Posts classified under: HIV Prevention

Choosing Life: Empowerment, Action, Results! (CLEAR) for Comprehensive Risk Counseling and Services (CRCS)

CLEAR-CRCS is an evidence based HIV prevention and health promotion intervention developed for people living with HIV enrolled in Comprehensive Risk Counseling and Services (CRCS). It is a client-centered program delivered one-on-one with clients who are having difficulty initiating or sustaining behaviors that prevent HIV transmission and reinfection. The program teaches clients cognitive-behavioral strategies to cope with triggers and other stressful situations that lead to risky behaviors and unhealthy choices. The goal of CLEAR-CRCS is to help these people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. CLEAR-CRCS 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.

CLEAR-CRCS is structured such that the CRCS provider can individually tailor the program to address the unique needs of each client. The program consists of six foundational sessions that teach the core behavioral strategies of the program. Within these initial sessions, the client also develops a personal life goal and his or her prevention plan which will direct the focus of subsequent sessions. The provider then has a menu of 21 sessions to choose from in which the client can practice and apply the core strategies to realize his or her goals. The sessions in the menu address five domains: sexual behavior, substance use, treatment adherence, mental health, and successful disclosures.

Research on the original CLEAR Intervention: The original CLEAR study was conducted from 1999-2003 with an ethnically and culturally diverse group of substance using young people living with HIV/AIDS. The intervention was conducted as a multi-site trial in Los Angeles, San Francisco, and New York. The study demonstrated a significant increase in protected sexual acts, such as using condoms, with all partners and with HIV-negative partners.

Underlying Theory and Principles: The intervention was developed based on the social action theory. Social action theory stresses the importance of social interactions and environmental factors in a person’s ability to control behaviors that may endanger his or her health. It incorporates the principles that are expressed in traditional social-cognitive models of health-behavior change, including social-cognitive theory, the health belief model, and the transtheoretical model (stages of change). CLEAR-CRCS is predicated on the notion that behavior change depends both on a person’s belief that he or she can change a behavior (self-efficacy) and the beliefs that changing the behavior will result in a desired outcome (response efficacy).

Interventions, Training Manuals, etc. : 
For the most current CDC manuals please CLICK HERE visit the DEBI website.

Original RCT Protocol 1998-2002

  • Module 1
  1.   CLEAR- Mod 1, Sess 1: Identifying My Strengths: Creating A Vision for the Future. (1.5 hrs)
  2.   CLEAR- Mod 1, Sess 2: I'm HIV-Positive: Attitudes as Barriers to Future Goals. (1.5 hrs)
  3.   CLEAR- Mod 1, Sess 3: Making Commitments: Evaluating and Changing Substance Use. (1.5 hrs)
  4.   CLEAR- Mod 1, Sess 4: Seeing the Patterns: Why Do I Use Drugs and Alcohol? (1.5 hrs)
  5.   CLEAR- Mod 1, Sess 5: Beliefs: Thoughts That Influence My Substance Use Patterns. (1.5 hrs)
  6.   CLEAR- Mod 1, Sess 6: Future Goals: The Impact of Using Drugs and Alcohol. (1.5 hrs)
  • Module 2
  1.   CLEAR- Mod 2, Sess 7: Higher Self and Sexual Decisions: Facing the Challenges. (1.5 hrs)
  2.   CLEAR- Mod 2, Sess 8: Higher Self and Sexual Decisions: Changing Risk Behaviors. (1.5 hrs)
  3.   CLEAR- Mod 2, Sess 9: Making Sexual Decisions: Having Safety and Pleasure. (1.5 hrs)
  4.   CLEAR- Mod 2, Sess 10: Making Sexual Decisions: Can I Use Condoms (Correctly)? (1.5 hrs)
  5.   CLEAR- Mod 2, Sess 11: Making Sexual Decisions: Can I Influence My Partner To Use Condoms? (1.5 hrs)
  6.   CLEAR- Mod 2, Sess 12: Making Sexual Decisions: How Do I Refuse Unprotected Sex? (1.5 hrs)
  • Module 3
  1.   CLEAR- Mod 3, Sess 13: Motivation for Change: Wanting to Stay Healthy (1.5 hrs)
  2.   CLEAR- Mod 3, Sess 14: Attending Health Care Appointments (1.5 hrs)
  3.   CLEAR- Mod 3, Sess 15: Participating In Medical Care: Communication and Decision-making Skills (1.5 hrs)
  4.   CLEAR- Mod 3, Sess 16: Medication Schedules: Can I Stay on Track? (1.5 hrs.)
  5.   CLEAR- Mod 3, Sess 17: Medication Schedules: More Tools to Stay on Track (1.5 hrs)
  6.   CLEAR- Mod 3, Sess 18: Maintaining My Progress: Focus on the Future. (1.5 hrs)
  •  Workbooks
  1. CLEAR Individual Workbook I (Prevention for HIV Positive Adult and Youths)
  2. CLEAR Individual Workbook II (Prevention for HIV Positive Adult and Youths)
  3. CLEAR Individual Workbook III (Prevention for HIV Positive Adult and Youths)

Telephone Conference Call Groups

NOTE:  The original randomized controlled trial had a telephone group format that was not feasible for youth at that time.  Only the 1st module was completed, but it is in included here for reference.  The activities can be adapted and used for more current interventions.

 

Surveys and Scales Used:

 

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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