Behavioral Interventions to Reduce Sexual Risk

Behavioral interventions aim to promote behavior change in an effort to prevent new HIV infections, often by reducing sexual risk. They can be implemented at the individual, group, and/or community level. Intensive behavioral counseling — providing information about sexually transmitted infections (STIs) and ways they are spread — is recommended by the U.S. Preventive Services Task Force for all sexually active adolescents, as well as for adults who are at a high risk for STIs. Behavioral interventions have been shown to reduce incidence of HIV and STIs, reduce risky sexual behaviors, and increase condom usage.

The Centers for Disease Control and Prevention (CDC) recommends behavioral interventions as an evidence-based model to prevent new HIV/STI infections and works with communities around the country to fund and implement these interventions as part of the Peers Reaching Out and Modeling Intervention Strategies for High-Impact HIV Prevention Project (PROMISE for HIP). Targeted behavioral interventions that use peer advocates to improve engagement are a large component of the PROMISE for HIP work, and CDC provides technical assistance to organizations and communities funded to implement this work.

Examples of Behavioral Intervention Programs:

Project Red Talon works to prevent HIV, hepatitis C, and other sexually transmitted infections at the system, policy, community, organization, and individual level among American Indian/Alaska Native populations. Funded by the Indian Health Service HIV/AIDS Program, Project Red Talon provides training and technical assistance to tribes interested in implementing and evaluating prevention programs that are culturally appropriate for their communities. One of the prevention programs implemented through Project Red Talon is Native VOICES, which is the only intervention included in the CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention that is designed specifically for American Indian/Alaska Native teens and young adults, ages 15-24. The program promotes condom use, educates about sexual health topics, and encourages testing for sexually transmitted infections.
Project Revolution was one of several SAMHSA-funded prevention projects implemented through the Health Services Center (HSC), a community-based organization that serves those impacted by HIV in fourteen counties in eastern Alabama. Project Revolution implemented prevention activities using the RESPECT intervention, which was featured in the CDC's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. This intervention delivers HIV prevention and education at the individual level, in the format of brief interactive behavioral counseling sessions. Participants can attend two HIV counseling sessions, receive a free HIV test and follow-up counseling, and, if necessary, referrals for additional social services. In more recent years, HSC has taken the RESPECT framework and created a new adaptation called IMPACT. This prevention intervention is implemented on a smaller scale and involves HSC staff traveling to college campuses to conduct the prevention counseling activities.
Colorado ManREACH (Rural Education in Action for Community Health) is a community-based intervention that targets gay, bisexual, transgender, and queer men who live in rural Colorado. The program aims to promote a sense of community among these men and to develop relationships that promote safe sex. Each summer there is a statewide gathering for the program.
Five Horizons Health Services (Formerly West Alabama AIDS Outreach) provides comprehensive case management, testing, and prevention education services in the Tuscaloosa, Alabama region. Five Horizons focuses on both clinical and non-clinical components of HIV care, including transportation and emergency financial assistance. Five Horizons also provides speakers about prevention topics to community and school groups. Several years ago, Five Horizons implemented an evidence-based intervention called Sister to Sister, which encourages condom use among African American women through community-based groups and businesses like hair salons. Sister to Sister can also be adapted for Latina populations. Sister to Sister is an evidence-based intervention that is part of the CDC High Impact Prevention initiative. It should be noted that while rural communities can still implement this intervention, CDC is no longer providing funding or training and technical assistance for Sister to Sister projects at this time.

Considerations for Implementation

Behavioral interventions have been shown to be most effective when tailored for a specific population and audience. The culture of a community and feasibility should always be considered when determining what type of intervention is most appropriate to implement. The setting and audience will also help determine whether a group- or individual-level intervention would be most appropriate for the intervention. As with initiating any type of program, adequate funding, resources, and personnel are important considerations.

CDC provides numerous resources for communities to use as guidance for implementing evidence-based interventions that fit the needs of particular populations. Moving forward, CDC has decided to only support and prioritize specific prevention programs that they have determined are the most “cost-effective and scalable.” Some of the evidence-based prevention programs that are the best fit for a community may not be on the list of those supported by CDC through technical assistance or funding, but organizations can still access all of the materials for implementation online.

When developing an intervention program for a particular at-risk population, recruitment and retention of participants can be the biggest challenge. Partnering with community organizations that already work with that group may be a useful strategy to recruit and retain participants. Since behavior change is a complex and iterative process, it can be challenging to measure success.

Resources to Learn More

Farmworker Justice: HIV/AIDS Prevention
Website
Provides details about HIV/AIDS prevalence and prevention among the rural migrant worker population. Includes both past and current strategies to overcome challenges to working in rural migrant communities. Offers several toolkits and resources providing technical assistance when implementing HIV/AIDS prevention programs.
Organization(s): Farmworker Justice

HIV Prevention in the United States: Mobilizing to End the Epidemic
Website
Highlights the progress made in preventing and fighting the HIV/AIDS epidemic over the past several decades and summarizes the Ending the HIV Epidemic initiative launched in 2019 by the Department of Health and Human Services. Identifies CDC's goals for preventing new infections and describes gaps in local and state-level prevention efforts.
Organization(s): Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC)

HIV: Interventions to Reduce Sexual Risk Behaviors or Increase Protective Behaviors to Prevent Acquisition of HIV in Men Who Have Sex with Men – Individual-Level Interventions
Website
Offers recommendations for behavioral interventions to increase protection to prevent HIV infection for men who have sex with men. Includes data and statistics on HIV behavioral interventions for individual, group, and community level.
Organization(s): Community Preventive Services Task Force, The Community Guide

Tearing Down Fences: HIV/STD Prevention in Rural America
Document
Discusses the prevalence of HIV and Sexually Transmitted Disease (STD) in rural America. Describes prevention strategies, barriers and challenges, and education programs currently implemented in, or that can be adapted for, rural settings. Offers resources generated by HIV/STD leaders to support those who work in treatment and management of HIV/STDs, or who develop policy focused on hard to reach populations.
Organization(s): Rural Center for AIDS/STD Prevention
Date: 2009