Introduction

This monograph describes EDC’s two decades of concentrated work on STD/HIV prevention research by EDC's Health & Human Development Programs division, its collegial partnership with CDC, the relationships between HHD researchers and STD clinic and community agency staff, and the many lessons learned that can inform future HIV prevention efforts in the U.S. and around the globe.

The 1980s were a frustrating time for clinics treating patients with sexually transmitted diseases (STDs). The same patients kept coming back, suffering from repeat infections and continuing to have unprotected sex with multiple partners. Clinic staff, busy providing treatment, had little time or resources for prevention. Frustration was plaguing the research community as well. STDs were rampant in some communities, with those   patients at heightened risk for getting and spreading HIV/AIDS. Condoms were known to be effective against the spread of STDs, but many patients did not use them.

Looking for innovative ways to prevent HIV/STDs, the Centers for Disease Control and Prevention (CDC) enlisted the expertise of EDC’s division of Health and Human Development (HHD) and its Center for Research on High Risk Behaviors.

From this partnership of almost 20 years emerged innovative, rigorously researched, practical interventions that have shown success in reducing STD infection and improving condom use. Lessons from its success have given momentum to promising new ventures in HIV prevention. The intervention, known as VOICES/VOCES, has evolved into a showcase project for CDC, which has asked HHD to test it further for potential use in clinics, jails, and community settings throughout the country.

“ As we continuously expanded on our research, we’ve learned a great deal about what it takes to develop an empirically-based program that can help people overcome some
of the risks that they face every day,” says Lydia O’Donnell, principal investigator for the HIV/STD work.

Much of HHD’s research and evaluation work in STD/ HIV and other disease and risk prevention measures changes in human behavior and in the ability of systems — schools, universities, workplaces, community agencies, clinics, hospitals— to deliver health promotion and prevention programs. In our HIV/STD work, we zeroed in on these key research questions:

• How can we best provide prevention education to clients of STD clinics and other health services that serve men and women at risk for both STD and HIV infection?
• Can prevention programs lead to behavior change and better health outcomes?
• What does it cost to provide effective STD/HIV prevention?
• How can we use evidence of effectiveness to help agencies garner the resources for better prevention programs?
• Does the money spent on prevention reduce the human costs and financial burden of disease and its treatment?
• What supports, such as training and technical assistance, can assist STD clinics, family planning clinics, community health centers and other health services to implement and sustain better prevention programs?
  

In the studies described in this report, HHD scientists looked at self-reports of HIV/STD knowledge and two different indicators of behavior change: condom acquisition and repeat STD infections. Outcomes showed that when compared to adults receiving routine clinic services, clients who participated in the interventions demonstrated the following: Fewer repeat STD infections Greater likelihood of redeeming coupons to get condoms and intention of using them regularly Increased motivation to change behaviors that place them at risk Increased knowledge about HIV and STDs An additional study demonstrated the feasibility and cost-effectiveness of the intervention.

To answer these questions, we draw on a variety of qualitative and quantitative methods:

• Formative and social marketing research to produce culturally and gender relevant prevention programs that meet the needs of both the patient and the provider.
• Randomized clinical trials to assess the effectiveness of interventions in promoting safer behaviors and reducing disease.
• Dissemination research to better understand the research to practice continuum, examining the process of technology transfer and the costs of prevention programs.
• Replication studies to examine how programs are implemented by community agencies and whether interventions developed and evaluated in the research setting are equally effective when delivered by agency providers.
• National dissemination and training and technical assistance to support community agencies as they seek to implement and sustain proven prevention interventions.

Our work builds upon a solid foundation in the social and behavioral sciences, public health, and innovative education and communications strategies. Our multidisciplinary teams have a commitment to improving both knowledge and practice.We seek to answer not only: What are effective strategies for reducing preventable diseases? But also, How can these strategies be effectively employed in the United States and around the world to reduce STDs and HIV— especially among those populations that comprise a disproportionate share of the cases?