Community-based HIV Prevention Intervention Research Articles

A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa

BackgroundCombination prevention interventions, when integrated with community-based support, have been shown to be particularly beneficial to adolescent and young peoples’ sexual and reproductive health. Between 2020 and 2022, the Africa Health Research Institute in rural South Africa conducted a 2 × 2 randomised factorial trial among young people aged 16–29 years old (Isisekelo Sempilo) to evaluate whether integrated HIV and sexual and reproductive health (HIV/SRH) with or without peer support will optimise delivery of HIV prevention and care. Using mixed methods, we conducted a process evaluation to provide insights to and describe the implementation of a community-based peer-led HIV care and prevention intervention targeting adolescents and young people.MethodsThe process evaluation was conducted in accordance with the Medical Research Council guidelines using quantitative and qualitative approaches. Self-completed surveys and clinic and programmatic data were used to quantify the uptake of each component of the intervention and to understand intervention fidelity and reach. In-depth individual interviews were used to understand intervention experiences. Baseline sociodemographic factors were summarised for each trial arm, and proportions of participants who accepted and actively engaged in various components of the intervention as well as those who successfully linked to care were calculated. Qualitative data were thematically analysed.ResultsThe intervention was feasible and acceptable to young people and intervention implementing teams. In particular, the STI testing and SRH components of the intervention were popular. The main challenges with the peer support implementation were due to fidelity, mainly because of the COVID-19 pandemic. The study found that it was important to incorporate familial support into interventions for young people’s sexual health. Moreover, it was found that psychological and social support was an essential component to combination HIV prevention packages for young people.ConclusionThe results demonstrated that peer-led community-based care that integrates SRH services with HIV is a versatile model to decentralise health and social care. The family could be a platform to target restrictive gender and sexual norms, by challenging not only attitudes and behaviours related to gender among young people but also the gendered structures that surround them.

Preventing infectious diseases at the community level: an asset ecosystems approach

BackgroundInterlocking planetary health crises can reveal the complex nature of human and environmental interactions and highlight the importance of broader health ecosystems. Reductionist approaches to human health overlook broader systems factors, such as informal economies and environmental factors. However, these systems play an key role in the promotion of health and prevention of infectious diseases such as HIV and malaria. To better understand these factors, we applied a community and health asset ecosystem approach to infectious disease prevention, drawing on systems thinking and asset-based methods. MethodsWe did a systematic review and qualitative synthesis, including English-language literature from community and participatory programmes in low-income and middle-income countries worldwide that were focused on Sustainable Development Goal 3.3, with no date restrictions. We applied a systems-minded, asset-based approach to analysis, to construct a community and health asset ecosystem and understand how community and health systems assets come together to prevent infectious diseases in dynamic, multilevel, and non-linear ways. FindingsWe included eight papers in the final review, which were original qualitative and quantitative research articles and systematic reviews from community-based HIV and malaria prevention interventions. Systems of health assets spanned micro, meso, and macro levels, and were identified across the informal community setting and the formal health system setting. Community assets represented primary (those inherent to the individual or community), secondary (knowledge, technologies, and rules to harness primary resources), and tertiary (higher-level community processes promoting quality and stewardship of local assets) resources. Process factors driving the success of community programmes involved partnerships, engagement, sufficient resource availability, and community leadership. InterpretationBeyond identifying systems of local assets for health, our approach emphasises the process of how these assets are best converted into meaningful outcomes. The community and health asset ecosystem reflects the complex human–environmental interface and sheds light on how individuals or communities can effectively and sustainably place a claim on assets necessary to achieve health. FundingNone.

Knowledge, attitudes and practices of young adults towards HIV prevention: an analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa

