The broad, long-term objective of this research is to reduce the morbidity and mortality caused by HIV.
The specific aims are to develop and evaluate a risk reduction intervention for patients seeking care at sexually transmitted disease (STD) clinics. This research will have two phases. First, formative research will be conducted with 100 STD clinic patients to clarify the determinants of risk behavior (and risk reduction) in impoverished urban environments. Information obtained will be integrated with behavioral science theory to develop sexual risk reduction interventions that can be delivered by digital video disc (DVD). It is expected that the DVDs will provide patients with information about HIV/STDS, activate patients'motivation to avoid risk, enhance the intra- and interpersonal skills essential for risk reduction, and provide detailed disease prevention strategies. The DVDs will employ a motivational style, be tailored by sex and sexual orientation, and employ dramatic as well as didactic components in order to optimize personal relevance. Second, a randomized controlled trial with 1000 STD clinic patients will be conducted to: (a) evaluate the effectiveness of the DVDs, and (b) separate the effects of the DVDs from the effects of detailed sexual behavior assessments. Patients will be randomized to one of four conditions formed by crossing assessment content (detailed sexual behavior vs. general health behavior) with intervention foci (sexual risk reduction vs. general health promotion). After patients complete a baseline assessment, they will receive a DVD-based intervention and standard clinical care. At 3, 6, 9, and 12 months, they will provide sexual behavior self-reports and specimens for STD testing. Analyses will test whether patients who view the sexual health DVD reduce risk behavior more and have fewer new STDs compared to patients who view a general health promotion DVD. Analyses will also be conducted to increase understanding of individual differences in response to the interventions. Overall, the proposed research will determine whether risk reduction messages delivered by DVD can reduce sexual risk behavior and incident STDs. If found effective, such DVDs can provide a highly feasible, easily disseminated risk reduction program for STD clinics nationwide. In addition, the research will investigate whether the detailed baseline sexual behavior assessments that are common to sexual risk reduction research actually promote sexual behavior change. Clarifying the effects of research assessments is essential to interpreting the intervention literature, and guiding public health practice. Finally, by identifying patients who do not benefit from these interventions, this research can suggest directions for intervention refinement for non-responders. This research will advance the development of practical and effective sexual risk reduction interventions for use in STD clinics, and thereby reduce the burden of disease caused by HIV and other STDs.

Public Health Relevance

The proposed research will help patients at sexually transmitted disease (STD) clinics to reduce their risk for HIV and other STDs. The initial phase of research will involve developing a HIV risk reduction intervention that can be administered with a digital video disc (DVD). After developing the DVD, a randomized controlled research study will be conducted with 1000 patients to determine if the DVD-administered intervention helps patients to reduce sexual risk behavior and prevent new STDs. This study will lead to the development of a practical, effective, and easily-distributed sexual risk reduction intervention for use in public STD clinics.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH068171-10
Application #
8287079
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Brouwers, Pim
Project Start
2003-07-01
Project End
2014-06-30
Budget Start
2012-07-01
Budget End
2013-06-30
Support Year
10
Fiscal Year
2012
Total Cost
$374,451
Indirect Cost
$44,646
Name
Miriam Hospital
Department
Type
DUNS #
063902704
City
Providence
State
RI
Country
United States
Zip Code
02906
Carey, Michael P; Senn, Theresa E; Walsh, Jennifer L et al. (2015) Evaluating a Brief, Video-Based Sexual Risk Reduction Intervention and Assessment Reactivity with STI Clinic Patients: Results from a Randomized Controlled Trial. AIDS Behav 19:1228-46
Senn, Theresa E; Walsh, Jennifer L; Carey, Michael P (2014) The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health. Ann Behav Med 48:215-24
Senn, Theresa E; Scott-Sheldon, Lori A J; Carey, Michael P (2014) Relationship-specific condom attitudes predict condom use among STD clinic patients with both primary and non-primary partners. AIDS Behav 18:1420-7
Scott-Sheldon, Lori A J; Senn, Theresa E; Carey, Kate B et al. (2013) Quantity, not frequency, of alcohol use moderates the association between multiple sexual partners and Trichomonas vaginalis among women attending an urban STD clinic. Sex Transm Infect 89:498-503
Walsh, Jennifer L; Senn, Theresa E; Carey, Michael P (2013) Longitudinal associations between health behaviors and mental health in low-income adults. Transl Behav Med 3:104-13
Carey, Michael P; Senn, Theresa E (2013) Health and life concerns among patients attending a publicly funded sexually transmitted infection clinic. J Public Health Manag Pract 19:E30-4
Mittal, Mona; Senn, Theresa E; Carey, Michael P (2013) Fear of violent consequences and condom use among women attending an STD clinic. Women Health 53:795-807
Carey, Michael P; Scott-Sheldon, Lori A J; Senn, Theresa E et al. (2013) Attitudes toward sexual partner concurrency: development and evaluation of a brief, self-report measure for field research. AIDS Behav 17:779-89
Carey, Michael P; Senn, Theresa E; Coury-Doniger, Patricia et al. (2013) Optimizing the scientific yield from a randomized controlled trial (RCT): evaluating two behavioral interventions and assessment reactivity with a single trial. Contemp Clin Trials 36:135-46
Walsh, Jennifer L; Senn, Theresa E; Scott-Sheldon, Lori A J et al. (2012) Using growth mixture modeling to identify heterosexual men who reduce their frequency of unprotected sex following a behavioral intervention. AIDS Behav 16:1501-10

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