Rural Prevention Report
(Summer 1997, Vol. 4, No. 1)

NIH Consensus Report Suggests Intervention for HIV Prevention

Editor's Note: Several significant reports focusing on improving HIV prevention education have been recently released. This Rural Prevention Report highlights four of these reports.

An independent, nongovernment panel of HIV prevention experts recently issued a draft consensus statement concerning behavioral interventions for HIV prevention. The report, Interventions to Prevent HIV Risk Behaviors, emanated from a conference convened by the National Institutes of Health in February 1997. The conference examined what is known about HIV prevention efforts for different populations for the two primary modes of HIV transmission: unsafe sexual behavior and unsafe drug injection practices.

The report states that an extensive body of research has shown ways to help persons change their HIV-related risk behaviors. Aggressive promotion of safe sexual behavior and prevention of substance abuse could deter thousands of new HIV infections and save millions of dollars of health care costs. Knowing which prevention strategies are most effective can assist officials in designating resources.

• Several conclusions and recommendations were issued by the consensus panel, including (quoting from the report):
• Interventions are effective for reducing behavioral risk for HIV/AIDS. These interventions should be widely disseminated. Their application in practice settings may require careful training of personnel, close monitoring of the fidelity of procedures, and ongoing monitoring of effectiveness.
• The epidemic in the United States is shifting to young people, particularly those who are gay and who are members of ethnic minority groups. In addition, AIDS is steadily increasing in women, and transmission of HIV virus to their children remains a major public health problem.
• Regional monitoring of changes in behavioral risk is necessary to identify groups and geographical regions with special risk for seroconversion to HIV-positive status.
• Preventive programs are essential for individuals already infected with HIV. Programs must be developed to help these individuals eliminate risky sexual and substance abuse behavior. This national priority will become more pressing as new biological treatments prolong life.
• Legisladve restriction on needle exchange programs must be lifted.
• Legislative barriers that discourage effective programs aimed at youth must be eliminated. Although sexual abstinence is a desirable objective, programs must include instruction in safe sex behavior, including condom use.

The complete draft consensus statement is available on the Internet: http://consensus.nih.gov

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RCAP to Provide New Information Service

To further the goal of providing current information to prevention practitioners, RCAP will begin issuing monthly fax bulletins titled RAP Time (Rural AIDS/STD prevention time). RCAP has continued to search for ways to highlight important HIV/STD information and to get this material quickly to practitioners. These two-page bulletins will assist persons in the field to keep current about the HIV/STD epidemic and new programs and materials.

A needs assessment will be soon conducted of all persons on the RCAP mailing list to determine specific interests and to acquire their current fax number, RAP Time will begin late summer and will be faxed monthly, for no charge, to all persons on the mailing list. Issues can be copied to share it with colleagues.

Persons not on the RCAP mailing list who would like to receive these bulletins should contact RCAP.

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AIDS Prevention Projects: Successful Approaches Found

Reiterating primary AIDS prevention messages is one factor identified that facilitated intervention effectiveness in a recent study of prevention programs published in the Health Education Quarterly. The report is a review of 37 AIDS prevention and service projects funded by the Robert Wood Johnson Foundation.

All projects reported utilizing a mean of 19 different activities. Across all prevention projects, small-group discussion was overwhelmingly reported to be the most effective intervention activity. Other reported effective activities were (in order of effectiveness rating): outreach to high risk populations, train peers/volunteers, provide safe-sex kits, large group discussions, support groups, and individual counseling.

Eight factors were identified that facilitated intervention effectiveness across 12 prevention projects that were site visited:

• Design culturally relevant language appropriate interventions.
• Embed AIDS information into broader contexts.
• Provide creative rewards and enticements.
• Build in opportunities for program flexibility.
• Promote integration into and acceptance by the community.
• Repeat essential AIDS prevention messages.
• Create a forum for open discussion.
• Solicit participant involvement.

Recommendations to guide the development and delivery of community-based AIDS prevention projects are presented.

SOURCE
Janz, N. K., et al. (1996). Evaluation of 37 AIDS Prevention Projects: Successful Approaches and Barriers to Program Effectiveness. Health Education Quarterly, 23(1), 80-97.

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Study of Rural Jails Shows Management Procuedures May Increase HIV Risk

The rate of death from AIDS is about three times higher in the prison population than in the total United States population for ages 15 to 54 years. Between 1991 and 1993, about 1 in very 3 prisoner deaths was because of AIDS-related causes.

An ecological assessment of risk of HIV/AIDS in 24 of the 29 jails in southern Indiana, which included 9 small jails and 15 medium-size jails, was conducted. Both staff and inmates were given a questionnaire, with the inmate form including items on histories of sex and injecting drug behaviors, population movement, HIV/AIDS knowledge and beliefs, concerns about AIDS in jail, and the existence of AIDS education in jails.Staff members were asked to estimate the number of AIDS cases in their jails.

The study concluded that although rural jail personnel may have hoped that their facilities would avoid the HIV/AIDS epidemic occurring in prisons and large urban jails, the findings indicate that a rural location may not provide protection from increasing rates of HIV infection in inmate populations. System management procedures may increase HIV risk to inmates and staff.

Because HIV is unevenly distributed in jails and prisons, institutional policies must be flexible enough to address the different needs of each particular facility. Jail administrators should have a role in the shaping of laws that affect institutional policies.

SOURCE
Kane, S., & Dotson, C. J. (1997). HIV risk and injecting drug use: Implications for rural jails. Crime and Delinquency, 43, 169-185.

(Editor's Note: This study was funded by RCAP.)

