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HIV Prevention Education and Risk Reduction

"Prevention through education" has been a priority of the Wisconsin AIDS/HIV Program since its inception in the 1980's. This theme focuses on the central role education plays in addressing the broad range of HIV-related prevention information and skill-building needs of diverse groups of individuals and communities.

Prevention education programs supported by the Wisconsin AIDS/HIV Program have taken many forms, including media campaigns for the general public, teen peer education, and focused risk reduction programs for men who have sex with men. While variable in content and approach, HIV prevention programs share a common goal of supporting and sustaining positive health behaviors in order to limit and ultimately eliminate HIV-related health risks. Prevention programs accomplish this goal through methods that effectively address the unique cultural, social, and educational needs of individuals, groups, and communities.

HIV prevention education programs in Wisconsin have been directed at the general population and individuals with HIV-related risk behaviors. Early prevention programs emphasized basic facts about HIV and AIDS, examined concepts related to infection control, and attempted to address common myths, misunderstandings, and irrational fears about the epidemic. Prevention education programs for the general public were usually didactic and frequently held in large group settings in schools and colleges, at meetings of civic organizations, and in the workplace.

HIV prevention education programs and related activities supported by the Wisconsin AIDS/HIV Program include:

  • Knowledge, attitude and behavior (KAB) surveys of the general public and ethnic minority communities that evaluated the need for and success of education initiatives.

  • A statewide media campaign that was tailored for Wisconsin residents and adapted from the national America Responds to AIDS media campaign.

  • Grant supported local and regional prevention education programs targeted to populations at risk and implemented by AIDS service organizations and minority community-based organizations.

  • A grant supported toll-free statewide information hotline and resource library serving as an information clearinghouse that collects and distributes brochures, video and audio tapes, books, posters, and other materials.

  • Print and audiovisual resources developed by the Wisconsin AIDS/HIV Program and provided to local public health agencies, physicians, community educators, infection control practitioners, and other service providers and agencies.

Prevention services for youth
For five years, the Wisconsin AIDS/HIV Program provided funding to AIDS service organizations (ASOs) and community-based organizations (CBOs) for general HIV prevention. The funds were used in communities to increase awareness of HIV and to dispel myths about HIV/AIDS. A few ASOs and CBOs began to include youth in World AIDS Day activities, presentations and small volunteer projects. In 1993, the AIDS/HIV Program recognized the need to develop specific HIV prevention programs for youth. Grants to nine ASOs and six CBOs enhanced or developed HIV youth peer education programs.

In 1995, the HIV Prevention Planning Council identified strategies to reach targeted population and the AIDS/HIV Program solicited HIV prevention grant applications for the following areas:

  • pregnant and parenting youth

  • runaway youth and youth in the juvenile justice system

  • HIV prevention teen peer mentor training

  • gay, lesbian, bisexual youth

Grant funds targeted at-risk youth by integrating HIV prevention messages into existing programs, reaching incarcerated youth, developing a statewide peer education training center, and coordinating a conference with mini-grants to assist providers working with gay youth. The result of this targeted funding increased HIV awareness among youth, developed a network of HIV programs serving gay youth, provided risk-reduction skills to incarcerated youth, and sponsored regional speak-out forums statewide. The AIDS/HIV Program continues to target HIV prevention services for at-risk youth.

Prevention services for men who have sex with men
Early efforts to reach gay men and other men who have sex with men (MSM) included distribution of risk reduction kits in gay bars and multi-session workshops with instruction on safer sex practices.

Prevention efforts for MSM in the late 1990's included:

  • outreach and distribution of risk reduction kits in bars and other high-risk settings;

  • opinion leader interventions in select areas in the state, based on the diffusion model developed by faculty at the Center for AIDS Intervention Research, Medical College of Wisconsin;

  • community-building efforts, including events, informal discussion groups, and support groups focused on HIV prevention and critical issues in men’s lives;

  • a social marketing campaign encouraging men who have sex with men to engage in safer behaviors; a  social marketing campaign encouraging men who have sex with men to engage in safer behaviors;

  • capacity-building efforts to improve services for gay and bisexual youth; and

  • conference and mini-grants to assist informal groups of African American and Latino gay and bisexual men to develop their capacity to provide prevention services.

An initiative beginning in 1999 is designed to develop the capacity of organizations in communities of color to reach men of color who have sex with other men.

