Heterosexual HIV transmission continues to be one of the most tenacious problems for reversing the epidemic, and incidence among women increases disproportionately in certain populations, particularly U.S. ethnic minorities, low-income and impoverished women. It is essential that women have available all effective prevention methods, including some they can initiate and control, in order to reduce heterosexual HIV risk. The goal of this 5-year study entitled, "Enhancing HIV Prevention Through Multi-level Community Intervention to Promote Women-Initiated Prevention Options," is to increase the community availability, accessibility, and support for use of the female condom (FC), as currently the most effective woman-initiated HIV/STI prevention option. Evidence increasingly supports the development of theoretically driven multi-level interventions, using a community-empowerment model to mobilize sectors of the community to move the issue forward in a sustained way. This study will use a community-based approach to develop and implement a multi-level community intervention by mobilizing and building the capacity of a body of key community agents, who will collectively develop and implement interventions at the community, organizational, and individual levels to achieve the project goals. A comprehensive dynamic trial (CDT) of this community intervention will be conducted first in Hartford, CT, and then repeated in New Britain, CT to identify core process and content needed for replication. The aims of the study are to: 1) create local Community Action and Advocacy Boards (CAABs) and build their capacity to develop, implement and evaluate a multi-level intervention designed to promote availability, accessibility, and support for FC in their community; 2) assist the CAABs to customize and tailor interventions promoting FC targeting multiple levels of the community with consistent messages/materials; 3) in two study communities sequentially, implement and test the ability of the multi-level intervention to increase availability, accessibility, and support for FC in organizations, and to increase awareness, knowledge, use and negotiation skills, ability to access, and willingness and efficacy to request, try, and use the FC among at-risk women and their partners in that community; 4) assess the sustainability of the CAABs and the CAAB- developed interventions; and 5) manualize the CAAB training protocol, and identify core elements of the community-based multi-level intervention needed for adaptation and implementation in other communities. The CDT will use intensive and iterative ethnographic process and outcome evaluation, repeated community assessments (observations and interviews) every 6 months in all local organizations and businesses that provide health, reproductive and sex information and products to document community and organizational level changes, and 3 cross-sectional surveys with at-risk target population members every 12 months to assess the impact and effects of the CAAB interventions on individuals in targeted high risk sectors of the community. PUBLIC HEALTH RELEVANCE: The proposed study will test a community participatory approach to developing and implementing a multi-level community intervention to increase availability, accessibility, and support for female condoms (FC), thereby increasing their use for the reduction of heterosexually transmitted HIV. Creation and capacity building of a local community coalition (the Community Action and Advocacy Board-CAAB) in each of two study towns is designed to increase local relevance and effectiveness of the CAAB-developed and implemented multi-level intervention(s) and to increase sustainability of intervention effects in their community.
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