BackgroundWith an HIV incidence of 1.00 skewed against women (1.51), adolescents in South Africa are at high HIV risk. This paper assesses young adults’ (18–24 years) knowledge, attitudes and practices regarding HIV prevention in Nkangala and OR Tambo districts.MethodsA cross-sectional household survey was conducted in two districts in 2017/8. Participants completed computer-assisted self-interviews on HIV knowledge, attitudes, behaviour practices, use of social media and condom use at last sex (proxy for high-risk sex). HIV knowledge was assessed using the South African-adapted UNAIDS scale. Descriptive analyses were conducted and logistic regression models were built to assess factors associated with being knowledgeable of HIV and condom use at last sex.ResultsOne thousand nine hundred fifty-five participants were interviewed (90% response rate). Less than half (44.7%) had correct knowledge of HIV prevention and 73% used a condom at last sex. Social media use predicted high HIV knowledge as higher odds were observed among participants using the print media (aOR1.87; 1.34–2.60), WhatsApp (aOR1.55; 1.26–1.90), radio/television (aOR2.75; 1.15–6.55) although social networking sites’ use protected against knowledge acquisition (aOR0.53; 0.34–0.82). Females (aOR0.75; 0.58–0.97) and participants reporting sexual risk were less likely to have HIV knowledge as negative associations were found for having multiple sexual partners in the last 3 months (aOR0.63;0.48–0.82) and ever having sex (aOR0.37;0.23–0.61). Participants who abused drugs (aOR1.40; 1.05–1.88) and had attitudes accepting people living with HIV (aOR2.05; 1.14–3.69) had higher odds of having HIV knowledge. Females (aOR0.70; 0.54–0.91), students (aOR0.52; 0.40–0.66) and participants who abused drugs (aOR0.58; 0.43–0.77) were less likely to report condom use at last sex.ConclusionsThere is a correlation between media use and HIV knowledge, non-condom use and HIV knowledge, and high-risk sexual behaviours and less HIV knowledge. An aggressive community media campaign utilising locally available, preferred and accessible media platforms among young adults is required for behaviour change.

Facilitators and barriers to linkage to HIV care and treatment among female sex workers in a community-based HIV prevention intervention in Tanzania: A qualitative study.

BackgroundHIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa.MethodsWe conducted 21 participatory group discussions (PGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania.ResultsInfluences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one’s status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks.ConclusionFindings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.

Award for Distinguished Professional Contributions to Applied Research: Gary W. Harper.

The Award for Distinguished Professional Contributions to Applied Research is given to a psychologist whose research has led to important discoveries or developments in the field of applied psychology. The 2018 recipient is Gary W. Harper, "for his exceptional scholarship and leadership in the development, implementation, and evaluation of community-based HIV prevention interventions for youth broadly, and youth of color and LGBT youth specifically, whose psychosocial needs are often marginalized or approached from a narrowly focused perspective." Her award citation, biography, and a selected bibliography are presented here. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador.

This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.

Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa.

BackgroundYoung Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa.MethodsA cohort study that included HIV-uninfected pregnant women was performed. Lay community-based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox’s regression were used to estimate HIV incidence and factors associated with HIV acquisition.ResultsThe 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74–2.40). Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64–2.93) and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33–3.19). 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 (95% CI: 3.8–282.2) and aHR = 126.4 (95% CI: 33.8–472.2) had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03–1.86).ConclusionsMaternal HIV incidence was substantially lower than previous regional studies. Community-based combination HIV prevention interventions may reduce high maternal HIV incidence in resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in Southern Africa.

Association Between Gambling and Exposure to Guns Among Cocaine-Using Women.

The purpose of this study is to assess the association between gambling severity and exposure to guns among substance-using women recruited in the community. Data for these analyses come from the baseline phase of two community-based HIV prevention interventions conducted among alcohol and drug-using women in St. Louis, MO. Gun exposure was assessed using the Violence Exposure Questionnaire (VEQ), and DSM-IV pathological gambling (PG) symptoms and other psychiatric symptoms were assessed using the Computerized Diagnostic Interview Schedule; The Composite International Diagnostic Interview Substance Abuse Module assessed DSM-IV substance dependence, including cocaine dependence and alcohol dependence. Women in the study were predominantly African American (80%), mean age was 35.70 years ±8.8. Women exposed to guns were significantly more likely than women not exposed to guns to have gambled with all consequences: without meeting PG criteria (21% vs. 15%); to meet 1 to 4 PG criteria (22% vs. 12%), and to report 5 or more PG criteria (10% vs. 5%). These differences were significant at p < 0.0001. Based on the multivariate analysis, women who gambled without PG symptoms (OR = 1.77; 95% CI = 1.10-2.85) were nearly twice more likely to have exposure to guns than women who did not gamble. The risk for gun exposure increased with severity of gambling. Women who gambled and reported one to four PG criteria were twice as likely to have had an exposure to guns (OR 2.04; 95% CI = 1.45-3.06) and this risk increased to nearly threefold among women who met five or more criteria of PG (OR 2.65; 95% CI = 1.32-5.32). In addition, endorsing five or more criteria for major depressive disorder (OR 1.44; 95% CI = 1.00-2.06) and three or more criteria for antisocial personality adult criteria (OR 3.78; 95% CI = 2.03-7.02) were strong predictors for gun exposure among these women. The findings indicate that substance-using women with gambling behavior are at an enhanced risk to have exposure to guns.

