This study proposes to develop and evaluate an educational intervention promoting condom use among patients at an inner city public STD clinic (Boston City Hospital). A randomized, single-blinded controlled trial involving two treatment groups (N1=N2=500) and a routine care group (N=500) will be used to test the efficacy of a 15 minute, soap-opera style video on STD prevention in two configurations: (1) video alone, viewed while waiting for diagnosis and treatment for presenting symptoms, and (2) video in combination with small group counseling conducted by a health educator while patients wait for diagnosis and treatment. The video and counseling will include information on the use of condoms for the prevention of a range of STDs, including HIV infection, as well as information on the risks of alcohol and drug use in compromising intended safe sex practices. Desire for children and the responsibilities of child rearing will also be discussed both within the context of the video and the small groups. The primary response variable will be condom use. Several surrogate measures will be used to measure this outcome, including STD reinfections at 6 months and one year as determined by (1) physical examination (6 weeks and 6 months follow-ups); (2) record review of return visits to the Boston City Hospital clinic, and by (3) use the Massachusetts Department of Health statewide STD reporting system (Data from the State reporting system will be provided to the study without identifiers.). Condom use will also be measured by self reports at follow-up interviews (six weeks and six months) and redemption rates for condom coupons at local private pharmacies. Other response variables will include: (1) reported condom use during sex following alcohol or drug use; (2) the number of sexual partners subjects have had; and, (3) the number of occasions of unprotected sex. Our hypothesis is that the subjects assigned to interventions will show a 20%, at one year posttest, reduction in STD reinfection rates relative to the routine care group (controls). Several previous studies have indicated the effectiveness of the video and video plus counseling approach to promoting condom use among the public STD clinic population. This study, however, uses a number of surrogate measures for condom use, including physiologic determination of STD endpoints.
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