A Brief Skill-Building Program Can Reduce STD or HIV Risk among Inner-City African American Women
A brief skill-building program on practices to reduce exposure to sexually transmitted disease (STD) and HIV improved the self-reported protective behaviors of inner-city black women for up to one year and actually decreased their risk of acquiring an STD, according to a study appearing in the June 2007 issue of the American Journal of Public Health. The women received the program from specially trained nurses either individually or in small group sessions at an inner-city women's health clinic. The study was conducted as part of the "Sister to Sister: The Black Women's Health Project," funded by the National Institute of Nursing Research (NINR), a component of the National Institutes of Health (NIH).
"Teaching healthy behaviors is an important part of what nurses do in the primary health care setting, and this research suggests a direct link between health behavior and disease prevention," said Patricia A. Grady, PhD, RN, Director of NINR.
Added Loretta Sweet Jemmott, Ph.D., RN, nursing professor at the University of Pennsylvania and lead investigator of the study, "Nurses working with inner-city African American women can incorporate this brief, evidence-based preventive intervention into their routine practice."
The findings address a significant area of health disparity. According to Dr. Jemmott, African American women in the U.S. suffer disproportionately high rates of several STDs. In addition, African American women have an elevated incidence of HIV/AIDS, a disease often transmitted to women through heterosexual contact, and the leading cause of death among African American women aged 25 to 34 years.
This study was designed to identify effective single-session STD or HIV risk reduction interventions for inner-city African American women. Researchers evaluated four separate behavioral interventions among a group of 564 sexually experienced African American women from an inner-city women's health clinic. The women ranged in age from 18 to 45 years, and nearly 90 percent reported being sexually active within the last 3 months. At baseline, less than one-quarter reported consistent use of condoms, and one in five tested positive for an STD, either gonorrhea, trichomoniasis, or chlamydia.
The nurse-led interventions were presented in two formats: information-only, or information plus behavioral skill-building. The information-only intervention involved reviewing and discussing a brochure on STD/HIV prevention and safe sex practices. The behavioral skill-building program included review of the STD/HIV brochure, while adding video clips, practice with applying a condom, and role-playing of negotiations for condom use with a sexual partner. Participants received the interventions either in one-on-one sessions lasting 20 minutes, or in small group sessions lasting roughly three hours.
At a 12-month follow-up, women who received the skill-building program, either individually or in a group, reported a higher proportion of condom use during sexual intercourse over the previous three months and were more likely to report using a condom during their most recent sexual episode than women who received information only. In addition, compared to a control group, women from the skill-building groups were less likely to test positive for an STD.
"Nurses are key health professionals in primary care, well-positioned to reach at-risk and underserved populations," said Dr. Jemmott. "The women in this study were encouraged to respect and protect themselves, both for their own sake and for their family and community. We need to make greater effort to reduce the spread of STDs, and especially HIV, which has already killed too many African American women and orphaned too many children."
According to Dr. Grady, "This study adds a significant piece to the effort to improve the protective health behaviors of inner-city African American women, a population that is often underserved in our country. This behavioral intervention can help women take better control of their lives and decrease the spread of many diseases, including HIV/AIDS."
Dr. Jemmott recently received funding from the Replicating Effective Programs initiative of the Centers for Disease Control and Prevention. This initiative promotes the translation of effective programs into clinical practice. Dr. Jemmott and her team are now collaborating with Family Planning Clinics in Philadelphia to determine the feasibility of integrating their 20-minute, one-on-one STD/HIV intervention into these clinical sites.
The primary mission of the NINR, one of 27 Institutes and Centers at the National Institutes of Health, is to support clinical and basic research and establish a scientific basis for the care of individuals across the life span. For additional information, visit the NINR web site at www.ninr.nih.gov.
The National Institutes of Health (NIH)--The Nation's Medical Research Agency--includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
Reference: Jemmott LS, Jemmott III JB, O'Leary A. Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings. American Journal of Public Health. 2007; 97 (6): 1034-1040.