What Works in HIV
Prevention for Youth
Introduction and Overview
Above all, HIV prevention works: there is
a wide range of proven strategies to reduce behaviors that
increase the risk of transmitting or acquiring HIV.
-- Institute of
As each generation comes of age, there is a substantial
increase in the rate of infection as individuals enter their late
teens and early twenties, with infection rates peaking in the
mid-to-late twenties. Sustained, targeted prevention for each
group entering young adulthood is what will keep these waves from
-- Centers for Disease
Control and Prevention (CDC), 1997
Despite remarkable advances in research and clinical practice,
AIDS is not over. Without a stronger commitment to HIV prevention
for youth, it never will be. Even the very best treatments fall
far short of a cure, and a vaccine is nowhere in sight. Young
people need the tools to protect themselves from HIV infection,
and we know a lot about what works. Making proven interventions
available to young people is the only way to stop the spread of
AIDS with this generation.
Every year, public health officials announce that at least half
of new HIV infections in the U.S. are in young people under the
age of 25, a statistic so often repeated that it is losing its
ability to shock and alarm. As the frontline in the war on AIDS,
community-based organizations (CBOs) have a special responsibility
to keep Americans from growing accustomed to over 20,000 young
people becoming HIV infected each year. CBOs are well-positioned
to protect young people from the devastation of AIDS and the
consequences of decisions made too young.
What Works in HIV Prevention for Youth offers insights
from prevention science and community-based programs about
strategies and approaches that can help prevent new HIV infections
among America's adolescents and young people. It is a
collaborative effort of AIDS Action and AIDS Alliance for
Children, Youth & Families. We hope that this guide will be useful
to community-based organizations wishing to begin, improve, or
expand HIV prevention services targeted toward youth.
After nearly 20 years of the HIV/AIDS
pandemic it can be said with confidence that:
- Prevention works.
- Prevention is cost effective.
- HIV/AIDS prevention promotes better
Presidential Advisory Council on HIV/AIDS (2000)
An Intractable Problem
Noting that at least one young American under
age 20 was becoming infected with HIV every hour of every day, the
Office of National AIDS Policy (ONAP) in 1996 called American
youth a "generation at risk." Today, this characterization is as
true as it was five years ago. Although protease inhibitors and
other new treatments dramatically reduced the AIDS death rate for
youth -- a 35 percent decline among those 15 to 24 years of age,
from 1996 to 1997 alone -- there has been no decline in the number
of new HIV infections among young people. AIDS remains a brutal
disease and a significant threat to America's youth.
Any young person who engages in the normal experimentation and
sexual curiosity that mark adolescence as a developmental period
is at some risk for HIV infection, especially in geographic
regions with a high HIV prevalence. But, as it does with adults,
AIDS most threatens youth who already face poverty, racism,
homophobia, gender inequality and other power differentials in
relationships, poor access to health care, and homelessness. These
same young people may also be struggling with sexual identity,
self-esteem, and discrimination or exploitation. Homeless and
runaway street youth, juvenile offenders, and young people who
exchange sex for drugs, money, or affection are especially at
While HIV/AIDS among youth is a problem that
defies easy solutions, HIV prevention science does provide some
answers. We know much about what works to prevent HIV infection in
youth, including programs that are frank and targeted -- employing
both the languages and vocabularies of the young people and
communities the programs are trying to reach, and offering risk-
and harm-reduction strategies to youth who are doing things that
put them at risk. Unfortunately, such programs are not available
in most schools and communities (ONAP, 2000).
If preventing HIV infection among young people were simply a
matter of applying research data, prevention programs across the
country would feature "school-based HIV education for youth,
condom availability, explicit public service messages targeted to
people most at risk, and needle exchange and syringe purchase, as
well as more traditional abstinence-based approaches" (FCAA, 1997,
p.8). Clearly, there is an enormous gap between this ideal and
what actually exists in local communities. In part, that's because
HIV is contracted through sexual and drug-using behaviors that
adults don't want to talk about with adolescents; they don't want
to believe that teens even have sex or use drugs. In part, it
reflects the triumph of politics over science. But it is never too
late to do the right thing for America's youth.
Community-based organizations are uniquely able to fill the gap
between what prevention science identifies as effective HIV
prevention for youth and what is available locally. Indeed, a
central tenet of the CDC's HIV prevention programs is that "those
closest to the problem, equipped with needed information and
tools, are best able to solve it" (CDC, 1998a, p.1). As families,
schools, youth-serving organizations, and policy makers struggle
to integrate their desire to protect adolescents from AIDS with
their concerns for traditional values and community norms, CBOs
are providing leadership locally. They are helping to develop a
community consensus for HIV prevention and putting in place
effective science-based HIV prevention interventions targeted for
those most in need. This document seeks to support these efforts
by offering those closest to the problem an update on what is
working in HIV prevention for youth.
Overview of the Guide
Chapter Two "Youth and HIV/AIDS Today," is a snapshot of the
current epidemic among young people in the United States,
including the disproportionate impact of HIV and AIDS on young men
who have sex with men and young African American and Latina women.
The behaviors and life circumstances that put certain groups of
young people at very high risk for HIV infection are reviewed, and
the need for voluntary HIV counseling and testing for youth is
Chapter Three "What Prevention Science Research Says,"
summarizes findings from research on effective HIV prevention
programs for youth, as well as on characteristics of effective
prevention interventions across the board. The need for both
individual-level and community-level interventions is stressed.
Chapter Four "What's Working in Local Communities," provides
examples of HIV prevention strategies and models that
community-based organizations are putting into practice to help
reduce new HIV infections among adolescents and young people.
Programs from across the country using peer education and social
marketing are profiled. A contact person is listed for readers who
want more information about individual programs.
Chapter Five "Summary and Resources," concludes the guide by
inviting CBOs to accept the challenge of reducing the 20,000 new
HIV infections each year among America's youth and advising
careful adaptation of proven HIV prevention interventions to meet
local needs and circumstances. It also refers CBOs who want to
explore more fully the art and science of HIV prevention for youth
to a variety of resources for more information, most of which is
obtainable free of charge, either through the Web or through
References includes the references for the cites used throughout the
What Works in HIV
Prevention for Youth
Chapter 2: Youth and
Teenagers, especially young women and men
in disadvantaged urban communities of color, are poised to become
the tragic new face of AIDS in the United States.
-- The Kaiser Family
AIDS has already exacted a heavy toll on young Americans; over
126,000 of them have developed AIDS in their twenties (CDC, 2001).
The typical delay between HIV infection and the onset of AIDS
means that most of them were infected as teenagers. There
continues to be 40,000 new HIV infections in the United States
every year, and it has long been estimated that young people under
age 25 account for at least 20,000 of these new infections, while
youth between the ages of 13 and 20 make up half of that 20,000 (CDC,
2000c). But not all young people are equally at risk. This chapter
profiles the epidemic among American youth, including the
population groups most affected today and the behaviors that are
putting young people at risk.
