Effective Interventions

Effective Interventions

High Impact Prevention

NOTE: CDC does not offer trainings for Holistic Health Recovery Program (HHRP). However, the intervention implementation materials are available for download from Yale University School of Medicine, Department of Psychiatry.

The Holistic Health Recovery Program (HHRP) is a 12-session, manual-guided, group-level program for HIV-positive and HIV negative injection drug users.

The primary goals of HHRP are health promotion and improved quality of life. More specific goals are abstinence from illicit drug use or from sexual risk behaviors; reduced drug use; reduced risk for HIV transmission; and improved medical, psychological, and social functioning. HHRP is based on the Information-Motivation-Behavioral Skills (IMB) model of HIV prevention behavioral change. According to this model, there are three steps to changing behavior: Providing HIV prevention information, motivation to engage in HIV prevention and opportunities to practice behavior skills for HIV prevention.

HHRP takes a harm reduction approach to behavior change in which abstinence from drug use or sexual risk-taking behavior is one goal along a continuum of risk-reduction strategies. Clients are not assumed to be abstinent from either drug use or sexual risk behaviors. Risk behaviors are viewed as being sustained by hopelessness in the face of a life-threatening illness, high levels of stress, psychiatric disorders, and medical and social problems. In addition, the ability to acquire and retain the skills needed for change may be impeded by the impact of HIV status and/or drug-related cognitive deficits. The HHRP intervention allows clients to meet their own harm-reduction goals by presenting materials in a way to minimize the effects of cognitive difficulties, and providing clients with an empathic, directive, non-confrontational setting where structure and consistency are emphasized.

Research and Development

Margolin A., Avants, S.K., Warburton, L.A., Hawkins, K.A., & Shi, J. (2003). A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users. Health Psychology, 22(2), 223-228.

Program Review Panel Information

The CDC requires all CDC-funded agencies using the Holistic Health Recovery Program intervention to identify, or establish, and utilize a Program Review Panel and complete Form 0.1113 to document this activity. The intervention researchers and developers are not involved in this activity. This is a CDC requirement for their grantees, and all questions in this regard should be directed to your agency's CDC Project Officer or to the health department funding your agency's implementation of the intervention.

The Program Review Panel guidelines, instructions for completion of Form 0.113, and the form itself are available under the Related Links section.

CDC Policy on Youth Peer Outreach Workers

CDC funded (directly or indirectly) agencies using youth (either paid or volunteer) in program outreach activities, it is very important that said organizations use caution and judgment in the venues/situations where youth workers are placed. Agencies should give careful consideration to the "age appropriateness" of the activity or venue. Additionally, agencies should comply with all relevant laws and regulations regarding entrance into adult establishments/environments. Laws and curfews should be clearly outlined in required safety protocols developed and implemented by agencies directly and indirectly funded by CDC.

If you have specific questions, please contact your CDC project officer.

More Info

HHRP Core Elements

  • Teaches skills to reduce harm of injection drug use and unprotected sexual activities.
  • Teaches negotiation skills to reduce unsafe sexual behaviors with sexual partners and teaches skills to heal social relationships.
  • Teaches decision making and problem solving skills using cognitive remediation strategies.
  • Teaches goal setting skills including developing action plans to achieve goals.
  • Teaches skills to manage stress, including relaxation exercises and understanding what aspects of the stressful situation can, and cannot, be controlled.
  • Teaches skills to improve health, health care participation, and adherence to medical treatments.
  • Teaches skills to increase clients' access to their own self-defined spiritual beliefs, in order to increase motivation to engage in harm reduction behaviors.
  • Teaches skills to increase awareness of how different senses of self can affect self-efficacy and hopelessness.

The materials on this site are designed for HIV/AIDS prevention with persons at risk for acquiring or transmitting HIV. They are meant to be resources used by HIV prevention providers such as health departments and community-based organizations so as to provide the best evidence-based HIV prevention services. These materials are not meant for the general public. They are not meant for children. They are not school-based HIV prevention strategies.