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A Randomized Trial to Evaluate the Efficacy of a Web-Based HIV Behavioral Intervention for High-Risk African American Women

Abstract

The aim of this study was to develop and test a cost-effective, scalable HIV behavioral intervention for African American women. Eighty-three African American women were recruited from a community health center and randomly assigned to either the web-based Safe Sistah program or to a delayed HIV education control condition. The primary outcome was self-reported condom use. Secondary measures assessed other aspects of the gender-focused training included in Safe Sistah. Participants completed self-report assessments prior to randomization, 1- and 4-months after their program experience. Across the entire study period, women in the experimental condition significantly increased their condom use relative to controls (F = 5.126, p = 0.027). Significant effects were also found for sexual communication, sex refusal, condom use after alcohol consumption, and HIV prevention knowledge. These findings indicate that this web-based program could be an important component in reducing the HIV disparities among African American women.

Resumen

El objetivo de este estudio fue desarrollar y probar una, escalable intervención conductual VIH rentable para las mujeres afroamericanas. Ochenta y tres mujeres afroamericanas fueron reclutados de un centro de salud de la comunidad y aleatoriamente asignados bien al programa Safe Sistah basados en Internet, oa una condición de retraso en el control de la educación del VIH. El resultado primario fue el uso del condón auto-reporte. Las medidas secundarias evaluaron otros aspectos de la capacitación con enfoque de género incluidos en Segura Sistah. Los participantes completaron las evaluaciones de auto-informe antes de la aleatorización, 1 mes y 4 meses después de su experiencia en el programa. En todo el período de estudio, las mujeres en la condición experimental aumentaron significativamente su uso de preservativos respecto a los controles (F = 5,126, p = 0,027). También se encontraron efectos significativos para la comunicación sexual, rechazo sexual, el uso del condón después del consumo de alcohol, y el conocimiento de la prevención del VIH. Estos hallazgos indican que este programa basado en la web podría ser un componente importante en la reducción de las disparidades del VIH entre las mujeres afroamericanas.

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References

  1. CDC. HIV among Women. http://www.cdc.gov/hiv/topics/women/pdf/women.pdf. Accessed 15 May 2014.

  2. CDC New HIV infections in the United States. http://www.cdc.gov/nchhstp/newsroom/docs/2012/hiv-infections-2007-2010.pdf. Accessed 15 May 2014.

  3. Farnham PG, Holtgrave DR, Sansom SL, Hall HI. Medical costs averted by HIV prevention efforts in the United States, 1991–2006. J Aquir Immune Defic Syndr. 2010;54(5):565–7.

    Article  Google Scholar 

  4. DiClemente RJ, Wingood GM. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. JAMA. 1995;274(16):1271–6.

    CAS  Article  PubMed  Google Scholar 

  5. Bellis JM, Grimley DM, Alexander LR. Feasibility of a tailored intervention targeting STD-related behaviors. Am J Health Behav. 2002;26(5):378–85.

    Article  PubMed  Google Scholar 

  6. Ehrhardt AA, Exner TM. Prevention of sexual risk behavior for HIV infection with women. AIDS. 2000;14(Suppl 2):S53–8.

    PubMed  Google Scholar 

  7. Wingood GM, DiClemente RJ. HIV sexual risk reduction interventions for women: a review. Am J Prev Med. 1996;12(3):209–17.

    CAS  PubMed  Google Scholar 

  8. Jemmott JB 3rd, Jemmott LS, Fong GT. Reductions in HIV risk-associated sexual behaviors among black male adolescents: effects of an AIDS prevention intervention. Am J Public Health. 1992;82(3):372–7.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kalichman SC, Coley B. Context framing to enhance HIV-antibody-testing messages targeted to African American women. Health Psychol. 1995;14(3):247–54.

    CAS  Article  PubMed  Google Scholar 

  10. Kalichman SC, Kelly JA, Hunter TL, Murphy DA, Tyler R. Culturally tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: impact on risk sensitization and risk reduction. J Consult Clin Psychol. 1993;61(2):291–5.

    CAS  Article  PubMed  Google Scholar 

  11. Stevenson HC, Davis G. Impact of culturally sensitive AIDS video education on the AIDS risk knowledge of African-American adolescents. AIDS Educ Prev. 1994;6(1):40–52.

    CAS  PubMed  Google Scholar 

  12. National Research Council. No time to lose: getting more from HIV prevention. Washington, DC: The National Academies Press; 2001.

    Google Scholar 

  13. Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health. 2003;93(8):1261–7.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Clarke GN. Improving the transition from basic efficacy research to effectiveness studies: methodological issues and procedures. J Consult Clin Psychol. 1995;63(5):718–25.

