America Living With AIDS

science, and health services research.
Social marketing and communications
research are also necessary to find out
whether national mass media campaigns, such as CDC's "America
Responds to AIDS" campaign are
effective, among what groups, and for
what purposes. The number of racial
and ethnic minority health professionals must be increased. Every effort
must be made to identify, nurture, and
support researchers indigenous to the
community.
It is critical that researchers clearly
establish what does and does not work
in prevention. The cost of not knowing will be measured not only in dollars spent and opportunities missed,
but also in lives lost. Future prevention efforts are greatly hindered by
insufficient evaluation of HIV prevention services and programs within
CDC and other federal agencies, as
well as within local communities. The
National Research Council (NRC) has
proposed an evaluation strategy based
on three key questions:
1. What interventions are actually
delivered?
2. Do the interventions make a difference?
3. What interventions or variations
work better?
As NRC notes, "The evaluation of
AIDS intervention programs is not an
easy task: it will take time, and it will
also require a long-term commitment

of effort and resources.... The nature
of the HIV/AIDS epidemic demands
an unwavering commitment to prevention programs, and ongoing prevention programs require a similar
commitment to their evaluation."
NRC recommends a full complement
of evaluation research, encompassing
formative, process, and outcome evaluation (NRC, 1991).
The Commission agrees that evaluation is needed at every step of development and implementation of HIV
prevention programs. Participatory
evaluation-which includes groups
targeted by the programs and groups
providing the programs, as well as
funding agencies-is a critical aspect
of evaluation that has been frequently
overlooked. Communities should not
be viewed by academic evaluators as a
place for experimentation without
consultation or collaboration. There
is a need for greater collaboration
among federal agencies, especially
CDC and the Alcohol, Drug Abuse,
and Mental Health Administration
(ADAMHA), related to research and
evaluation strategies and HIV prevention. The federal behavioral research
establishment has an important role to
play in "meta analysis"-the collation
and comparison of various small-scale
research studies. It can also provide
mechanisms so that those responsible
for the development of prevention
programs can be kept abreast of the
latest developments.
But even the best efforts to increase
the knowledge base and to improve
information dissemination strategies
will be for naught if the knowledge
gained is not effectively applied.

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