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• HIV/AIDS has grown to alarming proportions. Globally, 33.4 million people are living with
HIV/AIDS and about 3% live in the United States (AIDS.gov, 2012).
• Anyone can be susceptible to getting HIV, although Injection Drug Users (IDUs) are at great risk due to drug related practices (e.g. sharing needles), however those partaking in unsafe sex (e.g. unprotected sex with multiple partners) could be exposed to HIV (NIH, 2012).
• Young people, age 13-24 are vulnerable to HIV (CDC, 2014). Consistent and safer sex help to prevent against STIs and HIV/AIDS. The use of barriers during sex is a common way to prevent contact with blood or sexual fluid. The most common barrier is a condom for men or the female condom, which is used to protect the vagina or rectum during sex (AIDSINFO.net,
2013).
• HIV Medications can lower the risk of contracting HIV. Persons who are HIV negative and are at risk for HIV infection can take medications, such as pre-exposure prophylaxis (PrEP) or before exposure and is used everyday, or post-exposure prophylaxis (PEP) within 72 hours of suspected exposure (AIDSINFO.net, 2013). An HIV-positive person that takes daily medications and has an undetectable viral load has a lower chance of passing the infection to others (AIDSINFO.net 2013)
• Behavioral interventions in the context of HIV/AIDS prevention messages help to improve the intentions and practices of condom usage and HIV medications such as PrEP which provides a great level of protection against HIV when used everyday consistently, and is beneficial when combined with condoms (CDC, 2014).
• Here we examine preventive interventions for HIV/AIDS in high risk adults globally. The purpose of this study was to provide insights into currently used interventions where
HIV/AIDS education can be improved and increased in number.
• Relevant English language studies were identified through a detailed search of CINAHL,
ERIC, MEDLINE, and Academic Search Complete databases for 1998 to 2014.
• Boolean search strategy was selected, where the major terms entered were “HIV/AIDS
‘Intervention’ Young Adults” or “Treatment Interventions” and “Prevention Interventions”.
• The focus for the studies were on preventative aspects, involving prevention interventions for high-risk groups, such as adolescents, young adults, in any setting worldwide, with quantitative design for evaluation.
• A total of 19 different interventions met these criteria.
• Studies will be reviewed in chronological order.
• Majority of the studies occurred from 2004-2011. 12 were pilot studies, n=218 subjects. 7 fully powered studies were identified n=1,316 subjects. Overall average total subjects from the 19 studies were n= 622.
• Most used written surveys that was developed in the context of HIV/AIDS. Intervention modalities that utilized theory helped to guide and select the type of questions being asked or the curriculum delivered.
• Many used behavioral theories (some used a combination of multiple theories) that included social learning theory, role theory, diffusion of innovations, transtheoretical model, normative feedback or social norms marketing, social cognitive theory, theory of planned behavior, theory of gender, health belief model, self-efficacy, and community-based model. 12 studies mentioned using no theory.
• Of the prevention interventions, 9 were from the US, 4 were from South Africa, 2 were from
Ethiopia, and one each from Chile, China, India, and Malaysia.
• College students (n=3); drug users (n=2); rural illiterate women (n=2); victims of partner violence (n=2); inmates (n=2); urban adolescent/young adults (n=2); social workers/educators (n=2); pre-initiates of male circumcision, traditional healers, and men having sex with men were all targeted.
• Quasi-experimental and cross-sectional studies were done. The average lasted 8-12 weeks with pre- and post- tests and follow-ups utilizing written surveys at multiple time points. Some had educational intervention programs (n=9). Several mentioned using brief one-time written surveys (Wyatt, 2011; Peltzer, 2008). The longest intervention lasted 6 years (McCoy, 2004).
The shortest intervention lasted one month (Wong, 2008).
• Sexual activity, sexual behaviors, risk factors, HIV/AIDS knowledge, and self-efficacy. Were assessed. 9 studies reported having increased knowledge of HIV/AIDS; 10 of the interventions showed increased knowledge of condom use and prevention activity.
