To identify the characteristics of the acquired immunodeficiency syndrome (AIDS) as it occurs in Haiti, we studied 61 previously healthy Haitians who had diagnoses of either Kaposi's sarcoma (15), opportunistic infections (45), or both (1) established in Haiti between June 1979 and October 1982. The first cases of Kaposi's sarcoma and opportunistic infections in Haiti were recognized in 1978-1979, a period that coincides with the earliest reports of AIDS in the United States. We do not believe that AIDS existed in Haiti before this period. The types of opportunistic infections and the clinical course in Haitians with Kaposi's sarcoma and opportunistic infections were similar in most aspects to those in patients with AIDS in the United States. The median age of Haitians with Kaposi's sarcoma and opportunistic infections was 32 years, and 85 per cent were men. The interval between diagnosis and death was six months in 80 per cent of the patients. Diarrhea was the most common reason for seeking medical attention in patients with opportunistic infections. Lymphopenia and skin-test anergy were observed in 86 and 100 per cent of patients, respectively. Potential risk factors (bisexual activity or blood transfusions) were identified in 17 per cent of male and 22 per cent of female patients. Demographic information suggests that patients belonged to all socioeconomic strata of Haitian society.

We used a modified acid-fast stain to detect Cryptosporidium oocysts in unconcentrated stools from 824 Haitian children less than 2 years of age with acute diarrhea. Oocysts were identified in stools from 17.5% of 291 children seen at a rural dispensary and in 16.3% of stools from 533 children in an urban hospital. Children with cryptosporidiosis were identified throughout a 22-month period from October 1982 to July 1984, without seasonal predilection. Cryptosporidiosis was twice as common in infants greater than 6 months of age than in younger infants. Cryptosporidium oocysts were rarely found in stools of infants receiving only breast milk. The clinical presentation of children with cryptosporidiosis was similar to other patients with diarrhea who did not have cryptosporidiosis. No asymptomatic Cryptosporidium infections were detected among 71 family members of 31 children with cryptosporidiosis. Three of the 71 family members less than 3 years of age were found to have diarrhea and Cryptosporidium oocysts. In follow-up studies of 31 patients, oocysts persisted in stools for a mean of 14 days (range 5-31 days). Duration of oocyst excretion was directly correlated with duration of diarrhea. These findings suggest that Cryptosporidium is an important cause of acute self-limited diarrheal illness to Haitian children.

The CDC AIDS Community Demonstration Projects Research Group Community-level interventions represent a promising approach to prevention of HIV infection. They aim to change communitywide norms and practices in order to support individuals' efforts to change.1'2 Since the 1970s, community-level interventions have addressed various health issues, including smoking cessation3-5 and the control and prevention of coronary heart disease. 1,6-10 However, "the size of effects has been meager in relation to the effort expended."'" In many studies, positive behavioral changes were seen in both the treatment and comparison areas, a result that seemed to be due in part to unexpectedly steep trends toward reducing unhealthy behaviors.4"''3Nevertheless, community-level interventions have had some success in prevention of HIV infection. Kelly and colleagues trained gay men to talk about prevention with their peers and to endorse behavior changes.'4 After the intervention, unprotected sexual intercourse decreased and condom use for anal intercourse increased. These trends continued for 3 years after the intervention,'5 and similar results were achieved when Kelly et al. replicated this study in 8 cities.'6 A community-level approach has also been used to reach young men who have sex with men.'7 Street outreach programs, mass media campaigns, and other forms of community-level interventions have been used extensively to reach injection drug users and other at-risk populations.2""20 Few studies have analyzed the degree to which community-level programs have led to behavioral changes at the community level. Rather, most have addressed changes among individuals. Here we describe the outcome evaluation results from the AIDS Community Demonstration Projects, an innovative 5-city trial to evaluate the effects of a community-level intervention for underserved populations at risk for HIV 21-23 infection. MethodsThe AIDS Community Demonstration Projects were conducted in Dallas, Tex; Denver, Colo; Long Beach, Calif; New York City; and Seattle, Wash. In each city, the project focused on members of 1 to 3 of the populations at increased risk for HIV infection: active injection drug users, female sex partners of male injection drug users, female commercial sex workers and other women who trade sex for money or drugs, youth in high-risk situations, non-gay-identified men who have sex with men, and residents of census tracts where rates of sexually transmitted diseases are high. A community was defined as an at-risk population in a specific geographic region. A total of 10 intervention-comparison community pairs were studied (Table 1).The study design, data collection methods, and intervention activities have been described in detail elsewhere.21-24 These activities were approved by human subjects review boards at each of the study sites. Intervention ActivitiesAll sites used a common intervention protocol that was based on behavioral theo-A complete list of the members of the CDC AIDS Community Demonstration Projects Research

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