Critique 

Center for AIDS Intervention Research (CAIR)

The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.

Evaluation: The "Center for Aids Intervention Research (CAIR)" of the Medical College of Wisconsin has tackled the frightful problem of AIDS in impoverished, inner-city minority women under 45 with a small-group HIV prevention intervention model and systematic follow-up that includes HIV risk education, sexual decision making, assertiveness in sexual situations and risk reduction skills building. The program has demonstrated extraordinary cost effectiveness compared with other life-saving interventions.

Women in the HIV Prevention Program improved risk knowledge and risk reduction skills, reduced rates of unprotected sex by 20 percent, and increased their use of barrier protection from 26 percent to 56 percent of intercourse occasions. Cost-effectiveness analysis showed program cost to be $269 per client and the base cost-utility ratio was $2024 per discounted QALY saved. The program was funded by the National Institutes of Mental Health. There was random assignment to the educational program; a peer-reviewed study is in press for the American Journal of Public Health, an excellent journal. There is potential for large population and cost-savings and reviewers would like to see it rolled out to more groups. Program goals are clearly delineated. Evaluation included a comparison group. It is a relatively low cost, high reward program. Reviewers liked the concept of the program very much. There are two articles in the journal of the Public Health Association; one on effectiveness and one on cost-effectiveness.

Single focus. Relatively small study. The program is not likely to do much unless it can be sustained and expanded. Five sessions of prevention over two months may be insufficient to produce lasting change.