Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• HIV/AIDS Guidelines and Recommendations   at http://www.cdc.gov/hiv/guidelines/index.html

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Guidelines for Health Education and Risk Reduction Activities

April 1995
                
Centers for Disease Control and Prevention
Atlanta, Georgia

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                               Introduction

Preventing the spread of human immunodeficiency virus (HIV) and sexually
transmitted disease (STD) requires a comprehensive strategy composed of
service delivery systems coupled with effective, sustained health education
and health promotion interventions.  These individual components of a
prevention program must not operate in isolation, but must work together
toward the well-being of the person at risk and the community as a whole. 
All education activities related to HIV/STD prevention should contribute to
and complement the overall goal of reducing high-risk behaviors.

The guidelines presented in this document are written to encourage HIV/STD
prevention programs to focus on developing programs and services that are
based on health education and health promotion strategies.  In Health
Behavior and Health Education: Theory, Research, and Practice, the authors
describe the ultimate aims of health education as being "positive changes
in behavior" (Glanz et al., 1990, p.9).  Green and Kreuter further define
health promotions as ". . . the combination of educational and
environmental supports for actions and conditions of living conducive to
health" (Green and Kreuter, 1991).  Health education is a powerful tool in
an epidemic in which the behavior of using a latex condom can make the
difference in whether or not a person becomes infected with HIV.

It is critically important that members of the populations to be served are
involved in identifying and prioritizing needs and in planning HIV/STD
education interventions.  Their involvement ensures that decisions are
made, purposes are defined, intervention messages are designed and
developed, and funds are allocated in an informed and realistic manner. 
Limited educational resources can be proactively directed to specific
populations, rather than reactively directed or directed on the basis of
guesswork or stereotyping.

Moreover, to be effective, an education intervention must be culturally
competent.  Participation of client populations throughout the process of
designing and implementing programs helps assure that the program will be
acceptable to the persons for whom it is intended.  For the purposes of
this document, cultural competence is defined as the capacity and skill to
function effectively in environments that are culturally diverse and that
are composed of distinct elements and qualities.  Cultural competence
begins with the HIV/STD professional understanding and respecting cultural
differences and understanding that the clients' cultures affect their
beliefs, perceptions, attitudes, and behaviors.  

Health departments across the country have implemented an HIV prevention
community planning process whereby the identification of a community's high
priority prevention needs is shared between the health departments
administering HIV prevention funds and representatives of the communities
for whom the services are intended.  The HIV prevention community planning
process begins with an accurate epidemiologic profile of the present and
future extent of HIV and acquired immunodeficiency syndrome (AIDS) in the
jurisdiction.  Special attention is paid to distinguishing the behavioral,
demographic, and racial/ethnic characteristics of the epidemic.   This is
followed by an assessment of HIV prevention needs that is based on a
variety of sources and is collected using different assessment strategies. 
Next, priorities are established among needed HIV prevention strategies and
interventions for specific populations.  From these priorities, a
comprehensive HIV prevention plan is developed.

Of the eight essential components of a comprehensive HIV prevention program
that are described in the community planning guidance document issued by
CDC, four relate specifically to the interventions described in these
Guidelines.  These are as follows:

  - Individual level interventions which provide ongoing health
    communications, health education, and risk reduction counseling to
    assist clients in making plans for individual behavior change and
    ongoing appraisals of their own behavior. These interventions also
    facilitate linkages to services in both clinic and community settings
    (e.g., substance abuse treatment settings) in support of behaviors and
    practices which prevent transmission of HIV, and they help clients make
    plans to obtain these services.

  - Health communications, health education, and risk reduction
    interventions for groups, which provide peer education and support, as
    well as promote and reinforce safer behaviors and provide interpersonal
    skills training in negotiating and sustaining appropriate behavior
    change.

  - Community level interventions for populations at risk for HIV
    infection, which seek to reduce risk behaviors by changing attitudes,
    norms, and practices through health communications, prevention
    marketing,(1) community mobilization/organization, and communitywide
    events.

   -    Public information programs for the general public, which seek to
        dispel myths about HIV transmission, support volunteerism for HIV
        prevention programs, reduce discrimination toward persons with
        HIV/AIDS, and promote support for strategies and interventions that
        contribute to HIV prevention in the community.

More information on the HIV prevention community planning process is
contained in the Handbook for HIV Prevention Community Planning (Academy
for Educational Development, 1994) or from the HIV/AIDS Program in  your
local health department.  All HIV health education and risk reduction
activities should complement and support the priorities established in the
HIV prevention comprehensive plan developed by the local HIV prevention
community planning group.

For the purpose of this document, communities are defined as social units
that are at least one of the following: functional spatial units meeting
basic needs for sustenance, units of patterned social interaction, or
symbolic units of collective identity (Hunter, 1975).  Communities are
selected for interventions based on their specific and identified needs and
on surveillance and seroprevalence data.

The recommendations in this document recognize that while communities may
have different approaches to HIV/STD prevention programs, certain basic
programmatic, management, and staff requirements are common to effective
health education and risk reduction activities.  These Guidelines describe
the core elements that are essential for success in a number of types of
health education and risk reduction activities -- Individual and Group
Interventions and Community-level Interventions -- and in public
information activities.

These guidelines are provided to assist program planners in enhancing their
health education and risk reduction activities.  In some cases, specific
programs of state and local health departments have advanced beyond the
basic steps outlined here.  In other instances, programs may benefit
greatly from these suggestions.  The priority activities described in this
document can be used in a variety of settings and can also be applied to
other health issues.  

(1) Prevention marketing is CDC's adaptation of social marketing in which
    science-based marketing techniques and consumer-oriented health
    communication technologies are combined with local community
    involvement to plan and implement HIV/AIDS prevention programs. 
    Essentially, Prevention marketing = social marketing + community
    involvement. 

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