Posts classified under: HIV Prevention

Together Learning Choices (TLC)

TLC (Together Learning Choices) is an HIV prevention and health promotion intervention developed for HIV-positive teens and youth (ages 13 to 29). TLC is delivered in small groups using cognitive-behavioral strategies to change behavior. It provides young people living with HIV the tools and skills necessary to live their best lives and to be able to make healthy choices. The goal of the intervention is to help these young people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. TLC is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

TLC consists of two sequential modules that totaled 16 sessions. Each module has eight sessions and is designed to be delivered by two Facilitators in a group setting.

  •  The Staying Healthy module encourages healthy living by focusing on health maintenance and forging effective partnerships with health care providers.
  • The Acting Safe module is dedicated to primary and secondary HIV prevention by addressing sex- and substance use-related risk behaviors and reducing new infections and reinfections.

– The goal of this study was to design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.
TLC is a science-based behavioral intervention that has demonstrated evidence of effectiveness in reducing risky behaviors, such as unprotected sex, or in encouraging safer ones, such as using condoms and other methods of practicing safer sex. It is offered by the Centers for Disease Control and Prevention (CDC) through the Replicating Effective Programs (REP) and Dissemination of Effective Behavioral Interventions (DEBI) at www.effectiveinterventions.org.

Targeted Risk Group:
Young People Living with HIV (YPLH) aged 13 to 24 in original efficacy trial and aged 13-29 in . The majority of participants were African-American and Latino.

Intervention model:
Small group intervention.
Original intervention manuals available here:

Module 1 – Staying Healthy

CDC funded replication manual: TLC Implementation Manual
TLC Broadsheet

Research Methods:
Group randomized trial with immediate intervention and delayed (waitlisted) control conditions. Assessment interviews conducted every three months over 24 months.

Local Significance:
The intervention reduced sexual risk behaviors, substance use, and emotional distress, and increased social support and other positive coping styles.

HIV/STD Risk Behaviors in Methamphetamine User Networks

SATH-CAP stands for the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program. The overall goal of SATH-CAP is to better understand how patterns of sexual and drug use behaviors along with other social and environmental factors, such as other sexually transmitted diseases, places where people gather for sex and drug activities, and types of partnerships, influence the spread of HIV/AIDS from people currently at high risk for HIV/AIDS, like drug users and men who have sex with men (MSM), to those at a lower risk.

Specifically, the study seeks to answer these primary questions:

  • To what extent do HIV infections among drug-using populations spread to uninfected drug users and non-drug users through drug-related and/or sexual transmission behaviors?
  • What individual (behavioral, biological), network, and structural characteristics influence the speed, extent and path of the spread?

The SATH-CAP includes five research centers, a scientific and logistical coordinating center at RAND, and the funder, the National Institute on Drug Abuse (NIDA). The research centers are:

  • Research Triangle Institute (RTI)
  • University of California, Los Angeles (UCLA)
  • University of Illinois, Chicago (UIC)
  • Yale University
  • The Biomedical Center (BMC), St. Petersburg, Russia, Andrei Kozlov

Los Angeles County Methamphetamine Prevention Initiative

There is a significant unmet need in Los Angeles County for methamphetamine-specific training, and community service agencies and outreach workers need education and training on effective approaches to engage and serve persons in the community at risk. Training and technical assistance is also needed for service providers on the latest evidence-based methamphetamine treatment approaches.

More specifically, trainings are needed that cover methamphetamine-specific issues crucial for the development of skills by medical providers, clinicians and outreach workers serving clients who use methamphetamine and address specific concerns around providing culturally appropriate care for specific populations. These trainings address issues such as: mental health considerations, psychological complications, sexual and cybersex addiction and current evidence based treatments.

