Diffusion of Effective Behavioral
Interventions (DEBI) project is a national-level
strategy to provide high quality training and on-going technical
assistance on selected evidence-based HIV/STD prevention interventions
to state and community HIV/STD program staff.
The interventions have been proven
effective through research studies that showed positive behavioral
(e.g., use of condoms; reduction in number of partners) and/or
health outcomes (e.g., reduction in the number of new STD infections).
Studies employed rigorous research designs, with both intervention
and control groups, so that the positive outcomes could be attributed
to the interventions.
With input from the researchers,
the materials necessary to implement the interventions have been
packaged into user-friendly kits. With the appropriate training
and intervention package, service providers can increase their
opportunities to conduct effective HIV/STD prevention programs
in their communities.
The following list describes the
different interventions.
CLEAR: Choosing Life: Empowerment! Action! Results!
CLEAR: Choosing Life: Empowerment! Action! Results! is an evidence-based, health promotion intervention for males and females ages 16 and older living with HIV/AIDS or at high-risk for HIV. CLEAR is a client-centered program delivered one-on-one using cognitive behavioral techniques to change behavior. The intervention provides clients with the skills necessary to be able to make healthy choices for their lives.
Connect
Connect is a six session, relationship-based intervention that teaches couples techniques and skills to enhance the quality of their relationship, communication, and shared commitment to safer behaviors. The program is based on the AIDS Risk Reduction Model, which organizes behavior change into three phases-recognizes risk, commit to change, and act on strategies-and on the Ecological Perspective which emphasizes the personal, relational, and societal influences on behavior. Connect integrates techniques commonly used in family therapy, which will allow couples to work together to solve shared problems.
d-up: Defend Yourself!
d-up: Defend Yourself! is a community-level intervention designed for and developed by Black men who have sex with men (MSM). d-up! is designed to promote social norms of condom use and assist Black MSM to recognize and handle risk related racial and sexual bias.
The d-up! intervention mantra is: Brothers Keeping Brothers Safe. Brothers Keeping Brothers Safe refers to black MSM influencing one another to practice safer sex and stop transmission. When the social norm is shifted in a social network of black MSM the behavior of every individual in the network is impacted. Brothers Keeping Brothers Safe indicates that brothers are the most effective and far-reaching agents of behavior change for themselves that exists in the world.
Focus on Youth + IMPACT
Focus on Youth (FOY) is a community-based, eight session group intervention that provides youth with the skills and knowledge they need to protect themselves from HIV and other STDs. The curriculum, founded on the Protection Motivation Theory, uses fun, interactive activities such as games, role plays and discussions to convey prevention knowledge and skills.
Healthy Relationships
Healthy Relationships is a five-session, small-group intervention
for men and women living with HIV/AIDS. It is based on Social Cognitive
Theory and focuses on developing skills and building self-efficacy
and positive expectations about new behaviors through modeling behaviors
and practicing new skills.
Holistic
Health Recovery Program
The Holistic Health Recovery Program (HHRP) is a 12-session,
manual-guided, group level program to reduce harm, promote health,
and improve quality of life. HHRP targets HIV-positive injection
drug users. The primary goal of HHRP is to provide group members
with the resources (i.e., knowledge, motivation, and skills) they
need to make choices that reduce harm to themselves and others.
The program is based on the Information,
Motivation, Behavior (IMB) model of behavior change. In addition
to providing substance abuse treatment, HHRP addresses medical,
emotional, and social problems that may impede harm reduction behaviors.
Treatment goals could include abstinence from illicit drugs or
sexual risk behavior, but reduced drug use, reduced risk of HIV
transmission, and improved medical, psychological, and social functioning
are also acceptable. HHRP activities are designed to address clients
as complex human beings in search of physical, emotional, social,
and spiritual well-being.
Many
Men, Many Voices
Many Men, Many Voices (3MV) is a six-
or seven-session, group level STD/HIV prevention intervention
for gay men of color. The intervention addresses behavioral
influencing factors specific to gay men of color, including
cultural/social norms, sexual relationship dynamics, and the
social influences of racism and homophobia.
Mpowerment
This community-level intervention for young men who have sex with
men uses a combination of informal and formal outreach, discussion
groups, creation of safe spaces, social opportunities, and social
marketing to reach a broad range of young gay men with HIV prevention,
safer sex, and risk reduction messages.
