Long term global evaluation of a national AIDS prevention strategy: the case of Switzerland

Objectives: The Swiss Aids prevention strategy has been subject to a contin uous process of evaluation for the past 12 years. This paper describes the conceptual approach, methodology, results obtained and contribution to poli cy-making of that evaluation. Design: The evaluation is on-going, global with respect to all components o f the strategy, and utilization-focused. Each successive phase of the evalu ation has included 10-20 studies centred either on aspects of process, of o utcome or of environmental context. Findings are synthesized at the end of each phase. Methods: Both quantitative and qualitative methods are used. Studies genera lly have one of three functions within the overall evaluation: assessment o f trends through surveys or other types of repeated studies; evaluation of specific areas through a series of studies from different viewpoints; in-de pth investigation or rapid assessment through one-off studies. Various meth ods of triangulation are used to validate findings. Results: The evaluation has allowed for: the observation of behavioural cha nge in different populations; the availability of scientific data in contro versial fields such as drug-use policy; an understanding of the diversity o f public appropriation of prevention messages. Recommendations are regularl y formulated and have been used by policy-makers and field workers for stra tegy development. Conclusions: The global approach adopted corresponds well to the evaluation requirements of an integrated long-term prevention strategy. Cost is low r elative to the extent of information provided. Such an evaluation cannot ho wever address the question of causal relationship between the strategy and observed changes. The evaluation has contributed to the development of a cu lture of evaluation in Swiss AIDS prevention more generally. (C) 1999 Lippi ncott Williams & Wilkins.