This research will compare the effectiveness of usual care counseling provided at STD clinics in the state of Georgia to an innovative minimal contact and an extended contact peer-led social-cognitive intervention in reducing rates of STD reinfection and changing the sexual practices that lead to HIV infection. The relative impact of the interventions will be evaluated in 16 STD clinics drawn from eight distinct STD clinic populations. The STD clinic populations were identified by stratifying the state's 159 counties on the basis of population density (urban vs. rural), ethnic composition (predominantly white vs. predominantly black), and STD rate (high vs. low). Subjects will be clinic patients aged 18 to 40 diagnosed with certain condom preventable STDs (syphilis, gonorrhea, trichomoniasis, and chlamydia). The outcome measures, including rates of STD reinfection (based on chart review and self-report), sexual behavior change, and cognitive antecedents to risk behavior (perceived vulnerability, safer sex knowledge, outcome expectations, skills, self-efficacy) will be assessed at 3, 6, 12, and 18 months post-randomization. The primary hypotheses are: (1) the minimal contact intervention win lead to significant improvements in all outcome measures when compared to the usual care controls; and (2) the extended contact intervention will lead to significant improvements in all outcomes measures when compared to the minimal contact intervention. No differential responses to treatment are predicted by population density or ethnic composition of the clinic location, although subjects from low STD rate clinic locations are expected to receive greater benefit from both the social-cognitive interventions. Treatment assignment will be nested within clinic, such that every clinic will offer each of the three interventions in a randomized order. All subjects will receive the clinic's usual care counseling. Subjects assigned to the minimal contact intervention will also attend two 2 hour small group sessions on consecutive weeks. Subjects assigned to the extended contact intervention will attend four 2 hour small group sessions on consecutive weeks. These small group sessions will be peer-- led and based on social-cognitive principles of behavior change. The sessions will be designed to promote the following cognitive outcomes: (1) perceived vulnerability to HIV infection; (2) outcome expectancies regarding condom use and safer sex; (3) safer sex skills including interpersonal negotiation strategies, sexual assertiveness, behavioral self-management, and social support development; and (4) self-efficacy to apply those skills and consistently avoid unsafe sex.
| DiIorio, Colleen; Hartwell, Tyler; Hansen, Nellie et al. (2002) Childhood sexual abuse and risk behaviors among men at high risk for HIV infection. Am J Public Health 92:214-9 |
| NIMH Multisite HIV Prevention Trial Group (2001) A test of factors mediating the relationship between unwanted sexual activity during childhood and risky sexual practices among women enrolled in the NIMH Multisite HIV Prevention Trial. Women Health 33:163-80 |