Scaling up combined community-based HIV prevention interventions targeting truck drivers in Morocco: effectiveness on HIV testing and counseling

BackgroundTruck drivers constitute an important bridging group in the HIV epidemic in Morocco. This study examined the effect of a community-based educational intervention in Morocco on HIV testing and counseling, in representative samples of truck drivers before (2007) and after (2012) the intervention.MethodsFace-to-face structured interviews, adapted from UNAIDS documents, collected data on socio-demographic characteristics, HIV testing and counseling, and HIV risk behaviors in both the 2007 and 2012 surveys. Information about exposure to the intervention was also collected in the latter. Individuals exposed to the intervention were compared with those unexposed (i.e. unexposed in 2012, and all the 2007 pre-intervention sample).ResultsThe 2012 group included 459 men with a median [IQR] age of 38 [31–44] years, 53% of whom reported exposure to the educational intervention. The percentage of participants tested for HIV and receiving HIV counseling in the last 12 months, was significantly higher in the 2012 group (29.6% vs 4.3% in 2007). Data from the 2012 survey confirmed a significant positive trend between being HIV tested and receiving counseling and the number of times a participant was exposed to the intervention (once: (OR = 5.17(2.38-11.25)), twice or more (OR = 19.16(10.33 - 35.53)). These results were confirmed after adjustment for employment, knowledge that the HIV test results would remain confidential, inconsistent condom use with occasional partners or sex workers, and when including individuals from 2007 considered unexposed.ConclusionsCommunity-based educational interventions targeting truck drivers can be effective in increasing coverage of HIV testing and counseling, particularly if they are repeated and cover a considerable portion of this at-risk population. These results are encouraging for other countries which urgently need to implement prevention interventions for most-at-risk populations. Furthermore, they clearly show the power of community-based organization interventions in settings where resources for HIV prevention remain limited.

Community Based HIV Prevention Intervention in Developing Countries: A Systematic Review

Aim. To describe the features and examine effects of community based HIV prevention interventions implemented in developing countries on HIV-related knowledge and self-reported risk behavior. Background. The HIV epidemic has a significant impact on developing countries, increasing the prevalence of HIV among young persons. Community-based HIV prevention interventions have been designed to improve HIV-related knowledge and decrease engagement in risk behavior. Variations in the design and implementation of these interventions have been reported, which may influence their effectiveness. Design. Systematic review. Method. Data were extracted on the characteristics of the study and interventions and effects of the interventions on knowledge and self-report of risk behavior. Results. In total, 10 studies were included in the review. Overall, the results showed variability in theoretical underpinning, dose, and mode of delivery of the interventions. Multicomponent interventions that used mixed teaching methods produced beneficial effects on knowledge and self-reported risk behavior. Conclusion. Examining the characteristics of HIV-prevention interventions provides direction for researchers in developing efficient interventions to improve knowledge and reduce engagement in self-reported risk behavior and, in turn, decrease transmission of HIV.

Context and group dynamics in a CBPR-developed HIV prevention intervention.

This paper will explore in detail the effects of context and group dynamics on the development of a multi-level community-based HIV prevention intervention for crack cocaine users in the San Salvador Metropolitan Area, El Salvador. Community partners included residents from marginal communities, service providers from the historic center of San Salvador and research staff from a non-profit organization. The community contexts from which partners came varied considerably and affected structural group dynamics, i.e. who was identified as community partners, their research and organizational capacity, and their ability to represent their communities, with participants from marginal communities most likely to hold community leadership positions and be residents, and those from the center of San Salvador most likely to work in religious organizations dedicated to HIV prevention or feeding indigent drug users. These differences also affected the intervention priorities of different partners. The context of communities changed over time, particularly levels of violence, and affected group dynamics and the intervention developed. Finally, strategies were needed to elicit input from stakeholders under-represented in the community advisory board, in particular active crack users, in order to check the feasibility of the proposed intervention and revise it as necessary. Because El Salvador is a very different context than that in which most CBPR studies have been conducted, our results reveal important contextual factors and their effects on partnerships not often considered in the literature.

Project Salud: Efficacy of a Community-Based HIV Prevention Intervention for Hispanic Migrant Workers in South Florida

Project Salud evaluates the efficacy of a community-based intervention to reduce risk behaviors and enhance factors for HIV-preventative behaviors. A randomized controlled trial of 278 high risk Latino migrant workers was conducted between 2008 and 2010. Participants completed an audio computer-assisted self-interview questionnaire at baseline and 3- and 9-month post-intervention follow-ups. Participants were randomly assigned to the community-based intervention (A-SEMI) or the health promotion condition (HPC). Both interventions consisted of four 2.5-hour interactive sessions and were structurally equivalent in administration and format. Relative to the comparison condition, A-SEMI participants reported more consistent condom use, were less likely to report never having used condoms, and were more likely to have used condoms at last sexual encounter during the past 90 and 30 days. A-SEMI participants also experienced a positive change in regard to factors for HIV-preventive behaviors over the entire 9-month period. Our results support the implementation of community-based, culturally tailored interventions among Latino migrant workers.