Young people whose life circumstances
contribute to high-risk behavior have been especially hard hit by
HIV and AIDS. Just two groups -- young gay and bisexual men and
young black and Latina women infected through heterosexual sex --
are thought to account for at least 75 percent of HIV-infected
youth. Also at high risk for infection are youth of color, those
exploring same-sex relationships who do not identify as gay or
bisexual, drug and alcohol users, young people who have been
sexually abused or exploited, out-of-school youth, those who are
homeless, migrant youth, juvenile offenders, and other young
people living on the margins of society. There is considerable
overlap among these groups of young people, confounding risk
factors and making it difficult for many who do become infected to
identify just how and when.
Among adolescents, race is even more a factor in the epidemic
than it is among adults (Collins, 1997). African American and
Latino youth -- gay and straight, male and female -- are affected
by HIV and AIDS far out of proportion to their numbers in the
population (see Figure 1 & 2). Although African Americans make up
only 15 percent of U.S. teenagers, they account for 60 percent of
new AIDS cases reported in 1999 in that age group (13-19 years),
up from 57 percent reported in 1998 (CDC, 2000b; Kaiser Family
Foundation [KFF], 2000). Latinos, who constitute 13 percent of the
adolescent population, represent 24 percent of new AIDS cases
among teens in 1999 (CDC, 2000b). Together, black and Latino youth
represent 84 percent of newly reported cases of HIV infection (Schemo,
For most of the epidemic, males have greatly
outnumbered females among people living with HIV and AIDS. In
1999, for the first time, more females than males were diagnosed
with HIV among 13 to 19 year olds -- over six out of every 10 new
HIV infections reported in this age group (CDC, 2000b). In that
same year, girls account for 58 percent of new AIDS cases reported
among adolescents (KFF, 2000b).
Young Gay and Bisexual Men
Half of young men ages 13 to 24 reported to
be living with HIV through June 2000 were exposed to the virus
through sex with other men, and half of AIDS cases reported in
1999 in that age group were also among men who have sex with men (CDC,
2000a, 2000c). As with all other ages and exposure categories,
young African Americans and Latinos are over-represented among men
who become HIV infected through sex with men when compared to
their numbers in the general population. In a recently released
six-city CDC study, young urban gay and bisexual men had an
alarming 12.3 percent rate of HIV infection, compared to a 7
percent overall rate in a similar study from 1994-1998 (Valleroy,
et al., 2001). Most alarming, though, was the finding that 30
percent of young gay and bisexual black men, ages 23-29, are HIV
Unsafe sex is clearly a problem among some groups of young gay
and bisexual men. In the 1994-98 CDC study of 3,500 men ages 15 to
22 who have sex with men, 41 percent reported having engaged in
unprotected anal sex, an extremely high-risk activity, in the
previous six months. Bisexual men also are a bridge for HIV
transmission to women. One in six of those young men had recently
had sex with women, and nearly one-fourth had recently had
unprotected sex with both men and women. Because sexual identity
and sexual behavior do not always match, HIV prevention programs
and strategies must be developed for young men who have sex with
men but do not think of themselves as gay or bisexual. Such men
are not likely to be reached by prevention messages aimed at men
who identify as part of the gay community.
Young Women of Color
Young disadvantaged women, particularly
African American women, are becoming HIV infected at higher rates
-- and at younger ages -- than their male peers (CDC, 1998). This
was demonstrated conclusively through HIV test results from over
350,000 16 to 21 year olds entering the Job Corps, a federally
funded training program for disadvantaged out-of-school youth.
Among the young women, rates of HIV infection were seven times
higher for African Americans than for their white counterparts.
For the population as a whole, black and Hispanic adolescents and
women ages 13 to 24 account for more than three-fourths of all
AIDS cases reported among females in that age group (CDC, 2000b).
Homeless and Runaway Youth
Homeless and runaway youth also are among
those at highest risk for HIV and AIDS. No one knows how many
young people are living in these circumstances. Estimates vary
widely, ranging from 730,000 to 1.3 million (ONAP, 2000). In order
to survive on the streets, many of these young people exchange sex
for money, food, or shelter; many also use injection and other
drugs. The rate of HIV infection in homeless and runaway youth is
also unknown, with one four-city study finding a median HIV
infection rate of 2.3 percent among homeless youth, and some
shelters reporting rates as high as 10 percent (ONAP, 2000).
One of the greatest risk factors for young
people is where they live, because they tend to socialize,
explore, and develop relationships close to home. A high HIV
prevalence in a community greatly increases their risk of becoming
HIV infected compared to youth living in communities where few
people are infected. The highest rates of adolescent HIV infection
are in the South and along the East Coast, as well as in Texas,
California, and some Midwestern states. However, new HIV
infections are appearing all over the country, and young people in
rural and other low-prevalence areas who live in high-risk
circumstances also need HIV prevention education and access to
targeted HIV prevention interventions.
Membership in a particular population group
does not confer automatic risk for HIV infection. Risk depends on
behavior, and millions of American youth are engaging in sexual
and drug-using behaviors that put them at risk for HIV. In fact,
experimentation and risk-taking are considered fundamental to the
period of adolescence, and as long as the epidemic exists each
generation of American youth will need access to the information
and skills necessary to make good decisions and to stay healthy.
More than in any other age group, HIV is spread sexually in
young people (Collins, 1997). The good news is that there has been
a drop in sexual risk behaviors and an increase in condom use
among sexually experienced high school students (National Center
for Health Statistics (NCHS), 2000). The bad news is that
two-thirds of the 12 million Americans who have sexually
transmitted diseases (STDs) are under age 25, and each year three
million teenagers contract a STD (CDC, 1999) -- indicators of
continuing high-risk sexual behavior among young Americans.
Despite significant drops in the prevalence of sexual intercourse
among high school students in the past decade, by their senior
year 65 percent of American students have had intercourse.
Although condom use reported at last intercourse by high school
students went up from 46 percent to 58 percent between 1991 and
1997 (KFF, 2000b), too many sexually active youth are not using
condoms. And, there are signs that young people at highest risk in
particular are not consistently protecting themselves with
condoms, such as the 46 percent of young urban men who have sex
with men in one study who reported recent unprotected anal sex (Valleroy,
et al., 2001). Among some groups of young women, not using a
condom may be a statement about their feelings for their partners.
In interviews with over 500 African American adolescent females,
Crosby and his colleagues (2000) found that more than 75 percent
had sex with a steady partner, while less than 10 percent had
casual sex; not using a condom with a steady partner was seen as a
sign of intimacy in the relationship and trust in their partner.
This is consistent with findings from several recent studies
that many sexually active teens, despite knowing the facts about
HIV and STDs, do not consider themselves at risk for infection. A
recent Kaiser Family Foundation/MTV survey found that 68 percent
of sexually active 15 to 17 year olds do not think they personally
are at risk (Kaiser, 2000b).
Drug and alcohol use among youth also contributes to sexual
risk behaviors, putting many young people at risk for HIV
infection by impairing their judgment. One in four sexually active
high school students say they were under the influence of alcohol
or drugs the last time they had sex. Substance abuse also is a
direct risk for some young people through shared needles: one in
50 high school students say they have injected illegal drugs (CDC,
Clearly, American youth are at risk for HIV infection from the
same behaviors that put adults at risk. Young people, however, may
have less power and fewer skills when it comes to navigating
through high-risk circumstances. Many studies have documented that
youth whose first sexual intercourse occurred in their early teens
report a very high incidence of involuntary or coerced sex, and in
some groups of girls, early sex is relatively common. Almost
one-third of babies born to 15-year-olds have fathers who are at
least 21 (FCAA, 1997). Coercive early sex and early sex with
partners several years older are both factors associated with high
risk for HIV infection.
