STD PREVENTION FOR AT RISK AFRICAN-AMERICAN WOMEN

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The purpose of the study is to test the effectiveness of a 12-month multi-modal Well Woman intervention to prevent new sexually transmitted diseases (STDs) among young, low-income African American women with a history of repeated STDs. The target group lives on or near the Chicago Westside, where women are plagued with some of the highest STD rates in the nation. The Specific Aim is to determine the effects of the randomized, controlled repeated measures trial on (a) the mediating outcomes--STD related social, psychological, and skill/behavioral factors, and (b) the health status outcome-laboratory-confirmed newly contracted STDs. The intervention is case-managed by advanced practice nurses (APNs) and complemented by a social worker and peer educators. The intervention has a 2 month intensive phase and a 10-month maintenance phase with evidence- based standardized and individualized STD-prevention strategies: STD diagnosis, treatment, teaching, and support by APNs; STD prevention classes led by peer educators; community referrals and retention strategies by a social worker; and partner classes, counseling, and referrals. Subjects will be 670 women aged 18-29 years who have an index STD and at least 1 other STD in their histories. Subject recruitment will occur at 4 publicly supported West Side clinics, and the intervention will be in the West Side Health Center, a new Cook County Health Services facility in the center of the area. After baseline measures, the women will be randomly assigned to control or intervention groups with the minimization subject distribution procedure, taking into account the history of intravenous drug use, number of sexual partners, sexual violence, and HIV seropositivity. The control group will have usual care, STD urine screening, HIV testing (offered) and a minimal didactic experience until the 12-month measure is taken. Then they will be offered a concentrated intervention. A STD-Prevention Framework derived from a tested nursing model, Cox's Interaction Model of Client Health Behavior, will guide the overall intervention and the components. Analyses include change scores, logistic regression, proportional odds regression and random regression analysis.