Evaluation of an HIV Prevention Intervention for African Americans and Hispanics: Findings from the VOICES/VOCES Community-Based Organization Behavioral Outcomes Project
First Online: 14 May 2011 DOI:
Cite this article as: Fisher, H.H., Patel-Larson, A., Green, K. et al. AIDS Behav (2011) 15: 1691. doi:10.1007/s10461-011-9961-7 Abstract
There is limited knowledge about whether the delivery of evidence-based, HIV prevention interventions in ‘real world’ settings will produce outcomes similar to efficacy trial outcomes. In this study, we describe longitudinal changes in sexual risk outcomes among African American and Hispanic participants in the Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES) program at four CDC-funded agencies. VOICES/VOCES was delivered to 922 high-risk individuals in a variety of community settings such as substance abuse treatment centers, housing complex centers, private residences, shelters, clinics, and colleges. Significant risk reductions were consistently observed at 30- and 120-days post-intervention for all outcome measures (e.g., unprotected sex, self-reported STD infection). Risk reductions were strongest for African American participants, although Hispanic participants also reported reducing their risky behaviors. These results suggest that, over a decade after the first diffusion of VOICES/VOCES across the U.S. by CDC, this intervention remains an effective tool for reducing HIV risk behaviors among high-risk African American and Hispanic individuals.
Keywords HIV sexual risk behaviors HIV risk reduction interventions VOICES/VOCES African Americans Hispanics HIV/AIDS Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Laurencin CT, Christensen DM, Taylor ED. HIV/AIDS and the African American community: a state of emergency. J Natl Med Assoc. 2008;100(1):35–43.
Centers for Disease Control and Prevention. Epidemiologic notes and reports: acquired immunodeficiency syndrome (AIDS) among Blacks and Hispanics-United States. MMWR Morb Mortal Wkly Rep. 1986;35(42):655–8, 663–6.
Hall I, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance, 2008. Atlanta: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; November 2009.
Centers for Disease Control and Prevention. HIV surveillance report, 2009, vol 21.
. Published February 2011. Accessed 30 March 2011.
U.S. Census Bureau. Overview of race and Hispanic origin: Census 2000 brief. Available at:
. Accessed 4 August 2010.
Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57:985–9.
Hall H, An Q, Hutchinson A, Sansom S. Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2004–2005. JAIDS. 2008;49(3):294–7.
Centers for Disease Control and Prevention. HIV prevention through early detection and treatment of other sexually transmitted diseases—United States. MMWR Morb Mortal Wkly Rep. 1998;47:1–24.
Darbes L, Crepaz N, Lyles C, Kennedy G, Rutherford G. The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. AIDS. 2008;22(10):1177–94.
Albarracin J, Albarracin D, Durantini M. Effects of HIV-prevention interventions for samples with higher and lower percents of Latinos and Latin Americans: a meta-analysis of change in condom use and knowledge. AIDS Behav. 2008;12:521–43.
Kalichman S, Kelly J, Hunter T, et al. Culturally tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: impact on risk sensitization and risk reduction. J Consult Clin Psychol. 1993;61(2):291–5.
O’Donnell L, Doval A, Duran R, O’Donnell C. Video-based sexually transmitted disease patient education: Its impact on condom acquisition. Am J Public Health. 1995;85:817–22.
O’Donnell L, Doval A, Duran R, O’Donnell C. The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients. Sex Transm Dis. 1995;22(2):97–103.
O’Donnell C, O’Donnell L, Doval A, Duran R, Labes K. Reductions in STD infections subsequent to an STD clinic visit: using video-based patient education to supplement provider interactions. Sex Transm Dis. 1998;25:161–8.
Sweat M, O’Donnell C, O’Donnell L. The efficacy of behavioral interventions in reducing HIV risk behaviors and incident sexually transmitted diseases in heterosexual African Americans. AIDS. 2001;15:781–7.
Centers for Disease Control and Prevention. CDC’s HIV/AIDS prevention strategy. Available at:
. Accessed 27 July 2010.
Centers for Disease Control and Prevention. HIV/AIDS prevention research synthesis project. Available at:
. Accessed 27 July 2010.
Center on AIDS and Community Health. Diffusion of Effective Behavioral Interventions (DEBI) Web site. Available at:
. Accessed 17 April 2010.
Neumann MS, Harshbarger C, Bankston A, Patel-Larson A. Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES). Presentation at Centers for Disease Control and Prevention, Atlanta, GA, 19 August 2009.
Galbraith JS, Stanton B, Boekeloo B, et al. Exploring implementation and fidelity of evidence-based behavioral interventions for HIV prevention: lessons learned from the Focus on Kids diffusion case study. Health Educ Behav. 2009;36(3):532–49.
Kalichman SC, Hudd K, Diberto G. Operational fidelity to an evidence-based HIV prevention intervention for people living with HIV/AIDS. J Prim Prev. 2010, Jun 27 [Epub ahead of print].
Neumann MS, O’Donnell L, San Doval A, et al. Effectiveness of the VOICES/VOCES STD/HIV prevention intervention when administered by health department staff: does it work in the “real world”? Sex Transm Dis. 2011;38(2):133–9.
Harshbarger C, Simmons G, Coelho H. An empirical assessment of implementation, adaptation, and tailoring: the evaluation of CDC’s national diffusion of VOICES/VOCES. AIDS Educ Prev. 2006;18(Suppl A):184–97.
Kelly JA, Heckman TG, Stevenson LY, et al. Transfer of research-based HIV prevention interventions to community service providers: fidelity and adaptation. AIDS Educ Prev. 2000;12(Suppl A):87–98.
Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton-Mifflin; 2002.
Smith BD, Kalayil EJ, Patel-Larson A, Uhl G, Vaughan, M, Stratford D. Retaining clients in an outcome monitoring project: HIV prevention efforts in community settings; 2010. Unpublished manuscript.
Thomas CW, Smith BD, Wright-DeAguero L. The Program Evaluation and Monitoring System: a key source of data for monitoring evidence-based HIV prevention program processes and outcomes. AIDS Educ Prev. 2006;18(Suppl A):74–80.
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.
Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.
Veniegas RC, Kao UH, Rosales R. Adapting HIV prevention evidence-based interventions in practice settings: an interview study. Implem Sci. 2009;4:76.
Heitgerd JL, Kalayil E, Patel-Larson A, et al. Evaluating an HIV prevention intervention for HIV-positive persons: outcome monitoring of Healthy Relationships by seven community-based organizations. AIDS Behav. 2011 [Epub ahead of print].
© Springer Science+Business Media, LLC (outside the USA) 2011