MIP
Modelo de Intervención Psicomédica (MIP) is a holistic behavioral intervention for reducing high-risk behaviors for infection and transmission of HIV among intravenous drug users (IDUs). The intervention is theory-driven and intensive, combining individualized counseling and comprehensive case management over a 3-6-month period. The strategies of motivational counseling, self efficacy, and role induction are used.
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NIA
Nia is a six-hour, two- to four-session, video-based, small group level intervention. The goals of this intervention are to educate African American men about HIV/AIDS and its effect on their community, bring groups of men together, increase motivation to reduce risks, and help men learn new skills to protect themselves and others by promoting condom use and increasing intentions to use condoms. Nia is based on the Information-Motivational-Behavioral Skills (IMB). The IMB model assumes that people need information, motivation, and behavioral skills to adopt preventive behaviors.
Partnership for Health
Partnership for Health (PfH) uses message framing, repetition, and reinforcement during patient visits to increase HIV positive patients' knowledge, skills, and motivations to practice safer sex. The program is designed to improve patient-provider communication about safer sex, disclosure of HIV serostatus, and HIV prevention. Implementation of PfH includes development of clinic and staff "buy-in" and training.
Project START
Project START is an individual-level, multi-session intervention for people being released from a correctional facility and returning to the community. It is based on the conceptual framework of Incremental Risk Reduction, and focuses on increasing clients' awareness of their HIV,STI, and Hepatitis risk behaviors after release and providing them with tools and resources to reduce their risk.
Popular
Opinion Leader (POL)
This four-session community-level intervention involves identifying,
enlisting, and training key opinion leaders to encourage safer sexual
norms and behaviors within their social networks through risk-reduction
conversations.
PROMISE (Peers Reaching Out and Modeling Intervention Strategies)
This community-level intervention is based on several behavior change
theories. A community assessment process is conducted, peer advocates
are recruited and trained from the target population, role model
stories are written from interviews with the target population, and
these stories are distributed along with other risk reduction materials
to target audiences to help people move toward safer sex or risk
reduction practices. The intervention can be adapted for various
population groups (IDUs, MSM, sex workers, Native Americans, and
youth at high risk).
Real
AIDS Prevention Project (RAPP)
A community mobilization program, designed to reduce risk for
HIV and unintended pregnancy among women in communities at high risk
by increasing condom use. This intervention relies on peer-led activities,
including: outreach/one-on-one brief conversations with brochures,
referrals, and condom distribution; small group safer sex discussions
and presentations. There is also peer interaction with community
businesses, who participate in media campaigns with distribution
of role model stories and prevention and health information newsletters
and brochures. RAPP is based on the transtheoretical model of behavior
change.
RESPECT
RESPECT is the first individual level intervention to be added to the Diffusion of Effective Behavioral Interventions (DEBI). The RESPECT intervention utilizes a client-focused, interactive HIV risk reduction counseling model based on Project RESPECT. This study was a randomized controlled trial, implemented in five cities, to assess the efficacy of HIV prevention counseling in reducing high risk sexual behaviors and preventing new STDs. The RESPECT intervention is designed to support risk reduction behaviors by increasing the client’s perception of his/her personal risks and by emphasizing incremental risk-reduction strategies. The intervention uses a structured protocol that guides the provider/counselor throughout the sessions. This protocol also helps address barriers to risk reduction and validate previous attempts made by the client.
Safe in the City
Safe in the City (SITC) is a 23-minute HIV/STD prevention video for STD clinic waiting rooms. This video has been shown to be effective in reducing sexually transmitted diseases (STDs) among diverse groups of STD clinic patients. Safe in the City aims to increase condom use and other safer sex behaviors, and thereby reduce infections among patients who view the video in the clinic waiting room.
Safety
Counts
Safety Counts is an HIV prevention intervention for active injection
drug and crack cocaine users aimed at reducing both high-risk drug
use and sexual behaviors. It is a behaviorally focused, seven-session
intervention, which includes both structured and unstructured psycho-educational
activities in group and individual settings. This intervention works
well with CDC's Advancing HIV Prevention initiative as it strongly
encourages HIV testing as a precursor to program enrollment, clients
can be recruited from testing programs, and sessions include a discussion
of the importance of testing to the client. The intervention addresses
the needs of both HIV-negative and HIV-positive clients.
