Purpose: To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation.
Design: Repeated cross-sectional sampling with matched intervention and comparison communities.
Setting: Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution.
Subjects: 3081 injecting drug users who were sexually active and/or shared injection equipment.
Intervention: Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms.
Measures: Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners.
Results: Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p < .001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p < .01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p < .05) and other partners (p < .01) and for cleaning injection equipment with bleach (p < .05).
Conclusions: The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.
PIP: The impact of the Long Beach (California, US) AIDS Community Demonstration Project, a community-based HIV prevention intervention based on the principles of the transtheoretical model of behavioral change, was tested in selected areas with high concentrations of intravenous drug users and prostitutes. Enrolled in repeated cross-sectional samples with matched intervention and comparison communities were 3081 injecting drug users who were sexually active and/or shared injection equipment. In the intervention areas (n = 1497), trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change as well as bleaching kits and/or condoms. By the last data collection wave, 77% of injecting drug users in the intervention area had been exposed to the project. Rates of condom carrying increased from 10% to 27% in this group and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with partners other than a main partner; the increase in stage of change for using condoms with a main partner was not significant. In contrast, condom use in the nonintervention area remained stable at about 8% and the stage of change for condom use with main and other partners decreased. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner and other partners and for cleaning injecting equipment with bleach. Overall, these findings support the utility of community-based approaches to changing behaviors that are related to a risk of HIV infection.