STDs and health-care-seeking behavior significantly reduce HIV transmission and population incidence of urethritis and syphilis (Grosskurth et al., 1995a, b; Mwijarubi et al., 1996).

One major community-based intervention for disenfranchised groups that may be directly applicable to community-based STD prevention is the AIDS Community Demonstration Projects initiative (CDC, 1996a). These programs were initiated in 1989 to target populations at high risk of HIV infection in five cities, such as intravenous drug users and their sex partners, female sex workers, men who have sex with men, and youths in high-risk situations. The goal of these programs was to determine the efficacy of a specific community-based intervention among hard-to-reach populations, and one of the two main objectives was to increase consistent condom use among these populations.2 The intervention included distribution of printed materials that described ''role models" who successfully changed their behaviors and provided basic HIV and condom information. Peers and other community network members were used extensively to distribute materials. Preliminary data indicate that high rates of exposure to the intervention can be achieved within two years of the initiation of the program. In addition, for the three sexual behaviors examined, the mean stages of change-continuum value among persons who reported exposure to the intervention was greater than that among persons who did not report exposure to the intervention.3 Replications of successful interventions among high-risk groups are being undertaken in the United States and abroad, and the results will shed light on the long-term impact and applicability of these approaches to other communities at risk.

In January 1994, the CDC implemented its Prevention Marketing initiative for HIV and STD prevention (U.S. Conference of Mayors, 1994). This initiative was motivated by research on community interventions showing that they were most effective when designed and managed by the communities themselves. As part of this program, the CDC is contributing funds for pilot prevention-marketing interventions and is providing technical assistance to state and local health departments, community coalitions, and other partners. The initiative uses commercial marketing techniques, including mass media messages, and community involvement to promote healthy sexual behaviors. The social marketing approach adapted by the CDC includes the concepts of the right product, the right price, the right place, and the right promotion (DeJong, 1989).

Public health workers recognize that, in order for behavior change to occur, the community environment should not be a barrier but should be supportive of


The other main objective was to increase the use of bleach by intravenous drug users to clean injecting drug equipment.


The stages of change continuum represents a series of steps on a behavior change continuum from precontemplation to adoption and maintenance of the behavior change. The higher the stages of change-continuum value, the greater is the progression of the individual from the precontemplation stage to the maintenance stage of behavior change.

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