Community-based HIV prevention interventions that combat anti-gay stigma for men who have sex with men and for transgender women

Men who have sex with men (MSM) have been disproportionately affected by HIV since the onset of the epidemic. Public health discourse about prevention has traditionally focused on individual risk behavior and less on the socio-structural factors that place MSM at increased risk of infection. Anti-gay bias and stigma are key structural drivers of HIV and must therefore be treated as a public health threat. Community-based prevention intervention programs that affirm the healthy formation of gay and transgender identities are strongly needed. Gay affirming school-based interventions and resiliency-focused social marketing campaigns have shown positive impact on health outcomes and should be implemented on a broader scale to challenge anti-gay stigma.

Advancing HIV Prevention Among Multiethnic Vulnerable Youths: Ethnoracial and Gender Differences

The need for the evaluation of community-based HIV prevention interventions among at-risk ethnoracial minority youth is warranted. A 5-day peer-led intervention was conducted among 201 at-risk youth aged 12 to 22 years old. We assessed ethnoracial and gender differences in sexual health knowledge, intention and ability to practice safe sex pre and post intervention. Participants were 57% male with a mean age of 16 years (50% Latino, 28% white, and 22% black). While participants in all ethnoracial groups showed improvement post intervention, black participants improved significantly less than whites in their intention to use condoms and HIV knowledge. Differences varied by baseline response. Results indicated that interventions may need enhancement in order to have a greater impact on ethnoracial minority youth.

The Bruthas Project: Evaluation of a Community-Based HIV Prevention Intervention for African American Men Who Have Sex With Men and Women

The Bruthas Project is a community-collaborative intervention to reduce HIV risk behavior among African American men who have sex with men and women (MSMW) but who do not form an identity around their same-sex behavior. The intervention was developed based on formative qualitative research with members of the population and involved four individualized risk reduction counseling sessions. Participants review general risk factors for HIV and are offered HIV testing and counseling (Session 1); discuss sexual dynamics and risk behaviors with female partners (Session 2); discuss sexual dynamics and risk behaviors with male partners (Session 3); review motivations and situational triggers for unsafe sex, and engage in role-play exercises that aim to reach personal risk reduction goals (Session 4). Community outreach and counseling are provided by African American men with whom participants can identify, and counseling is designed to respond to men's need for privacy, cultural affirmation, and masculine values. Thirty-six African American MSMW completed a pilot intervention, including baseline and 3-month follow-up assessments of sexual risk behaviors and psychosocial factors. Preanalysis and postanalysis found significant reductions in unprotected receptive and insertive anal sex with male partners, fewer numbers of female and male unsafe sex partners, and decreased sex while under the influence of drugs. Men also reported significantly increased social support, self-esteem, and reduced loneliness at follow-up. Positive outcomes suggest this is a promising approach for reducing HIV risk in this population.

In their own voices: rural African American youth speak out about community-based HIV prevention interventions.

The HIV epidemic is a major public health problem in the United States, particularly among rural African American adolescents and young adults. We sought to explore young, rural African American's perspectives about key programmatic components to consider when designing youth-targeted, community- based HIV prevention interventions. We report data from four focus groups with adolescents and young adults aged 16 to 24 (n = 38) conducted as part of a community-based participatory research (CBPR) project designed to develop multilevel HIV risk reduction interventions in two rural North Carolina communities with high HIV rates. Analysis was performed by academic and community partners using a modified grounded theory approach to content analysis. Interventions should target preadolescents and early adolescents rather than older adolescents and young adults in an effort to "catch them while they're young." Intervention developers should obtain input from local young people regarding critical programmatic components, such as whom to employ as study recruiters and intervention leaders; intervention format and delivery options, acceptable recruitment and intervention locations, and incentive structures. Participants believe selecting community collaborators representing varied community sectors is critical. Important barriers to address included limited transportation, discomfort communicating about sexual issues, lack of community interest in HIV prevention, and unwillingness to acknowledge and address sexual activity among adolescents. When designing HIV/AIDS prevention interventions, targeting young people, it is important to form academic-community partnerships that ensure young people's perspectives are integral to the intervention development process.

In their own voices: rural African-American youth speak out about community-based HIV prevention interventions.