    CAS  Article  PubMed  Google Scholar 

  15. Hodges S. Taking charge. http://www.whsc.emory.edu/_pubs/ph/phfall06/taking_charge.html. Accessed 15 May 2014.

  16. Downs JS, Murray PJ, da Bruin B, Penrose J, Palmgren C, Fischhoff B. Interactive video behavioral intervention to reduce adolescent females’ STD risk: a randomized controlled trial. Soc Sci Med. 2004;59(8):1561–72.

    Article  PubMed  Google Scholar 

  17. Marsch LA, Bickel WK. Efficacy of computer-based HIV/AIDS education for injection drug users. Am J Health Behav. 2004;28(4):316–27.

    Article  PubMed  Google Scholar 

  18. Lightfoot M, Comulada WS, Stover G. Computerized HIV preventive intervention for adolescents: indications of efficacy. Am J Public Health. 2007;97(6):1027–30.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Mackenzie SL, Kurth AE, Spielberg F, et al. Patient and staff perspectives on the use of a computer counseling tool for HIV and sexually transmitted infection risk reduction. J Adolesc Health. 2007;40(6):572.e9–16.

    Google Scholar 

  20. Locke SE, Kowaloff HB, Hoff RG, Safran C, Popovsky MA, Cotton DJ, Finkelstein DM, Page PL, Slack WV. Computer-based interview for screening blood donors for risk of HIV transmission. JAMA. 1992;268(10):1301–5.

    CAS  Article  PubMed  Google Scholar 

  21. Gerbert B, Bronstone A, Pantilat S, McPhee S, Allerton M, Moe J. When asked, patients tell: disclosure of sensitive health-risk behaviors. Med Care. 1999;37(1):104–11.

    CAS  Article  PubMed  Google Scholar 

  22. Galbraith JS, Stanton B, Boekeloo B, et al. Exploring implementation and fidelity of evidence-based behavioral interventions for HIV prevention: lessons learned from the focus on kids diffusion case study. Health Educ Behav. 2009;36(3):532–49.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS. 2009;23(1):107–15.

    Article  PubMed  Google Scholar 

  24. Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS Behav. 2008;12(3):335–53.

    Article  PubMed  Google Scholar 

  25. Fishbein M. The role of theory in HIV prevention. AIDS Care. 2000;12(3):273–8.

    CAS  Article  PubMed  Google Scholar 

  26. Miller S, Exner TM, Williams SP, Ehrhardt AA. A gender-specific intervention for at-risk women in the USA. AIDS Care. 2000;12(5):603–12.

    CAS  Article  PubMed  Google Scholar 

  27. O’Leary A. Women at risk for HIV from a primary partner: balancing risk and intimacy. Annu Rev Sex Res. 2000;11:191–234.

    PubMed  Google Scholar 

  28. CDC. Subpopulation estimates from the HIV incidence surveillance system—United States 2006. MMWR. 2008;57(36):985–9.

    Google Scholar 

  29. Neighbors CJ, O’Leary A. Responses of male inmates to primary partner requests for condom use: effects of message content and domestic violence history. AIDS Educ Prev. 2003;15(1):93–108.

    Article  PubMed  Google Scholar 

  30. Macaluso M, Demand MJ, Artz LM, Hook EW 3rd. Partner type and condom use. AIDS. 2000;14(5):537–46.

    CAS  Article  PubMed  Google Scholar 

  31. Beadnell B, Stielstra S, Baker S, et al. Ethnic identity and sexual risk-taking among African-American women enrolled in an HIV/STD prevention intervention. Psychol Health Med. 2003;8(2):187–98.

    Article  Google Scholar 

  32. Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;1(1):003255.

    Google Scholar 

  33. Kasen S, Vaughan RD, Walter HJ. Self-efficacy for AIDS preventive behaviors among tenth grade students. Health Educ Q. 1992;19(2):187–202.

    CAS  Article  PubMed  Google Scholar 

  34. Cecil H, Pinkerton SD. Reliability and validity of a self-efficacy instrument for protective sexual behaviors. J Am Coll Health. 1998;47(3):113–21.

    CAS  Article  PubMed  Google Scholar 

  35. DiClemente RJ, Wingood GM, Harrington KF, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA. 2004;292(2):171–9.

    CAS  Article  PubMed  Google Scholar 

  36. Friedman LM, Furberg CD, DeMets DL. Fundamentals of clinical trials. New York: Springer; 2010.

    Book  Google Scholar 

  37. Singer JD, Willett JB. Applied longitudinal data analysis: modeling change and event occurrence. New York, NY: Oxford University Press; 2003.