Chernoff Study (Chernoff & Davison, 1999)
Meekers Study (2000)
Glik Study (Gilk, Nowak, & Valente, 2002)
Toro-Alfonso Study (Toro-Alfonso, Varas-Diaz, &
Andújar-Bello, 2002)
McCoy Study (McCoy, Lai, Metsch, Messiah, &
Zhao, 2004)
Stephens Study (Stephens, Braithwaite & Tiggs,
2004)
Theall Study (Theall, Sterk & Elifson, 2004)
Chernoff Study (Chernoff & Davison, 2005)
Peltzer Study (Peltzer, Mngqundaniso & Petros,
2006)
Sweifach Study (Swifach & LaPorte, 2006)
College students and late-adolescents ranging from 17-47 yrs old, racial/ethnically diverse; sample n=761. This was a non-randomized control trial where subjects were given a survey. Subjects reported their behavior for the preceding 12-month period. The study offered cash incentives to participating fraternities in order to increase the number of men volunteering. No follow-up mentioned.
Adolescent females from urban areas in Soweto, South Africa, ages 16-20 yrs old; sample n=430. This study used a quasi-experimental control group. subjects were randomly assigned to an intervention or a control group, which comprised of pre- and post- intervention surveys. The intervention occurred in two phases. The first phase was from 1995-1996 and focused on developing reproductive health messages and materials tailored to adolescents. The second phase was from 1996-1997 and focused on the actual intervention.
Adolescents and Young Adults attending a national (US) conference on performing arts for youth HIV/AIDS prevention, racial/ethnically diverse; sample n=270. This study used a quantitative survey data and qualitative interviews. The telephone interviews occurred about
4 to 8 weeks after the conference. Overall, 34 in-depth interviews were conducted, which lasted for one hour.
Puerto Rican MSM; n=587. This study used a pre- and post-test design and the intervention consisted of 3 hour small group meetings and four 3 hour large group workshops for an ongoing period of 3 yrs. The workshops were developed to increase safer sex practices among subjects.
Subjects were either: 1) injection drug users (IDUs); 2) crack-cocaine smokers; 3) dual users who both smoked crack and injected drugs; and 4) non –drug-user; at least 18 yrs and older and from two rural communities in Florida and or Miami. The study took place from 1988 to 1994; sample n= 3555. This study used a cross-sectional survey design. The subjects were administered a standardized HIV risk assessment and provided with pre-test counseling. Blood samples were taken to test for HIV. Subjects were also administered a selfreported drug use exam confirmed by urinalysis. Screen kits for opiates, cocaine, and marijuana were utilized and direct examination was given for physical track marks. Small incentives were given to participating subjects.
Inmates at three correctional institutions in Georgia and were soon to be released. Respondents were mostly African American with less than 5 percent white and Hispanic; sample n=230. This study used a cross-sectional survey design with a health education intervention.
Data was collected at baseline, at release and at three; six, and nine months post release, at follow-up. Baseline data was presented and collected form August 2000 to December 2001. Inmates received monetary incentives, money, and personal kits.
African-American female drug users in Atlanta, GA, HIV-negative, 18 to 59 yrs old; sample n=336. This study was a quasi-experimental design where subjects were given a written survey and an intervention. Subjects received either: (a) standard intervention for drug users, which was also the control group; (b) a four-session enhanced motivation intervention; and (c) a four-session enhanced negotiation intervention. The intervention was ongoing, which lasted 3 yrs, June 1998-January 2001. Subjects were interviewed for a follow-up 6 months after the intervention.
College students sexually active within the last 12 months with 2 or more partners, ranging from 17 to 37 yrs old, diverse race/ethnic groups; sample n=155. This study used a quasi-experimental design with an intervention. subjects were assigned to an intervention group (normative feedback and goal setting) and control group (information given was related to AIDS prevention). subjects received a cash incentive at the end of the survey session and if subjects returned follow-up survey they received another cash incentive.
South African Traditional Healers; sample n=233. This study used a quasi-experimental design with a written survey and education intervention. The intervention group participated in a training curriculum and there was an information booklet given afterwards. The control group did not receive the training curriculum but did receive an information booklet after follow-up interviews, which were immediately after the intervention. The intervention lasted 3.5 days.
