AIDS is rapidly increasing in the United States among women; it is now the fourth leading cause of death in women aged 25-44 years. STDs are a marker for HIV risk: active STD infection places a person at greater risk of contracting HIV is exposed. In the proposed four-year study the Principal Investigator and her associated will develop and test an individually-and small-group- administered behavior changes intervention, Practicing Safer Sex Today (Psst), to improve STD treatment, compliance and to prevent further STD infection, including HIV. The underlying hypothesis is the Psst will be associated with (1) more consistent and appropriate reported condom use, (2) lower rates of physiologically documented STD infection, (3) lesser emotional burden of these illnesses on patients, and (4) lower utilization and cost of health care services.
The specific aims are to: (1) develop and pretest the Psst program, obtaining input and structured feedback from members of the target population (n=80) by way of focus groups and personal interviews. with consultant review, throughout the multi-stage development process; (2) enroll 600 women, 18-35 years of age, diagnosed with any of several STDs at one of three Kaiser Medical Centers in Northern California; (3) gather demographic and other baseline information on their sexual behavior, condom use, and other psychosocial characteristics, provide them with a safer-sex kit and coupon for condoms to be redeemed at the Health Education Department, and assign them randomly in equal numbers to the Psst program with those assigned to the treatment condition, consisting of individual education (in person and with up to two phone contacts) and three small group sessions with a health educator, in which the women will discuss the transmission route, treatment, and risks associated with STDs, couple opportunities to practice new self-protection strategies; (5) follow these women over an 18-month period, gathering information at six- month intervals on health care utilization and costs, and documenting both symptomatic and asymptomatic new/recurring STD infections; (6) compare Psst and control women in terms of the proportions fully compliant with STD treatment recommendations, the proportions consistently and correctly using condoms, STD incidence rates, levels of depression, utilization of health care services, and health care costs; and (7) determine the cost- effectiveness of the intervention (marginal cost of the intervention in relation to health care cost savings).