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Although a necessary component of good program management and accountability, monitoring data do not usually provide answers to questions about whether, how, and why a specific program works. More in-depth, systematic inquiry is needed to do this. In this article, the authors focus on the evaluation of human immunodeficiency virus (HIV)-prevention interventions. HIV prevention was selected as the area of choice because it is under pressure to prove its effects within a context of competing demands for acquired immunodeficiency syndrome (AIDS) treatment that are beginning to scale up around the world. Hence, HIV-prevention evaluation is a pertinent and timely matter. Because of the urgency to tackle the HIV/AIDS problem, many prevention programs have rushed to carry out interventions without sufficient grounding in baseline research, models of causality, or lessons learned from small-scale pilot projects. In the haste to mobilize a rapid response, resources for HIV prevention have often been allocated suboptimally, supporting the scaling up of interventions without solid evidence of their effectiveness. This has compromised the ability to control new infections. Further rises in HIV incidence will be slowed only by massive expansion of prevention efforts. HIV-prevention interventions have maximum potential for impact when they are part of a comprehensive package of interventions and are spearheaded by governments that break the silence around HIV/AIDS and deploy sufficient human and financial resources. The effects of these interventions can be enhanced when there are wider public health and development strategies present. Because the epidemic is constantly shifting, HIV-prevention efforts must continue to be tailored to developments in the epidemic and linked to evaluations that confirm their success or failure. The charge for researchers and program evaluators, then, is to estimate which approaches work best for specific target populations in different epidemiological settings with a given level of inputs in order to allocate resources in a cost-effective manner and for public health practitioners to implement evidence-based interventions. (Contains 2 tables and 1 figure.)

In this article, the authors first highlight the experiences in global monitoring and evaluation (M&E) coordination and collaboration. They then describe the collaboration experiences of two U.S. government agencies active in HIV prevention and care, the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), and how they have participated in the global M&E partnership to set international standards and provide direct M&E support to national AIDS programs. As the main U.S. development agency, USAID works generally through country and regional missions to implement multisector programs, including preventive health and related services, through nongovernmental organizations. The CDC is the main U.S public health agency and part of the U.S. Department of Health and Human Services (DHHS), working both domestically and internationally. The CDC's international HIV/AIDS efforts operate generally through field offices that support the ministries' of health and their implementing partners. The CDC and USAID agencies have been working together intensively on HIV/AIDS M&E since 1999 and coordinating M&E financial and technical support to countries around the world. In 2004 they joined other U.S. government agencies in formulating one strategy for international HIV monitoring and evaluation. In fifteen HIV/AIDS focus countries, the agencies participate in a mission team that submits a yearly HIV/AIDS operational plan. The authors discuss the challenges faced and the successes achieved in harmonizing M&E strategies between the two agencies. They then describe the application of their M&E approaches within a real-life context in Cambodia, highlighting how these agencies work together on the ground to support the work of ministries of health, multisectoral national HIV/AIDS programs and councils, and a range of other governmental and nongovernmental organizations to strengthen implementation of M&E systems. The authors conclude by calling for enhanced coordination among "all" in-country partners within the commitment to the "three ones principle," which calls for "one" organizing authority, "one" national strategic plan, and "one" comprehensive national M&E plan. (Contains 1 figure.)

The authors discuss the use of meta-analysis in examining behavioral and social interventions for heterosexual adults. The topics of interest include the effect of these interventions on the adoption of the heterosexual adults safer sex behaviors or on the incidences of sexually transmitted diseases.

The authors discuss the role of systematic reviews in evidence-based health-care decision-making in HIV/AIDS prevention and care. The topics of interest include the overview of the ongoing systematic review effort of the Cochrane Collaborative Review Group on HIV infection and AIDS and the description of how these reviews are conducted.

The authors discuss the studies on response to HIV/AIDS epidemics in both the United States and in other countries. The topics of interest are the experience of the HIV/AIDS Prevention Research Synthesis project with aquiring and reviewing these studies, the efforts to find them and the necessity to include the reports of non-U.S.-based HIV risk reduction intervention studies in Prevention Research Synthesis detabase.

The authors discuss behavioral and social intervention studies aimed at reducing HIV infection risk. The topics of interest include the study of the characteristics of behavioral and social intervention and the examination of reporting extent on variables which are important for the development, transfer and evaluation of intervention research.

The authors discuss the HIV/AIDS prevention research synthesis project. The aim of this project is to accumulate HIV prevention research studies and to analyze the effectiveness of these studies in sexual and drug-related risk behavior reduction to eliminate HIV transmission.

Introduction There is increasing attention to 'structural barriers' in the HIV literature and to the ways these inhibit the effectiveness of HIV responses at national and local levels. Despite the [...], Introduction: Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. Methods: Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. Results: Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention. Conclusions: Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses. Keywords: AIDS; HIV; human rights; key populations; law; policy; structural barriers.

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In 1996, the Centers for Disease Control and Prevention (CDC), in collaboration with many partners, initiated the HIV/AIDS Prevention Research Synthesis (PRS) project to accumulate HIV prevention research studies and analyze their effectiveness in reducing sexual and drug-related risk behaviors for HIV transmission. The PRS team developed standardized guidelines and procedures for the systematic reviews, conducted systematic searches for pertinent studies, characterized the selected studies, analyzed effectiveness data, and established a cumulative database. As of June 1998, the database contained more than 5000 reports: 4068 were reports that met the PRS scope criteria for inclusion and 586 of those reports contained outcome data from an intervention study. Of the 586 reports that included outcome data, 276 have been reviewed: 223 (81%) included measures of PRS-specified behavioral or biologic HIV-related outcomes, and 124 of the 223 (56%) used PRS-defined rigorous study designs. The PRS database is a valuable resource for accessing and integrating the literature on HIV prevention research. CDC is committed to 1) updating the database; 2) producing systematic reviews, including meta-analyses, related to key research questions; and 3) disseminating findings to encourage and facilitate the use of science-based research in preventing HIV infection.