Repeat sexually transmitted infections (STI), such as Chlamydia, gonorrhea, trichomoniasis, and syphilis indicate persistent elevated risk activity for HIV, and repeated STI infections increase the likelihood of HIV transmission during exposure. Repeat STI patients represent a significant proportion of public STI clinic visits. Patients who seek treatment for repeat STI infections, by definition, are not adequately served by the prevention services currently provided by STI clinics, and may benefit from additional clinic-based services to reduce their risk of future infections of STI and HIV. The HIV prevention field has largely been silent about assisting repeat STI patients;there are no published studies testing interventions specifically for this population. In addition, most HIV risk-reduction intervention research based in STI clinics has focused directly on the presenting problem of sexual risk behavior, at most addressing one other related factor, such as co- existing depression or substance use, in a single study, whereas it is clear that repeat STI is driven by a wide range of contextual factors. Novel, individually tailored intervention approaches are likely needed to help repeat STI patients reduce their risk of HIV infection and infecting others. We propose to address these limitations of previous research by developing and testing an individually-tailored strengths-based prevention case management intervention strategy based on Social Action Theory (Ewart, 1991) that addresses repeat STI patients'social context and other factors that heighten STI and HIV risk among these patients. This research will be conducted in two phases. During the first 12-15 months of the project, our efforts will be devoted to conducting formative research on the phenomenon of repeat STI in Milwaukee, WI, a city with high and rising rates of STI, and on developing and piloting the intervention protocol. Our formative work will consist of three major elements. First we will conduct qualitative interviews with a sample of repeat STI patients to better understand the factors that lead to their repeated infection and what services they believe could help them avoid future infections. Second, we will develop an individually tailored clinic-based intervention to reduce risk among repeat STI patients. Third, we will conduct a feasibility and acceptability trial of the intervention. In the second phase of the project, we will conduct a full randomized clinical trial with 250 men and 250 women attending the clinic with two or more STI in a 12 month period. We will follow participants in the experimental group and the control group (clinic standard care) for 12 months following recruitment to examine the effects of the intervention on sexual risk activity, repeat STI, and other beneficial health effects. Finally, we will conduct a cost and cost-effectiveness analysis of the intervention.
We propose to develop an intervention that will reduce the potential for HIV infection and other health risks among patients with repeat sexually transmitted infections. We expect that the planned intervention will also have broader positive effects on patients'social context, ability to plan for the future, and quality of life, which may result in positive health effects in other areas as well. By developing an individualized intervention to help these patients to reduce their exposure to infection with HIV and other STIs we expect the intervention could be used in many US STI clinics to reduce the burden of STI and risk for HIV among these patients, their partners, and health systems.