HIV Prevention for STD Clinic Patients

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DESCRIPTION (provided by applicant): The broad, long-term objective of this research is to reduce the morbidity and mortality caused by HIV. The specific aims are to develop and evaluate a risk reduction intervention for patients seeking care at sexually transmitted disease (STD) clinics. This research will have two phases. First, formative research will be conducted with 100 STD clinic patients to clarify the determinants of risk behavior (and risk reduction) in impoverished urban environments. Information obtained will be integrated with behavioral science theory to develop sexual risk reduction interventions that can be delivered by digital video disc (DVD). It is expected that the DVDs will provide patients with information about HIV/STDS, activate patients' motivation to avoid risk, enhance the intra- and interpersonal skills essential for risk reduction, and provide detailed disease prevention strategies. The DVDs will employ a motivational style, be tailored by sex and sexual orientation, and employ dramatic as well as didactic components in order to optimize personal relevance. Second, a randomized controlled trial with 1000 STD clinic patients will be conducted to: (a) evaluate the effectiveness of the DVDs, and (b) separate the effects of the DVDs from the effects of detailed sexual behavior assessments. Patients will be randomized to one of four conditions formed by crossing assessment content (detailed sexual behavior vs. general health behavior) with intervention foci (sexual risk reduction vs. general health promotion). After patients complete a baseline assessment, they will receive a DVD-based intervention and standard clinical care. At 3, 6, 9, and 12 months, they will provide sexual behavior self-reports and specimens for STD testing. Analyses will test whether patients who view the sexual health DVD reduce risk behavior more and have fewer new STDs compared to patients who view a general health promotion DVD. Analyses will also be conducted to increase understanding of individual differences in response to the interventions. Overall, the proposed research will determine whether risk reduction messages delivered by DVD can reduce sexual risk behavior and incident STDs. If found effective, such DVDs can provide a highly feasible, easily disseminated risk reduction program for STD clinics nationwide. In addition, the research will investigate whether the detailed baseline sexual behavior assessments that are common to sexual risk reduction research actually promote sexual behavior change. Clarifying the effects of research assessments is essential to interpreting the intervention literature, and guiding public health practice. Finally, by identifying patients who do not benefit from these interventions, this research can suggest directions for intervention refinement for non-responders. This research will advance the development of practical and effective sexual risk reduction interventions for use in STD clinics, and thereby reduce the burden of disease caused by HIV and other STDs.