Risk reduction interventions tailored to gender and culture may be effective at reducing incident STD and increasing preventive behaviors among black adolescent females seeking sexual health services,1 a particularly vulnerable subpopulation, given that they have high rates of STDs and generally eschew preventive strategies. In a randomized controlled trial of an STD prevention program designed specifically for this group, intervention participants had lower risks than controls of acquiring chlamydia and of having a recurrent chlamydial infection over a 12-month follow-up period (risk ratios, 0.7 and 0.3, respectively). In addition, intervention participants reported using condoms a higher proportion of the time than controls in the 60 days preceding follow-up assessments; females in the intervention group used condoms 22% more often than those in the control group.
To evaluate the efficacy of an STD intervention addressing a broad array of factors associated with sexual risk, black females aged 15–21 were recruited from three sexual health clinics in Atlanta between March 2002 and August 2004. Females were eligible if they reported vaginal intercourse in the previous 60 days and were not married, pregnant or attempting to become pregnant. In all, 715 adolescents participated in the study and were randomized into the intervention group (348 women) or a control group (367).
Participants in the intervention group attended two four-hour interactive group sessions, designed to foster gender and cultural pride, on consecutive Saturdays. During these sessions, the adolescents were taught methods to reduce sexual risk, were advised to reduce douching and were given a $20 voucher for their male partner to use toward STD testing services. During roughly the next nine months, participants received four phone calls from health educators to reinforce prevention methods. In the comparison group, participants attended a one-hour group session, during which they watched a video on STD prevention and had a question-and-answer period and group discussion.
At baseline, six months and 12 months postintervention, participants from both groups completed audio computer-assisted self-interview questionnaires assessing their social and demographic characteristics, sexual history and attitudes. In addition, participants provided two self-collected vaginal swabs for STD testing. The primary biological outcome was the incidence of chlamydial infection at each follow-up point; the primary behavioral outcome was the proportion of sex acts during which a condom had been used in the 60 days prior to each. The researchers also assessed a variety of other risk-related behaviors. Logistic and linear generalized estimating equations regression models were used to assess the effects of the intervention from baseline to the 12-month follow-up.
At baseline, participants had a mean age of 17.8 years, and about 65% were in school. The young women reported an average of nine lifetime sex partners; 43% had used a condom at last sex, and 30% had chlamydia. Over the 12-month follow-up period, 42 females in the intervention group had a chlamydial infection, compared with 67 in the control group (risk ratio, 0.7). During the study period, four participants in the intervention group had a recurrent chlamydial infection, while this was true for 14 participants in the control group (0.3).
Females in the intervention group reported a reduction in douching compared with those in the control group: Over the 12-month follow-up period, women in the intervention douched 56% less often than controls. In addition, participants in the intervention group reported condom use a higher proportion of the time than those in the control group. In the 14 and 60 days preceding their follow-up assessments, women in the intervention group used condoms 17% and 22% more often, respectively, than controls.
Intervention participants were more likely than controls to report consistent condom use in the 14 days before follow-up interviews (risk ratio, 1.3), consistent condom use in the previous 60 days (1.4) and condom use at last sex (1.3). In addition, relative to those in the control group, participants in the intervention group reported greater partner communication, greater STD prevention knowledge and higher condom use self-efficacy over the follow-up period.
Among STD-positive participants, those in the intervention group were more likely than controls to report that they had told their male partners about their status (odds ratio, 2.1) and that their partner had received STD treatment (2.2).
The researchers note that the intervention may have been effective because it was “designed not only to provide STD/HIV risk-reduction education and training skills, but to also intervene on relational, sociocultural and structural factors that exacerbate African American adolescent females’ risk for STDs and HIV.” They conclude, however, that achieving “population-level reductions in risk behaviors and disease requires development of a competent and fully operational infrastructure to promote the efficient dissemination” of evidence-based interventions.
1. DiClemente RJ et al., Efficacy of sexually transmitted disease/human immunodeficiency virus sexual risk–reduction intervention for African American adolescent females seeking sexual health services: a randomized controlled trial, Archives of Pediatrics & Adolescent Medicine, 2009, 163(12):1112–1121.