School Social Workers who were members of the School Social Work Association; sample n=272. This study used a quantitative study design with a cross-sectional survey. Written surveys were mailed to respondents and they were asked to rate the suitability of school nurses, physical education instructors, and social workers on functions related to HIV/sex education. This study did not mention how long the survey took to complete and this study did not mention the socio-demographics of the respondents.
IDUs in the Shanghai Drug Abuse Treatment Center; sample n=101. This study used a cross-sectional survey. The written survey was used to gather data on injection user practices, demographic information and sexual behaviors. HIV, HBV, and HCV, infection status was confirmed through subjects medical records at the Shanghai Drug Abuse Treatment Center. The study was ongoing for 5 months. There was no mention of a follow-up.
School teachers from four public and private schools, male and female teachers, from 25 to 54 yrs old from Northwest Himalayas; sample n=80. This study used a cross-sectional survey. The survey assessed knowledge of HIV/AIDS, attitudes toward people with
HIV/AIDS and comfort with sensitive topics such as discussing HIV related topics. This study did mention if there were follow-ups conducted.
Post intervention, those that reported risky sexual behaviors had significantly different value priorities than those that reported lower-risk sexual behavior. Risky sexual behavior was highly associated with a lack of caution, restraint and self-discipline. Risky sexual behavior was associated with a lack of concern for the welfare of others.
Participants that received the intervention had an increase in awareness of the risk of pregnancy, and increased knowledge of condom use and
HIV/AIDS prevention. There was also an increase in awareness of contraceptives effective for pregnancy prevention.
Findings from the intervention showed that actively involving youth in designing and delivering disease prevention messages are empowering and helpful. The survey results indicated there was an increase in self-efficacy with respect to protective actions, and effective decision making and changing peer or social norms were also reported. The interviews revealed that youth were more likely to listen to other youth regarding health related messages, such as sexuality, drug use, or academics.
After the intervention participants showed reduction in high- and moderate risk sexual practices, specifically for behaviors that are most likely to expose one to HIV infection. After the intervention there was an increase in safe sex behaviors, such as using condoms during sex. Risk indexes were lower after the intervention. Intervention workshops were effective in promoting behavior change.
After the analysis IDUs accounted for the largest risk for HIV. Also, the analysis provided evidence that the risk for HIV is a burden for two specific subgroups of IDUs, women and African-Americans. The report found HIV rates were higher among dual users, IDUs and crack cocaine users than those that only smoked crack. In addition, dual users were more likely to engage in high risk sexual practices such as, engage in unprotected sex, have multiple sex partners, exchange money for sex, and have a history of STDs.
After the intervention results showed that higher levels of substance use resulted in lower occurrences of belief in using a condom. Also, the less education reported, the more likely respondents were to have been incarcerated more than once.
After the intervention participants showed a decline in new victimization experiences, emotional abuse significantly decreased, sexual abuse dropped, and physical abuse fell too. The enhanced interventions showed an association with fewer new victimization experiences, especially sexual and emotional abuse. Women learned conflict negotiation skills in order to progress their motivation to decrease or stop risky drug using or sexual behaviors in order to focus on the betterment of their health and quality of life.
After the intervention men that were in the intervention group reported higher condom use while the women reported fewer partners. After the intervention men and women might have had different motivations to change their risk behaviors, such as wearing condoms more for men or choosing to have fewer partners for women. Moreover, women and men had more direct control over their choices.
After the intervention participants showed a high level of preparedness regarding referring patients to health practitioners. The traditional healers had correct knowledge on major HIV transmission routes, prevention methods and treatment; however, their knowledge was poorer on other transmission routes (breast feeding, oral sex, dry sex) and HIV/AIDS myth. The knowledge on curability, treatment course, and major transmission routes were adequate for TB.
Peer education is viewed by social workers as a successful, worthwhile technique to be used for sex education and prevention. Respondents believed that students that took part in peer education had an active involvement and were less likely to initiate in sexual activity and unsafe sex practices.
