AIDSWEEKLY Plus; Monday, June 29, 1998
Daniel J. DeNoon, Senior Editor
The intervention includes group education, role playing, teaching of communications skills, motivation training, and goal setting.
The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial - the largest, controlled HIV behavioral intervention study ever conducted in the U.S. - enrolled 3706 African American and Hispanic men and women in 37 inner-city sexually transmitted disease (STD) and public primary healthcare clinics.
"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," said Colleen Dilorio of Emory University, Atlanta, Georgia. "Men and women really enjoyed participating in our groups and demonstrated significant behavioral change."
Emory was one of seven participating sites and enrolled 630 study participants from 1994 to 1996. Other sites included Columbia University, Rutgers University, Johns Hopkins University, the Medical College of Wisconsin, and the Universities of California at Los Angeles and Irvine.
Eligibility for the study was determined by having engaged in unprotected sex within the past 90 days and either: sex with a new partner; more than one sex partner; an STD; sex with a partner known to have other sex partners; sex with an injection drug user; or sex with an HIV infected person.
Dilorio said that participants were educated about HIV and behavioral risk factors via activities that explored the myths and realities of HIV, role-playing communications skills that might encourage condom use or sex abstinence, and demonstrations of correct condom use.
Participants received wallet reminder cards to prompt them on their new skills. Each week they were encouraged to set both long- and short-term goals for risk-behavior reduction.
The investigators conducted seven 90- to 120-minute intervention sessions of over a three-week period. Eight to 10 participants were scheduled to attend each session. In place of the intervention, subjects assigned to a control group attended a one-hour AIDS education session including a videotape presentation and a question- and-answer period.
Intervention efficacy was measured via self-report interviews conducted at three, six, and 12 months following intervention; by a review of participants' medical charts for STD infections; and by blood tests for chlamydia and gonorrhea. Data on number of unprotected sex acts, condom use, and sexual abstinence were collected during interviews.
During the 12-month follow-up period, gonorrhea incidence among men in the study group was half that of men in the control group. Participants receiving the intervention reported fewer unprotected sex acts, higher levels of condom use, and fewer STD symptoms. Behavior change was positively correlated with the number of group sessions attended.
"Although condom use was a major topic in the interventions, 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," Dilorio said. "Many people in our intervention groups reported limiting or eliminating sex during the period following the intervention and increasing their use of condoms."
The Emory researcher said that she and her colleagues will now work to implement long-term programs using the study's intervention techniques.
"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," she said.
The study has been published in the journal Science ("The NIMH Multisite HIV Prevention Trial: Reducing HIV Sexual Risk Behavior," Science, 1998;280:1889-94).
Correspondence regarding the study may be addressed to Multisite Staff Collaborator, National Institute of Mental Health, National Institutes of Health, Parklawn Building, Room 18-101, 5600 Fishers Lane, Rockville, Maryland 20857.
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