Counseling and Testing
Because most youth who are HIV infected don't
know it, they are not receiving the care that can help prevent or
delay HIV's early damage. Getting tested is a first step to
getting the health care they need and learning how to protect
themselves and their partners. Those who test negative can get
counseling and support to help them stay that way.
Voluntary counseling and testing is an important component of
youth HIV prevention, but adolescents and young people face
significant barriers to getting tested. Many who are at risk have
no health care provider they can turn to for advice and do not
know how to arrange for an HIV test. A recent Kaiser Family
Foundation national survey found that two-thirds of teens do not
know for sure where to go to get tested, including a majority of
those who are sexually active (KFF, 2000a). Some counseling and
testing facilities are open primarily during school hours. Many
sites are geared toward adults and are not youth-friendly in
language, environment, or approach. In some states, parents will
be notified of an adolescent's HIV-positive test result. In
others, parental permission is a significant barrier for youth who
are afraid to tell their parents why they need to be tested. Even
when young people manage to overcome these barriers and get tested
for HIV, many never return for their test results.
Community-based organizations can change this for the better.
Where feasible, a CBO might choose to open a youth-friendly
counseling and testing program. Those already operating testing
programs can review them to see if they are, in fact, youth
friendly and how they can be modified, if necessary, to better
serve adolescents and young people. CBOs not in a position to
offer such services directly can form strong links with
youth-friendly testing sites and actively encourage young people
in high-risk circumstances to get counseled and tested.
Chapter 3: What
Prevention Science Research Says
Prevention science has identified programs
that can reduce risk behavior. . . . Some of the proven programs
were designed for small group or classroom use. With an emphasis
on communication, negotiation, and refusal skills, they state
clearly that abstinence is important, and also provide information
about condoms and other contraceptives. Other effective programs
offer individualized counseling to high-risk youth, or use
outreach workers to deliver prevention messages. A final group of
programs mentor young people in activities that make the future
seem brighter and staying safe seem worthwhile.
-- Office of National
AIDS Policy, 2000
Prevention science combines behavioral and social science
perspectives to evaluate the effectiveness of HIV prevention. Many
questions are still unanswered -- especially with respect to youth
of color, both young men who have sex with men and young black and
Latina women -- but the evidence is clear and compelling:
prevention works. A variety of HIV prevention interventions have
been proven effective in reducing HIV risk behavior among youth
Chapter Five references, Compendium of HIV Prevention
Interventions with Evidence of Effectiveness and Replicating
Effective Programs Plus). No one intervention is best for all
young people, and both individual-level and community-level
interventions are necessary to defeat the epidemic in America's
youth (Kelly, 2000).
This chapter offers an overview of what prevention science has
to say about what works for preventing HIV infection in young
Characteristics of Effective Prevention
Although HIV prevention interventions must be
targeted to the specific needs of individuals and communities,
prevention science has discovered principles and characteristics
of effective prevention generally. Coates and his colleagues
(1996) identify nine such principles, which can be a useful guide
for CBOs considering initiating HIV prevention programs as part of
their constellation of services:
Principles of Effective HIV Prevention
- Sustained interventions are more likely to
lead to sustained behavior change.
- More intense interventions are more likely
to result in greater risk reduction.
- Accessibility to devices that are
necessary for safer practices reduces risk of HIV infection.
- Skill building and the modification of
social norms appear to enhance behavior change.
- Timing of interventions matters.
- Individual-level interventions can change
behavior, but are probably not equal to the task of risk
reduction for populations with high prevalence of HIV infection.
- HIV counseling and testing have a place in
HIV risk reduction, but are not sufficient for HIV prevention.
- Working at the level of community can
sometimes lead to significant behavioral changes.
- Media interventions can sometimes lead to
significant general population behavior changes. (Coates et al.,
These principles are consistent with the findings of the CDC's
HIV/AIDS Prevention Research Synthesis Project (1999) and the
recent report to Congress from the Institute of Medicine (2000) on
the state of HIV prevention in the United States.
Prevention research and the experiences of
CBOs both attest to the importance of targeted HIV prevention.
Prevention can be targeted in a variety of ways to match multiple
risk factors and circumstances. Interventions can be targeted by
age, gender, sexual experience, ethnicity, behavioral risk, or
neighborhood, among others. Many HIV prevention programs and
interventions use a combination of factors in targeting their
The Asian & Pacific Islander Coalition on HIV/AIDS (APICHA) in
New York City is one such program. This CBO seeks to meet the
needs of New York's Asians and Pacific Islanders, richly diverse
communities that vary greatly with respect to culture and
ethnicity. Therefore, APICHA offers a broad range of HIV
prevention programs to reach these communities, many of whose
members do not use mainstream services because of language and
cultural barriers. The Young People's Project's bilingual
volunteers reach youth with HIV prevention interventions through
school-based workshops and one-on-one street outreach at community
centers, video arcades, pool halls, and other places where Asian
young people gather.
Timing, Frequency, and Intensity
Early and often are good guideposts for HIV
prevention interventions for youth. Early prevention education
encourages young people to adopt healthy behaviors and to avoid
beginning unhealthy ones. Prevention is most effective when it
reaches adolescents before they initiate sexual and drug-using
behaviors that put them at risk for HIV. In a study on the impact
of mother-adolescent communication on HIV prevention among 372
sexually active teens, the CDC found that condom use increases
only among teens whose mothers talk to them about condoms before
they have intercourse for the first time (CDC, 1998c). These teens
are three times more likely to use condoms than teens who either
never discuss condoms with their mothers or who discuss them only
after initiating sexual activity. Condom use at first intercourse
dramatically predicts future use, with youth who use condoms at
first intercourse 20 times more likely to use condoms
Below a certain threshold of frequency, many youth HIV
prevention interventions are not effective in changing risk
behavior. The frequency differs with the intervention and the
group targeted, but, in general, effective interventions for youth
are sustained and intense. In a social marketing campaign aimed at
getting prevention messages out to youth, more frequent exposure
to the messages resulted in youth feeling more able to avoid
sexual risk. Reporting on a scientific review of successful
interventions, Collins (1997) called 10 to 14 sessions with
homeless and runaway youth a "full dose," while 12-session
interventions produced substantial change in risk behavior among
Information Combined with Skill Building
Behavioral prevention interventions attempt
to prevent someone from acquiring or transmitting the virus by
trying to change individual sexual and drug-using behavior. In the
early days of the epidemic, most interventions were based on the
assumption that knowing the facts about HIV transmission would
prevent someone from becoming infected. Despite early successes,
however, it soon became apparent that information is not enough;
high rates of risky behavior continue in hundreds of thousands of
individuals who know how HIV is transmitted. Dozens of prevention
science studies have since demonstrated that behavioral
interventions that combine information with skills building are
more effective in producing sustained behavior change and risk
reduction. For example, Lawrence and colleagues (1995) in a study
with 246 African American adolescents compared a
cognitive-behavioral intervention with information only and found
that one year after intervention almost three times as many
abstinent teens had initiated intercourse in the information-only
group than had in the skills training and information group.
