VOICES/VOCES Intervention at a Glance

In the 1980s, HIV/AIDS emerged as a public health crisis, casting a spotlight on
the longstanding problem of sexually transmitted infections. STDs were — and are now — a major preventable cause of morbidity and mortality in the United States. Today, as in the 1980s, adults seeking services from STD clinics often have multiple STDs and engage in unprotected sex that jeopardizes their own and their partners’ health. Although most STDs can be treated successfully with antibiotics, infection puts a person at risk of developing subsequent and more serious infections. Repeat STDs have been associated with infertility, ectopic pregnancy, cervical cancer, and HIV transmission.

HIV/STD rates also illuminate the stark health disparities between U.S. population groups. Fifty-four percent of new HIV cases reported in the U.S. occur among African Americans, and 19 percent of new cases occur among Hispanics, who represent only an estimated 13 percent and 12 percent, respectively, of the total U.S. population. Gonorrhea rates are about 30 times higher among African Americans in the U.S. as compared to whites, and 3 times higher among Hispanics. Likewise, rates of syphilis are 21 times higher among African Americans as compared to whites, and 3 times higher among Hispanics. (source: CDC website).

To address the problem of STDs and HIV, we brought together multidisciplinary teams of scientists and practitioners. Collectively, these teams have training and expertise in public health research and practice, the behavioral sciences, education, performance art and communication, and health care practice. A key ingredient of our work is the collaboration between those with research backgrounds and those with experience working on the front lines of STD/HIV prevention. Experienced field staff contribute first-hand knowledge of the operations of health agencies and knowledge of what is important to both patients and providers. The investigators bring their understanding of theories of human and social behavior that underlie informed prevention strategies and their knowledge of research methods and tools.

Our work in STD prevention began with an innovative idea: Can we create an educational video that motivates STD clinic clients to protect their health? Millie Solomon and her colleague William DeJong, drawing on their backgrounds in public health, education, and the dramatic arts, set out to produce the first in what would become a series of dramatic brief videos that could be viewed by patients during their clinic visit. This early 1980s video, Let’s Do Something Different, offered at the major STD clinic in Massachusetts, was shown to be effective in motivating STD patients to take the medication prescribed to them by clinic staff and to get and use condoms.

This research provided a springboard for what has now become the VOICES/VOCES project (Video Opportunities for Innovative Condom Education and Safer Sex) and
addresses the combined problems of STD and HIV.With continued funding from the CDC, Lydia O’Donnell has continued this early work and led an expanded team to develop,
evaluate, and disseminate brief, video-based prevention interventions. Instrumental to the success of this work has been the long-term involvement of Alexi San Doval, senior project director, and Richard Duran, field supervisor. Both San Doval and Duran came to EDC after years of working with the New York City Department of Health. Their knowledge and contacts within this system have enabled EDC to establish a longterm relationship with city clinics, where programs have been developed and evaluated. EDC specialists have also joined the team, including Melanie Adler, materials developer, and senior
methodologist Carl O’Donnell. This team created several new videos in the mid 1990s, including the bilingual and award-winning Porque Si, designed for Latino men and
women, and the more recently completed Love Exchange for African Americans.

Through these multiple efforts, HHD investigators have cultivated intensive involvement of community members in the development process, a key factor in the effectiveness of our approach. In multiple focus groups and clinic observations involving patients and staff, HHD researchers learned what educational messages are most important to convey and how these messages can be delivered with the greatest impact. Community advisory boards have helped guide the development process. Thus, the team includes not only expert researchers and practitioners, but also community experts.

HHD researchers published the promising results of the clinical trials in academic papers (see Publications – inside back cover) and have now turned their attention to assisting
other health care providers who are adopting the intervention. In 1997, the CDC selected the VOICES/VOCES program for inclusion in the Replicating Effective Programs project (REP), its flagship initiative to build a bridge between research and practice. Through REP, HHD developed and tested a technical assistance package of materials to aid replication
in other clinics and health care settings. HHD found that with brief technical assistance, the intervention could be successfully implemented with similar audiences.With the
REP nomination, and additional evidence about the feasibility of replication, VOICES/VOCES became one of the first proven HIV prevention programs to be disseminated through a federally sponsored national training and technical assistance network.