In our current study, we collected extensive ethnographic data and integrated these data with the AIDS Risk Reduction Model (ARRM) to create culturally relevant, risk-reduction interventions for high-risk (all participants had an STD at baseline), inner-city Mexican- and African- American women. 315 women were randomly assigned to intervention and 306 served as controls. Attendance at intervention sessions was high (91% of women showed; of these, 84% attended all three sessions and 91% attended two of the three). The 12-month retention rate is high (approximately 90% thus far). Preliminary data indicate that infection with gonorrhea and/or chlamydia (the two diseases we have scored thus far) is 40% lower in the study than in the control group at 12 months' follow-up. Preliminary examination of behavioral data indicates that more study- than control- group women have decreased number of partners and use condoms consistently. Our goals in the current study are to expand our understanding of factors that contribute to high-risk sexual behavior and to improve magnitude of risk reduction by adding and evaluating the long- term (24 months) effectiveness of monthly support groups.
Specific aims are: 1) To determine psychosocial and situational factors/combinations of factors associated with high-risk sexual behavior and whether patterns of factors vary by ethnicity; 2) To determine the psychodynamic factors associated with high-risk behavior. These are derived from ARRM constructs, the theory we adapted to guide all aspects of our research; 3) To determine patterns of sexual behavior and related factors (e.g., douching) that contribute to infection. We will integrate these data with clinical and microbiologic information collected at the same timepoints to more fully understand disease acquisition after exposure; 4) To determine how sexual behavior patterns change over time (6, 12 and 24 months) following standardized counseling at baseline; 5) To test the ARRM, i.e., to determine if naturally occurring and intervention- associated change to safer sexual behaviors proceeds through its stipulated stages; 6) To evaluate the effects of the expanded interventions (with attention to the effect of initial pregnancy status) on risk awareness, high-risk sexual behavior, symptom recognition, health- seeking behavior and reinfection rates over 6, 12 and 24 months. Basically this is a two-part study: 1) natural history of sexual behavior and reinfection following standardized STD counseling and 2) evaluation of intervention effectiveness (change in these same domains over time for the group receiving intervention plus support groups using the natural history sample as controls). A prospective, stratified random design, using repeated measures will be employed. Based on attrition rates calculated from the current study, we will enroll a total of 600 minority (African- and Mexican-American) women with a current STD from public health clinics across the city. We expect 70% will be less than 24 years old and 25% will be pregnant. Linear and logistic regression will be the principal multivariate analysis techniques used.
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| Thurman, Andrea Ries; Holden, Alan E C; Shain, Rochelle N et al. (2009) The male sexual partners of adult versus teen women with sexually transmitted infections. Sex Transm Dis 36:768-74 |
| Thurman, Andrea Ries; Holden, Alan E C; Shain, Rochelle N et al. (2008) Preventing recurrent sexually transmitted diseases in minority adolescents: a randomized controlled trial. Obstet Gynecol 111:1417-25 |
| Thurman, Andrea Ries; Holden, Alan E C; Shain, Rochelle et al. (2008) Partner notification of sexually transmitted infections among pregnant women. Int J STD AIDS 19:309-15 |
| Thurman, Andrea Ries; Shain, Rochelle N; Holden, Alan E C et al. (2008) Partner notification of sexually transmitted infections: a large cohort of Mexican American and African American women. Sex Transm Dis 35:136-40 |
| Champion, Jane Dimmitt; Shain, Rochelle N; Korte, Jeffrey E et al. (2007) Behavioural interventions and abuse: secondary analysis of reinfection in minority women. Int J STD AIDS 18:748-53 |
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| McGirt, Laura Y; Beck, Lisa A (2006) Innate immune defects in atopic dermatitis. J Allergy Clin Immunol 118:202-8 |
| Amanna, Ian J; Slifka, Mark K (2006) Quantitation of rare memory B cell populations by two independent and complementary approaches. J Immunol Methods 317:175-85 |
| Schauber, Jurgen; Dorschner, Robert A; Yamasaki, Kenshi et al. (2006) Control of the innate epithelial antimicrobial response is cell-type specific and dependent on relevant microenvironmental stimuli. Immunology 118:509-19 |
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