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In 2000, the government of Vietnam conducted the first assessment of its national peer education program for HIV prevention. Twenty (32%) of Vietnam's 61 provinces and urban areas had functioning peer education programs, and program coordinators of all 20 were interviewed regarding their programs. In addition, on-site reviews were done for 10 of the 20 programs, including interviews of peer educators and high-risk persons in each program. The assessment found that a total of 500 peer educators were functioning either independently or as part of one of 79 teams. In the 20 provinces, the peer educators made an estimated 7,000 total contacts per month with high risk persons, but many persons were likely contacted repeatedly. Despite this, coverage was limited: some provinces with high numbers of persons reported with HIV/AIDS had few peer educators. Although most provinces targeted IDU and many targeted CSW, few provinces targeted sex partners of IDU or CSW. The definition of peer education and composition of teams varied substantially by province; only one province included persons living with HIV/AIDS as peer educators. The services provided by peer educators were primarily distributional: delivering information either through word of mouth, pamphlets, or brochures, providing condoms, and sometimes providing clean syringes and needles. Skills building or goal setting interventions aimed at HIV risk reduction were rarely provided. Most provinces had concerns about ongoing funding and sustainability of the programs. Based on the assessment, specific recommendations were provided for strengthening and expanding Vietnam's peer education programs. [ABSTRACT FROM AUTHOR]

Since 1994, the Centers for Disease Control and Prevention has required that the 65 health department grantees that receive funding for HIV prevention interventions engage in a community planning process to involve affected communities in local prevention decision making; to increase the use of epidemiological data to target HIV prevention resources; and to ensure that the planning process takes into account scientific information on the effectiveness and efficiency of different HIV interventions. Local community planning groups are charged with identifying and prioritizing unmet HIV prevention needs in their communities, as well as prioritizing prevention interventions designed to address these needs. Their recommendations, in turn, form the basis for the local health department's request for HIV prevention funding from the Centers for Disease Control and Prevention. Given the community planning process's central role in the allocation of federal HIV prevention funds, it is critical that sound decision-making procedures inform this process. In this article, we review the basics of the community planning prioritization process and summarize the decision-making experiences of community planning groups across the US. We then describe several priority-setting tools and decision analytic models that have been developed to assist in HIV community planning prioritization and discuss their strengths and weaknesses. Finally, we offer suggestions for improving the decision-analytic basis for HIV prevention community planning. [ABSTRACT FROM AUTHOR]

Beginning in fiscal year (FY) 1994, the Centers for Disease Control and Prevention (CDC), in collaboration with health departments and other human immunodeficiency virus (HIV) prevention partners, set in motion a significant innovation in HIV prevention programs: HIV Prevention Community Planning. This process, implemented by all 65 health departments receiving HIV prevention funds from CDC, requires that the identification and prioritization of HIV prevention needs be a shared responsibility between the health departments administering the funds and representatives of the affected communities for whom the services are intended. Guidance for this planning process strongly embraces the notion that high priority HIV prevention strategies and interventions must have a sound basis in behavioral and social science and that program planning must begin with an accurate assessment of the epidemiology of the current and projected future HIV epidemic. Rather than mandate a single standardized process for all of the 65 jurisdictions, CDC guidance provides flexibility for each jurisdiction to configure a planning process responsive to its own unique circumstances. However, all planning activities must be guided by 13 essential principles. This article will describe the principles and logistics of HIV Prevention Community Planning, identify the potential program benefits of this new undertaking, and describe implementation challenges. [ABSTRACT FROM AUTHOR]

Late diagnosis of HIV infection contributes to poor medical outcomes and helps sustain continued transmission of virus. Published evidence suggests that despite current public health recommendations, patients receiving care in the Veterans Health Administration (VHA) system are not being routinely tested for HIV infection. Using a sample of computer-literate veterans, we conducted a survey of recent testing experiences. My HealtheVet (MHV) is a secure website allowing registered Veterans to access limited personal VHA health information. Using the American Customer Satisfaction Index (ACSI) Survey, an electronic questionnaire on "health screening" was conducted in late Fall/early winter 2008-2009. A random sample (4%) of MHV users were surveyed; approximately 17% completed the survey and responses ranged from 31,237 to 33,074. Only 9% of the respondents indicated that they had been offered a test for HIV in the last 12 months compared to 83% who had been offered cholesterol screening, 65% blood sugar screening and 19% who had been offered testing for Hepatitis C virus (HCV). Of those who had been offered HIV testing, 91% indicated that they'd had the test performed. Of note, the percentage of respondents who indicated that they would "very likely" accept a test, if offered, was similar for HIV (73%), HCV (79%), cholesterol (75%), and blood sugar (75%). Although these results cannot be generalized to all Veterans in care, they suggest that routine testing for HIV has not been taking place and support recent VHA policy changes to remove barriers to HIV testing.

In order to identify the optimal configuration of HIV prevention programs, it is necessary to examine different theoretical models of behavior change. Cognitive/decision-making theories of human behavior change are compared to social learning theories vis-a-vis their influence on the structure of service delivery systems. Cognitive/decision-making theories ascribe behavior change to the provision of new information and favor the development of homogeneous interventions providing clients with information about risk behaviors. These interventions are easily standardized across delivery sites and various target populations. Social learning theories view behavior change as a series of stages and recognize the influence of sociocultural variables. They favor multiple heterogeneous interventions in a variety of settings, with the provision of skills training as well as information. Ongoing HIV prevention research indicates that social learning theories provide a more accurate paradigm of human behavior change for the complex behaviors related to HIV risk. Public health agencies must therefore continue to strengthen organizational and referral relationships with community-based organizations that can provide the specialized prevention interventions called for by social learning theory. This will require ongoing collaboration and technical assistance.

As a result of the AIDS (Acquired Immune Deficiency Syndrome) epidemic, many community health agencies are faced with the task of planning and implementing programs to prevent or reduce the risks of HIV (Human Immunodeficiency Virus) infection. Furthermore, the urgency of AIDS will force community groups to develop prevention programs prior to an analysis of substantial data relating to intervention efficacy. By using the five criteria for the development of health promotion and education programs enumerated by the American Public Health Association, planners can benefit from the experience of past health promotion initiatives, and insure a comprehensive approach to planning. The authors describe, using specific examples, how these criteria were used to develop and implement an AIDS risk reduction program for gay and bisexual men.