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ABSTRACT: The purpose of this study was to evaluate the separate and combined effectiveness of brief and intensive interventions for sexual risk reduction among patients at a sexually transmitted disease (STD) clinic. Patients (N =1483; 54% men; 64% African-American; M = 29.2 years old) were recruited from a publicly funded, walk-in STD clinic. Patients completed a baseline assessment, and then were randomized to one of six intervention arms; each arm combined a brief intervention with an intensive intervention. The interventions provided different levels of information, motivational counseling, and behavioral skills training, guided by theory, formative research, and empiric precedent. Follow-up assessments, including STD screening, occurred at 3, 6, and 12 months post-intervention. The results showed that infection rates declined from 18.1% at baseline to 4.5% at 12 months. At a 3-month follow-up, patients reported fewer sexual partners, fewer episodes of unprotected sex, and a lower percentage of unprotected sexual events; they strengthened sexual health knowledge, safer sex attitudes and intentions, and self-efficacy beliefs. No consistent pattern of differential risk reduction was observed among the six intervention conditions, nor was any evidence of decay from 3 to 12-month follow-ups obtained. We conclude that implementing behavioral interventions in a STD clinic was associated with significant reduction of sexual risk behavior and risk antecedents.
AIDS and Behavior 08/2009; 14(3):504-17. · 3.49 Impact Factor
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ABSTRACT: Sexual partner concurrency plays an important role in HIV and STD transmission. The shortage of African-American men may facilitate partner concurrency. This study evaluated whether the male-to-female ratio was associated with African-American participants' number of recent sexual partners, and whether this association differed by gender. Multilevel modeling was used to determine the influence of individual (i.e., gender) and population-level (i.e., sex ratio) variables on the number of recent sexual partners. African-American patients (N = 915; 52% male) were recruited from an STD clinic. Patients reported their number of sexual partners; the male-to-female ratio per census tract was obtained from the U.S. Census Bureau. There were fewer men than women in nearly all census tracts. The interaction between gender and the male-to-female ratio was significant. For men, there was no association between the sex ratio and their number of sexual partners. For women, as the sex ratio increased, their number of sexual partners increased; however, this association was driven by participants who reported trading sex. We found no evidence that fewer African-American men in a census tract was associated with men having more sexual partners.
AIDS and Behavior 06/2008; 14(4):942-8. · 3.49 Impact Factor
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ABSTRACT: Sexual partner concurrency, which fuels the spread of HIV, has been hypothesized as a cause of higher rates of HIV among low-income, urban African-Americans. Despite this hypothesis, little is known about the phenomenology of partner concurrency. To address this gap in the literature, we recruited 20 urban African-American men from a public STD clinic to elicit their ideas about partner concurrency. Five themes emerged during focus group discussions. First, there was a general consensus that it is normative to have more than one sexual partner. Second, men agreed it is acceptable for men to have concurrent partners, but disagreed about whether it is acceptable for women. Third, although men provided many reasons for concurrent partnerships, the most common reasons were that (a) multiple partners fulfill different needs, and (b) it is in a man's nature to have multiple partners. Fourth, men described some (but not all) of the negative consequences of having concurrent partners. Finally, men articulated spoken and unspoken rules that govern concurrent partnerships. These findings increase knowledge about urban, African-American men's attitudes toward concurrent partnerships, and can help to improve the efficacy of sexual risk-reduction interventions for this group of underserved men and their partners.
AIDS and Behavior 06/2008; 14(1):38-47. · 3.49 Impact Factor
