This paper draws out and distils three key themes that have emerged from a substantial bibliographical review of a range of HIV intervention programmes, implemented throughout the world between years 1987 and 1995. Specifically, the paper assesses (1) to what extent intervention programmes have been tailored to meet the requirements and needs of specific target groups; (2) to what extent intervention programmes are supported by social and psychological theory of attitudinal and behavioural change, and also to what extent the results and findings from the interventions have amended existing theory; and, finally, (3) the range of methodologies employed in evaluating intervention programmes and also to what extent behavioural measures have been used in examining a programme's effectiveness. In light of these themes, the paper presents and discusses the principal factors thought to contribute towards the effectiveness of HIV intervention programmes.
PIP: An extensive review of the evaluation literature on global human immunodeficiency virus (HIV) prevention programs implemented during 1987-95 identified three key areas of focus: 1) the extent to which interventions have been tailored to meet the needs of target populations; 2) the extent to which programs are supported by social and psychological theories of attitudinal and behavioral change; and 3) assessment of the methodologies used in program evaluation, especially behavioral measures. The literature reveals a shift over time from interventions aimed at the general public to those tailored to the needs of four risk groups: young people, homosexual/bisexual men, commercial sex workers, and intravenous drug users. Only a minority of programs were based on a specific theoretical approach to behavioral change, and there has been little refinement of existing psychosocial theory; however, awareness of the inadequacy of purely cognitive, information-giving approaches has increased. A trend toward inclusion of an evaluation component has enhanced program design. The ideal evaluation strategy would include explicit theoretical grounding, both process and outcome evaluation methodologies, baseline testing of attitudes and behaviors, use of equivalent control groups, evaluation of both cognitive and behavioral impacts, post-test measures of behavioral change, and longitudinal evaluation of sustained change over time. The literature indicates that prevention programs should involve a significant pre-planning component to assess the nature and extent of salient behaviors. Most effective have been multifaceted efforts that encompass not only knowledge acquisition, but also social skills, role-plays, communication techniques, assertiveness training, and improvements in self-efficacy. Finally, community participation (especially with hard-to-reach or stigmatized groups) and establishment of referral linkages to local health care agencies have been critical to program success.