Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use.

PURPOSE: To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation.

DESIGN

Repeated cross-sectional sampling with matched intervention and comparison communities.

SETTING

Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution.

SUBJECTS: 3081 injecting drug users who were sexually active and/or shared injection equipment.

INTERVENTION: Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms.

MEASURES: Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners.

RESULTS

Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p < .001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p < .01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p < .05) and other partners (p < .01) and for cleaning injection equipment with bleach (p < .05).

CONCLUSIONS

The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.