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Behavioral Interventions

Behavioral interventions aim to promote behavior change in an effort to reduce risk of HIV infection. 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.

The Centers for Disease Control and Prevention (CDC) recommends behavioral interventions as an evidence-based model to prevent new HIV infections and works with communities around the country to fund and implement these interventions as part of the High-Impact HIV Prevention Project (HIP). Targeted behavioral interventions comprise a large component of HIP work, and CDC provides technical assistance to organizations and communities funded to implement this work.

CDC has also compiled a Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention that continues to be updated with new effective interventions. Each intervention included in the compendium is evaluated based on established criteria. The compendium is divided into three sections which include 1) linkage to, retention in, and re-engagement in HIV care; 2) medication adherence; and 3) risk reduction.

High-risk populations generally targeted by these types of prevention programs include:

New HIV infections in the United States are generally driven by a few high-risk behaviors. Programs may target a high-risk group in order to maximize their reach.

Comprehensive Risk Reduction for Adolescents will address evidence-based prevention programs for adolescents and Prevention with Positives will include prevention programs for people who are living with HIV/AIDS.

Examples of Behavioral Intervention Programs:

  • Project Red Talon works to prevent HIV 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 Centers for Disease Control and Prevention 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 Centers for Disease Control and Prevention Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention intervention titled RESPECT. 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.
  • Chattanooga CARES (Council on AIDS, Resources, Education and Support) is a nonprofit, community-based organization with the mission of reaching and supporting people impacted by HIV, hepatitis C, and STIs by providing education, advocacy, health, and social services. The organization seeks to achieve this mission by providing evidence-based HIV prevention programming. One program being implemented at CARES is the intervention VOICES, which is listed in the Centers for Disease Control and Prevention Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. This intervention is being implemented in Chattanooga, Tennessee, and within surrounding rural counties. VOICES (Video Opportunities for Innovative Condom Education & Safer Sex) is an intervention presented to groups in clinical settings which aims to increase condom use and promote safe sex behaviors. This intervention specifically targets heterosexual African American and Latino adult populations.
  • The Anchorage Men's Project is a program run by the Alaskan AIDS Assistance Association and is an adaptation of the Centers for Disease Control and Prevention Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention intervention Mpowerment. This HIV prevention intervention is designed to empower young gay and bisexual men to build safer, healthier communities for themselves and their friends. Evaluations of Mpowerment have shown it to be cost-effective in decreasing unprotected male-to-male sex, especially among younger men. The program can be adapted for diverse settings and uses a community-based approach rather than targeting individual men. It includes elements like informal or social outreach, publicity campaigns, and small group discussions about safer sex practices.
  • ManREACH (Rural Education in Action for Community Health) is a community-based intervention that targets gay, bisexual, 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 Centers for Disease Control and Prevention (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.

The Centers for Disease Control and Prevention (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

American Indian Health: HIV/AIDS
Website
Comprehensive listing of resource pages and information relevant to American Indian HIV/AIDS prevention. All links include on this webpage include a short summary indicating what materials can be found there, such as statistics, training materials, and treatment guidelines.
Organization(s): National Library of Medicine

Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention
Website
This is a consolidated resource which is periodically updated providing information about evidence-based interventions related to HIV prevention and care, medication adherence, and overall risk reduction.
Organization(s): Centers for Disease Control and Prevention

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

PROMISE for HIP
Website
Describes the CDC strategy for preventing HIV infections. Includes information on populations at greatest risk, examples of prevention programs or interventions, and how to make the most of your dollar with high-impact prevention. 
Organization(s): Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

HIV Prevention in the United States: New Opportunities, New Expectations
Document
Report highlighting the progress made in fighting the HIV/AIDS epidemic over the past several decades and summarizing initiatives led by the Centers for Disease Control and Prevention to address the current situation. The document also highlights gaps in local and state-level prevention efforts.
Organization(s): Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
Date: 12/2015

HIV/AIDS: 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
Recommendations for behavioral interventions to increase protective behaviors which can prevent HIV infection for men who have sex with men. Included data and statistics on the 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
A guide that provides resources and programs that can be adapted and used to prevent HIV and STIs in rural settings. Also outlines many barriers to implementing programs in rural communities and offers strategies to address some of these challenges.
Organization(s): Rural Center for AIDS/STD Prevention
Date: 2009