Library

Background: In 1997, the National Institutes of Health (NIH) reviewed evidence of the effectiveness of HIV prevention programs for injection drug users (IDUs) and recommended that three types of interventions be implemented to prevent transmission of HIV among IDUs: 1) community-based outreach, 2) expanded syringe access (including needle exchange programs [NEP] and pharmacy sales), and 3) drug treatment. Progress on increasing the acceptance and feasibility of implementing these programs has been made at the national level, but their implementation has been varied at the local level. Objective: To study the acceptance and implementation of the three interventions by communities and to identify the factors that contributed to the success or failure of communities to implement these programs on the local level. 81: Forty-three in-depth qualitative interviews were conducted with key informants in six U.S. cities. Informants included AIDS prevention providers, political leaders, activists, substance abuse and AIDS researchers, health department directors, and law enforcement officials. Cities were classified according to when they initiated interventions as 1) early adopters, 2) middle adopters, and 3) late or never adopters. Results: Conditions that facilitated or deterred the adoption of interventions were identified. Coalition building and community consultation were key to the acceptance and sustainability of new interventions. Leadership from politicians, public health officials, and program directors provided necessary authority, legitimacy, and access to resources. Grassroots activists took initiative and risks in the face of opposition, but often lacked the resources to sustain their efforts. Researchers played an important role in initiating interventions and legitimizing them by providing access to the scientific information supporting their safety and effectiveness. Successful implementers worked with or avoided the opposition rather than creating polarized positions. Changes in funding and structure of publicly supported drug treatment programs have limited the implementation of new programs. Lack of leadership in the political and public health sectors, and, indeed, fear of adopting or even discussing needle exchange because of perceived political opposition, were the biggest barriers to implementation of syringe exchange programs. Conclusion: Understanding the conditions under which communities accept and implement interventions can help guide effective strategies to foster the implementation of these interventions in areas where programs do not currently exist.

Many Black gay men are at high risk for HIV, yet few programs exist for them, and even fewer have been evaluated for effectiveness. The African-American Men’s Health Study (AAMHS) represents the first published attempt to develop and evaluate the impact of a culturally appropriate, community-based, HIV risk reduction intervention designed to change high-risk sexual behaviors among African-American homosexual and bisexual men in the San Francisco Bay area. (posted 9/96).

.

The following Spanish-language survey has been used to assess risk behavior. It was developed through the Hermanos de Luna y Sol program, a culturally appropriate HIV risk–reduction intervention that targeted immigrant, Spanish-speaking gay and bisexual men in San Francisco.

Instrument: SSE-LM Scoring: Included in article Reliability or validity: Bowleg L, Neilands TB, Choi K-H. Evaluating the Validity and Reliability of a Modified Schedule of Sexist Events: Implications for Public Health Research on Women’s HIV Risk Behaviors. Women & Health, Vol. 47(2) 2008.