Prevention science has demonstrated that
involving parents is an effective strategy for preventing HIV
infection in youth. Frank discussions about sex between parents
and young people can lead youth to adopt healthy behavior, such as
condom use. One survey of 522 African American adolescent girls
found that those who regularly discussed sex with their parents
were significantly less likely to engage in risky sexual behavior
and much more likely to bring up STD and HIV prevention with their
sexual partners when compared to girls whose parents did not talk
with them about sex (Crosby, et al., 2000).
The AIDS and Adolescents Network of New York (AANNY)
demonstrates how involving parents can help overcome community
resistance to HIV prevention education in the schools. AANNY
recruits and trains lesbian and gay youth, their parents, and
lesbian and gay parents to serve as advocates and educators for
school-based AIDS education. Since 1987, this diverse group of
youth service providers, health care providers, teachers,
activists, researchers, parents, and youth have been promoting
HIV/AIDS education and prevention programs for young people, as
well as advocating for public policies to end the epidemic among
youth. AANNY offers a series of small interactive workshops
facilitated by parents and youth who have experience in peer
education and advocacy around HIV. Among the workshop content are:
HIV/AIDS 101, adolescent development, sexual identity issues,
attitudes about sexuality, communication, and living with HIV/AIDS
in the family.
Sexuality Education and HIV Prevention Education
Both the Institute of Medicine and the
President's Council on HIV/AIDS recently identified a key problem
in preventing HIV among America's teenagers -- the proliferation
of abstinence-only sexuality education in our schools at the
expense of comprehensive programs:
". . . the nation is spending approximately
$440 million in federal and state funds over five years on
abstinence only sex education -- in the absence of any evidence
that this approach is effective, much less cost-effective --
solely because of social forces that prevent effective
comprehensive sex education courses from being offered." (IOM,
"Unlike many other nations, the U.S. government has been
unwilling to implement systematic, population-wide education that
teaches children and adults about sexual and drug-related risks
for transmitting HIV. This barrier to explicit sexual and
drug-related conversations with young people has had enormous
consequences. . . . Fears that explicit sexual information would
increase sexual initiation among U.S. youth have not been
supported by studies that have evaluated such claims. Yet too many
policy makers continue to push to censor the prevention that youth
receive by mandating and funding 'abstinence only' approaches."
(PACHA, 2000, p.20)
One of the most persistent challenges to HIV prevention for
youth is the widely held belief that early sexuality and HIV
prevention education lead to promiscuity, a myth that underpins
the abstinence-only movement. In fact, the opposite is true.
Several studies reviewing the scientific literature found that
teens who receive HIV education are less likely to engage in
sexual intercourse; those who do have sex less often and use
contraceptives more when they have intercourse (IOM, 2000; Kirby,
1995). In contrast, no scientific evidence supports the
effectiveness of abstinence-only programs.
Although most young people know the facts about HIV
transmission (KFF, 2000b), they still want and need to know more,
including how to protect themselves. Unfortunately, in schools all
across the country, they are being taught less now than they were
a dozen years ago. Abstinence-only programs are proliferating: in
1999, 23 percent of public school sexuality teachers reported
teaching abstinence as the only way to prevent STDs, including
HIV, compared with 2 percent in 1988 (Alan Guttmacher Institute,
How CBOs Can
Help School HIV Prevention Programs
- Send speakers on HIV prevention to
classes or special events. (Many schools have found that
people who are HIV positive can make effective educators
- Assist in training teachers, school
staff, or peer educators about HIV.
- Out-station HIV counselors or peer
educators at school clinics or in the health resource
- Accept referrals for counseling,
case management, and support groups for students, family
members, or school staff.
Source: N. Freudenberg and
A. Radosh. Protecting youth, preventing AIDS, 1998.
Because policies on sexuality education and condom availability
are to a large extent determined locally, community-based
organizations are much better positioned than national ones to
advocate for comprehensive sexuality and HIV prevention education
in their local schools. Where such advocacy is not successful,
CBOs can help to fill the gap by offering these kinds of programs
Even when schools do provide comprehensive programs, many youth
at highest risk are out of school entirely, while others do not
attend regularly. These young people will not be reached by
school-based programs, and they are significantly more likely than
in-school youth to be sexually active, to have had four or more
sex partners, and to have used alcohol and other drugs (Harper and
DeCarlo, 1999) -- all behaviors that put them at very high risk
for HIV infection. Prevention programs for these young people are
needed in venues accessible to them, and CBOs can play an
important part in meeting this need.
Peer education is a highly effective
prevention strategy with youth. In fact, it is more than just a
strategy; it is also an "approach, a communication channel, a
methodology, [and] a philosophy" (UNAIDS, 1999, p.2). Peer
education uses young people as credible prevention messengers to
effect change among other young people. It has been successful
both at the individual level, in changing attitudes and skills,
and also at the societal level in influencing group norms. Peer
education is consistent with several behavior change theories,
among them social learning theory, the theory of reasoned action,
the diffusion of innovation theory, and the theory of
Community-level interventions have
demonstrated considerable efficacy in preventing HIV infections.
The social marketing of condoms in developing countries is one
often-cited example of a remarkably effective community-level
intervention (IOM, 2000). Social marketing uses advertising
expertise -- media campaigns and other marketing strategies -- to
reach large numbers of people and influence their attitudes and
behavior, motivating them to healthy behavior change. Because
advertising is so effective in helping to define youth culture,
social marketing for HIV prevention has great potential for use
with young people. Evaluations of social marketing stress that the
messages must be delivered through diverse channels, be sustained
over time, and respond to changes in the market (Collins, 1997).
Societal HIV prevention interventions
try to change social and environmental factors that
contribute to individuals' HIV risk. AIDS Action (1997)
articulated three kinds of interventions that Thomas Coates
identified at this level:
- Community Interventions -- Community
interventions seek to change social norms to discourage
risk-taking behavior and promote the social acceptability
of risk avoidance. Community interventions reach people
within the context of their social lives and the things
they care about and like to do.
- Policy/Legal -- Policy/legal
interventions change law or policy to reduce HIV
infection, such as overturning restrictions on needle
exchange or instituting public health monitoring in
- Superstructural -- Superstructural
interventions address long-term societal issues that
contribute to HIV infection, such as sexism, racism,
homophobia, and violence against women.
The CDC studied the effectiveness of social marketing approaches
with adolescents in a five-city project called the Prevention
Marketing Initiative (PMI). Volunteer coalitions that included
youth as members planned and launched youth-oriented media
campaigns that reached thousands of young people with HIV
prevention messages. In one city, in 15 zip codes with high STD
rates, 60 percent of 15 to 18 year olds reported hearing of PMI,
and the campaign was associated with significant increases in
condom use (Kennedy and Mizuno, 1999).