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Report States That AIDS Prevention Efforts Fail American Young Adults

A recent collaborative report of the Center for AIDS Prevention Studies (CAPS) and the Harvard AIDS Institute contends that AIDS is becoming a disease of the young in the United States, and that current prevention efforts are not adequate. The report, Dangerous Inhibitions, How America is Letting AIDS Become an Epidemic of the Young, says one half of all new U.S. infections occur in people under age 25, with the numbers of new infections sky-rocketing among African-Americans and Latinos.

The report details the epidemiology of HIV/AIDS in young adults, behavioral risk factors, traits of effective programs, barriers to effective intervention, and provides recommendations for improving prevention education. It concludes that "we need an emergency, targeted effort to reach young people at highest risk with sustained interventions tailored to specific needs."

Recommendations of the report include:

• increasing age-appropriate school based sex and STD/HIV education and condom availability;
• the federal government and other agencies must identify strategies to deliver HIV prevention media;
• the federal government must ensure prevention spending addresses needs of young men who have sex with men, African-Americans, Latinos, and young women at higher risk of infection; and
• the private sector has a responsibility to provide its expertise in research and prevention efforts.

The complete report is available from CAPS or by calling (415) 537-3100.

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Increase in Heterosexual AIDS Cases Among Changes in the United States Since 1991

Surveillance data of United States AIDS cases from the Centers for Disease Control and Prevention shows changes in percent of total AIDS cases for known and preventable categories of transmission. A comparison of percents from 1990 and 1996 (see Figure 1), indicates an increase in AIDS cases for both female and male heterosexuals, with the increase being 6 percent for females and a doubling for males (from 3 percent to 6 percent).

Also noteworthy was the 14 percent decrease of percent of AIDS cases for female injecting drug users. Further, the comparison showed a 13 percent decrease for men who have sex with other men.

Figure 1. Changes, in Percent, of Reported U.S. AIDS Cases by Known and Preventable Categories of Transmission for 1990 and 1996*

a Injecting drug use b Heterosexual c Men who have sex with men d Men who have sex with men and also inject drugs
* Based on: Centers for Disease Control. HIV/AIDS Surveillance Report. January 1991:9. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1996: 8 (no.2): 11-12.

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Adolescent Health Behavior Reviewed

A valuable new resource has recently been published for persons working with HIV/STD prevention for adolescents. The publication describes the epidemiology, prevention, and treatment of 12 adolescent risk behaviors, including HIV/STD.

SOURCE
DiClemente, R. J., Hansen, W. B., & Ponton, L. E. (Eds.). (1996). Handbook of Adolescent Health Risk Behavior. New York: Plenum Press.

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New Curriculum for Migrant Youth

The National Coalition of Advocates for Students has published a bilingual HIV education curriculum. Viviremos is intended for adolescent Latino migrant students in grades 6 to 12, and contains 5 lesson plans and 23 bilingual learning activities.

CONTACT
N.C.A.S., 100 Bolyston Street, Suite 737, Boston, MA 02116 (617/357-8507).

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1998 Conference at Purdue University

The RCAP will have its fourth annual conference, "HIV/STD in Rural Areas: Prevention Issues," on April 16, 1998, at Purdue University on the West Lafayette campus. The program and registration information will be mailed in early 1998.

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Abstracts of Current RCAP Projects

The major focus of RCAP is the promotion of HIV/STD prevention in rural America, with the goal of reducing HIV/STD incidence. Current projects include the development and evaluation of prevention education materials and approaches, the examination of the behavioral and social barriers to HIV/STD prevention applicable prevention programming, and the providing of prevention resources to professionals and the public. A booklet of current project abstracts is available free from RCAP.

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In the Literature...

Female-controlled Methods to Prevent Sexual Transmission of HIV. C.J. Elias & C. Coggins. AIDS 10 (suppl), 1996: S43-S51.

• Women throughout the world face a growing risk of HIV infection. Consistent condom use is not always feasible for many women. This paper reviews current efforts to develop and test female-controlled methods for preventing sexual transmission of HIV and other STDs. Both physical and chemical methods are summarized, including findings concerning the female condom and vagina microbicides.

Fertility, Family Planning, and Women's Heath: New Data from the 1995 National Survey of Family Growth. J.C. Abma, A. Chandra, W.D. Mosher, L. Peterson, & L. Piccinino. Vital Health Statistics 23(19), 1997.

• The study found that 50 percent of women 15 to 19 years of age have had sexual intercourse, the first decline in the two decades the survey had been given. For the same age group, 55 percent had experienced coitus in 1990, 53 percent in 1988, 47 percent in 1982, 36 percent in 1975, and 29 percent in 1970. Condom use also increased from 18 percent in the 1970s to 36 percent in the late 1980s and 54 percent in the 1990s.

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CDC Study: Improvements in School-Based HIV-Prevention Education Needed

The Centers for Disease Control and Prevention (CDC) conducted a comprehensive assessment of HIV prevention education policies and programs nationwide in 1994. Questionnaires were mailed to the state education agency in all 50 states and the District of Columbia and to a nationally representative sample of 502 school districts.

Of health education teachers in heath education classes, at least 50 percent reported teaching 16 of 17 specific HIV-prevention topics, with about 37 percent teaching correct use of condoms. Health education teachers in other subjects were significantly less likely than health education teachers in health education classes to teach each of the 17 topics.

CDC concluded that efforts are needed to increase the percentage of teachers who teach HIV-prevention education in a health education setting and who receive in-service training on HIV prevention.

SOURCE
Division of Adolescent and School Heath, CDC. (1997). School-based HIV-prevention education--United States, 1994. Journal of School Health, 67 103-105

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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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