Abstract

PIP: As part of the Acquired Immunodeficiency Syndrome (AIDS) Community Demonstration Projects program, a community-level HIV prevention program was implemented among high-risk women (female sex workers and intravenous drug users or their sex partners) from Long Beach, California, US, during 1991-94. The intervention, based on health behavior theory and formative research, included publications portraying the experiences of local role models moving through the stages of behavioral change, distribution of role-model stories by peer volunteers, and environmental facilitation through distribution of condoms and bleach. The program was evaluated through anonymous street interviews in control and intervention communities. 71% of at-risk women interviewed in the intervention area but only 2.2% of controls were reached by the project. An increase of about one-third of a behavioral stage occurred in the intervention group, but the increase was significant (p 0.01) only for condom use with non-main partners. When exposed vs. nonexposed women in the intervention area were compared, significant increases in condom use were recorded for exposed women with both main (p 0.05) and non-main partners (p 0.001); the mean behavioral stage gains were one-quarter and one-half a stage, respectively. Increased condom use with both types of partners was significantly associated with perceived condom use by peers, prior experience with condoms, sex work, self-efficacy, perceived behavior control, attitudes, and perceived risk. Likely to be at relatively earlier stages of change were women who smoked crack cocaine, African-Americans, and those with a jail/prison history.