Rural Prevention Report
(Spring 1995, Vol. 2, No. 1)

HIV Prevention Programs Shown to Be Effective

The magnitude of the HIV epidemic and the remote prospects of an HIV vaccine and cure in the near future has placed HIV prevention efforts as a major component in controlling HIV. Since HIV infection mainly results from individual behaviors, prevention efforts must help people avert or reduce behaviors that place them at risk for HIV. Numerous prevention programs have been developed, which must be evaluated systematically to assist decision-makers in determining HIV prevention priorities.

Some people question whether HIV prevention efforts have been successful, given the increasing HIV prevalence. Some also expect that prevention programs, to be considered successful, should result in all participants avoiding HIV. However, behavior change efforts in other health areas, such as diet, drinking and driving, exercise, and smoking, indicates that none of these interventions have been 100 percent successful, although significant successes have occurred.

Research Reviewed
No HIV prevention program is likely to completely reduce the risk of HIV infection, and insisting on too high of standard may overlook or undermine the program's effectiveness. More than a decade of evaluation studies of HIV prevention programs has demonstrated that quality programs have resulted in a lasting, positive impact in promoting HIV-avoiding behaviors.

Choi and Coates reviewed numerous reports of formally evaluated interventions designed to change HIV-risk behaviors. The vast majority demonstrated significant results in achieving short-term behavioral changes. Twenty studies showed long-term changes, with 11 studies using HIV or STD prevalence or incidence to demonstrate impact.

Holtgrave, et al., analyzed outcome studies of HIV prevention programs, and concluded: The preponderance of the empirical evidence reviewed showed that behaviorally based HIV prevention programs have a favorable impact on behavioral outcomes in specific populations, especially when delivered with sufficient resources, intensity, and cultural competency. In addition, of the programs examined by cost-benefit analysis, HIV prevention efforts need have only a small favorable impact on behavioral outcomes for the program's economic benefits to outweigh the financial costs.

Program Elements Recommended
Holtgrave, et al., extracted several common elements from successful programs. Effective programs:

• were based on specific needs and community planning
• were culturally competent
• had clearly defined audiences, objectives, and intervention
• were based on behavioral and social science theory and research
• included monitoring, evaluation, and mid-course corrections
• had sufficient resources.

Shriver noted that changes are necessary to enhance HIV prevention programs. He identified five precedents that must exist to make prevention possible: sound policies that promote HIV risk reduction, health and social services, organizations in local communities capable of reaching people at risk, and technologies to stop the spread of HIV.

Conclusion
Research indicates that quality HIV prevention programs have a favorable impact on behavioral and economic outcomes. The elements of successful HIV prevention programs can be also applied to STD prevention efforts. Knowing that risk behaviors can be averted or reduced, we must strengthen our commitment to HIV/STD prevention.

References
Cates, W., & Hinman, A. R. (1992). AIDS and absolutism: The demand for perfection in prevention. New England Journal of Medicine, 327: 492-494.

Choi, K.H., & Coates, T. J. (1994). Prevention of HIV infection. AIDS, 8: 1371-1389.

Holtgrave, D. R., Qualls, N. L., Curran, J. W., Valdiserr, R. O., Guinan, M. E., & Parra, W. C. (1995). An overview of the effectiveness and efficiency of HIV prevention programs. Public Health Reports, 110: 134-146.

Shriver, M. (1994, April). The five correlates of immunity. Presented at the meeting of HIV Prevention: Looking Back, Looking Ahead, Washington, DC. Stryker, J., Coates, T. J., DeCarlo, P., Haynes-Sanstad, K., Shriver, M., & Makadon, H. J. (1995). Prevention of HIV infection: Looking back, looking ahead. Journal of the American Medical Association, 273: 1143-1148.

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RPC Co-Sponsors National Satellite Videoconference

A live, national satellite video-conference, "AIDS in Rural Communities: Education for Prevention," will air on September 19, 1995, 2:00 - 4:00 p.m., EDT. The videoconference is primarily directed toward Cooperative Extension Service county educators and public health officials. Anyone who has access to a steerable satellite downlink can view the videoconference. The video-conference is co-sponsored by the Rural Center for the Study and Promotion of HIV/STD Prevention (RPC), the Cooperative State Research, Education and Extension Service, United States Department of Agriculture, the Purdue University Cooperative Extension Service, Indiana University, and The UpJohn Company.

This videoconference will (1) discuss the HIV/STD problem and prevention strategies for rural areas, (2) present selected models of prevention programs for youth and families with emphasis on partnerships, (3) present sources of prevention materials and programs, and (4) describe the functions of the RPC and other prevention organizations. Persons can interact with various national experts and colleagues by telephoning, faxing, or e-mailing questions during the videoconference.

The program will originate from studies at Purdue University, West Lafayette, Indiana, closed-captioned technology will be utilized, and materials will be distributed to each registered site prior to the videoconference.

