Objective: STD/HIV is a major cause of morbidity and mortality among African American women. Although considerable evidence indicates that behavioral interventions are effective in reducing self-reported HIV sexual-risk behavior, relatively few randomized controlled trials have tested the long-term effects of such interventions on inner-city African American women, fewer have examined biological markers as outcome measures, and none were implemented by nurses in primary care settings. Therefore, the purpose of this study was to identify and evaluate the effectiveness of STD/HIV risk-reduction nurse-led interventions for African American women on STD/HIV sexual risk behaviors and incidence of sexually transmitted diseases that can be implemented in clinics and other primary health-care facilities. Design: A randomized controlled trial with 3-, 6-, and 12-month follow-up. Sample, Setting and Years: African American women recruited at the women's health clinic of an inner-city hospital (N=564, mean age=27.2 years). Intervention: Participants were randomly assigned to receive 1 of 5 nurse-led, culturally sensitive, theory-driven interventions: (a) 20-minute one-on-one STD/HIV behavioral skill-building intervention, (b) 20-minute one-on-one STD/HIV information intervention, (c) 3.33 hour small group behavioral skill-building STD/HIV intervention; (d) 3.33 hour small group STD/HIV information intervention; (e) 3.33 hour control intervention on general health issues. Main Outcome Measures: Primary outcomes were self-reported condom use and unprotected sexual intercourse; secondary outcomes included the incidence of STDs, beliefs about condom use, behavioral intentions, self-efficacy, and condom-use knowledge. Methods: A Randomized Controlled Trial of Brief Behavioral STD/HIV Prevention Interventions for African American Women in Primary Care Settings. Results: Compared with health control group participants, over the entire follow-up period, the one-on-one and group skill-building intervention participants reported more consistent condom use (P=.016), a greater proportion of protected sexual intercourse (P=.047), and a lower frequency of unprotected sexual intercourse (P=.054). In addition, they were more likely to report condom use at last intercourse (P=.051). Over the entire follow-up period, skill-building participants reported a greater proportion of protected sexual intercourse (P=.009) and a lower frequency of unprotected sexual intercourse (P=.004) than did information interventions. The rates of subsequent STD infection were lower among skill-building participants than among controls at 12-month follow-up (P=.032). The retention rate was 86.9% at 12-month follow-up. Conclusion: Brief nurse-led, one-on-one or group skill-building interventions can reduce STD/HIV sexual risk behaviors and STD morbidity among inner-city African American women.
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