Introduction

Abstract

Functioning as a resource to HIV prevention service providers, planners, policy makers, funders, and others, this book includes information and materials to learn about, replicate, or adapt structural interventions (those that focus on the physical, social, cultural, political, economic, legal, and/or policy aspects of the environment) (Abdul-Quader & Collins, 2011) which have demonstrated efficacy in preventing HIV transmission in the United States (USA) and around the globe. Within this book, 18 subject-matter expert-selected structural interventions are presented according to their targeted risk behaviors (injection drug use, noncommercial sex, and commercial sex) and protective behaviors (utilization of testing and treatment).

Appendices

Appendix 1 Selection Criteria for Structural Interventions

1. Quality of Program Implementation

Includes:

• Content quality

• Faithfulness of implementation

2. Scientific Rigor of Evaluation

Includes:

• Appropriate design

• Appropriate sample size and sampling procedures

• Comparable control or comparison group where feasible, otherwise, another appropriate design such as a time series analysis

• Adequate instrumentation and data collection procedures

• Adequate retention across follow-up data collection, as appropriate depending on sampling procedures

• Appropriate analytic procedures

3. Adequacy of Follow-Up Timeframe

Includes:

• Follow-up assessment conducted a minimum of six months after intervention initiation

4. Positive Impact on Hiv Risk Behavior or STI/HIV Infection Rates for One or More Subgroups

Includes:

Sexual Risk Behaviors

• Postponement of sexual intercourse

• Decreased frequency of sexual intercourse

• Decreased number of sexual partners

• Decreased frequency of sexual intercourse with partners who engage in high-risk behaviors

• Decreased number of HIV-risk sexual partners

• Decreased frequency of concurrent sexual partners

• Increased use of effective HIV/AIDS prophylactics at first sexual contact

• Increased use of effective HIV/AIDS prophylactics use at most recent sexual contact

• Increased consistent use of effective HIV/AIDS prophylactics at every sexual contact

• Substitution of lower-risk for high-risk sexual behaviors

• Increased performance of other sex-related HIV/AIDS prevention behaviors (e.g., increased condom carrying)

Drug Injection Risk Behaviors

• Abstinence from injection drug use

• Reduced frequency of injection drug use

• Increased seeking of drug abuse treatment

• Reduced receptive sharing of needles and syringes (i.e., using needles and syringes used by others)

• Reduced distributive sharing of needles and syringes (i.e., passing on used needles and syringes to others)

• Reduced sharing of other drug injection equipment (e.g., cottons, cookers, rinse water)

• Reduced re-use of needles

• Increased use of sterile needles

Prenatal and Perinatal Transmission Risk Behaviors

• Increased contraceptive use among HIV-positive females

• Decreased pregnancy among HIV-positive females

• Decreased births among HIV-positive females

• Decreased births of HIV-positive newborns

STI/HIV Infection Rates

• Decreased STI/HIV infection rates for one or more subgroups

• Decreased STI/HIV prevalence rates for one or more subgroups

Appendix 2 Case Studies Pathways and Strategies for Change

Title	Year published	Target population	Region	Pathways for change		Common strategies
				Changes in policy/law	Changes in programs and practices	Social marketing/media campaign	Community outreach	Counseling/skills development	Peer education
Legal Access to Needles and Syringes (Connecticut, USA)	1995	IDUa	North America	✓
Needle Exchange Program (Bangladesh)	2001	IDU	Asia		✓	✓	✓	✓	✓
Safer Injection Facility (Vancouver, Canada)	2004	IDU	North America	✓	✓		✓
Needle Social Marketing (China)	2007	IDU	Asia		✓	✓	✓	✓	✓
China-Vietnam Cross Border Project (China-­Vietnam)	2007	IDU	Asia		✓	✓	✓	✓	✓
Louisiana Condom Social Marketing Campaign (Louisiana, USA)	1999	Adults	North America		✓	✓
Youth Responsibility Project (Zimbabwe)	2001	Youth	Africa		✓	✓	✓		✓
100 % Jeune Social Marketing (Cameroon)	2005	Youth	Africa		✓	✓	✓	✓	✓
Let’s go with the times Radio Soap Opera (Tanzania)	2000	Youth	Africa			✓
A televised Safe Sex Media Campaign w/at risk Youth (Kentucky, USA)	2009	Youth	North America			✓
Mandatory Condom Law in Brothels (Nevada, USA)	1995	CSW & clients	North America	✓ (Mandatory)
Compromiso Collectivo for Female Sex Workers (Dominican Republic)	2006	CSW & clients	Central America	✓ (Mandatory)	✓	✓	✓	✓	✓
Sex Workers (Philippines)	2006	CSWa & clients	Asia			✓	✓	✓	✓
100 % Condom (Thailand)	2006	CSW & clients	Asia	✓ (Mandatory)	✓	✓	✓	✓
Sonagachi Project (India)	2009	CSW & clients	Asia		✓		✓	✓	✓
Prenatal HIV Screening (France)	1998	Pregnant women	Europe	✓ (Mandatory)
Free ART (Taiwan)	2004	PLWHAa	Asia	✓	✓
Drama Based Intervention to Promote VCT (South Africa)	2006	General population	Africa			✓	✓	✓	✓

1. ^aIDU, Injection Drug Users. CSW, Commercial Sex Workers. PLWHA, People Living with HIV/AIDS

Appendix 3 Bibliography of Case Studies. Best-Evidence: Structural Interventions for HIV Prevention