One effective social marketing approach uses members of
high-risk populations who are popular with other members to
advocate behavior change at the community level. This "opinion
leader" model, developed by Kelly and his colleagues at the Center
for AIDS Intervention Research (CAIR), recruits popular people
within a community and trains them to deliver and model prevention
messages to their peers. This approach has been used successfully
with gay men in bars, with inner-city women in housing
developments, and with young people, among others.
Strategies and Approaches that Are Working for Young People
- Age-appropriate and developmentally
- Early sexuality education
- Peer education
- School-based peer-led programs
- Small group counseling
- Intensive, repeated education
- Skill building to build self-esteem
- Skill building for negotiating safer
- Skill building for proper use of
- Social marketing and community-level
approaches that change peer norms
Sources: Office of
National AIDS Policy; CAPS, University of California, San
Francisco; Funders Concerned About AIDS.
Chapter 4: What Is
Working in Local Communities
We are here to promote self-worth for the
girls, especially self-esteem to empower them to make good and
healthy decisions for the future.
-- Keleigh Matthews, Metro TeenAIDS, Washington, D.C., 2000
We believe that
empowering gay youth and building a strong gay community are as
important to HIV prevention as teaching them how to use condoms.
-- Gay City, Seattle, Washington, 2001
by AIDS also have great strengths. One of the most important
strengths is the presence of ordinary people who are willing to help
in the fight against AIDS. . . . Interventions developed and carried
out not just by professionals but in concert with community members
themselves have great potential because they are owned by community
members and draw upon their power through the strengths of its
-- Jeff Kelly, 2000
Community-based organizations, often in partnership with
researchers, grantmakers, and government, are developing innovative
HIV prevention programs for youth. This chapter describes several
CBO programs and one state health department initiative that
translate findings from prevention science into behavioral and
community-level interventions for adolescents and young people. Each
of the programs highlighted features peer education or social
marketing -- two approaches that have been shown to be especially
effective with young people -- or combines both strategies.
AIDS Alliance and AIDS Action spoke with
youth-serving and HIV prevention organizations across the country to
identify programs that are using peer education and social marketing
to reach young people with HIV prevention messages. The examples
that follow reflect the rich diversity of such programs in terms of
geography, populations of young people served, and sponsoring
organization. Three of the five programs profiled are in
community-based organizations dedicated to HIV prevention, two are
parts of organizations with much larger missions, and one is
sponsored by a state health department.
Queercore Peer Education and Social Marketing
Queercore, a program for men under 30, is part
of Gay City, a community-based HIV prevention organization in
Seattle, Washington, where 75 percent of new infections in the
county each year remain among men who have sex with men. Gay City's
mission is to promote gay and bisexual men's health and prevent HIV
transmission by "building community, fostering communication, and
nurturing self esteem."
Gay City's holistic
approach to HIV prevention addresses the causes of unsafe behavior,
blending grassroots organization, culturally relevant marketing, and
empowerment theories to nurture a culture in which gay and bisexual
men see their lives as worth living. Gay City creates a variety of
innovative ways to do this, including gay summer camp and community
forums that attract large, diverse audiences, one fourth of whom are
men under age 25. Gay City's HIV prevention programs are constructed
from several science-based theories of mass behavior change,
including empowerment education (Freire), social marketing (Kotier
and Roberto), and diffusion of education (Kelly).
Queercore's goal is to
empower young gay and bisexual men to take control of their own
lives, health, and future. Rather than offering "HIV 101," Queercore
wants to connect young men with others in the community, creating a
friendly space to meet new people and make new friends and providing
alternatives to the "mainstream gay scene" in Seattle. Retreats,
film nights, forums, "Coffee Talks" and other informal discussion
nights, and even camp -- which Queercore describes as "a weekend of
fun, creativity, and bonding in the bush" -- all provide social
alternatives to bars.
activities have included "The Dish," a talk show held at the
Broadway Performance Hall at Seattle Central Community College,
which used true stories and invited comments and questions from the
audience to raise issues of concern to young gay and bisexual men,
such as fetishes of older men and meeting guys in chatrooms. A
"Queer and Loathing" forum addressed reasons why many young men who
know the facts are still having unsafe sex that puts them at risk
for HIV and STDs.
Queercore also performs
theater pieces at local theaters, including "Fruit Cocktale," a
full-length piece in 1999 dealing with interracial dating. The
success of "Fruit Cocktale" stimulated interest in the arts among
Queercore participants, which resulted in the creation of "Spout," a
Web site area that Queercore describes as a "space for gay and bi
guys in Seattle under 30 to express themselves through the written
and visual arts."
All of Queercore's
materials and programs use the vocabulary and communication styles
of the young men they want to reach, the kind of frank, targeted
approach that characterizes effective HIV prevention. One Queercore
outreach flyer to young men reads:
"Today, one young Seattle queer will get
infected with HIV. Will it be you? Will you pass it on? Do you even
care? Queercore is young fags, queers, bi-guys and gay boys taking
action to make this STOP! AIDS is not inevitable. We can change our
behavior. We can change our community."
Gay City evaluates its events and activities in a variety
of ways. Survey data from post-event questionnaires indicate
that 70 to 80 percent of participants feel more pride in and
connection to the gay community, while 70 to 90 percent report
an increased commitment to protecting their health. A random
follow-up telephone survey found that in the two weeks
following an event, participants, on average, discuss the
information presented with eight other people. Annually, that
means that in addition to the 2,400 people reached directly by
Gay City events, an additional 19,000 are indirectly reached.
Queercore Community Organizer
Queercore, Gay City
123 Boylston Avenue East, Suite A
Seattle, WA 98102
Phone: (206) 860-6969
Metro TeenAIDS Peer Education
Metro TeenAIDS is a community-based
organization in Washington, D.C., dedicated to preventing HIV
infection among youth and improving the quality of life for those
already infected. Through a variety of HIV prevention programs,
Metro TeenAIDS seeks to empower youth, improve their self-esteem,
and make it less likely that they will engage in risky behavior.
Believing that youth learn from youth, Metro TeenAIDS relies on peer
education as a mainstay of its HIV prevention interventions.
Sisters for Life,
targeted to girls between the ages of nine and 14, is a mentoring
program serving three public housing communities in Alexandria,
Virginia. The program builds the life skills of African American
girls, supporting their efforts to develop into healthy, responsible
adults who avoid HIV infection, substance abuse, STDs, and other
negative consequences. Based on the black sorority model and the
seven Kwanza principles, Sisters for Life teaches girls that they
have the power to make healthy decisions. It promotes academic
accomplishments, as well as self-worth and self-esteem. Girls are
offered guidance through homework and tutoring workshops, lectures
by peers and elders in the community, and retreats and other small
group interactive activities.
Sisters for Life
addresses risks surrounding HIV/AIDS indirectly, concentrating on
supporting the girls as maturing youth and addressing high-risk
behaviors in the larger context of the girls' lives. Each year,
girls who complete the Sisters for Life program take part in a
ceremony based on African rites of passage that welcomes graduates
into the realm of sisterhood.
