Acceptability of a Computer-Tailored Safer Sex Intervention for Heterosexually Active African Americans Attending an STI Clinic.

Since African Americans are disproportionately affected by HIV/AIDS, interventions that increase correct and consistent condom use are urgently needed. We report baseline acceptability data from a randomized controlled trial (RCT) testing the Tailored Information Program for Safer Sex, a computer-tailored intervention designed to increase correct and consistent condom use among low income, heterosexually active African Americans attending an urban sexually transmitted infection (STI) clinic. We enrolled 274 participants at baseline in an RCT-147 in the intervention group. The intervention had high acceptability, with a mean acceptability of 4.35 on a 5-point scale. We conducted a multiple regression analysis examining demographic, structural, and sexual risk characteristics that revealed only sex to be significantly (p < .01) associated with intervention acceptability. While women were more likely than men to find the intervention acceptable, overall the results indicated broad acceptability of this intervention to the target audience. eHealth interventions are a viable option for HIV prevention among African Americans visiting a publicly-funded STI clinic. We discuss implications of these results for the future application of such programs.

Sexual partnerships, risk behaviors, and condom use among low-income heterosexual African Americans: a qualitative study.

The purpose of the current investigation was to contextualize the sexual relationships and risk behaviors of heterosexually active African Americans. A total of 38 participants (20 females and 18 males) aged 18-44 years were recruited in a large city in the southeastern U.S. to participate in focus group discussions exploring sexual partnerships, general condom perceptions, and condom negotiation. Results indicated that participants distinguished among at least three partner types-one-night stand, "regular" casual partner, and main partner. Partner types were found to shape and influence types of sexual behaviors, perceptions of risk and condom use, and condom negotiation. Participants also shared general perceptions about condoms and elucidated situations in which intentions to use condoms were not realized. Gender differences emerged in many of these areas. Implications of these findings are discussed and directions for future research on sexual partnerships and risk behavior are offered.

Using computer technology for HIV prevention among African-Americans: development of a tailored information program for safer sex (TIPSS).

New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans--the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups.

Childhood sexual abuse in black men who have sex with men: results from three qualitative studies.

This report describes the high prevalence and context of childhood sexual abuse (CSA) among Black men who have sex with men (MSM) across 3 independent qualitative studies. Semistructured one-on-one interviews were conducted with 87 Black MSM across 3 cities (Rochester, NY, n = 28; Lexington, KY /Atlanta, GA, n = 30; and Atlanta, GA, n = 29). A combined CSA prevalence of 32% (28/87) was found among the 3 samples, despite variation in geographic location, mean age, and sexual identification. Common themes emerging across the 3 samples included prolonged and repeated abuse by a close male relative; blaming of same-sex desire on CSA; and descriptions of adverse mental health reactions to CSA. Implications of CSA and its potential influence on the mental health and risky sexual behavior among Black MSM are discussed.

Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum.

CONTEXT: Although a number of interventions are effective at reducing risky adolescent sexual behavior, it may be possible to make them even more effective by addressing adolescents' approaches to risk-taking. METHODS: Schools were assigned to teach one of three curricula in a quasi-experimental intervention study: the school's standard pregnancy and HIV prevention curriculum; the Reducing the Risk curriculum; or a modified Reducing the Risk curriculum, adapted for high sensation seekers and impulsive decision makers. A sample of 1,944 students from 17 schools was surveyed at three time points between 1995 and 1997. Mixed models regression and logistic regression were used to examine the difference in impact among curricula. RESULTS: Differences in the impact of the original and modified Reducing the Risk interventions were not significant for the total sample or for high sensation seekers and impulsive decision makers separately. Students from both intervention groups demonstrated short-term improvements in knowledge; students who received their schools' standard curriculum were significantly more likely than those assigned to either intervention to have initiated sexual intercourse by the third time point (odds ratio, 2.4). CONCLUSION: More work is necessary to understand the best ways to design classroom messages that will be effective in reducing the risk behaviors of high sensation seekers and impulsive decision makers.

Longitudinal test of a multiple domain model of adolescent condom use.

A comprehensive multiple domain model (MDM) to understand condom use in adolescents was proposed and tested using structural equation modeling of data at three time points. The proposed model integrates social psychological theory, demographic and personality factors, social environment, and situational/contextual variables. Adolescents who were sexually active at time 2 (6 months after baseline) and time 3 (1 year after time 2) and completed surveys at all three time points were included in the analyses (N = 511). An iterative process of model testing resulted in a structural equation model that provided a good fit to the data (CFI = .92, RMSEA = .04). Models comparing gender and race as moderators also were calculated and supported the generalizability of the model. Results provide support for an MDM that goes beyond traditional social psychological models for a broader understanding of condom use in adolescents. Implications for further theory testing and safer sexual interventions are discussed.

Efficacy of an American alcohol and HIV prevention curriculum adapted for use in South Africa: results of a pilot study in five township schools.

The high prevalence of HIV among young people in African countries underscores a pressing need for effective prevention interventions. Adapting school-based prevention programs developed in the United States for use in African schools may present an alternative to the time-consuming process of developing home-grown programs. The researchers report the results of a pretest-posttest field trial of an alcohol/HIV prevention curriculum adapted from an American model and delivered to ninth-grade students in five South African township schools. The revised intervention was based primarily on the Project Northland alcohol prevention and Reducing the Risk safer sex programs. The researchers found significant differences in change from baseline to follow-up between students in intervention and comparison groups on intentions to use a condom; drinking before or during sex; and, among females, sex refusal self-efficacy. The results of the field trial suggest that behavioral interventions developed in Western countries may be rapidly adapted to work in other cultural contexts.

Targeting HIV prevention on African American crack and injection drug users.

The use of drugs in the African American community, particularly crack cocaine, has been linked to sexual risk-taking behavior, which increases the likelihood that persons will become infected with Human Immuno Virus. In order to more fully understand risk-taking behavior and to target interventions among African American men and women, this study used data collected from 1277 individuals residing in Lexington and Louisville, Kentucky, who were recruited into National Institute on Drug Abuse (NIDA) Cooperative Agreement Project from 1993 to 1998. The study compared African Americans treated for Sexually transmitted diseases (STDs) (n = 292) with African Americans who reported never being treated for a STD (n = 504) with regard to HIV information, awareness, and the number of HIV tests between those with and without STD exposure. Additionally, we examine gender differences among African Americans who have and have not been exposed to STDs on risk behaviors and HIV knowledge, awareness, and testing. It was hypothesized that African American drug users in the STD group would engage in more risk behaviors than those who reported no STDs. Results indicated that individuals in both groups, the STD exposure group and the no STD group, engaged in similar HIV-risky behaviors. However, the STD group used a greater number of different drugs in their lifetime. The STD group reported they were more likely to get HIV and were more frequently tested for HIV. Females with an STD history were more likely to have been in drug user treatment and to perceive themselves as homeless. Both males and females in the STD group were more likely to report involvement in exchanging sex.

Effects of peer education on the peer educators in a school-based HIV prevention program: where should peer education research go from here?

Although many HIV/AIDS prevention programs for adolescents have used peer educators to deliver risk reduction information, few researchers have evaluated the effects of participation in educational activities on the peer educators themselves. The present study compares several outcomes experienced by peer educators involved in a school-based HIV prevention program with those of their classmates to determine areas in which involvement in the curriculum had an effect on peer educators. Analyses revealed few differences between peer educators that could be attributed to the implementation of the intervention. The findings are discussed in terms of their implications for prevention programs targeting adolescent populations, and suggestions are made concerning the importance of future research on the selection, training, and integration of peer educators into school-based programs.