Program name	Reference	Country
Structural interventions to decrease IDU risk
Legal Access to Needles and Syringes	Groseclose, S. L., Weinstein, B., Jones, T. S., Valleroy, L. A., Fehrs, L. J., & Kassler, W. J. (1995). Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers—Connecticut, 1992–1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10(1), 82–89	Connecticut, USA
Needle Exchange Program	Jenkins, C., Rahman, H., Saidel, T., Jana, S., & Hussain, A. M. Z. (2001). Measuring the impact of needle exchange programs among injecting drug users through the national behavioral surveillance in Bangladesh. AIDS Education and Prevention, 13(5), 452–461	Bangladesh
Safer Injecting Facility	Wood, E., Kerr, T., Lloyd-Smith, E., Buchner, C., Marsh, D. C., Montaner, J., & Tyndall, M. W. (2004). Methodology for evaluating InSite: Canada’s first medically supervised safer injection facility for injection drug users. Harm Reduction Journal, 1(9), 1–5	Canada
Needle Social Marketing	Wu, Z., Luo, W., Sullivan, S. G., Rou, K., Lin, P., Liu, W., & Ming, Z. (2007). Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China. AIDS, 21(8), S115–122	China
China-Vietnam Cross Border Project	Des Jarlais, D.C., Kling, R., Hammett, T. M., Ngu, D., Liu, W., Chen, Y., et al. (2007). Reducing HIV infection among new injecting drug users in the China-Vietnam Cross Border Project. AIDS, 21(suppl 8), S109–S114	China and Vietnam
Structural interventions to decrease non-commercial sex risk
Louisiana Condom Social Marketing Campaign	Cohen DA, Farley TA, Bedimo-Etame JR, Scribner R, Ward W, Kendall C, & Rice J. (1999). Implementation of condom social marketing in Louisiana, 1993 to 1996. American Journal of Public Health, 89(2), 204–208	Louisiana, USA
Youth Responsibility Project	Kim, Y.M., Kols, A., Nyakauru, R., Marangwanda, C., & Chibatamoto, P. (2001). Promoting sexual responsibility among young people in Zimbabwe. International Family Planning Perspectives, 27(1), 11–19	Zimbabwe
100 % Jeune Social Marketing	Meekers D, Agha S, & Klein M. (2005). The impact on condom use of the “100 % Jeune” social marketing program in Cameroon. Journal of Adolescent Health, 36, 530.e1–530.e12	Cameroon
Let’s go with the Times Radio Soap Opera	Vaughan, P. W., Rogers, E. M., Singhal, A., & Swalehe, R. M. (2000). Entertainment-education and HIV/AIDS prevention: A field experiment in Tanzania. Journal of Health Communication, 5 (Suppl), 81–100	Tanzania
A Televised Safe Sex Media Campaign with At-Risk Youth	Zimmerman, R. S., Palmgreen, P. M., Noar, S. M., Lustria, M. L., Lu, H., & Lee Horosewski, M. L. (2007). Effects of a televised two-city safer sex mass media campaign targeting high-sensation-seeking and impulsive-decision-making young adults. Health Education & Behavior, 34(5), 810–826. doi:10.1177/1090198107299700	Kentucky, USA
Structural interventions to decrease commercial sex risk
Mandatory Condom Law in Brothels	Albert AE, Warner DL, Hatcher RA, Trussell J, & Bennett C. (1995). Condom use among female commercial sex workers in Nevada’s legal brothels. American Journal of Public Health 85(11), 1514–1520.	Nevada, USA
Compromiso Collectivo for Female Sex Workers	Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, Barrington C, Weiss E, & Sweat M. (2006). Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. American Journal of Public Health, 96(1), 120–125.	Dominican Republic
Social and Structural Influence Intervention for Establishment-­based Sex Workers	Morisky DE, Stein JA, Chiao C, Ksobiech K, & Malow R. (2006). Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis. Health Psychology, 25(5), 595–603	Philippines
100 % Condom Use	Celentano DD, Nelson KE, Lyles CM, Beyrer C, Eiumtrakul S, Go VFL, Kuntolbutra S, & Khamboonruang C. (1998). Decreasing incidence of HIV and sexually transmitted diseases in young Thai men: evidence for success of the HIV/AIDS control and prevention program. AIDS, 12(5), F29–F36	Thailand
Sonagachi Project	Swendeman, D., Basu, I., Das, S., Jana, S., & Rotheram-Borus, M. J. (2009). Empowering sex workers in India to reduce vulnerability to HIV and sexually transmitted diseases. Social Science & Medicine (1982), 69(8), 1157–1166. doi:10.1016/j.socscimed.2009.07.035	India
Structural interventions to increase HIV screening and access to HIV antiretrovirals
Prenatal HIV Screening	Rey D, Carrieri MP, Obadia Y, Pradier C, & Moatti JP. (1998). Mandatory prenatal screening for the human immunodeficiency virus: the experience in south-eastern France of a national policy, 1992–1994. British Journal of Obstetrics and Gynecology, 105, 269–274	France
Free ART	Fang CT, Hsu HM, Twu SJ, Chen MY, Chang YY, Hwang JS, Wang JD, Chaung CY, & the Division of AIDS and STD, Center for Disease Control, Department of Health, Executive Yuan. (2004). Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. Journal of Infectious Diseases, 190, 879–885	Taiwan
Drama-Based Intervention to Promote VCT	Middelkoop KM, Myer L, Smit J, Wood R, & Bekker LG. (2006). Design and evaluation of a drama-­based intervention to promote voluntary counseling and HIV testing in a South African community. Sexually Transmitted Diseases, 33(8), 524–526	South Africa