other intervention studies in China.

International Significance: 

This is the first test of the efficacy of a similar intervention in multiple international sites. China is the first of the five countries that has begun the baseline assessment and intervention activities. More than 15 peer-reviewed papers have been published.

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