Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 14272-14277 237

S14272 Cost-effectiveness of an intervention for runaway youth
Mary-Jane Rotherram-Borus, Martha Lee, M.J. Rotherram-Borus, M. Gwadz.
University of California, Los Angeles, Los Angeles, CA, USA
Background: The cost-effectiveness of an intensive HIV prevention program with
demonstrated efficacy for runaway and homeless youth in shelters was evaluated
over 2 years.
Methods: HIV-related sexual and substance-use risk acts were compared at
3, 6, 12, 18, and 24 months among 167 runaway adolescents from two shelters
who received an intensive HIV intervention and 145 adolescents at two control
shelters. The cost for delivering the intervention, the cost of an infection and the
probability of an infection among runaways (4%), and the social costs of care in
mental health facilities, health care settings, criminal justice settings, and foster
care were monitored over two years.
Results: Significant reductions in the number of unprotected sexual acts, a
weighted index of substance use, and the number of drugs used were found
based on intervention condition and interactions of adolescents' gender and
intervention condition. Alcohol and marijuana use also tended to be lower in
the intervention group. Overall, females in the intervention group demonstrated
greater reductions in sexual risk and substance use compared to males. Being
older or pregnant were associated with substantially higher reports of sexual risk
acts. African Americans reported greater reductions in substance use than other
ethnic groups. Compared to the cost of delivering the program and the social
costs, the intervention resulted in a 10% reduction in social costs over 2 years.
The intervention appears cost-effective.
Conclusion: The long-term efficacy and cost-effectiveness of delivering an HIV
prevention program to youths at highest risk must be considered as a national
policy issue.
S14273 NIMH multisite HIV prevention trial: A randomized,
controlled trial of a risk reduction intervention
Jeffrey Kelly. NIHM HIV Prevention Trial, Natl. Inst. of Mental Health, Rockville;
Med. Coll. of WI, 1201 N Prospect Ave., Milwaukee, Wisconsin 53202, USA
Objectives: The efficacy of a behavioral intervention to reduce HIV risk behaviors
was tested in a randomized, controlled trial with three high-risk populations at
seven sites across the US.
Methods: Participants recruited in the waiting rooms of sexually transmitted
disease clinics (N = 1,564 men; N = 862 women) and in health service organizations (women only, N = 1,280) were randomly assigned to either: (1) an
intervention condition consisting of a small group, 7-session HIV risk reduction
program based on behavioral principles (N = 1,851), or (2) a one-session control
condition presenting HIV/AIDS information (N = 1,855). The participant retention
rate after one year of follow-up was 82%. Extensive quality control procedures
were implemented to ensure uniformity across sites in recruitment, baseline and
follow-up assessments, and intervention delivery.
Results: Results will compare the intervention to the control condition for unprotected sexual acts, levels of condom use, and consistent condom use over
a 12-month follow-up period. In addition, results will be presented on STD incidence, based on clinic chart review, between the two intervention conditions.
Self-reported STD symptoms over the one-year follow-up will also be reported by
intervention condition.
Conclusions: Findings of the trial for this large multi-site, randomized, controlled clinical trial will be presented. Thus, the study will have implications
regarding the implementation of an HIV preventive intervention with high-risk
individuals in public health settings.
14274 The effect of a theory-based HIV prevention intervention
on condom use with main partners in samples of US
women
Rebecca Cabral1, Christine Galavotti2, A. Cohen3, L. Fogarty4, B.M. Green3,
A. Gielen4, K. Armstrong3, B. Milstein2. 14770 Buford Hwy, NE Mailstop K-34
Atlanta, Georgia 30341-3717; 2Centers for Disease Control and Prevention,
Atlanta GA; 3Family Planning Council, Philadelphia PA; 4Johns Hopkins
University, Baltimore MD, USA
Objective: To evaluate the effect of a stages of behavior change intervention,
delivered in clinics/facilities, on condom use with main partners among women at
risk for or infected with HIV.
Methods: Data are from Project CARES (Comprehensive AIDS and Reproductive Health Education Study) funded by the US Centers for Disease Control and
Prevention. The goal of Project CARES was to implement and evaluate a behavior
change intervention for women at risk for HIV, STDs, and unplanned pregnancies.
Women at increased risk for HIV infection were recruited from drug treatment
centers, housing projects and homeless shelters in Philadelphia (n = 1289), and
women living with HIV from hospital-based HIV clinics in Baltimore (n = 322).
The behavior change counseling intervention delivered by specially trained peer
paraprofessional counselors was based on the Transtheoretical Model of Behav
ior Change (Prochaska & DiClemente, 1983). Counselors assessed a woman's
level of readiness to change her condom behavior and then tailored individual
counseling sessions to her stage. Logistic regression analyses were performed.
Results: In the at risk sample, 6-month longitudinal follow-up data showed
(adjusted odds ratios) that women exposed to individual counseling were twice
as likely to report condom use with main partner at last sex (OR = 2.0, p <.02)
and always use of condoms (OR = 2.02, p <.03), and less likely to report never

