This supplement to the Journal of Public Health Management and Practice marks an important step in sharing with practitioners and the community at large insights on capacity building practice and its important role in human immunodeficiency virus (HIV) prevention. To better understand the context for this focused issue, it would be helpful for readers to first understand the critical issues associated with the HIV epidemic that influence the Centers for Disease Control and Prevention's (CDC's) capacity building initiatives.

In the last decade, major advances in prevention and treatment for HIV/acquired immune deficiency syndrome (AIDS) have prolonged and improved the lives of many. However, an estimated 40,000 Americans still become infected with HIV every year, a large percentage of these are persons younger than 25.1 African American men and women are among the hardest hit populations in the United States. In 2004, they accounted for half of all new HIV diagnoses in this country and more than a third of AIDS deaths to date.2 In addition, certain subpopulations remain at increased risk such as men who have sex with men, who account for approximately 45 percent of newly reported HIV/AIDS diagnoses; racial and ethnic minority communities also are disproportionately affected.3 Currently, women account for approximately one quarter of all new HIV/AIDS diagnoses and in 2002, HIV infection was the leading cause of death for Black women aged 25-34 years.4

Recognizing the need to address these disparities, the CDC uses a comprehensive approach to prevent the further spread of HIV and AIDS through prevention strategies that include monitoring the epidemic to target prevention and care activities, researching the effectiveness of prevention methods, diffusing proven effective interventions, funding the implementation and evaluation of prevention efforts in high-risk communities, encouraging early diagnosis of HIV infection, and fostering linkages between prevention and treatment programs.5

The CDC has developed a three-pronged approach that supports (1) prevention activities directed at persons at high risk for contracting HIV; (2) HIV counseling, testing, and referral services; and (3) prevention activities directed at improving the health of persons living with HIV and preventing further transmission.5 Governmental and nongovernmental organizations at multiple levels collaborate with the CDC to provide capacity building assistance through information, technical assistance (to include technical consultation and services), skills development, and technology transfer for the purpose of imparting knowledge, building skills, and strengthening infrastructure to sustain and conduct effective HIV prevention. In order to achieve success with its approach, the CDC supports several national HIV-prevention initiatives with the collaboration and cooperation of state and local health departments, community planning groups, community-based organizations, and other partners.6

A major prevention activity for the CDC has been the diffusion of effective behavioral interventions (DEBIs) for primary and secondary HIV prevention among individuals, small groups, and communities. These interventions help to ensure that those at the greatest risk for HIV transmission or acquisition are able to obtain intensive support to reduce risk behaviors and adopt protective strategies for their health and the health of their partners. A growing number of these evidence-based interventions have been packaged for use in local HIV-prevention programs.7 These packages, or kits, and training on how to use them are available through the CDC DEBIs project (http://www.effectiveinterventions.com). In this special issue, Collins et al share information about the DEBIs project and describe the six domains of their model, which was developed to help agencies implement evidence-based interventions and use indicators to identify capacity building needs.

Since 1994, the CDC has supported a wide range of other activities designed to build the capacity of local HIV-prevention providers and their organizational infrastructures. Not surprisingly, this publication is devoted to a discussion of general capacity building models, capacity building examples for racial and ethnic minorities, evaluation, and the practical application of geographic information systems (GIS) in planning for high-risk subpopulations. Taveras et al's description of the evolution of CDC's capacity building framework sets the stage for capacity building by defining the goals, objectives, and activities in the context of the workforce, the community, the organization, community planning groups, and the individual. Richter et al illustrate how training is used as a mechanism for building skills and the importance of using evaluation to determine whether outcomes have been achieved and to improve training activities.

The continued need for the CDC and its local, state, and national prevention partners and affected communities to work together to improve the quality, efficiency, and cultural competence of HIV-prevention programs has resulted in capacity building models that address the needs of racial and ethnic minority communities. Thurman et al discuss how the Community Readiness Model can be utilized to more effectively build capacity for HIV/AIDS prevention within Native American communities. Takahashi et al present a conceptual model for culturally appropriate HIV- prevention capacity building, and Sheth et al describe a national HIV prevention capacity building program for Asian Pacific Islander communities using a multitiered approach addressing systems, institutional, and individual levels. Ayala et al's approach, although different, uses the findings from a needs assessment of Latino communities in the western region of the United States to inform a seven-pronged approach to deliver capacity building.

Program monitoring/evaluation is an additional challenge for HIV/AIDS prevention providers and over the last 3 years has been the most frequent area for capacity building requests through the CDC's capacity building system (Capacity Building Branch: Unpublished Branch Report, 2005). Despite these challenges, substantial opportunities remain to enhance and demonstrate the effectiveness of HIV prevention through CDC's special funded projects and through data collection and monitoring of programs. Building organizational capacity to conduct program monitoring and evaluation is, therefore, essential. The article by Nu'man et al reinforces this issue by describing a framework for building sustainable organizational capacity that integrates program planning, monitoring, and evaluation and focuses on building understanding of the value of appropriate organizational change. The framework was used over a 3-year period with CDC-funded community-based organizations. Another relevant article by Pierce et al illustrates the application of GIS tools and spatial analysis methods to understand the service needs of a specific population of African American men at risk for HIV infection. Their exploratory analyses use GIS tools to produce maps that combine data from multiple sources and can inform prevention service planning decisions.

Eliminating HIV/AIDS in the United States requires public health partnerships with communities, agencies, and the private sector. This special issue is heavily influenced by a public health framework dedicated to research, prevention, treatment, and care for persons affected by HIV/AIDS. The release of this publication is, therefore, timely in sharing these insights about capacity building because many health departments and other prevention providers are currently designing and enhancing capacity building efforts. As progress continues to be made in advancing HIV prevention, success and areas of improvement need to be shared so that we can implement effective strategies and high-quality programs. This special issue is dedicated to the hope that the practical information and insights herein will be helpful to all readers who are embarking on, or strengthening capacity for, HIV/AIDS prevention.

Aisha Gilliam, EdD

Behavioral Scientist, Coordinating Center for Infectious Disease National Center for HIV, Viral Hepatitis, and STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

Ted Duncan, PhD

Research Behavioral Scientist, Capacity Building Branch Centers for Disease Control and Prevention, Atlanta, Georgia

Karla Scott, PhD

Director of African American Studies Saint Louis University Saint Louis, Missouri

George Ayala, PsyD

Director of Education, AIDS Project, Los Angeles, California

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