HIV and other sexually transmitted infections (STIs) have harmful and costly consequences (i.e., infertility, cancer, AIDS). Young women who misuse alcohol are particularly vulnerable to HIV and other STIs. Single- focus interventions (i.e., those that focus primarily on sexual risk behavior or on alcohol use) result in only modest reductions in alcohol-related sexual risk behavior. Lacking are integrated, gender-tailored interventions that address alcohol use in the context of intimate relationships and sexual behavior. We propose a program of research to develop and pilot test an integrated alcohol and sexual risk reduction intervention for use in reproductive health and family planning (RHFP) settings where many young at-risk women can be found. First, we will recruit ~30 young women (18-29 years old) who report risk for alcohol misuse and STIs, and conduct 6- 8 focus groups (FGs) to elicit information regarding how alcohol use and relationship type drive sexual risk behavior. Second, using information obtained from the FGs, we will develop an integrated, individually- delivered Brief Intervention (BI) that draws upon proven strategies (e.g., personalized feedback, normative comparisons, goal setting) to promote alcohol and sexual risk reduction.
We aim to enhance the efficacy of the integrated BI by developing novel components that (a) address sexual behavior as both a cause and consequence of alcohol intoxication and (b) address partner type as a contextual determinant of both alcohol use and sexual risk behavior. Third, we will pilot test the BI with ~10 patients to refine the BI. Fourth, we will deveop a user-friendly website (using previously developed and evaluated materials) that (a) broadens the scope of the BI (i.e., by promoting behavioral skills development) and (b) promotes maintenance of initial intervention gains (i.e., by extending the BI into the natural environment). Finally, we will conduct a pilot trial to evaluate the feasibility and acceptability of both the BIand the website, and obtain initial evidence of their efficacy. For the pilot trial, 50 at-risk young women will be recruited and asked to (a) complete a baseline assessment, (b) be randomized to either the clinic-based BI (supplemented by mobile messages that encourage them to view the extender website) or a control condition, and (c) return for a three-month follow-up. At both baseline and follow-up, we will measure alcohol use and sexual risk behavior as well as hypothesized mediators of behavior change. The proposed research, which builds on and integrates the investigators' expertise in sexual risk reduction and alcohol use intervention development, provides a preliminary pilot test of the BI, and will also allow us to pilot assessments, interventions, and procedures to prepare for a fully- powered, R01-supported, randomized controlled trial testing longer-term effects of the integrated alcohol and sexual risk reduction intervention. If successful, this research will lead to an efficacious BI that can be disseminated to sexual health clinics across the nation, and thereby reduce the incidence of HIV, STIs, harmful alcohol use, and related health consequences in young women.
Alcohol use increases risk for HIV/STI acquisition, especially among young women. This research will develop and pilot test an integrated alcohol and sexual risk reduction intervention for use in reproductive health and family planning clinics. The in-person intervention will be augmented with supplemental online and text materials. Our goals are to reduce alcohol misuse as well as risky sexual behavior and, thereby, to prevent HIV/STIs among young women.