use (OR =.32, p <.001), vs. women in the comparison sites. Among women
infected with HIV, women in the intervention group were significantly more likely
to move up a stage or remain consistent condom users (OR = 2.62, p <.06) and
less likely to relapse from consistent use (OR =.33, p <.04), than women in the
comparison group.
Conclusion: HIV prevention interventions for women based on the TM can
be effective for women with different risk profiles. The stage-tailored counseling
helped to both increase consistent condom use and to prevent relapse among
women further along the stage of change continuum. This intervention may be
most feasible in communities where women at risk can be reached through family
planning or other health and social service settings.
S14275 Research and evaluation of social marketing
interventions for HIV/AIDS prevention: The AIDSMark
program
Kerry Richter. 1120 19th St. Suite 600 Washington, DC 20036, USA
Issues: Social marketing is a cost-effective method of HIV/AIDS prevention for
low-income people worldwide. To implement effective social marketing programs,
research and evaluation activities must be designed to improve information systems and indicators of program success. Needed information includes profiles
of the baseline population, identification of the appropriate target population
for interventions, measures of distribution systems, and indicators of program
effectiveness.
Project: AIDSMark is a new project funded by the US government to provide assistance to social marketing programs throughout the world. AIDSMark
interventions contain research and evaluation components designed to improve
information on the effectiveness of social marketing in preventing HIV infection
and on providing communications strategies regarding HIV/AIDS risks.
Results: This poster will give an overview of the current research and evaluation
activities of the AIDSMark social marketing program. It will illustrate examples
from several countries where AIDSMark interventions are underway. The results will emphasize improved methodologies for evaluation of social marketing
interventions.
Lessons Learned: The AIDSMark program provides examples of "state of
the art" interventions in social marketing. Research and evaluation activities of
the program illustrate how well-designed information systems contribute to the
effectiveness of these interventions for HIV/AIDS prevention.
S14276 HIV risk among out-of-treatment drug users: A cluster
analysis of the NIDA AIDS outreach cooperative
agreement
Michael Dennis1, W.M. Wechsberg2, R.F.R. Rasch 3. 720 West Chestnut Street,
Bloomington Illinois 61701; 2Research Triangle Institute, Research Triangle
Park, NC; 3Research Triangle Institute, Research Triangle NC, USA
Objectives: To a) identify subgroups of out-of-treatment drug users who have
similar patterns of HIV risk behaviors, b) then examine how these groups are
related to their characteristics, HIV status and changes in behavior, and c) discuss
the implications for program planning.
Design: Prospective longitudinal survey across 22 HIV demonstration sites in
the USA.
Methods: The data for this presentation come from two random quarters (01
and V1) of the 12/94 national cross-site data, each of which includes data from
18 sites on approximately 4500 injection and crack users. All clients completed
questionnaires, urine tests, and HIV tests at intake and 6 months later. The
results were also replicated with an independent sample of over 500 people from
the North Carolina site. In all three samples we only included people with either
positive OnTrak urine tests for opioid or cocaine or visual needle tracks, and
excluded people who had been in treatment during the past 30 days. Over 250
Results: Individual Risk Group was able to explain 55.9 to 82.3% of the variance in the 4 statistical dimensions at intake (99.6% of their joint distribution) and
12.8 to 36.4% of the variance at follow-up (62.8% of their joint distribution). It was
significantly related (p <.0001) to participant characteristics, HIV status, site, and
follow-up rates. The results were replicated in both the other random sample and
the subsequent independent sample.
Conclusion: HIV risk behaviors are very heterogenous among out-of-treatment
drug users and should be considered in targeting outreach, designing interventions, and evaluating them. Use of risk subgroups can focus the evaluation
findings and dramatically improve statistical power.

14277 Quali-quantitative evaluation of a model of school HIV
education implemented by teachers and health workers
Saugo Mario, Tomasi M.. ULSS 4 Dip. to Prevenzione Via Rasa, 936016 Thiene
(VI), Italia
Objectives: To evaluate the efficacy and the quality of the impementation of a
durable and extensive school HIV educational program, carried out by teachers
and health workers.