摘要：Objectives. We tested the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings. Methods. In a randomized controlled trial, 564 African American women recruited at a Newark, NJ, inner-city women’s health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, 200-minute group HIV/STD behavioral skill-building intervention, 20-minute one-on-one HIV/STD information intervention, 200-minute group HIV/STD information intervention, or 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence. Results. At 12-month follow-up, participants in the skill-building interventions reported less unprotected sexual intercourse than did participants in the information interventions (Cohen’s d [ d ]=0.23, P =.02), reported a greater proportion of protected sexual intercourse than did information intervention participants ( d =0.21, P =.05) and control participants ( d =0.24, P =.03), and were less likely to test positive for an STD than were control participants ( d =0.20, P =.03). Conclusions. This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African American women in primary care settings. There is growing concern about morbidity and mortality associated with sexually transmitted diseases (STDs) among African American women. Although STDs are widespread across racial and ethnic groups in the United States, reported rates of chlamydia are 10 times higher, and reported rates of gonorrhea and syphilis 25 times higher, among African Americans than among Whites. 1 , 2 African American women are also disproportionately affected by HIV/AIDS, which is commonly transmitted through sexual behavior. Although only 12% of women in the United States are African Americans, 67% of US women diagnosed with AIDS in 2004 were African Americans, 3 and AIDS is the leading cause of death among African American women aged 25 to 34 years. 4 Interventions are needed in a variety of venues to comprehensively address African American women’s risk of STDs, including HIV. One important venue for such interventions is the primary health care setting. Nurses and other health care providers may be especially effective agents of behavior change. Because health care providers are generally unable to devote a great deal of time to primary prevention, brief single-session interventions may be especially practical in primary health care settings. Unfortunately, there is a paucity of evidence on the efficacy of such interventions. Although there is considerable evidence of the efficacy of behavioral interventions in reducing self-reported HIV/STD sexual-risk behavior, 5 few trials have demonstrated significant reductions in the rate of biologically confirmed STDs among women, 6 – 8 and none have examined brief single-session interventions implemented by health care providers with African American women in a primary care setting. Moreover, in some of these studies, 6 , 7 participants were selected on the basis of recent STD or HIV test results. Whether the findings of these trials would generalize to a less restricted population of African American women is unclear. There is a growing consensus that merely providing information is not enough to induce sexual behavior change and that it is also necessary to instill behavioral skills, including condom use and condom-use negotiation skills. Both one-on-one counseling 9 and small-group interventions 6 , 9 are appropriate in primary care settings. Small-group interventions can allow participants to learn from each other, whereas one-on-one interventions can be shorter and more tailored to the individual. Our randomized controlled trial was designed to identify effective single-session HIV/STD risk-reduction interventions for inner-city African American women that can be implemented by nurses and other health care providers in clinics and other primary care facilities. We tested 4 culture-sensitive, HIV/STD risk-reduction interventions involving 2 kinds of intervention content—information versus behavioral skills—and 2 methods of intervention delivery—group versus individual. We randomly assigned African American women from an inner-city women’s health clinic to 1 of these 4 HIV/STD risk-reduction interventions or a general health-promotion intervention, which served as the control group. We hypothesized that the skill-building interventions would reduce self-reported sexual-risk behavior and the rate of STDs compared with the control group or information interventions. In addition, we tested whether the skill-building group intervention was more effective than the skill-building one-on-one intervention.
