Despite studies showing that African-American adolescent girls are at particularly high risk of being infected with HIV, no intervention strategy designed specifically for this population has previously proven effective in reducing the behaviors that lead to HIV risk. Now a team of behavioral scientists from the Rollins School of Public Health at Emory University has found that an intervention specifically tailored to gender and culture can make a measurable difference in curbing risky sexual behaviors. The Emory research was reported Sunday, July 11 in Bangkok at the XV International AIDS Conference and will be published in the Journal of the American Medical Association (JAMA) on Thursday, July 14.
Ralph J. DiClemente, PhD and Gina Wingood, ScD, MPH and a multi-university team of colleagues conducted a randomized, controlled clinical trial of 522 sexually experienced adolescent African-American girls aged 14 to 18 years, between September 1995 and August 2002. Participants were randomly assigned to either an HIV intervention group or a general health promotion group. At the beginning of the study all participants completed a self-administered questionnaire and an interview, demonstrated condom application skills, and provided specimens for STD testing. The HIV intervention consisted of four, 4-hour group sessions, emphasizing ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The control group participated in a structurally identical program of four, 4-hour group sessions that emphasized exercise and nutrition.
The primary measurable outcome of the study was consistent condom use, defined as condom use during every instance of vaginal sexual intercourse. This measure was selected given its strong association with a significantly reduced risk of acquiring an HIV infection. Other outcome measures included self-reported sexual behaviors, including numbers of protected and unprotected instances of sexual intercourse, condom application skills, new vaginal sex partners, STD infections, self-reported pregnancy, and attitudes and beliefs that are related to sexual behavior. These included HIV prevention knowledge, perceived partner barriers to condom use, attitudes toward condom use, and frequency of sexual communication.
Outcomes of the intervention were assessed at 6 and 12 months following completion of the HIV or general health promotion interventions. Participants in the HIV intervention group reported using condoms 75.3% of the time during the 30 days preceding the 6-month follow-up vs. 58.2 % for the control group. HIV group participants also reported consistent condom use of 73.3% in the 30 days preceding the 12-month follow-up vs. 56.5% for the control group. In the 6 months preceding the 6-month and 12-month follow-ups, HIV group participants reported using condoms more consistently than control group participants (61.3% vs. 42.6% and 58.1% vs. 45.3%). Overall, the girls in the HIV intervention group were more likely to use a condom at last intercourse, less likely to have a new vaginal sex partner in the past 30 days, have better condom application skills, report a higher percentage of instances of condom-protected intercourse, and report fewer instances of unprotected intercourse. They also had fewer chlamydia infections and fewer new pregnancies.
Other study authors include: Kathy F. Harrington, MPH, MAEd; Delia Lang, PhD, MPH; Susan L. Davies, PhD, MEd; Edward W. Hook, III, MD; M. Kim Oh, MD; Richard A. Crosby, PhD; Vicki Stover Hertzberg, PhD; Angelita B. Gordon, MS; James W. Hardin, PhD; Shan Parker, PhD, MPH; and Alyssa Robillard, PhD, MSPH.