August 3, 1998
Volume 50, No. 36
Study shows education cuts down risk of AIDS infection
Sexual behaviors that place individuals at high risk for contracting HIV and AIDS can be voluntarily and significantly modified-even in underserved, lower socioeconomic groups-through group education, role playing, communications skills, motivation and goal setting, according to a nationwide study published recently in Science.
The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial-the largest controlled HIV behavioral-intervention study ever conducted in the United States-enrolled 3,706 African American and Hispanic men and women in 37 inner-city sexually transmitted disease (STD) and public primary health-care clinics. As one of seven participating sites nationwide, Emory enrolled 630 individuals in the study from 1994 to 1996. Other study sites included Columbia, Rutgers, Johns Hopkins, Medical College of Wisconsin, University of California-Los Angeles and University of California-Irvine.
According to Colleen DiIorio, professor of behavioral sciences and health education at the Rollins School of Public Health and principal Emory investigator, participants were educated about HIV and behavioral risk factors through activities that explored the myths and realities of HIV, role-playing communications skills that might encourage partners to use condoms or abstain from sex, and demonstrations of correct condom use.
Participants received reminder cards to prompt them to put their new skills into practice. They were encouraged each week to set both short-term and long-term goals to decrease their risky behaviors.
Over a three-week period, investigators conducted seven sessions with groups of eight to 10 participants. The control group attended a one-hour education session that included a videotape and a question-and-answer period. The study measured effectiveness using self-reported data three, six and 12 months following the intervention, as well as through a review of participants' charts and blood tests. Self-reported data included the number of unprotected sex acts, condom use and abstinence.
During the 12-month follow-up period, gonorrhea incidence among men in the study group was half that of men in the control group. In addition, study group individuals reported fewer unprotected sex acts, higher levels of condom use, greater likeliness to use condoms consistently and significantly fewer STD symptoms. Study participants who attended the most sessions had the greatest change in behavior.
Eligible participants must have engaged in unprotected sex within the previous 90 days. They also must have reported at least one of the following during the same period: sex with a new partner; more than one sexual partner; an STD; sex with a partner known to have other sexual partners; sex with an intravenous drug user; or sex with a person infected with HIV.
"Although condom use was a major topic," said DiIorio, "we also talked about not having sex, reducing the number of partners or having sex only within a monogamous, committed relationship with a disease-free partner. Many people reported limiting or eliminating sex following the intervention and increasing their use of condoms."
"This study demonstrates that we can approach and encourage [high-risk] people to [commit] to using condoms, to not having sex or to limiting their number of partners. Men and women really enjoyed participating in our groups and demonstrated significant behavioral change.
"Our next step will be to test the results over a longer term and to take the intervention to the community and make it available to organizations that serve people in areas with high rates of HIV."