This training project included the following activities:

  • Providing consultation and technical assistance to the Los Angeles County Alcohol and Drug Program Administration (ADPA) and the Office of AIDS Programs and Policy (OAPP)
  • Developing training curricula and module for ADPA or OAPP-funded substance abuse or HIV/AIDS treatment providers
  • Developing and disseminating web-based training module
  • Providing in-service trainings for Los Angeles County Methamphetamine Task Forces
  • Providing in-service trainings for ADPA and OAPP-funded Drug Abuse and HIV prevention agencies serving young women
  • Providing tailored technical assistance

Recruiting and Engaging Adolescents in Creating Hope (Project REACH)

Project REACH aims to create an effective recruitment and retention method for family interventions for substance abuse and adapt culturally-appropriate substance abuse programs targeting African American adolescents who are enrolled in Los Angeles County Office of Education (LACOE) schools and their parents (parents includes an adult guardian).
Targeted Risk Group: 
Probation youth and their families in Los Angeles
Research Methods: 
The project has two phases. The first phase is to develop an effective way to recruit families into a family intervention for substance abuse and determine how to make the intervention culturally appropriate. The family intervention that will be adapted for this project is Families that Care: Guiding Good Choices ((aka “Preparing for the Drug Free Years”) (GGC). GGC has been proven to reduce substance abuse, address family conflict through problem solving and communication techniques, and finally increase family connectedness. These activities will be done in collaboration with school administrators, probation officials, teachers, students and parents through key informant interviews and focus groups. The second phase will pilot test the adaptation of GGC in a sample of 60 African American from LACOE schools and their parents.
Local Significance: 
Expect to improve recruitment and retention in GGC, and GGC will improve family functioning and mental health, and decrease problem behaviors (HIV risk behaviors, school performance and recidivism).

Safety Counts

Drug users have a high risk of HIV infection. Because certain neighborhoods have higher levels of substance abuse, HIV risk becomes related to geography as well. Thus, there is need for local street outreach programs such as Safety Counts.

Research Methods:

In a quasi experimental, cross-over design, two Los Angeles neighborhoods were randomly assigned to receive either (1) Voluntary HIV Counseling and Testing (VCT) or (2) Safety Counts. In Phase 1, injection drug users and crack users in these neighborhoods attended the respective intervention. In Phase 2, each neighborhood and therefore its participants received the alternative intervention. Participants were reassessed at 5–9 months. Data collected included demographics, sexual risk behavior, and substance abuse.The Safety Counts intervention differed from the VCT intervention in that Safety Counts offered skill-building and goal-setting workshops, one-on-one counseling sessions to implement goals, street contacts to support other participants, and social events.

Local Significance: 

Drug users in the Safety Counts program reported significantly greater reductions in risky sex, crack and hard drug use, and risky drug injection. The more sessions of Safety Counts attended, the greater were the reductions in risky acts. Different analytic decisions result in very different findings for the same intervention. Safety Counts is an effective intervention for injection drug users and crack users.

Mamekhaya

In South Africa, where a large portion of pregnant women are HIV positive, prevention of mother-to-child transmission of HIV (PMTCT) is an important endeavor. To improve the effectiveness of the standard PMTCT programs, the Mamekhaya program used peer mentoring and a culturally adapted cognitive behavioral intervention (CBI).
Research Methods:
HIV-positive pregnant women at the Gugulethu Midwife Obstetric Unit and at the Vanguard Community Health Center in Cape Town were invited to participate in the study. Participants at both sites received the standard PMTCT care; however, participants at the Gugulethu site received the Mamekhaya intervention.The first part of the intervention consisted of assigning a participant with a mentor mother through Mothers2mothers. The mentor mother was a woman who was HIV-positive, had recently had a child, and had received PMTCT and was doing well. Participants also attended group sessions of a cognitive-behavioral intervention. The sessions included information on living with HIV, preventing HIV transmission, parenting, social support, and mental health.
Local Significance: 
Participants in the Mamekhaya intervention had increased HIV knowledge scores, significantly increased social support, and significantly decreased depression scores compared to women in the control group.

