Project SAFE: Sexual Awareness For Everyone An Intervention to Prevent STDs Among Minority Women

Investigators: Rochelle N. Shain, Reyes Ramos, Sondra T. Perdue, & Edward R. Newton

Developed for use in public health clinics, PROJECT S.A.F.E. is a three session cognitive-behavioral intervention designed to reduce STD infections among Hispanic and African American women. Sessions are designed to facilitate skill development to avoid infections while increasing awareness that STDs (including AIDS) disproportionately affect minority women. The intervention also helps build decision-making and communication skills, and encourages participants to set risk reduction goals. Participants gain mastery through role-play, group discussion, and behavioral skills exercises. The original evaluation, conducted in metropolitan San Antonio, TX, between 1993 and 1994, included 617 Hispanic and African American women. Participants were randomly assigned to either the intervention group (n=313) or the control group (n=304). Intervention group participants took part in three small-group sessions while their control group counterparts received standard STD counseling. Program participants showed a lower rate of infection as well as a better understanding of risky sexual behavior as compared to the control group. Click here to view more detailed information on this program.

Project SMART: AIDS Education for Drug Users in Short-Term Treatment

Investigators: Benjamin Lewis

Developed for use in short-term in-patient drug treatment programs, Project SMART includes two distinct interventions: a two-session informational intervention and a six-session enhanced intervention that includes both informational and behavioral skills training. A trained health educator delivers both interventions. In the informational intervention, participants receive an overview presentation about AIDS, complete homework, and watch condom-use and works-cleaning demonstrations. In the enhanced intervention, participants also participate in role-plays, watch video presentations, and practice condom-use and works-cleaning skills. Click here to view more detailed information on this program.

Prospero Project Condom Study, San Francisco, 1989-1991

Investigators: Dan Waldorf and David Lauderback

The Prospero Project Condom Study, San Francisco, 1989-1991, which was conducted between December 1989 and April 1991, explored condom use in 552 male sex workers in San Francisco - men who are at high risk to contract and spread the human immunodeficiency virus (HIV). Investigators employed face-to-face interviews to gather detailed information about the conditions (e.g., type of partner, type of sexual activity) under which condoms were and were not used. In addition, the investigators sought to quantify the amount of condom failure (i.e., breakage and/or slippage) in this population. This dataset includes information on 736 variables across 552 cases. Respondents were identified through a combination of methods, including snowball sampling, and represented two types of sex workers, hustlers and call men, who are gay, bisexual, heterosexual, or transvestite/transsexual.

Protect and Respect

Investigators: Michelle Teti, Linda Lloyd, Susan Rubinstein, Lisa Bowleg, Mary Ann Nkansa, Russell Cole, Zekarias Berhane, Erika Aaron, Ann Ricksecker, Marla Gold, Susan Spencer, Rhonda Ferguson, Dianne Rorie

PROTECT AND RESPECT, a clinic-based, behavioral intervention, aims to reduce the sexual transmission of HIV by decreasing high-risk behaviors among women living with HIV/AIDS. The intervention delivers HIV prevention messages in the following three ways: (1) a primary care provider counsels participants during health care visits; (2) an Intervention Specialist leads five group skills building sessions that teach skills to reduce sexual risk behaviors; and (3) Peer Educators conduct weekly discussion groups, which support participants. attempts to implement behaviors learned in the group skills building sessions. The program provider delivers a one-time, brief prevention message lasting 3 . 5 minutes, while the group skills building sessions consist of five 2-hour weekly educational sessions delivered over a 5-week period. The peer-led support groups meet weekly for 1-hour, beginning after the group skills building sessions have concluded, and may extend for as long as the program is in effect. During support group sessions, women are provided with an opportunity to discuss specific topics such as HIV risk reduction strategies, how to disclose, handling stress, or communicating with partners. Click here to view more detailed information on this program.

Queens Hospital Center's Teenage Program

Investigators: Jill M. Rabin & Vicki Seltzer

Based upon the premise that a teen's first pregnancy may stem from underlying, unmet needs, this clinic-based program provides medical care, psychosocial support, and education to the adolescent, her partner, and her family. The comprehensive approach to service emphasizes early intervention, beginning during pregnancy. For the duration of the intervention, each patient and her infant remain with a team of providers: an obstetrician-gynecologist, pediatrician, social worker, and health educator. The program also includes a physician/ practitioner 24 hour "on call" system and a reproductive health and family life education program, featuring bi-weekly classes for the patient, her partner, and family. In an effort to prevent repeat pregnancy and STDs, the teen's partner is encouraged to participate in education, support, and counseling activities. A field study of the intervention was conducted in Queens, New York, with 498 adolescents and their infants. Compared to a control group of teen mothers, program participants were more likely to attend and graduate from school and (for those who were sexually active) use regular contraception; additionally, both they and their infants experienced significantly better health. Moreover, the repeat pregnancy rate was significantly lower for program participants compared to the control group. Click here to view more detailed information on this program.