In their own voices: rural African-American youth speak out about community-based HIV prevention interventions.

A Quasi-Experimental Evaluation of a Community-Based HIV Prevention Intervention for Mexican American Female Adolescents: The Shero's Program

This article describes a quasi-experimental evaluation of a community-based, culturally and ecologically tailored HIV prevention intervention for Mexican American female adolescents grounded in the AIDS risk reduction model. A total of 378 Mexican American female adolescents (mean age = 15.2) participated in either the nine-session SHERO's (a female-gendered version of the word hero) intervention or a single session information-only HIV prevention intervention. Assessment data were collected at pretest, posttest, and 2-month follow up. Significant improvements across all time points were revealed on measures of self-esteem, condom attitudes, beliefs regarding a woman's control of her sexuality, beliefs regarding sexual assault, perceived peer norms, and HIV/AIDS and STI knowledge. At posttest SHERO's participants were more likely to carry condoms and to report abstaining from vaginal sex in the previous 2 months; and at 2-month follow up they reported using condoms more often in the preceding 2 months and planned on using them more frequently in the coming 2 months. Findings support the development of community-based adolescent HIV prevention interventions that address culturally specific ecological factors.

The Regai Dzive Shiri Project: a cluster randomised controlled trial to determine the effectiveness of a multi‐component community‐based HIV prevention intervention for rural youth in Zimbabwe – study design and baseline results

To assess the effectiveness of a community-based HIV prevention intervention for adolescents in terms of its impact on (1) HIV and Herpes simplex virus type 2 (HSV-2) incidence and on rates of unintended pregnancy and (2) reported sexual behaviour, knowledge and attitudes. Cluster randomised trial of a multi-component HIV prevention intervention for adolescents based in rural Zimbabwe. Thirty communities were selected and randomised in 2003 to early or deferred intervention implementation. A baseline bio-behavioural survey was conducted among 6791 secondary school pupils (86% of eligibles) prior to intervention implementation. Baseline prevalences were 0.8% (95% CI: 0.6-1.0) for HIV and 0.2% (95% CI: 0.1-0.3%) for HSV-2. Four girls (0.12%) were pregnant. There was excellent balance between study arms. Orphans who made up 35% of the cohort were at increased risk of HIV [age-sex adjusted odds ratio 3.4 (95% CI: 1.7-6.5)]. 11.9% of young men and 2.9% of young women reported that they were sexually active (P < 0.001); however, there were inconsistencies in the sexual behaviour data. Girls were less likely to know about reproductive health issues than boys (P < 0.001) and were less likely to have used and to be able to access condoms (P < 0.001). This is one of the first rigorous evaluations of a community-based HIV prevention intervention for young people in southern Africa. The low rates of HIV suggest that the intervention was started before this population became sexually active. Inconsistency and under-reporting of sexual behaviour re-emphasise the importance of using externally validated measures of sexual risk reduction in behavioural intervention studies.

The Diffusion of a Community-Level HIV Intervention for Women: Lessons Learned and Best Practices

Abstract Early in the HIV/AIDS epidemic in the United States, relatively few women were diagnosed with HIV infection and AIDS. Today, the epidemic represents a growing and persistent health threat to women in the United States, especially young women and women of color. In 2005, the leading cause of HIV infection among African American women and Latinas was heterosexual contact. In addressing HIV prevention needs among women, community-level strategies are needed to increase consistent condom use by women and their partners and to change community norms to support safer sex behaviors. The Real AIDS Prevention Project (RAPP) is a community-based HIV prevention intervention for women and their partners. RAPP is based on a community mobilization model that involves a combination of activities, including street outreach, one-on-one discussions called stage-based encounters, role model stories, community networks, and small group activities. The objectives of RAPP are to increase consistent condom use by women and their partners and change community norms associated with perceptions of condom use and high-risk behaviors in an effort to make safer sex practice more acceptable. This paper describes the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) effort to nationally diffuse RAPP from March 2003 through May 2007 and lessons learned from that diffusion experience. The paper specifically discusses (1) collaborating and planning with researchers, (2) a diffusion needs assessment that was designed to assess prior implementation experiences among select agencies, (3) developing the intervention package, (4) developing and piloting training for community-based organizations (CBOs), (5) a rollout of national trainings for health departments and community-based organizations interested in implementing RAPP, and (6) ongoing quality assurance activities and the provision of technical assistance and support. RAPP has been proven effective in reducing HIV transmission risk behaviors and improving communication and negotiation skills necessary for African American women and Latinas to reduce their risk for HIV infection and improve their overall health status.