Preventing the spread of AIDS in youth: principles of practice from 11 diverse projects.

PURPOSE: The purpose of this study was to identify the factors that contributed to intervention effectiveness in acquired immunodeficiency syndrome (AIDS) prevention projects targeting youth. METHODS: Eleven AIDS prevention projects funded by the Robert Wood Johnson Foundation whose target populations consisted of at least 60% youth were studied. A blended methodology resulted in quantitative data (i.e., survey responses) from all 11 projects supplemented with qualitative data (i.e., open-ended interviews) drawn from in-depth site visits to six projects. RESULTS: Projects reported using a mean of 16.6 intervention activities (selected from a list of 30). Six activities were used by all 11 projects. Small group discussions were rated as one of three most effective activities by 72.7% of the projects that used them. Project staff identified three elements of effective interventions: involvement of peer educators, recognition of the role of adults (e.g., parents, teachers), and use of structured settings to gain access to the target population (e.g., schools, clubs). CONCLUSIONS: The most powerful strategies described by project staff for reaching adolescents at risk for human immunodeficiency virus (HIV) transmission also bring considerable challenges. Opportunity costs associated with using peer educators, gatekeeper support, and structured settings may include limited control of the message, impaired credibility, and failure to reach those youth at greatest risk of HIV infection, respectively. Health educators will do well to consider the advantages and disadvantages of these factors when developing, implementing, and evaluating AIDS prevention programs for youth.

More than mothers and whores: redefining the AIDS prevention needs of women.

Women are increasingly at risk for AIDS. At the root of this risk is women's relative lack of control over their bodies and their lives. Those women with least control, generally poor women of color, are at greatest risk in both developed and developing countries. To date, AIDS prevention programs have ignored most women, focusing almost exclusively on women in the sex industry and, more recently, prenatal women. We urgently need prevention programs for women that view women as more than "mothers and whores" and recognize that AIDS poses a real risk to many of us; programs that are sensitive to the complex realities of women's lives and offer realistic alternatives that will allow women to protect themselves from HIV infection.

PIP: The author recommends a change in AIDS prevention programs in developed and developing countries which recognizes 1) the lack of mutually exclusive sex roles of, for instance, the mother and the prostitute, and 2) the economic position of dependency, and 3) the social identification as childbearer. The risk of all poor women of color has been overlooked in the immediate focus on prostitution and AIDs, and female rates are increasing. For instance, the U.S. reported females AIDS cases rose from 7% in 1985 to 11% in 1989, and in West Germany female HIV cases rose from 4% in 1984 to 25% in 1988. Sub-Saharan African women constitute 50% of AIDS cases. As a direct consequence, pediatric AIDS cases have increased. For the female teenager in developing countries school based AIDs education is rare, and because of the lack or limited formal education for most women, out of school programs need to be provided in ways which offer choices and information about contraception. For women of reproductive age, the use of condoms as protection from HIV also denies the culturally determined status of motherhood. For prostitutes, effective and appropriate prevention programs provide information and tools for protection against AIDs. It is cautioned that police harassment, HIV testing, and job training and alternative employment deny underlying economic and social conditions and hence are ineffective. Prostitute's age, number of children, general health, drug use, work situation, sex practices, and economic choices affect whether prevention may involve training in safe sex negotiation or condom use techniques. For HIV positive women, birth rates may increase as a security investment. Counseling to terminate pregnancy denies the cultural importance of the motherhood role. Care must be directed to both mother and child in the same location.