Project Lifeguard is
Metro TeenAIDS's peer-led support program for youth at high risk in
the Metro Washington, D.C. area, with three local drop-in centers --
The STOP in Virginia, Freestyle in D.C., and The HOUSE in Maryland,
each tailored to the needs of neighborhood youth. Lifeguard conducts
case finding and outreach to troubled adolescents, provides
prevention case management, organizes recreational activities, and
offers both peer-support groups, such as Sister to Sister and
Protecting Our Brothas and Sistahs, and professional-led groups,
such as Alcoholics and Narcotics Anonymous and teen mother groups.
The centers, open during
weekday after-school hours, combine HIV prevention information with
general health education, skills building, and empowerment tools.
They share a goal of making it possible for youth to express
themselves while having fun and to learn to make informed, healthy
decisions. Center activities may include small group sessions,
community empowerment projects, art and other creative endeavor
workshops, field trips, sports, discussions with guest speakers, and
psychoeducational skills empowerment. The STOP, for example, offers
a job preparation course focused on producing a resume and
developing interview skills.
Metro TeenAIDS uses an external evaluator to measure the
outcomes of its prevention programs. Evaluation data document
that Metro TeenAIDS reaches 35,000 youth annually with
community/street outreach, peer education, and both individual
and group interventions. Sixty percent of these young people
are male; 40 percent are female. Seventy-six percent are
African American, 7 percent are white, 12 percent are Latino,
and 5 percent describe themselves as "other." Almost
two-thirds are 16-18 years old; 21 percent are 13-18, 9
percent are 19-21, and 5 percent are 22-24. Metro TeenAIDS'
risk assessment survey shows that 90 percent of the 35,000
youth served each year have at least one risk factor.
On site group-level interventions are evaluated using the
Knowledge, Attitude and Behavior (KAB) Survey, which is
administered on a client's first day and at three-month
intervals. After one year, youth demonstrate an 85 percent
increase in knowledge about HIV prevention, a 50 percent
change in attitude, and a 25 percent change in risky behavior.
Off-site group-level interventions are evaluated with a pre-
and post-test survey. After a six-session series, participants
demonstrate an 80 percent increase from pre- to post-test.
Keleigh L. Matthews
Director of Programs
P.O. Box 15577
Washington, DC 20003
Phone: (202) 543-9355
Midwest AIDS Prevention Project Peer Education and Social
The Midwest AIDS Prevention Project (MAPP) in
Ferndale, Michigan, is one of Michigan's oldest and largest
community-based organizations dedicated to preventing HIV infection.
Its HIV prevention programs -- developed in conjunction with the
Michigan Department of Community Health -- include a variety of
interventions targeted toward youth. MAPP targets students in middle
school through high school, as well as students in alternative
education centers and out-of-school youth. MAPP reaches gay and
lesbian youth, minority youth, incarcerated youth, runaways,
sexually abused youth, and other young people in high-risk
situations, as well as the general student population.
MAPP works with school
and community organizations to develop and implement its peer
education programs, first selecting teen educators and then training
these young people to provide HIV prevention information to their
peers. MAPP also counsels teachers and school counselors. MAPP
advises other CBOs to get youth invested in HIV prevention programs
by encouraging them to have as much input into program design and
implementation as possible.
MAPP employs a variety
of behavior-based workshops, outreach projects, theater programs,
and educational programs to reach young people. Alaye -- Yoruba for
"Fit to Be King" -- is a MAPP program targeted toward African
American youth from 13 to 24 years of age. Alaye emphasizes
self-esteem, self-reliance, communication skills, and relationships
to help young men make safe and healthy decisions and lead healthy
lives. The program is presented over three sessions at local Detroit
youth service agencies. MAPP's theater program, "The Many Faces of
AIDS," is a 90-minute eight-vignette play shown to students and
teachers in school auditoriums, using live theater to help both
teens and their teachers understand AIDS. Among the topics covered
in the vignettes are: myths and mysteries, Joe Condom, still a
virgin, getting tested, AIDS wears many faces, double trouble, what
men will say to get what they want, and the news that no parent
wants to hear. A discussion period led by a MAPP AIDS education
specialist follows the play.
Through its Teen
Leadership Corps (TLC), MAPP trains popular teens to serve as
endorsers of HIV risk reduction to their friends. TLC translates
CAIR's prevention science research on opinion leaders into a program
designed to change social norms among teenagers. Teens identified as
popular and influential within their social network are chosen to
participate in TLC. They learn basic information about HIV and other
STDs, substance abuse, ways to assess risk, practical strategies for
changing risky behavior, and ways to communicate with peers. The
most important prevention messages that TLC opinion leaders deliver
to their peers are that unprotected intercourse is not what teens do
today, and that there are many ways to safely express sexuality.
Teen ADAPT is MAPP's
youth version of its Alcohol and Other Drug Abuse Prevention
Training (ADAPT) program. ADAPT was developed to increase the gay,
lesbian, bisexual, and transgender population's awareness of the
link between drug abuse and increased risk for HIV and other
negative outcomes, as well as to increase their ability to get
substance abuse services that are sensitive to their needs as a
community. Teen ADAPT combines social marketing and peer education
approaches to reach this population of teenagers, including opinion
leader trainings and a media campaign. An easy-to-use Teen ADAPT
field guide offers teen peer educators ideas for starting
conversations, signs of substance abuse, barriers to safer behaviors
for teens, and other resources. The media campaign, "Out. Proud.
Sober." uses posters, postcards, and print advertising to advise
youth to "Rebel against the people who want you to stay in the
closet, and rebel against those who are trying to talk you into
experimenting with alcohol or drugs."
Since it was founded in 1988, MAPP has distributed over a
million AIDS education materials and condoms to more than
300,000 people. Until recently, MAPP's evaluation focused on
counting services and other documentation measures, as well as
on post-event satisfaction measures, which show a high level
of satisfaction with services. Recognizing the need for pre-
and post-event evaluation, MAPP is now working with the
Michigan Department of Community Health to develop these
Midwest AIDS Prevention Project
Ferndale, MI 48220
Phone: (248) 545-1435 ex. 23
Huckleberry Youth Programs Peer Education
Huckleberry Youth Programs is a community-based
organization serving homeless, runaway, and at-risk youth in San
Francisco and Marin County. It began 30 years ago with the
establishment of Huckleberry House in Haight Ashbury. Since that
time, 24-hour services and emergency shelter have been available
there for young people in trouble. Over the years other services
these young people need grew up around Huckleberry House, including
crisis and after care counseling for families of youth seeking
services from Huckleberry. In 1992, the Cole Street Youth Clinic was
established as a collaborative effort of Huckleberry, the San
Francisco Department of Public Health, and the University of San
Francisco's Department of Adolescent Medicine. The Clinic, which
employs a team of peer educators, has become a national model of
adolescent health services, addressing the primary health care needs
of adolescents at risk, as well as their psychosocial needs.
With funding from the
CDC, Huckleberry Youth Programs was one of the first community-based
organizations in the U.S. to develop an adolescent peer counseling
HIV prevention program. Huckleberry recruited youth from their
target population and trained them to provide HIV prevention
information and materials through street outreach and through
presentations in the schools and the community. These peer educators
were recognized by the National AIDS Commission.
Programs is committed to decreasing high-risk behavior among youth
and empowering them to make healthy choices in their lives.
