Young African-American women who report a higher frequency of alcohol use have markedly higher rates of STDs and HIV sex behaviors. Unfortunately, there are no evidence-based HIV interventions designed to be gender- and culturally-congruent for this population. To address this gap in the HIV intervention armamentarium, we propose to supplement a CDC-defined evidence-based intervention, Horizons, with an innovative intervention modality, Group Motivational Enhancement Therapy (GMET), which has demonstrated promise in reducing alcohol use and alcohol-related HIV risk-taking. To test the efficacy of the combined Horizons+GMET alcohol-specific module to a time-equivalent Horizons+attention control general health promotion (GHP) module focusing on diabetes prevention, and to enhanced standard-of- care. In the proposed study, 600 young African American women, 17-21 years of age, seeking sexual health services and reporting =>3 drinking occasions in the prior 60 days, will complete a baseline assessment consisting of an ACASI, videotaped communication role plays to objectively measure communication skill proficiency, and provide a vaginal specimen to assess STDs. Subsequently, they will be randomly assigned to one of three conditions: (1) Horizons+GMET alcohol-specific condition, (2) a time-equivalent Horizons+GHP condition, or (3) an enhanced standard-of-care control condition. The GMET alcohol-specific module has demonstrated evidence of efficacy in influencing several alcohol- specific constructs (attitudes, norms, self-efficacy) and reducing sexual risk-taking among culturally- diverse high-risk youth. The GMET alcohol-specific module was designed to increase woman's awareness of the adverse effects of alcohol on themselves, their sexual decision-making, and their male partner and teaches women strategies to reduce the likelihood of engaging in sex under the influence of alcohol and provides skills training needed to effectively communicate their sexual intentions to use condoms and/or refuse risky sex, when they or their male sex partner has been using alcohol. After completing the two active interventions or control condition, participants complete a brief post-test ACASI to assess immediate changes in hypothesized psychosocial mediators of safer sex and alcohol use. Subsequently, women return to complete follow-up assessments at 6-months (ACSAI and STD assessment) and 12- months (ACASI, STD assessment, objective communication skills assessment) post-intervention. An intent-to-treat analysis, using linear and logistic generalized estimating equations (GEE), will examine the efficacy of the Horizons+GMET condition in reducing incident STDs, enhancing condom-protected vaginal and anal sex acts, and enhancing alcohol-related and HIV-related mediators of HIV-preventive behaviors over the 12-month follow-up period. If the intervention is observed to be effective we will work closely with the CDC DEBI program to facilitate dissemination to public health agencies and CBOs.
Relevance of the Research to Public Health Given the high rate of STDs and HIV risk behaviors observed among alcohol-using young African American women seeking sexual health services, and the lack of effective interventions for this sizeable subgroup, this could be amongst the first interventions that has the potential to effectively reduce risk behaviors and STDs among a population that has been underserved and substantially impacted by the HIV epidemic.
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