Reach for Health: A School-Sponsored Community Youth Service Intervention for Middle School Students

Investigators: Lydia O'Donnell, Alexi San Doval, Richard Duran, Deborah Haber, Rebecca Atnafou, Patricia Piessens, & Renee F. Wilson-Simmons, Ann Stueve, Joseph H. Pleck, Norma Johnson, Uda Grant, Helen Murray

The REACH FOR HEALTH COMMUNITY YOUTH SERVICES PROGRAM (RFH-CYS) targets African-American and Hispanic youth living in urban areas. REACH FOR HEALTH combines a classroom teaching component with community service work. The intervention, as implemented, provides opportunities for middle school students to participate in service activities within their communities while simultaneously reducing early and unprotected sexual activity. The intervention was initially delivered in 1994 to two large middle schools in Brooklyn, NY; one school was designated as the intervention school, the other as the control. A total of 68 classrooms participated in the initial implementation. In the control school, 33 classrooms (584 students) received the standard New York City health education program, which includes some mandated lessons on drugs and AIDS. Within the intervention school, 22 classrooms (222 students) were randomly assigned to receive core RFH curriculum (classroom component only). The remaining 13 intervention classrooms (255 students) received the enhanced RFH plus Community Youth Services program (RFH-CYS). Bi-lingual and special education classes were included from both school sites. At follow-up six months later, reports of sexual activity were higher across the sample. However, students in the control condition showed greater increases in risk behavior (ever had sex, recent sex, recent sex without condom, recent sex without birth control) than did their peers in the treatment conditions. In contrast, students in both intervention conditions showed increases in their use of STD protection and birth control. Also noteworthy are the findings that eighth graders and special education students showed the greatest improvement. Click here to view more detailed information on this program.

Real Men Are Safe (REMAS)

Investigators: Donald A. Calsyn, PhD, Mary Hatch-Maillette, PhD, Susan Tross, PhD, Suzanne R. Doyle, PhD, Yong S. Song, PhD, Judy M. Harrer, PhD, Genise Lalos, MA, Sara B. Berns, PhD

REMAS is a group-level, clinic-based behavioral intervention designed to reduce HIV/STI risk among male substance abuse treatment center attendees. More specifically, the program aims to reduce the number of times that men engage in unprotected vaginal and anal sexual intercourse, or have sex while under the influence of drugs or alcohol. Two trained male health counselors teach participants information, help participants develop risk-reduction skills, and motivate behavior change through group discussion, role-play, and condom use skill training. REMAS is comprised of five 90-minute sessions where participants learn about HIV risky-behaviors, HIV prevention planning, and methods for communicating about safer sex and discussing sex without drugs. Click here to view more detailed information on this program.

Reproductive Health Counseling for Young Men

Investigators: Ross Danielson, Anne Plunkett, Shirley Marcy, William Wiest, & Merwin Greenlick

Originally developed for boys between 15 and 18 years of age, this is a one-hour, single-session, clinic-based intervention. The program is designed to meet the needs of sexually active and inactive teens, and to promote abstinence as well as contraception. The session begins with a video presentation that is viewed privately by each teen. The materials address reproductive anatomy, fertility, hernia, testicular self-examination, STDs (including HIV/AIDS), contraception (including abstinence), communication skills, and access to health services. A half-hour private consultation with a health care practitioner follows the presentation. Guided by the young men's interests, the consultation may include such topics as sexuality, fertility goals, and reproductive health risks, along with rehearsal and modeling of sexual communication. A field study of the intervention was conducted with 1,195 high school-aged males visiting health maintenance organizations in two Northwestern cities. Compared to a control group of their peers, sexually active program participants were significantly more likely to use effective contraception at the one-year follow-up assessment, especially if they were not yet sexually active at the time of the intervention. Sexually active female partners of program participants were also more likely to use effective contraception at the follow-up. Click here to view more detailed information on this program.

Rikers Health Advocacy Program (RHAP)

Investigators: Stephen Magura, Janet Shapiro, & Sung-Yeon Kang

This program, originally developed for use with incarcerated male adolescent drug users between 16 and 18 years of age, consists of four one hour small group sessions focusing on health education issues, particularly HIV/AIDS. Adapting techniques of Problem Solving Therapy, the facilitator guides eight-person groups in discussing the following topics: general health, HIV and AIDS, drug abuse and its consequences, sexual behavior, health and AIDS-risk behaviors, and strategies for seeking health and social services. Active learning is emphasized, with opportunities for youths to define high-risk attitudes and behaviors, suggest alternative actions, and engage in role play and rehearsal activities. A field study of the curriculum compared the attitudes and behaviors of RHAP participants with those of a control group of teens, selected from a waiting list for the program. Both samples were predominantly African-American and Hispanic. Following the intervention, program participants were more likely to use condoms during intercourse, compared to the comparison group of teens. RHAP is supported by the Office of Adolescent Health (OAH)'s Teen Pregnancy Prevention (TPP) program as an EBI that is medically accurate, age appropriate, and has proven through rigorous evaluation to prevent teen pregnancy and/or associated sexual risk behaviors. Click here to view more detailed information on this program.

SMART Couples

Investigators: Robert Remien, PhD, Michael Stirratt, PhD, Joanna Dognin, PsyD, Emily May, MA, Curtis Dolezal, PhD, Alex Carballo-Dieguez, PhD, Nabila El Bassel, DSW, Tiffany Jung, NP, Patricia Warne, PhD, & Glenn Wagner, PhD

SMART COUPLES is a four-session intervention delivered by a nurse practitioner to serodiscordant (mixed HIV status) couples. The program aims to increase antiretroviral therapy (ART) adherence in the partner living with HIV/AIDS by increasing knowledge about the importance of medical care adherence, increasing adherence motivation and self-monitoring, increasing problem solving skills to overcome adherence issues, increasing self-efficacy, and optimizing partner support. In addition, the program was designed to foster active support between partners and help couples address issues of sex, intimacy, and transmission risk behaviors. During four 45- to 60-minute sessions, the couples engage in structured discussion and instruction, as well as specific problem-solving and couple-communication exercises. The nurse practitioner helps participants learn the different components of medical care adherence, and how a partner can help prompt adherence. Participants are also given an opportunity to discuss barriers to adherence, and how to communicate with their partners about different health care concerns including sexual risk taking. Finally, couples determine what their .triggers. are for poor medication adherence, and how to avoid these triggers in the future. Click here to view more detailed information on this program.