Sarah Goodwin

Kathi Ovnic
Holly Korschun
June 18, 1998

Sexual behaviors that place individuals at high risk for contracting HIV and AIDS can be voluntarily and significantly modified, even in underserved, lower socioeconomic groups, through the use of an intervention that includes group education, role playing, communications skills, motivation and goal setting, according to results from a nationwide study published in the June 19 Science.

The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial - the largest, controlled, HIV behavioral intervention study ever conducted in the United States - enrolled 3,706 African American and Hispanic men and women in 37 inner-city STD and public primary healthcare clinics. Emory University, as one of seven participating sites nationwide, enrolled 630 individuals in the study from 1994 to 1996. Other study sites included Columbia University, Rutgers University, The Johns Hopkins University, the Medical College of Wisconsin, UCLA, and UC-Irvine.

According to Colleen DiIorio, Ph.D., professor of behavioral sciences and health education at Emory University's Rollins School of Public Health and principal investigator for the Emory arm of the study, participants were educated about HIV and behavioral risk factors through activities that explored the myths and realities of HIV, role-playing communications skills that might encourage partners to use condoms or to abstain from sex, and demonstrations of correct condom use.

Participants were given wallet reminder cards to prompt them in putting their new skills into practice. They were encouraged each week to set both short-term and long-term goals to decrease their risky behaviors.

The investigators conducted seven intervention sessions of 90 minutes to two hours each in groups of 8 to 10 participants over a three-week period. Participants assigned to a control group attended a one-hour AIDS education session that included a videotape and a question-and-answer period. The effectiveness of the intervention was measured using self-reported data in interviews at three, six and 12 months following the intervention, as well as through a review of participants' charts for STD infections and through blood tests to detect chlamydia and gonorrhea. Self-reported data included the number of unprotected sex acts, condom use and sexual abstinence.

During the 12-month follow-up period, gonorrhea incidence among men in the study group was half that of men in the control group. In addition, study group individuals reported fewer unprotected sex acts, had higher levels of condom use, were more likely to use condoms consistently and reported significantly fewer STD symptoms. Study participants who attended the most sessions had the greatest change in behavior.

Eligibility for the study included having engaged in unprotected sex within the past 90 days and having at least one of the following during the past 90 days: sex with a new partner; more than one sexual partner; an STD; sex with a partner known to have other sexual partners; sex with an injection drug user, or sex with a person infected with HIV. Seventy-four percent of participants were African American and 25 percent were Hispanic.

"Although condom use was a major topic in the interventions," explains Dr. DiIorio, "we also talked about not having sex, reducing the number of partners or having sex only within a monogamous, committed relationship with a disease-free partner. Many people in our intervention groups reported limiting or eliminating sex during the period following the intervention and increasing their use of condoms," she said.

"This study demonstrates that we can approach and encourage people who are considered at highest risk for HIV to change their behaviors by committing to using condoms, or to not having sex, or to limiting their number of partners. Men and women really enjoyed participating in our groups and demonstrated significant behavioral change.

"This is important, because in order to control the AIDS epidemic right now we have to encourage people to adopt safe behaviors," said Dr. DiIorio. "We showed as researchers that our intervention worked in changing behaviors in groups of people at greatest risk. Our next step will be to test the results over a longer term and to take the intervention to the community and make it available to STD clinics, county health departments and other organizations that serve people in areas with high rates of HIV."

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