Intervention Cuts STI Rates Among Black Women


MEXICO CITY — African American women who receive an intervention that includes a package of safer-sex options have a large reduction in the incidence of sexually transmitted infections relative to peers who receive general health promotion, researchers reported at the International AIDS Conference.

“Among women in the U.S., marked racial as well as regional disparities [in HIV incidence] exist,” said lead author Gina M. Wingood, Sc.D., of Emory University in Atlanta. “Specifically, women in the deep southern U.S. are severely affected.” A related issue, she noted, is that HIV interventions for women have focused on the use of condoms and penile-vaginal sex, giving women few preventive options.

To address these issues, Dr. Wingood and her colleagues undertook the STARS (Sisters Talking About Real Solutions) trial. With the database of a health maintenance organization in Georgia, they randomly selected African American women aged 18-29 years and invited those who were sexually active and reported having unprotected vaginal sex in the prior 6 months to participate. Participating women were randomly assigned to an intervention group or a comparison group, Dr. Wingood said. The intervention, delivered in two 4-hour workshops, focused on fostering ethnic and gender pride (to enhance self-esteem, self-awareness, and self-worth), increasing awareness of healthy and unhealthy relationships (to address the link between abuse and sexually transmitted infections [STIs]), and introducing a package of safer-sex options known as AMOUR (Abstain from unsafe sex and douching; Mutual stimulation, meaning nonpenetrative sex; Oral sex with protection; Uninfected partners, referring to ensuring that partners do not have STIs; and Regular condom use and reduction of number of partners). The comparison group received a single 4-hour workshop that focused on general health promotion.

The women enrolled in the trial were a mean age of 24 years; 57% lived with a family member, 89% had completed high school, and 86% were in relationships lasting an average of 23 months. Intention-to-treat analyses were based on 605 women in the intervention group and 243 women in the comparison group. The workshops were completed by 96% and 100%, respectively, and 75% of women in each group completed the trial's 12-month follow-up assessment.

In terms of biologic outcomes at 12 months, women in the intervention group were significantly less likely to have acquired any of four STIs studied (human papillomavirus type 16 or 18, chlamydia, gonorrhea, or trichomoniasis) relative to their counterparts in the comparison group (odds ratio, 0.35). In addition, intervention women were significantly less likely to have acquired human papillomavirus infection individually (O.R. 0.37) and the other, nonviral STIs individually (O.R. 0.62).

Women in the intervention group had significantly more favorable levels of each of nine risk behaviors than did the comparison group. For example, they were more likely to have asked their main partner to be tested for STIs (O.R. 1.41) and to have had protected oral sex (O.R. 2.05), and they were less likely to have douched (O.R. 0.38) and to have had sex with more than one partner (O.R. 0.73) or with casual partners (O.R. 0.66).

Finally, women in the intervention group had significantly higher scores on tests of knowledge regarding prevention of STIs and HIV, greater self-efficacy regarding condom use, and lower levels of barriers to safer sex.

Dr. Wingood stated that she had no conflicts of interest regarding the study.

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