SHIELD
The Self-Help in Eliminating Life-threatening Diseases (SHIELD) intervention is based on several theories; Social Cognitive Theory, Social Identity Theory, Cognitive Dissonance (or inconsistency) Theory, and Social Influence Theory. In the SHIELD model of HIV prevention, one individual (a Peer Educator) is taught strategies to reduce HIV risk associated with drug use and sex behavior. In addition, Peer Educators are taught effective communication skills in order to talk with people in their social networks about HIV prevention information. Peer Educators are trained to be leaders within their social networks and communities. They use their communication skills to have conversations about prevention to help stop the spread of HIV.
SIHLE (Sisters Informing, Healing, Living, and Empowering)
A group level intervention, SIHLE is a peer-led, social-skills training intervention aimed at reducing HIV sexual risk behavior among sexually active, African American teenage females, ages 14-18. An adaptation of the SISTA intervention, SIHLE emphasizes ethnic and gender pride, and enhances awareness of HIV risk reduction strategies such as abstaining from sex, using condoms consistently, and having fewer sex partners. It consists of four 3-hour sessions, delivered by two peer facilitators (ages 18-21) and one adult facilitator in a community-based setting. The sessions are designed for 10-12 African American teenage females. The sessions are gender-specific, culturally relevant and include behavioral skills practice, group discussions, lectures, role-playing, and take-home exercises.
SISTA
This group-level, gender- and culturally- relevant intervention,
is designed to increase condom use with African American women. Five
peer-led group sessions are conducted that focus on ethnic and gender
pride, HIV knowledge, and skills training around sexual risk reduction
behaviors and decision making. The intervention is based on Social
Learning theory as well as the theory of Gender and Power.
Sister to Sister
Sister to Sister is a brief (20-minute), one-on-one, skill-based HIV/sexually transmitted disease (STD) risk-reduction behavioral intervention for sexually active African American women 18 to 45 years old that is delivered during the course of a routine medical visit. The purpose of Sister to Sister is to: provide intensive, culturally sensitive health information to empower and educate women in a clinical setting; help women understand the various behaviors that put them at risk for HIV and other STDs; and enhance women’s knowledge, beliefs, motivation, confidence, and skills to help them make behavioral changes that will reduce their risk for STDs, especially HIV.
Street
Smart
A multi-session, skills-building program to help runaway and homeless
youth practice safer sexual behaviors and reduce substance use. Sessions
address improving youths' social skills, assertiveness and coping
through exercises on problem solving, identifying triggers, and reducing
harmful behaviors. Agency staff also provide individual counseling
and trips to community health providers.
Together
Learning Choices (TLC)
Together Learning Choices (TLC) is an effective intervention
for young people (ages 13 to 29) living with HIV. TLC is delivered
in small groups using cognitive-behavioral strategies to change behavior.
Young people meet regularly to provide social support, learn and
practice new skills, and socialize. This program helps young people
identify ways to improve the quality of their lives by setting new
habits and daily social routines. They set goals regarding their
health, sexual relationships, drug use, and daily peace. The TLC
intervention is based on the Social Action Theory.
VOICES/VOCES
(Video Opportunities for Innovative Condom Education & Safer
Sex)
A group-level, single-session video-based intervention designed
to increase condom use among heterosexual African American and Latino
men and women who visit STD clinics. Participants, grouped by gender
and ethnicity, view an English or Spanish video on HIV risk behaviors
and condom use and take part in a facilitated discussion.
WILLOW (Women Involved in Life Learning from Other Women)
The WILLOW intervention is a social-skills building and educational intervention for adult women living with HIV. It consists of 4 four-hour sessions which are delivered by two trained adult female facilitators, one of whom is a woman living with HIV. The small group sessions consist of 8-10 women living with HIV and are conducted in a community-based setting. An adaptation of the SISTA intervention, WILLOW emphasizes gender pride, informs women how to identify and maintain supportive social networks, teaches coping strategies to reduce life stressors, enhances awareness of STD transmission and HIV reinfection risk behaviors, teaches communication skills for negotiating safe sex, reinforces proper and consistent condom use, distinguishes between healthy and unhealthy relationships, and defines types of abusive relationships and their effect on a woman's ability to negotiate safer sex practices.
