A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women

Background African-American and Hispanic women are disproportionately affec ted by sexually transmitted diseases, including the acquired immunodeficien cy syndrome (AIDS). In the effort to reduce infection rates, it is importan t to create and evaluate behavioral interventions that are specific to the target populations. Methods We enrolled women with nonviral sexually transmitted diseases in a randomized trial of a sex- and culture-specific behavioral intervention. Th e intervention consisted of three small-group sessions of three to four hou rs each designed to help women recognize personal susceptibility, commit to changing their behavior, and acquire necessary skills. The control group r eceived standard counseling about sexually transmitted diseases. The design of the intervention was based on the AIDS Risk Reduction Model and ethnogr aphic data on the study populations. Participants in both groups underwent screening, counseling, and an interview before randomization and at the 6- and 12-month follow-up visits. The principal outcome variable was subsequen t chlamydial or gonorrheal infection, which was evaluated on an intention-t o-treat basis by logistic-regression analysis. Results A total of 424 Mexican-American and 193 African-American women were enrolled; 313 were assigned to the intervention group and 304 to the contr ol group. The rate of participation in the intervention was 90 percent. The rates of retention in the sample were 82 and 89 percent at the 6- and 12-m onth visits, respectively. Rates of subsequent infection were significantly lower in the intervention group than in the control group during the first 6 months (11.3 vs. 17.2 percent, P=0.05), during the second 6 months (9.1 vs. 17.7 percent, P=0.008), and over the entire 12-month study period (16.8 vs. 26.9 percent, P=0.004). Conclusions A risk-reduction intervention consisting of three small-group s essions significantly decreased the rates of chlamydial and gonorrheal infe ction among Mexican-American and African-American women at high risk for se xually transmitted disease. (N Engl J Med 1999;340:93-100.) (C) 1999, Massa chusetts Medical Society.