ANN ARBOR—What distinguishes an effective AIDS prevention program from an exercise in futility? A new book, “AIDS Prevention in the Community,” edited by health behavior specialists from the University of Michigan and Hunter College in New York, has some no-nonsense advice.

The book, which presents 12 case studies, incorporates lessons drawn from a decade of AIDS prevention and evaluations of 54 AIDS prevention projects.

Funded by the Robert Wood Johnson Foundation, the projects were diverse, ranging from the California Prostitutes Education Project in San Francisco to Cleveland’s Catholic Counseling Center for Latino youth and families and the Gay Men’s Health Crisis Inc., headquartered in New York City.

Based on the evaluations, Professors Marc A. Zimmerman of the U-M and Nicholas Freudenberg of Hunter College recommend that:

• mingle with the target population. Go to bars, parks, homes, migrant worker camps, union halls, and “stroll districts” for prostitutes. Developing acceptance is crucial because “due to denial, fear or lack of information,” many people fail to acknowledge that their own behavior places them at high risk for AIDS.

• context that acknowledges immediate struggles and needs. AIDS prevention messages about infections that may develop in 10 years “go unheeded” by participants concerned about finding today’s food, clothing and shelter. Programs that incorporated immediate needs from the beginning had much greater success in recruitment and retention.

• effective than one-on-one counseling or large audience presentations. Small groups relieve the intense focus of a counseling session, provide a safe communal space, offer participants the chance to hear that they are not alone and help to change group norms.

• group and tailor your message. “For example, the projects serving the Latino community incorporated the values of family, personal respect, and responsibility into their interventions.” Those working with street gangs worked hard to use the most current slang and idioms.

In California, prostitutes became safer-sex outreach workers and gave workshops in motel rooms.

• may need help dealing with “power imbalances” between themselves and men in sexual situations, while ” men may benefit from messages promoting condom use as masculine.”

• prostitute’s program offered food and beverages, cash for correct answers on sex quizzes, and condoms, lubricants and bleach “to attract a highly mobile and sometimes suspicious population.”

• school credit to peer educators and workshop leaders. The credit also provided “an easily justifiable reason for participating in an AIDS program.”

• teen theater group developed a menu of 13 AIDS prevention skits. Elementary schools frequently selected the “Saying No and Meaning It” skit while a Catholic high school opted to eliminate the condom presentation.

• different speakers, celebrities, skits, videos, murals, song-writing contests, group discussions, brochures, counseling, and health fairs.

• are reluctant to discuss condoms and safer sex, but “those projects that did address these issues head on seldom encountered serious problems” and found that their “fears about engendering conflict had been exaggerated.”

• Catholic Counseling Center projects offered training sessions to parents so they could become familiar with the content of the sessions and ask questions in advance. In both instances, 100 percent of the students ultimately participated.

Related Links:

• Marc A. Zimmerman
• Nicholas Freudenberg