Behavioral Journalism for HIV Prevention: Community Newsletters Influence Risk-Related Attitudes and Behavior

Article excerpt

Research teams in five cities used behavioral journalism to promote condom use and injection hygiene (use of bleach to clean shared injection equipment) among subpopulations at risk for human immunodeficiency virus (HIV) infection. For three years, HIV-prevention campaigns were conducted in which newsletters containing stories about peer models were distributed in selected communities. We report exposure to the campaigns across time, the cognitive and behavioral effects of increasing degrees of exposure, and the degree to which other sources of HIV information reached these communities. After one year, campaigns reached approximately 40 percent to 80 percent of the intended audiences. The reported number of campaign exposures was associated with theoretical cognitive determinants of behavior change and with risk-reduction behavior in communities that were not being effectively reached by other HIV prevention messages.

Introduction

Journalism and mass media are important tools for public health education. We present findings from the AIDS Community Demonstration Projects (ACDP) of the Centers for Disease Control and Prevention (CDC) in which journalistic methods were used to conduct HIV prevention campaigns in Dallas, Denver, Long Beach, New York, and Seattle. The ACDP was a multisite public health education study conducted from 1991 to 1994 among "hard-to-reach" populations at risk for human immunodeficiency virus (HIV) infection.2The ACDP promoted condom use among (a) sexually active residents in neighborhoods with high rates of gonorrhea and syphilis, (b) injection drug users who are not seeking treatment, (c) female sex partners of male injection drug users, (d) women who exchange sex for money or drugs, (e) youth who spend most nights away from home, and (f) non-gay-identified men who have sex with men. Among injection drug users, the projects also promoted injection hygiene (the use of bleach to clean shared injection devices-cleaning needles with bleach was the recommended approach for reducing HIV transmission among injection drug users at the time of this study). We used a quasi-experimental study design to assess the effects of HIV prevention campaigns for one or more of these populations in each of the five cities. Each geographically defined intervention community was matched with a comparison community (usually in the same city) in order to evaluate the campaigns.

The effect of the HIV prevention campaigns on behavior change was assessed by comparing change in self-reported behaviors and intentions among representative samples in the intervention and comparison communities. Published results of combined data showed significantly greater increases in condom use in intervention communities, where the campaigns were implemented, than in comparison communities.3 In the present report we present data on campaign implementation and exposure at each site, relationships between campaign exposure and the theoretical determinants of behavior change, and the effect of this campaign compared with that of other sources of HIV prevention messages in these communities.

Research teams in the five cities applied a theory-based communication technique that had been developed in earlier public health studies.4 In this approach, paid or volunteer project staff recruit members of peer networks to distribute materials promoting the imitation of peer models who have adopted a specific behavioral innovation.5 The theoretical basis is Bandura's dual-link communication technique, 6 in which media communication is used mainly to present peer models for behavior change, and interpersonal communication is used mainly to provide peer support and reinforcement for imitating the models.

The dual-link communication technique has been effective in community studies of heart disease and cancer prevention. In the North Karelia Project in Finland, a network of several hundred lay leaders (who promoted a televised peer modeling documentary and distributed printed guides) played a central role in speeding the adoption of lifestyles that helped lower heart disease rates. …