Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
Sexually active, low-income, inner-city clinic patients at high-risk for
HIV and STD infection
Goals of Intervention
- Eliminate or reduce sex risk
behaviors
- Prevent new STD infections
- Increase self-efficacy and
problem-solving skills for practicing
safer sex
Brief Description
“light” is a 7-session,
small-group HIV-risk reduction
intervention to stimulate motivation for
behavior change along with
individualized skill building required
to accomplish personal HIV-related
goals. The intervention covers topics,
including HIV/AIDS knowledge,
identification and management of
triggers for risk acts, problem-solving
in risk situations, condom use,
interpersonal assertiveness to negotiate
safer sex, and maintenance of new
behavioral routines. Each session has a
focus, but skills are reinforced and
practiced throughout the 7 sessions.
Each participant practices skills
specific to his or her risk
circumstances involving steady partners,
casual partners, drug-using partners,
and other personally relevant
relationships. Goals to reduce risk are
set every session and revised at the
following session for feedback, review
or problem-solving as appropriate. Each
session contains scripted role plays and
activities to facilitate group
interaction and learning. The
intervention is delivered to same-sex
small groups of 5 to 15 persons twice
weekly. |
Theoretic Basis
Intervention Duration
Seven 90- to 120-minute sessions conducted
twice weekly.
Intervention Settings
Inner-city community based clinics,
including STD clinics and primary care
clinics at Health Service Organization (HSO)
Deliverer
Co-led by one male and one female trained
facilitators
Delivery Methods
- Demonstration
- Exercises
- Goal Setting/plan
- Role play
- Practice
- Video
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Intervention Package Information
An intervention package was developed with funding from CDC’s Replicating
Effective Programs (REP) Project. Information about the intervention package can
be found at CDC’s REP
project website.
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Evaluation Study and Results
The original evaluation study was
conducted in Bronx, Harlem, Manhattan, and
Brooklyn, New York City; northern New
Jersey; Baltimore, Maryland; Atlanta,
Georgia; Milwaukee, Wisconsin; and Los
Angeles, Orange and San Bernardino counties,
California between 1994 and 1997.
Key Intervention Effects
- Reduced unprotected sex
- Increased condom use
- Reduced STD infections
Study Sample
The baseline study sample of 3,706 clinic patients is characterized by the
following:
- 74% African American, 25%
Hispanic, 1% Other
- 42% Male, 58% Female
- 97% heterosexual, 3% homosexual
or bisexual
- 25% < 25 years old, 42% 25 to 35
years old, 33% > 35 years old
- 55% completed high school
education or more
Recruitment Settings
Men were recruited from STD clinics and women were recruited from
both STD clinics and primary care clinics at
Health Service Organizations (HSOs).
Eligibility Criteria
Men and women were eligible if they were
sexually active, did not consistently use
condoms, and engaged in one of the following
activities in the last 90 days: sex with a
new partner, sex with more than one partner,
sex with someone who was having sex with
others, treated for STD or at clinic to be
treated for STD, injected drugs, sex with
someone who injects drugs, or sex with
someone who has HIV. The age requirement for
STD patients was 20 years or older and for
women attending HSOs was 18 years or older.
Assignment Method
Participants
(N = 3,706) were randomly assigned to 1 of 2
groups: “light” (n = 1,851) or AIDS
education comparison (n = 1,855).
Comparison Group
The
comparison group received a 60-minute AIDS
education session which included a
videotape, a question-and-answer period, and
a brochure that had referral numbers for
HIV/AIDS information. It was delivered by
trained facilitators at community based
clinics.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors during
past 90 days (including number of
unprotected vaginal and anal
intercourse, consistent condom use or
abstinence, proportion of
condom-protected vaginal or anal
intercourse) were measured at 3-, 6-,
and 12-month follow-ups.
- STD infection during the
12-month follow-up period was assessed by
reviewing medical charts for incidence of
gonorrhea and urine test result for point
prevalence of Chlamydia and gonorrhea.
Self-reported STD symptoms in the past 90
days were also measured at 3-, 6-, and
12-month follow-ups.
Participant Retention
- “light” intervention:
84% retained at 3 months
85% retained at 6 months
83% retained at 12 months
- AIDS Education comparison:
83% retained at 3 months
86% retained at 6 months
84% retained at 12 months
Significant Findings
- Intervention participants reported
significantly fewer unprotected vaginal
and anal intercourse acts than
comparison participants at each of three
follow-ups and longitudinally over time
(all p’s < .0001). The intervention
effect for this outcome was also found
to be significant at each follow-up and
longitudinally over time for the
following subgroups: male STD clinic
patients, female STD clinic patients,
and female HSO patients.
- Intervention participants reported
significantly greater proportion of
condom-protected vaginal or anal
intercourse acts than comparison
participants at each of three follow-ups
and longitudinally over time (all p’s <
.0001). The intervention effect for this
outcome was also found to be significant
at each follow-up and longitudinally
over time for the following subgroups:
male STD clinic patients, female STD
clinic patients, and female HSO
patients.
- Intervention participants were more
likely to report either consistent
condom use or abstinence than comparison
participants at each of three follow-ups
and longitudinally over time (all p’s <
.0001). The intervention effect for this
outcome was also found to be significant
at each follow-up for male STD clinic
patients and female HSO patients, at the
3- and 12-month follow-ups for female
STD clinic patients, and longitudinally
over time for all subgroups.
- Intervention participants were less
likely to report STD symptoms at one or
more follow-ups than comparison
participants (p = .001). The
intervention effect for this outcome was
also found to be significant for the
following subgroups: male STD clinic
patients, female STD clinic patients,
and female HSO patients.
- A significantly smaller percentage
of intervention participants were
diagnosed with incident gonorrhea (based
on medical chart review) than comparison
participants during the 12-month
follow-up period (p < .05). This finding
was also found to be significant among
the subgroup of male STD clinic
patients.
Considerations
- Intervention effect was consistent
across racial/ethnic subgroups of
African American and Hispanic.
- Participants who attended more “light”
intervention sessions exhibited greater
magnitudes of behavior change.
- Significant intervention effects
were observed for self-reported STD
symptoms and medical chart review of
gonorrhea rates, but urine assessments
for point prevalence of Chlamydia and
gonorrhea were not found to be
significant.
- The reduction of gonorrhea rates was
found to be significant among men but
not among women, which may be due to the
fact that gonorrhea is more prevalent
among men than women over the age of 24
years and is generally more symptomatic
in men than women.
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References and Contact Information
- NIMH Multisite HIV Prevention Trial Group. (1998). The NIMH Multisite HIV Prevention Trial: Reducing HIV Sexual Risk Behavior. Science, 280, 1889-1894.
- NIMH Multisite HIV Prevention Trial Group. (1997). Screening, Recruiting and Predicting Retention of Participants in the NIMH Multisite HIV Prevention Trial. AIDS, 11(Suppl. 2), S13-S19.
- NIMH Multisite HIV Prevention Trial Group. (1997). Methodological Overview of the NIMH Multisite HIV Prevention Trial for populations at risk for HIV. AIDS, 11(Suppl. 2), S1-S11.
- NIMH Multisite HIV Prevention Trial Group. (1997). Conceptual basis and procedures for the intervention in a multisite HIV prevention trial. AIDS, 11(Suppl. 2), S29-S35.
Researcher: Multisite Staff Collaborator
National Institute of Mental Health (NIMH)
Public Information and Communications Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
email: nimhinfo@nih.gov
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