Nsindikanjake Vocational Training Project

Socio-economic status plays an important role in HIV risk and prevention. Specifically, poverty can lead to survival sex and unprotected sex. The Nsindikanjake Vocational Training Project, a collaboration between UCLA and the Uganda Youth Development League (UYDEL), aims to reduce HIV risk among urban Ugandan youth through vocational education and training.

From February 2005 to January 2006, 100 13- to 23-year-old participants were recruited from two different youth centers in the slums of Kampala, Uganda. Youth were randomized by site to an immediate vocational training intervention (N=50 youth) or a 4-month delayed vocational training (N=50 youth). Participants were assessed at baseline, 4, and 24 months later. Youth were asked about employment, sexual risk behaviors, delinquent behavior, quality of life, mental health symptoms, and drug use.Vocational education consisted of apprenticeships with local artisans for 4 to 8 hours, 5 days a week. Artisans received training in having conversations with youth about HIV and how to cope with unprofessional behavior (e.g., tardiness, hygiene problems). Youth in the delayed training condition received vocational training after a 4-month follow-up assessment was completed. The final assessment was administered 24 months after enrollment, by which time all youth had received training.
Vocational training may be highly useful in supporting the impact of HIV prevention. The participants receiving vocational training showed reduced delinquent behaviors and greater improvements in employment, life satisfaction, and social support compared to control participants. Both conditions demonstrated such improvements at two years, especially ongoing employment which remained strong.

Project i (Prevention Among Homeless Youth)

A number of studies have informed us about the substantial risk for HIV associated with chronic homelessness among youth in both the U.S. and Australia, even though these studies have typically been cross-sectional or samples of convenience. To understand the high seroprevalence rates among older homeless youth, the developmental trajectories into and out of risk for HIV and homelessness can best be understood from longitudinal studies of first time runaways, in which contextual factors (the national, community supports, street experiences, peers, and family) that influence these trajectories can be identified and observed over time.

The National Institute of Mental Health (NIMH) funds this study of new homeless young people. The purpose of the study is to understand the life course of new homeless youth and runaways. The study focuses on the many sources that are influencing youths pathways into and out of homelessness and risk for HIV, such as a youth’s family background, individual characteristics, personal resources, street experiences, peer social networks, interactions with social service providers, and informal support systems.

PROJECT i is following new homeless youth over time to see if they become more similar or dissimilar to experienced homeless youth. We know that among homeless youth, remaining homeless may only serve to increase their risk for HIV. This suggests a critical need to find ways to divert new homeless youth from the path of chronic homelessness and greater risk for HIV infection. The results of the study will be used to design interventions for new homeless youth to reduce their risk for HIV and to help inform service providers who may influence the life course of runaways and homeless youth and as a result help decrease their risk for HIV and becoming chronically homeless.

Approximately 240 youth, ages 12 to 20 years, are being recruited throughout various parts of Los Angeles County. A similar sample is being recruited in Melbourne, Australia. Youth who report having left home no more 180 days are eligible to participate in the study. An additional 200 youth per year, ages 12 to 20 years, who report having left the home for more than 180 days and who do not meet the above criteria, are eligible to participate in a one-time interview as part of a comparison group.

Following a baseline interview, study participants are interviewed at three months and then every six months for a total of eight interviews over a three-year period. Interviews take approximately one hour to complete. The baseline interview is conducted at the shelter or center where the youth was recruited. Follow-up interviews are conducted at a place convenient for the youth.

Vaccine Interest and Benefit Evaluation (VIBE)

Relatively few studies have addressed consumers’ potential responses after a hypothetical Human Immunodeficiency Virus (HIV) vaccine becomes available for widespread use (e.g., vaccine acceptance, possible changes in risk behavior). Similar consumer research is used widely in the manufacturing industry to inform new product development, marketing and dissemination. We anticipate that the same type of consumer research will be valuable to inform the HIV vaccine research and policy communities to understand the potential demand for vaccines under development, to prioritize research efforts, to design social marketing campaigns for post-trial vaccines, and to design behavioral interventions to accompany vaccination and mitigate potential increases in risk behavior among vaccine recipients.

