PARAPROFESSIONAL DELIVERY OF A THEORY-BASED HIV PREVENTION COUNSELINGINTERVENTION FOR WOMEN

THIS REPORT DESCRIBES A MID-COURSE PROCESS evaluation of an HIV risk-r eduction counseling intervention delivered by specially trained peer p araprofessionals. One of the key questions addressed is whether parapr ofessionals can successfully implement a theory-based counseling inter vention. The project, known as Project CARES, is a 5-year demonstratio n research project to prevent HIV infection and unplanned pregnancies in women at risk for HIV infection and transmission who were recruited from homeless shelters, drug treatment facilities, and hospital-based service settings for HIV-infected women. Project CARES uses an enhanc ed counseling intervention based on the Transtheoretical Model, also k nown as the Stages of Change model, to promote condom and other contra ceptive use for women who wish to avoid pregnancy, condom use for dise ase prevention, and reproductive health service use. Peer paraprofessi onals, called advocates, provide stage-tailored counseling using a str uctured manual which guides them in the selection of specific counseli ng activities appropriate to a woman's level of readiness to change he r behavior. Data from process evaluation forms completed by advocates in Philadelphia and Baltimore document that the delivery of the interv ention is consistent with the theoretical model upon which it was base d. Paraprofessionals can become skilled in the delivery of a stage-bas ed counseling intervention in health and social service settings. The use of paraprofessionals in HIV prevention service delivery may be a c ost-effective way to enhance and extend services for women.