Behavioral Interventions and Abuse: Results of a Two-Year Controlled Randomized Trial in Minority Women

Jane Dimmitt Champion, PhD¹, R. N. Shain, PhD², J. E. Korte, PhD², A. E. C. Holden, PhD², J. M. Piper, MD², and S. Perdue, DrPh³. (1) Department of Family Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA, (2) Department of Obstetrics and Gynecology, The Univ of Texas Health Science Center at San Antonio, San Antonio, TX, USA, (3) Department of Microbiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

Background: Sexually transmitted disease (STD), including AIDS disproportionately affects African-and Mexican-American women with a history of physical or sexual abuse.

Objective: To evaluate efficacy of standard and enhanced (addition of optional support groups) gender- and culture-specific, small-group behavioral interventions, compared to interactive STD counseling, for high-risk minority women with a history of physical or sexual abuse for two years.

Methods: Women with a non-viral STD were treated and enrolled in a randomized trial. Follow-up screens and interviews occurred at 6 months, 1 year, 18 months (short interview, optional exam) and 2 years. The primary outcome was subsequent infection with chlamydia and/or gonorrhea. Comparisons of primary outcomes were made by self-reports of physical or sexual abuse. We employed logistic regression based on intention-to-treat.

Results: Data from 775 women were included; the retention rate was 91%. Adjusted infection rates were higher in the controls in Year 1 (26.8%), Year 2 (23.1%) and cumulatively (39.8%) than in the enhanced (15.4%, P=.004; 14.8%, P<.03; 23.7%, P<.001, respectively) and standard (15.7%, P=.006; 14.7%, P=.03; 26.2%, P<.008, respectively) intervention arms at these time points. Enhanced-intervention women who opted to attend support groups (attendees) had the lowest adjusted infection rates in Year 1 (12.0%) and cumulatively (21.8%). Intervention women in general, but particularly attendees, were significantly less likely than controls to have repeat infections. Multiple partners and unprotected sex with an untreated partner helped explain group differences in infection. Logistic regression analyses by self-reports of abuse identified abused women as more likely to be re-infected at 2 year follow-up than nonabused. Abused adolescent women were most likely to experience re-infection.

Conclusions: Risk-reduction interventions significantly decreased both single and multiple infective episodes with chlamydia and/or gonorrhea in the two-year study period for non-abused women. Abused women had significantly increased infective episodes in the same study periods.

Learning Objective #1: describe 2 year follow-up results of a controlled randomized trial of a behavioral intervention for sexually transmitted diseases.
Learning Objective #2: describe association of abuse and reinfection among minority women enrolled in a controlled randomized trial of a behavioral intervention for sexually transmitted diseases.