Huckleberry does this by creating safe and friendly places for
youth, increasing their knowledge of health issues and awareness of
HIV/AIDS, providing care, serving as a resource as needed, creating
opportunities for youth to work towards self sufficiency, and
educating peers. Huckleberry serves primarily multi-ethnic
inner-city adolescents in San Francisco, including both in-school
and out-of-school youth. The majority are at high risk for
homelessness, substance abuse, and STD's -- including HIV infection.
prevention peer education initiatives began in 1988 and have been
adapted and revised over the years. Huckleberry works with the
Violence is Preventable (VIP) Girls Collaborative and the Highway
101 Program, which serves youth living in shelters. Among
Huckleberry's current peer education interventions are group
sessions that run from one to six sessions in length, covering
HIV/AIDS risk prevention, negotiating safer sex, and setting limits
and boundaries. At the Huckleberry Teen Health Program at Montecito
Plaza in San Rafael, these peer-led workshops are provided in middle
and high schools, through street outreach, and in community sites
such as Planned Parenthood. Creating access to reproductive health
care for at-risk youth through linkages to community-based clinics
is an essential component of the Montecito Plaza peer education
In 2000, the Huckleberry Youth HIV/AIDS Prevention Program
at Cole Street Clinic reached 287 youth through individualized
peer education encounters, 304 youth through multi-session
groups, and 591 youth through outreach efforts. The
Huckleberry Teen Health Program at Montecito Plaza reaches
over 2,000 youth each year. Benefits to the youth and
community include increased awareness of HIV/AIDS and
prevention methods and, for the youth, the opportunity to
learn and talk in a comfortable, supportive setting.
Huckleberry does not yet have outcome measures for long-term
behavior change, but the California Wellness Foundation
recently invested $400,000 in an independent evaluation of
Huckleberry Youth Programs at Cole Street Clinic to provide
behavioral outcome measures and to determine their potential
as a national model.
Cole Street Youth Clinic
555 Cole Street
San Francisco, CA 94117
Phone: (415) 386-9398 ex. 21
BASE -- Be Active in Self-Education Peer Education
Be Active in Self-Education (BASE) is a peer
HIV prevention education program that focuses on student
empowerment, helping high school students teach each other about HIV
prevention in youth-friendly, effective, and replicable ways. BASE
began in 1991 in the New York City Public Schools; by 2000, 9,000
students in New York City had designed HIV/AIDS peer education
projects and presented them to over 500,000 students. The program
has been replicated in seven other cities: Atlanta, Kansas City, Los
Angeles, Minneapolis, San Jose, Salt Lake City, and Albuquerque.
The BASE Program is
founded on four principles:
- An assumption that young people are
inherently smart and creative. Given the proper resources and
thoughtful supervision, young people will come up with effective
solutions to the challenges they face.
- Anyone who has lived through adolescence
knows that young people have a tremendous influence on each other,
lending strength to the peer education principle for this group.
- Merely providing information about HIV/AIDS
is not sufficient to inspire behavioral change among adolescents.
Young people must be involved in the learning process.
- HIV/AIDS education must be repeated over a
sizable stretch of time. One-shot information sessions are not
BASE works by helping
high school students foster positive peer pressure that promotes
healthy decision making and discourages HIV risk behaviors. BASE
operates as a grantmaking program, with a student-designed and led
process for soliciting and funding proposals from other students for
innovative prevention projects. The projects address adolescent
health issues, primarily HIV prevention, sexuality, peer pressure,
STDs, and drug and alcohol abuse prevention. A student advisory
committee writes and issues requests for proposals, coordinates a
bidders conference with high schools and community agencies to help
students write up their project ideas, and -- working with
foundation representatives and AIDS service providers from the
community -- decides which projects will be funded, with a funding
level of up to $1,000 per project. The committee also reviews past
projects and evaluates their effectiveness.
projects have included talk-show format videos, interactive theater
presentations, support groups, posters and murals, T-shirts,
buttons, comic books, health fairs, conferences, mobile van
displays, school assemblies with guest speakers, awards and
scholarships, and community service projects. In Kansas City, a BASE
project raised awareness among their peers about the consequences of
unprotected sex by organizing a student HIV testing campaign with
the Kansas City Free Health Clinic. In the previous year, only 169
teens were tested at the clinic all year; the BASE campaign resulted
in 112 students being tested in two months. Nine high schools in the
Kansas City area now participate in BASE.
Some projects take on a
life of their own, as did a BASE project at Monroe High School in
the Bronx where a student-run AIDS awareness conference became an
annual event. The Teen-to-Teen HIV/AIDS Peer Education Conference is
so popular that it is now open to all public high school students in
New York City. In at least one school, the BASE team grew beyond a
focus on HIV prevention alone. At the LAB school, BASE now
encompasses three additional causes: Free Tibet, Stopping
Sweatshops, and Stop the Hate. Folding HIV prevention education into
other causes popular with and important to youth can reduce the
stigma often associated with HIV prevention messages and help ensure
its acceptability to young people.
With as little as
$7,500, a community-based organization can start a small peer grants
program along the lines of the BASE Program. CBOs also can partner
with their local public school system to help them develop a BASE
program, providing community expertise for evaluating student HIV
An independent external evaluation of the BASE Grants
Program demonstrated the following key findings:
- Grantees increased their knowledge of
HIV/AIDS and became much more aware of their personal risk
for HIV infection.
- Grantees experienced an array of
transformations, from gaining confidence and self-esteem to
breaking the barriers that prevented them from becoming
close to the people in their lives living with HIV/AIDS.
- Project grantees gained life skills,
such as group dynamics, negotiation, and time management,
that will assist them with their personal and professional
HIV/AIDS Technical Assistance Project
131 Livingston Street, Room 623
Brooklyn, NY 11201
Phone: (718) 935-5606
California Department of Health Services Social Marketing
The California Department of Health Services,
Office of AIDS partners with local community-based organizations to
develop and support a variety of HIV prevention programs targeted to
youth, including diverse cultural experiences aimed at delivering
community-level HIV prevention messages through social marketing.
- The Lowrider Campaign
The Lowrider Campaign, launched in April 2000, targets at-risk
Latino youth with the prevention messages "Respect Yourself,
Protect Yourself" and "Tu Vida Cuenta, Usa Condones," in both
English and Spanish. Those messages were incorporated into the
Aztec-themed original artwork on a fully restored and customized
1953 Chevy Bel-Air that serves as an attention-grabbing "moving
billboard" traveling throughout the state to lowrider car shows
and Latino cultural events. Local CBOs were invited to collaborate
with the campaign by providing outreach and educational services
at each event. A Modesta Lowrider group donated the use of the car
and oversaw restoration.
- Rap It Up
"Rap It Up" Safer Sex Rap Writing Contest and Radio Promotion is a
summertime promotion targeting sexually active adolescents and
young adults ages 15 to 25 in the San Francisco and Los Angeles
urban markets. Rap It Up is designed to raise awareness and
acceptance of condom use through a safer sex rap writing contest.
Prizes in 2000 ranged from a studio recording opportunity valued
at $5,000 to cash prizes of up to $1,000. The promotion
capitalized on the credibility of popular disc jockeys as
prevention messengers. The deejays invited radio listeners to
enter the contest by submitting a one-minute rap on safer sex.
