Sexually transmitted diseases (STD) are a major public health problem in the U.S. From a public health perspective, preventing STD in individuals most likely to transmit infection to others will have the greatest impact on reducing the incidence of infection. Clients attending STD clinics are a population at increased risk for acquisition and transmission of STDs, including HIV, and are an appropriate target population for behavioral interventions designed to enhance the adoption and maintenance of consistent condom use. The proposed study uses a randomized, controlled design to test the efficacy of a behavioral intervention based on the Trans-theoretical Model to reduce the risk of recurrent urethritis among male STD clinic clients. A random sample of 936 predominantly African-American males, 15-40 years of age, with urethritis will be recruited at the Jefferson County Department of Health (JCDH) STD Clinic. Each participant will complete written informed consent, a baseline assessment designed to assess each individuals' stages of change for condom use, psychosocial influences on condom use and other high-risk sexual and drug-related behaviors. At baseline, participants will receive standard-of-care antibiotic treatment for urethritis, usual care counseling to reduce behavioral risk-taking and will be scheduled to return within one-month for follow-up/ test-of-cure. Returning participants will be randomized to receive stage-tailored counseling based on the Trans-theoretical Model or the usual care counseling routinely provided to patients as part of standard clinic practice. Participants randomized to the stage-tailored counseling condition will receive information and skills tailored to their readiness to adopt STD-preventive behavior changes. All participants will be followed prospectively and will complete biological assessments for urethritis, a stage determination assessment and psychosocial assessments similar to that completed at baseline at 3-, 6-, and 12-months post- baseline. Statistical analyses, controlling for baseline assessments, will determine the efficacy of the stage-tailored intervention to reduce the proportion of participants who experience recurrent urethritis over the 12-month follow-up period.
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