This proposal is for a community-based intervention among African American women in a rural town of North Carolina. It is based on an epidemiological study entitled the Sexually Transmitted Epidermic Prevention (STEP Project; one of the projects in the NC STD Cooperative Research Center. The STEP Project seeks to identify STD-related behavior changes among a cohort of STD clinic clients, and factors potentially determining those changes. It is a collaborative effort between researchers in the Departments of Epidemiology and Health Behavior/Health/Education at UNC-CH, and the Wilson County Health Department. The study, which combines psychosocial epidemiology and ethnographic methods, has found that; the demographic group in the State of North Carolina experiencing the greatest increases in infection rates during reent years in rural African American women; a geographically-defined 'core' or high incidence census blocks, like those described for cities, exists in this rural county; 62% of African American women in the Wilson County STD clinic believe their main partner has sex with others, yet half of these women report never using a condom during vaginal sex with him; 64%of African American women waited 7 or more days following STD symptoms to seek treatment, and 26% continued to have sex while symptomatic; and African American women in this county seek information about sex and STDs from mothers and other 'older women. The proposed intervention will identify women respected by African American women living in the core census blocks and train them into volunteer lay health advisors (LHAs). A Community Outreach Specialist will act as a liaison between the LHAs and health agencies in the county. The LHAs will aim to affect condom use and STD care-seeking behaviors among women in their social networks by providing knowledge and skills through everyday conversations and small group discussions. They will also work together to change social norms for these behaviors and bring about changes in agencies such as the health department. The two-year intervention will be evaluated with behavioral data collected from door-to-door surveys in 'core' census blocks of the town of Wilson, and the control town, Kinston, in nearby Lenoir County. Changes in infection rates for gonorrhea and chlamydia will also be calculated for the core census blocks. This LHA program and evaluation will be among the first used to address STDs. As such, it will demonstrate the utility of this approach for preventing STDs and provide valuable information leading eventually to a larger, multi-site intervention and evaluation.
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