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This document is being maintained for historical purposes, but is now out of date.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

---

Guidelines for Health Education and Risk Reduction Activities

April 1995
                
Centers for Disease Control and Prevention
Atlanta, Georgia

*****************************************************************************

                      Community Level Intervention

Community Level Intervention combines community organization and social
marketing -- a strategy that takes a systems approach.  Its foundation is
an assumption that individuals make up large and small social networks or
systems.  Within these social networks or systems, individuals acquire
information, form attitudes, and develop beliefs.  Also, within these
networks, individuals acquire skills and practice behaviors.

The fundamental program goal of Community Level Intervention is to
influence specific behaviors by using social networks to consistently
deliver HIV risk reduction interventions.  Although the intervention
strategy is community-based, Community Level Interventions target specific
populations -- not simply the community in general.  The client populations
have identified shared risk behaviors for HIV infection and also may be
defined by race, ethnicity, gender, or sexual orientation.

In order to influence norms that support HIV risk reduction behavior,
Community Level Interventions are directed at the population, rather than
at the individual.  The primary goal of these interventions is to improve
health status by promoting healthy behaviors and changing those factors
that negatively affect the health of a community's residents.  A specific
intervention may take the form of persuasive behavior change messages, or
it may be a skills-building effort. Whatever its form, an intervention
achieves reduced HIV risk by changing group norms to improve or enhance the
quality of health for members of the client population.  These norms may
relate to condom use, contraceptive use, or needle-sharing.  They may also
focus on diagnosis and treatment of sexually transmitted diseases or HIV-antibody counseling and testing.

It takes time to change social norms.  Social norms cannot be changed
quickly or at the same rate that knowledge acquisition or skills
development can occur.  Change occurs as a result of sustained, consistent
intervention efforts over time.  The intervention must be implemented
thoroughly throughout the social networks.  A firm grounding in behavioral
theory is essential to the development and implementation of Community
Level Interventions. 

Community-based needs assessment is critical to the development and
implementation of Community Level Interventions. This phase is important
for identifying and describing structural, environmental, behavioral, and
psychological facilitators and barriers to HIV risk reduction.  To
successfully conduct this intervention, a program must identify the sources
for and patterns of communication within a social network.  Peer networks
must be defined and described.  

Note: Community Level Intervention is referred to as Community Intervention
Programs in Program Announcement #300.

The following questions should be considered in designing community level
interventions: 

  - Who are the gatekeepers to the client population?

  - What are the important points of access?

  - What are the appropriate and relevant risk-reduction messages, methods,
    and materials?  

  - What are the linguistic and literacy needs of the client population? A
    needs assessment should yield this vital information. 

For further reading on the developmental steps of Community Level
Intervention, see Cooperative Agreement for Human Immunodeficiency Virus
(HIV) Prevention Projects Program Announcement and Notice of Availability
of Funds for Fiscal Year 1993.

A variety of methods exists for collecting the answers to these questions. 
It is recommended that programs select the method that is most appropriate
for their professional orientation (e.g., social work, health education). 
Whatever method is chosen, it is critical that the formative activity be
community-based and as collaborative as possible with the client
population.

The information gathered during the formative phase provides the foundation
on which an effective program can be built.  Completing this activity
should result in culturally competent, developmentally appropriate,
linguistically specific, and sexual-identity-sensitive interventions that
promote HIV risk reduction.

Members of existing and relevant social networks can be enlisted to deliver
the interventions.  Other peer networks may also be created and mobilized
to provide intervention services.  This, of course, means volunteer
recruitment and management.  Community Level Intervention strategies offer
opportunities for peers to acquire skills in HIV risk reduction and, in
turn, reinforce these abilities when the peers become the teachers of these
same skills to others.

In this manner, Community Level Interventions become community-owned and
operated; thus, they are more likely to be sustained by the community when
the program activity is completed.  Social norms changed in this way are
likely to have a long-lasting and effective impact upon HIV risk reduction. 

---