Registration and Downlink Information
Register as soon as possible. There is no charge to register for the videoconference, although you must register to receive site materials and satellite coordinates. To register, contact:

Purdue University
Agricultural Communications
Distance Education and Information Technology
1304 Stewart Center G-53
West Lafayette, IN 47907-1304
(800) 319-2432
Fax: (317) 496-1548
disted@aes.purdue.edu

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Study Examines U.S. Adult HIV/STD Risk Behaviors

A recently released report on the nation's most comprehensive representative survey of sexual behavior in the general population concludes that there is a sizable response to HIV/STD risk, but that the response is inadequate in magnitude to prevent the transmissions of infection. The report, based on data from the National Health and Social Life Survey, included interviews with 3,434 Americans aged 18 to 59, and dealt with HIV/STD risk behavior and incidence. Major findings include:

• About 16 percent and 18 percent of men and women, respectively, who have ever had a sex partner report ever having an STD (bacterial and viral).
• The more sex partners the respondent had, the greater the likelihood the respondent reported contracting an STD. For example, 1 percent of the respondents with one sex partner within the last year, 4.5 percent of those who had two to four partners, and 5.9 percent of those with five or more partners last year became infected with an STD.
• The more sex partners the respondents had, the more likely each of those partners were unfamiliar and nonexclusive. Unfamiliarity with the partner, especially knowing the person less than a month before first having sex, and having non-exclusive partners were both strongly associated with a higher incidence of being infected.
• Those always using condoms reported far lower STD rates. Condom use rose substantially with the number of partners the respondent had within the past year. Blacks, younger adults, and the more educated were more likely to use a condom the last sex event.
• Nearly 30 percent of the respondents say that they have changed their own sexual behavior to avoid HIV/AIDS, including using condoms more, having fewer sex partners, getting to know their partners better, and being celibate.

SOURCE
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: The University Chicago Press.

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AIDS Leading Cause of Death in 24-45 Age Group

As a result of the expanding epidemic of severe HIV disease, in 1993 AIDS became the leading cause of death among all Americans aged 25 to 44, reports the federal National Center for Health Statistics. As shown in the chart below, the AIDS curve for death has has risen steadily since the disease was first recognized in 1981.

More than 440,000 cumulative AIDS cases have been reported, with over 270,000 deaths. AIDS became the leading cause of death among men from 25 to 44 in 1992. It remains fourth among women, behind cancer, unintentional injuries and heart disease. Death from severe HIV disease is expected to rise to second place for women in the next few years.

REFERENCE
National Center for Health Statistics. (1994). Annual summary of births, marriages, divorces, and deaths: United States, 1993. Monthly Vital Statistics Report, 42(13), 18-20. Hyattsville, MD: US Dept. of Health and Human Services.

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Description of RPC Projects Available

The RPC is conducting several projects directed toward the promotion of HIV/STD prevention in rural America. The projects include the development and evaluation of prevention education materials and approaches, the examination of the behavioral and social barriers to HIV/STD prevention which can be applied to prevention programming, and the providing of prevention resources to professionals and the public. The RPC has prepared a booklet of project abstracts. Single copies of the booklet are available free of charge upon request.

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Study Finds Lack of Knowledge about STDs

According to a new study released recently by the American Social Health Association, most adults in the United States and Europe have little knowledge about sexually transmitted diseases other than HIV/AIDS. The survey of nearly 5000 adults showed that one-third could not name an STD besides HIV or AIDS. Among the STDs listed, syphilis and gonorrhea were named most often. Relatively few respondents listed the STDs that have emerged as rapidly spreading infections during the last 20 years, such as genital herpes, chlamydia, and human papillomavirus, the cause of genital warts.

For more information about the survey contact ASHA at (919) 361-8400.

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In the Literature...

AIDS/HIV Knowledge Level and Perceived Chance of Having HIV Among Rural Adolescents. R.H. DuRant, C.S. Ashworth, C.L. Newman, L. McGill, C. Rabun, & T. Baranowski. Journal of Adolescent Health. 13 (September 1992): 499-505.

• A CDC student risk behaviors questionnaire was administered to 294 sixth, seventh, and eighth grade students from a rural community with significant social problems. A lower proportion of students were found to correctly answer several knowledge questions than those from a national comparison group. Only having school-based AIDS/HIV education was a significant predictor of knowledge. Self-reported behavior change to avoid HIV exposure was associated with previous AIDS education and older age. The authors concluded that younger rural adolescents lacked adequate knowledge to make responsible decisions about AIDS/HIV risk behavior and possessed beliefs about HIV exposure that may increase their risk.

Preventing AIDS: Theories and Methods of Behavioral Interventions. R.J. DiClemente & J.L. Peterson (eds.). (1994). Plenum: New York

• This book is a collection of papers from a multidisciplinary group of behavioral researchers who have conducted research interventions in HIV primary prevention. The volume identifies the principal theories and methods utilized in behavioral change interventions and examines their impact in a variety of populations.

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National Hotlines

National AIDS Hotline

• English Service (7 days/week, 24 hours/day): (800) 342-2437
• Spanish Service (7 days/week, 8 a.m.-2 a.m. EST): (800) 344-7432
• TDD Service for the Deaf (Monday-Friday, 10 a.m.-10 p.m. EST): (800) 243-7889

National STD Hotline

• (Monday-Friday, 8 a.m.-11 p.m. EST): (800) 227-8922

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