Zhao Study (Zhao et al., 2006)
Ghosh Study (Ghosh, Chhabra, Springer &
Sharma, 2008)
After the intervention the data revealed that sexual risk behaviors among IDUs were common. The majority of the participants had not used a condom consistently in the previous 3 months, over a quarter had multiple partners, almost half had IDU partners, and more than 3 quarters did not know their partner's HIV status. IDUs who were married or did not intend to use condoms in the future were more likely to have unprotected sex. The prevalence of HBV and HCV infection was greater than a quarter and over half respectively, however, no one tested positive for HIV. IDUs with an injection history of 3 years or more and with an overdose history were more likely to be infected with HBV and/or HCV.
The findings from the survey revealed that private school teachers scored higher on all three measures than public school teachers. Also, private school teachers were younger and had less teaching experience than the public school counterparts. There were significant sex differences by school type, over half of public school teachers and more than a quarter of private school teachers were male. Teachers that received their training from traditional areas, which emphasized and enhanced cognitive development, and subjects like public health were not part of the curriculum.
Peltzer Study (Peltzer, Nqeketo, Petros & Kanta,
2008)
Wong Study (Wong, Chin, Low & Jaafar, 2008)
Pre-initiates for male circumcision, from three different sites in the Eastern Cape province of South Africa. Ages ranged from 16 to 27 yrs old; sample n=350. This study used a cross-sectional survey. The written survey was developed based on the literature review of male circumcision in the context of HIV infection. The aim for this study was to assess attitudes of pre-initiates towards traditional male circumcision. The study took place during June 2007 to July 2007 and did not mention if there was a follow-up conducted.
Adolescents to adults from 4 states in Malaysia, mainly low-income, half were attending school, 15-49 yrs old; sample n=1075. This study used a cross-sectional survey. The main objective of the written survey was to assess knowledge, attitudes, and risk behaviors related to HIV/AIDS. The data was collected between June 2006 to July 2006. Respondents were interviewed face-to-face using a structured survey and questions on risk behavior were self-administered. This study did not mention a follow-up.
Respondents of the survey mostly reported having received AIDS education in the past and had an average level knowledge of HIV. The main reasons for male circumcision were to improve body strength and hygiene, protect from sexually transmitted infections (STIs), including HIV, protect from other infections, peer motivation, penile and sexual potency, and cultural acceptance. The major attitudes about traditional male circumcision reported was cultural acceptance, apprehension of negative consequences, fear, and pain.
Respondents of the survey had a high awareness of HIV/AIDS and the level of HIV/AIDS knowledge was moderate. Although a large majority of respondents had correct knowledge of the most common methods of transmission, such as sharing needles and sexual risk activities, there were misconceptions held regarding nonsexual routes of transmission. There were misconceptions about HIV prevention methods, some believed that washing their gentile regions with soap after sexual intercourse and avoiding touching people living with HIV would prevent infection.
Bogale Study (Bogale, Boer & Seydel, 2009)
Stephens Study (Stephens et al., 2009)
Rural females from two separate communities in Ethiopia, low-literate/illiterate age 13-24 yrs old; sample n=200. This study used a cross-sectional design with a written survey. The study used trained data collectors from each community. Written close-ended (yes/no type questions) surveys were collected via data collectors that read aloud the questions to respondents. The estimated time each survey took was 1.5 - 2 hours. After completion of the survey the participant received cash for their time and participating in the study. Study was conducted in February and March 2007 utilizing written surveys.
Male inmates from two South African provinces, most inmates were Black Africans, 18-35 yrs old; sample n=2381. This study used a cross-sectional descriptive study design with a written survey and intervention. The intervention consisted of a health education curriculum for 12 months. The study did not mention how many sessions were given or if there was a follow-up after the intervention.
Knowledge about sexual transmission of HIV and knowledge about condoms was very low, especially among illiterate individuals. The level of condom use was low among illiterate individuals. Findings show that rural women in Ethiopia do not have appropriate information about condoms and condom use.