Prevention services for injection drug users
For many years, the majority of HIV prevention services for injection drug users (IDUs) and their partners was limited to street outreach workers providing leaflets and health promotion materials. Historically, the drug using population was approached individually to increase knowledge of detrimental effects of drugs. Most programs focused on changing beliefs and behavior. Many IDUs face enormous challenges such as low literacy skills, cultural, language, stigmatization, poverty, and social acceptance.

The AIDS/HIV Program supports prevention programs targeting IDUs and their partners. Street outreach services for drug using populations occur in jails, crack houses, shelters, meal programs, and group homes. AIDS service organizations in the metropolitan areas of Milwaukee, Madison, and Kenosha have utilized HIV prevention funds to support effective outreach to IDUs, including outreach counseling and testing services. These efforts are coordinated with prevention services promoting harm reduction and treatment interventions for IDUs.

Prevention services for women
Since nearly the beginning of the epidemic, efforts aimed at women have included a focus on preventing transmission from mother to infant. In 1994, the federal 076 trial found that zidovudine (AZT) provided to pregnant women during pregnancy and delivery resulted in a dramatic reduction in risk of transmission from an infected pregnant woman to her fetus.

The AIDS/HIV Program has collaborated closely with the Wisconsin Association for Perinatal Care, members of the Wisconsin Chapter of the American College of Obstetric and Gynecology, the Wisconsin Chapter of the American Academy of Pediatrics, and other professional groups in promoting routine prenatal counseling and voluntary testing for HIV. The Wisconsin AIDS/HIV Program developed advisory materials for prenatal care providers as well as consumer education materials for pregnant women. In 1995-96, the AIDS/HIV Program contracted with the Medical College of Wisconsin to provide in-service training to physicians and other medical providers to ensure that pregnant women were offered HIV counseling and testing and if identified as HIV-infected, offered AZT and other appropriate treatment. 

Efforts to prevent HIV transmission in women focus on those in the sex industry, those currently in or recently released from correctional facilities, women who abuse alcohol and drugs, and pregnant and parenting adolescents. Strategies to reach women at risk include facilitator- and peer-led group sessions, street and community outreach, and individual risk-reduction counseling.

Prevention services for HIV positive persons
Since early in the epidemic, two strategies have been critical to reaching HIV-infected persons--HIV counseling and testing, and partner counseling and referral services. Recently, prevention case management is being provided to reach HIV-infected persons continuing to engage in risky behaviors.

HIV counseling and testing offers individuals an opportunity to know their serostatus. As part of counseling and testing services, individuals who learn they are HIV-infected can access timely medical and support services and can change behavior in order to reduce the risk of infecting others.

Partner services, formerly known as "partner counseling and referral services" and previously as "partner notification," has been the primary HIV prevention strategy aimed at reducing transmission from persons who know they are HIV-infected. Sexual and needle-sharing partners of HIV-infected persons are contacted, without revealing the identity of the source patient, and advised that they may have been infected. They are encouraged to seek HIV counseling and testing services.

Prevention services for communities of color
Reaching minority populations through public information alone has limited effectiveness. To reduce HIV infection in communities of color, prevention programs should address the cultural and linguistic needs of these populations.

In 1989, the Wisconsin AIDS/HIV Program received funds to provide direct funding to minority community-based organizations (CBOs) for HIV prevention. A competitive grant application process identified five CBOs from the African American, Hispanic, and Native American target populations. CBOs spent the first few years conducting HIV prevention presentations and risk reduction programs led by social workers, nurses, teen peers and indigenous outreach workers. These programs dispel the myths of HIV/AIDS, increase HIV community awareness and promote risk reduction. CBOs were identified as the best agent to deliver these prevention messages because of established trust among community leaders and track records in working with minorities.

In 1996, CBOs were encouraged to redirect prevention strategies to reach at-risk populations. HIV prevention programs were developed targeting men of color who have sex with men (MCSM); injection drug users and their partners; pregnant and parenting teens; homeless and incarcerated youth; and gay, lesbian, and bisexual youth. The targeted programs promoted counseling and testing and risk reduction for high risk youth, identified a leadership task force for MCSM, provided direct funding for culturally-specific case management services in minority CBOs, and increased collaborations with ASOs.

Prevention efforts in communities of color are most successful when HIV is addressed as a community health issue. The 1999 federal and congressional focus on addressing HIV/AIDS as state of emergency in minority populations provided an opportunity to initiate and reinvigorate HIV prevention efforts among communities of color. Many of these are under the rubric of capacity-building.