Listeners also were encouraged to call the California AIDS Hotline
for more information about safer sex and HIV testing and
counseling. The promotion included radio spots that played for
four to eight weeks, live remotes, appearances at summer concerts
and festivals, Web site hyperlinks, studio interviews, public
service announcements, and promotional merchandise.
One way to evaluate social marketing campaigns is in terms
of the number of messages that reach the target audience. In
2000, the Lowrider events reached tens of thousands Latino
youth at over 12 venues. For every dollar in on-radio air time
purchased for the Rap It Up campaign, the Office of AIDS
received over six dollars in value, and the promotion
delivered over 18 million gross impressions, effectively
reaching large numbers of African American and Latino youth in
California Dept. of Health Services
Office of AIDS
P.O. Box 942732
Sacramento, CA 94234
Phone: (916) 323-7290
Chapter 5: Summary
We do not yet have a cure or a vaccine to
prevent HIV and AIDS. AIDS is still winning the war, but we do
have an arsenal of weapons at our command. We have the resources
and the know-how. Now we must have the will, the energy, and the
passion to continue the fight. Community-based organizations on
the front lines can make all the difference between a resigned
acceptance of 20,000 new infections each year among American youth
and an ardent recommitment to HIV prevention.
Key to making a difference for youth at the local level is the
adoption or careful adaptation of successful HIV prevention
interventions, paired with ongoing evaluation of their
effectiveness in reducing risky behavior or increasing safer
behavior. This concluding chapter refers CBOs to readily available
resources that can help them achieve this goal.
Adapting Prevention Programs
Adapting proven HIV prevention interventions
to meet local needs and client circumstances is a cost-effective
and often-successful strategy for CBOs. Before a CBO chooses to
adapt, it is critically important to understand the
characteristics of the original intervention and its audience, and
how they are similar to or different from the CBO's intended use.
The Center for AIDS Prevention Studies illustrates this crucial
aspect of adapting programs:
"One successful prevention program for gay
men in small cities recruited popular opinion leaders from bars,
and trained them to deliver and model prevention messages to their
peers. This program was then adapted to address minority women in
inner city housing developments. However, the program didn't work
there. The reason? Women didn't know their neighbors, and because
of high crime rates in the housing developments, were reluctant to
open their doors to someone they didn't know. This program was
then reworked, starting by helping women in the housing
developments establish a sense of community through potluck
dinners and music festivals. As a result, not only did the women
increase condom use and communication, but the community began to
tackle other issues besides HIV such as drugs and violence in the
housing development." (DeCarlo and Kelly, 1996, p.3)
Failing to account for such differences can torpedo an
intervention that might otherwise be successful. Recognizing them
and making adjustments allows CBOs to tailor interventions to
local needs and populations while retaining the core of what makes
an intervention work.
CBOs interested in beginning or expanding
their HIV prevention services for youth can choose from a wide
range of easily obtainable resources, the majority of them free of
charge. The CDC is a rich source of information, a great deal of
it available on the Web. Many prevention science centers, such as
the Center for AIDS Prevention Studies at the University of
California San Francisco also have useful Web sites. CBOs, too,
are increasingly making available information about their
prevention programs through their own Web sites or through
collaborative efforts. Finally, a number of local and national
organizations offer CBOs direct technical assistance.
Centers for Disease Control and Prevention
The CDC is responsible for administering
federal HIV prevention programs and is an excellent resource for a
wide range of information from epidemiological data to fact sheets
and updates to consensus documents on HIV prevention. Almost all
of this information is available for downloading from the Web. The
CDC's home page is
Look for Compendium of HIV Prevention Interventions with
Evidence of Effectiveness at
www.cdc.gov/hiv/pubs/hivcompendium/HIVcompendium.htm. The CDC
developed the compendium to respond to requests from CBOs and
others for science-based interventions that work. It is a
collection of summaries of rigorously studied behavioral and
social interventions that are state-of-the-science, have no
negative findings, and have demonstrated evidence of effectiveness
in reducing sex- and drug-related risk behaviors or improving
health outcomes, with a statistically significant difference
between the intervention and control groups. The summaries include
content, method, intervention goal, setting, population, findings,
and a contact person. Nine interventions included in the
Compendium target youth.
Interventions included in the document were identified by CDC's
HIV/AIDS Prevention Research Synthesis Project, an ongoing
database of studies. For more information on the Compendium,
contact Linda Kay at the CDC, 1600 Clifton Road, Mailstop E-37,
Atlanta, GA 30333, (404) 639-1900.
Look also for Replicating Effective Programs Plus at
www.cdc.gov/hiv/projects/rep/default.htm. Like the
Compendium, the REP+ site offers descriptions of science-based
programs with demonstrated effectiveness in reducing risky
behaviors or encouraging safer ones. The CDC has translated
program information into everyday language and packaged it to be
user-friendly. REP interventions are available for a variety of
populations; information is provided on the research behind the
interventions and on how to get program materials.
Center for AIDS Prevention Studies (CAPS)
CAPS is a program of the AIDS Research
Institute at the University of California San Francisco. CAPS
conducts theory-based HIV prevention research and focuses heavily
on disseminating research results in a variety of user-friendly
formats. For this reason, CAPS is an excellent resource for CBOs.
CAPS' Web site, HIV InSite (hivinsite.ucsf.edu),
offers a comprehensive array of prevention tools, fact sheets,
monographs, reports, articles from the media, and links, including
links to download documents from other sources. A stated goal of
the site's prevention section is to help service providers build
strong programs based on prevention science.
A CAPS publication of special interest to CBOs wanting to know
more about targeting HIV prevention for youth is Dangerous
Inhibitions: How America is Letting AIDS Become an Epidemic of the
Young. The sections on "Understanding Risk" and "Rethinking
the Message" offer a succinct analysis of why prevention paradigms
for youth need changing and why some research methods are missing
CBOs can contact CAPS at: AIDS Research Institute, University
of California San Francisco, 74 New Montgomery, Suite 600, San
Francisco, CA 94105, (415) 597-9100.
The Kaiser Family Foundation
The Henry J. Kaiser Family Foundation is an
independent philanthropy dedicated to health care issues. The
foundation runs its own research and communications programs,
often partnering with universities, policy think tanks, and other
organizations. The Kaiser Family Foundation is a leading source
for policy and program information related to HIV/AIDS, and
disseminates the "Daily HIV/AIDS Report." Most foundation products
are available free from the publications request line
(1-800-656-4533) or through download from
www.kff.org. The Web site includes a section devoted to
HIV/AIDS prevention, including links to facts sheets, briefs, and
Of special interest to CBOs concerned about youth-friendly HIV
testing services is Hearing Their Voices: A Qualitative
Research Study on HIV Testing and Higher-Risk Teens, a report
on research conducted for the Kaiser Family Foundation about the
attitudes and concerns of at-risk youth toward HIV testing. The
report, which is based on a series of in-depth interviews and
focus groups with 73 high-risk teenagers in Miami, Houston, New
York City, and Newark, examines the complex issues surrounding
adolescents' views of and experiences with HIV testing, including
why they do or do not get tested.
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