This study examines consumers’ demand for HIV vaccines (e.g., would people be willing to be vaccinated?), motivators and barriers to potential trial participation or post-trial adoption, and potential behavioral responses to vaccination, such as increases in risk behavior. We focus on both HIV Vaccine trial participation and hypothetical post-trial HIV vaccines under the “what if” assumption that those vaccines have already been developed and tested favorably, and are ready for dissemination. (No drugs or vaccines are involved in this study; this is not a vaccine trial.) The current phase of the study involves focus groups among communities at risk for HIV in Los Angeles County. Seventeen focus groups have been completed with potential consumers recruited from Sexually Transmitted Disease (STD) clinics, Needle Exchange Programs (NEPs), community based health clinics, and gay and lesbian community centers and include groups of Men who have Sex with Men (MSM), Injection Drug Users (IDUs), African American women, and monolingual Spanish speaking MSM, women, and heterosexually self-identified men. In addition, twelve key informant interviews and one key informant focus group have been conducted with service providers ssociated with these potential consumer groups. The second phase of the study will involve piloting a survey instrument with a sample of a larger number of potential consumers (n=200) recruited and interviewed at the same sites.

Sample Focus Group Questions:

If an HIV vaccine were available, what are some concerns your friends might have about being vaccinated (e.g., side effects; testing HIV positive even though they are not HIV infected; it might not prevent HIV infection; that they might be infected with HIV by the vaccine)?

Would your friends accept an HIV vaccine if it were approved by the US government (Federal Drug Administration – FDA), was 50% effective against HIV infection, and had no side effects? What if it gave you flu-like symptoms for a week?

Discussion Questions:

1. How might the availability of an HIV Vaccine influence risk behaviors and prevention messages?

Current Aspects of HIV Vaccines in Development
Effectiveness: may only be effective in some persons, against some viral strains, or less than 100% effective in preventing infection.

2. Will high-risk or HIV positive persons increase risk behaviors if a vaccine becomes available or if a large-scale “Phase 3” vaccine efficacy trial is implemented in the area?

3. What kind of prevention messages and activities should accompany HIV vaccine trial participation and post-trial HIV vaccine dissemination?

China Stigma Project

China has 1 million Persons Living with HIV (PLH) and will have an anticipated 10 million PLH by the year 2010. With 1/5 of the world’s population (1.4 billion persons) in China, the risk of an epidemic is substantial. Recently, the Chinese government has recognized the substantial risk it faces in HIV and has allocated resources to fight HIV. Yet HIV-related stigma and discrimination continue to impede every step in mounting an effective response for prevention, treatment, and care in China.

The National Institute of Mental Health funds this 3-year project of HIV/AIDS-related stigma among health care providers in China. The specific aims of this project are: To document base rates of HIV related stigma among service providers and health administrators and its impact on health service behaviors and care for PLH; To identify socio-cultural, structural, and personal factors that are associated with HIV-related stigma towards PLH among service providers and health administrators; and To design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.

A total of 105 participants have taken part in the in-depth qualitative interview in Phase I study. Among them 30 are PLH, 15 are family members of PLH, 33 are health care providers, and 27 are health care administrators. Approximately 1,000-1,400 health care providers are being recruited to participate in Phase II quantitative survey study. Using data collected from Phases I and II, the research team will design and pilot test an intervention aimed at reducing HIV/AIDS-related stigma among health care providers in China.

Geographical location:

Yunnan Province,China

Targeted group:

Service providers working at the provincial, city, county, township and village level medical facilities.

Intervention model:

Psych-education and planned behavioral change

 Research methods:

  • In-depth qualitative interviews with PLH, family member of PLH, service providers, and health administrators.
  • A survey of 1,001 service providers and health administrators
  • Intervention pilot with baseline, 3-month and 6-month follow-ups.

Published Journal Articles :

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