After the intervention, results indicated there was limited knowledge regarding HIV/AIDS and STIs, specifically on the basic transmission of HIV.
Findings also suggested inmates did not care to use condoms and reported that it was not important to use them all the time. Overall, the study reflected the need for more prevention efforts to prevent the spread of HIV/AIDS and other STIs.
Bogale Study (Bogale, Boer & Seydel, 2011)
Miner Study (Miner et al., 2011)
Wyatt Study (Wyatt & Oswalt, 2011)
Rural females, low-literate/illiterate from two separate communities in Ethiopia, 15-38 yrs old; sample n= 420. The study used a quasiexperimental pre- post- test design with intervention. Three audio episodes on HIV/AIDS prevention played on audiocassette recorders in listening groups, each lasted 15 min. Discussion questions were posed afterwards. Interventions included presentations that lasted 45 min. The prevention messages were played on 3 consecutive days in the local school. The pre-post-test surveys took 2.5 hours to complete with the use of data collectors.
Chilean females from major metropolitan in Santiago, low-income, sexually active within the last 6 months prior to baseline, 18-49 yrs old; sample n=261. This study used a quantitative, correlational design with face-to-face interviews using a structured survey. The average length of the interview was 1 hr. Interviews took place from April 2006 - August 2007. Post-intervention follow-up occurred 6weeks after baseline and at 3 months through structured interview survey.
College students from Southwest Texas involved in a student organization, diverse race/ethnic groups, 18 to 29 yrs old; sample n=126.
This study used pre-post- test design with an intervention. The intervention was a peer lead education on HIV/AIDS prevention and was implemented with 4 student organizations. Each intervention was a brief one-time event lasting 2 hours. Each group utilized a survey that had been pre-tested for readability and clarity.
After the intervention, the level of HIV/AIDS knowledge was high. The intervention also had a major impact on self-efficacy, vulnerability, and intention to use condoms. In fact, the intent to use condoms was highly related to self-efficacy. Audio HIV/ AIDS prevention message that used narrative format, not only increased knowledge and social cognitions, but also strengthen the importance of self-efficacy for condom use intention.
After the intervention, the experience showed IPV was a high occurrence among the participants. The overall percentage of females who had experienced abuse was much higher than in other studies in Chile. HIV risk was low among participants though the women in the sample were most at risk for acquiring HIV because of their low-income status, financially dependence on their partner, and their recent experience of IPV.
After the intervention, participants reported they were more likely to communicate with others about HIV issues, negotiated safer sex practices in some situations, and intend to use condoms during oral sex. The student leaders were similar in culture and experiences as their peers as well as interests and gender. This supports the idea that role model characteristics and shared experiences help to add to the credibility of the content for
HIV/AIDS prevention.
• HIV/AIDS is a global epidemic, it would be valuable to develop and test preventative intervention programs in more countries.
• There is a need for more interventions that include long-term evaluation measures. Long-term measures often account for reductions in disease or infections associated with the program objectives
(CDC, 2013). Many studies reviewed did not include long-term measures (n=3) .
• Peer-designed and led HIV/AIDS education allowed peers that share similar experiences, values, age, and culture to aid peers in adopting and discussing basic HIV/AIDS information.
• Peer-led outreach programs are grounded on the idea that peers can profoundly impact a persons’ behavior (Wyatt et al., 2011) and that peers are more relaxed and comfortable with sharing sensitive topics (Jain et al., 2014).
• HIV/AIDS education is significant to young people even if they are not engaging in sex or other risky behaviors to ensure they are prepared for risky situations in the future (CDC, 2014). As established by this presentation in some countries HIV/AIDS knowledge is very low.
• Active role-playing methods allow youth to pretend and act out situations that might happen. HIV/AIDS prevention education classes should be fun and designed in a way that incorporates games, quizzes, or drama and still be effective in promoting HIV/AIDS prevention messages (Avert.org, 2014).
• Future studies should address HIV medication (e.g. PrEP) as a prevention method to promote healthy behavior change in the context of safer sex promotion.