Capacity building
Since the 1980s, the AIDS/HIV Program has provided targeted trainings and sponsored statewide AIDS/HIV conferences. In the early years, training was directed at provider skill-building, increasing community awareness, and sponsoring training-of-trainer workshops. In 1996, funds were distributed to grantees to address staff training needs and upgrade computer and information systems. The AIDS/HIV Programs continues to sponsor the biennial AIDS/HIV Program conference, minority conferences, grantee administrative meetings, youth peer education conferences, grant-writing workshops, regional teleconferences, and program-specific work group training.

Major capacity-building efforts focus on communities of color and include:

  • leadership summits in African American and Latino communities to identify stakeholders and leaders, and to increase awareness and mobilize communities to reduce the spread of HIV;

  • capacity-building efforts aimed at enhancing the ability of agencies in communities of color to reach men of color who have sex with men;

  • coalition-building efforts to utilize faith-based institutions in communities of color to disseminate HIV prevention messages; and

  • technical assistance regarding program development, evaluation, and agency infrastructure to enhance the capacity of ethnic minority community-based organizations to provide targeted HIV prevention services.

Prevention evaluation
The AIDS/HIV Program is committed to improving the effectiveness and quality of HIV prevention programs in Wisconsin through comprehensive evaluation efforts.

The AIDS/HIV Program believes that:

  • evaluation helps agencies improve their services;

  • evaluation is essential in program planning and resource allocation;

  • process evaluation is critical to ensure effective outcome evaluation;

  • whenever possible, evaluation should be conducted by grantee agencies, with support and technical assistance from outside resources; and

  • evaluation activities should be developed by a broad range of stakeholders.

Towards these goals, the AIDS/HIV Program has developed a statewide prevention evaluation system to implement and monitor evaluation activities and provide high quality, accessible training, and technical assistance to local grantee agencies.

In October 1995, the AIDS/HIV Program initiated its first formal efforts to offer evaluation technical assistance to grantee agencies through the development of a contract with the Center for AIDS Intervention Research (CAIR) at the Medical College of Wisconsin. CAIR conducted grantee needs assessments, facilitated regional workshops, and provided individualized on-site and telephone technical assistance to local organizations.

In 1996, the AIDS/HIV Program convened an evaluation work group to provide input on evaluation activities and instruments. The group is comprised of AIDS/HIV Program staff, members of the HIV Prevention Community Planning Council, staff from grantee agencies, and local and regional evaluation consultants.

In 1997, the Centers for Disease Control identified Wisconsin as one of five sites to participate in a national demonstration project to evaluate the impact of community planning on statewide prevention activities. This project was critical in identifying the strengths and weaknesses of Wisconsin's HIV prevention evaluation efforts up to that time.

As part of current contracts with HIV prevention grantees, the AIDS/HIV Program requires that at least 10% of HIV prevention funds allocated to grantee agencies be designated towards evaluation. For some agencies, this represents their first formal efforts to systematically conduct needs assessment and process and outcome evaluation activities, in addition to traditional work plan monitoring activities.

In 1997, the AIDS/HIV Program, in collaboration with the Evaluation Work Group, developed and pilot tested an Annual Report Form, the program's first uniform data collection instrument that collects demographic data about program participants served through grantee agencies and includes grantees' assessments of their projects.

In September 1998, the AIDS/HIV Program added a full-time HIV prevention evaluator position to the staff. The position is responsible for coordinating a statewide evaluation system, collecting and analyzing contract performance indicator data, providing technical assistance and training to local agencies, and advising the AIDS/HIV Program on future evaluation initiatives.

The AIDS/HIV Program, in conjunction with the work group, has developed a comprehensive five-year work plan to assist in the design and implementation of future evaluation activities. This is part of a larger national initiative to create a core evaluation system that assesses and improves state health department and CDC prevention programs.

In early 2000, the AIDS/HIV Program issued new evaluation guidance to grantees which includes a revised data collection system.

The AIDS/HIV Program continues working collaboratively with grantee agencies and other public and private organizations to implement comprehensive evaluation activities in order to deliver the highest quality, most effective HIV prevention services possible.

For further information regarding the following areas, contact the staff listed below:

Overall HIV prevention programming:
Timothy Pilcher: 608-264-6514

HIV prevention programs for communities of color:
Karen Johnson: 608-266-1808

HIV prevention evaluation activities:
Mari Gasiorowicz: 608-261-6731

Last Revised: March 24, 2014