    Book  Google Scholar 

  38. Rosser BR, Oakes JM, Konstan J, et al. Reducing HIV risk behavior of men who have sex with men through persuasive computing: results of the Men’s INTernet study-II. AIDS. 2010;24(13):2099–107.

    Article  PubMed  Google Scholar 

  39. Gagnon H, Godin G, Alary M, Bruneau J, Otis J. A randomized trial to evaluate the efficacy of a computer-tailored intervention to promote safer injection practices among drug users. AIDS Behav. 2010;14(3):538–48.

    Article  PubMed  Google Scholar 

  40. Jemmott LS, Jemmott JB 3rd, O’Leary A. Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings. Am J Public Health. 2007;97(6):1034–40.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Sterk CE, Theall KP, Elifson KW, Kidder D. HIV risk reduction among African-American women who inject drugs: a randomized controlled trial. AIDS Behav. 2003;7(1):73–86.

    Article  PubMed  Google Scholar 

  42. Shain RN, Piper JM, Newton ER, et al. A randomized, controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med. 1999;340(2):93–100.

    CAS  Article  PubMed  Google Scholar 

  43. Wingood GM, DiClemente RJ. The influence of psychosocial factors, alcohol, drug use on African-American women’s high-risk sexual behavior. Am J Prev Med. 1998;15(1):54–9.

    CAS  Article  PubMed  Google Scholar 

  44. Seth P, Wingood GM, DiClemente RJ, Robinson LS. Alcohol use as a marker for risky sexual behaviors and biologically confirmed sexually transmitted infections among young adult African-American women. Womens Health Issues. 2011;21(2):130–5.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107(1):51–9.

    Article  PubMed  Google Scholar 

  46. Wingood GM, Card JJ, Er D, et al. Preliminary efficacy of a computer-based HIV intervention for African-American women. Psychol Health. 2011;26(2):223–34.

    Article  PubMed  Google Scholar 

  47. Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health. 2014;104(1):17–22.

    Article  PubMed  Google Scholar 

  48. Rhodes SD, Vissman AT, Stowers J, et al. A CBPR partnership increases HIV testing among men who have sex with men (MSM): outcome findings from a pilot test of the CyBER/testing internet intervention. Health Educ Behav. 2011;38(3):311–20.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Bull SS, Levine DK, Black SR, Schmiege SJ, Santelli J. Social media-delivered sexual health intervention: a cluster randomized controlled trial. Am J Prev Med. 2012;43(5):467–74.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Kegeles SM, Rebchook G. Implementation of an evidence-based intervention by 72 CBOs over time. 2nd annual NIH conference on the science of dissemination and implementation. 2009. http://obssr.od.nih.gov/news_and_events/conferences_and_workshops/DI2009/02_Speaker%20Presentations/Concurrent%20Session%20II/CCII_Balcony%20B_Kegeles.pdf. Accessed 1 Nov 2014.

  51. Noar SM. Computer technology-based interventions in HIV prevention: state of the evidence and future directions for research. AIDS Care. 2011;23(5):525–33.

  52. Knudsen HK, Staton-Tindall M, Oser CB, Havens JR, Leukefeld CG. Reducing risky relationships: a multisite randomized trial of a prison-based intervention for reducing HIV sexual risk behaviors among women with a history of drug use. AIDS Care. 2014;26(9):1071–9.

    Article  PubMed  Google Scholar 

  53. Morrison-Beedy D, Crean HF, Passmore D, Carey MP. Risk reduction strategies used by urban adolescent girls in an HIV prevention trial. Curr HIV Res. 2013;11(7):559–69.

    CAS  Article  PubMed  Google Scholar 

  54. Scholes D, McBride CM, Grothaus L, Civic D, Ichikawa LE, Fish LJ. A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial. AIDS. 2003;17(10):1547–56.

    Article  PubMed  Google Scholar 

  55. Goldberg E, Millson P, Rivers S, Manning SJ, Leslie K, Read S. A human immunodeficiency virus risk reduction intervention for incarcerated youth: a randomized controlled trial. J Adolesc Health. 2009;44(2):136–45.

    Article  PubMed  Google Scholar 

  56. Metcalf CA, Malotte CK, Douglas JM Jr, Paul SM, Dillon BA, Cross H. Efficacy of a booster counseling session 6 months after HIV testing and counseling: a randomized, controlled trial (RESPECT-2). Sex Transm Dis. 2005;32(2):123–9.

    Article  PubMed  Google Scholar 

  57. Head KJ, Noar SM, Iannarino NT, Harrington NG. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013;97:41–8.

    Article  PubMed  Google Scholar 

  58. Smith A. (2014). African Americans and technology use: a demographic portrait. http://www.pewinternet.org/files/2014/01/African-Americans-and-Technology-Use.pdf. Accessed 1 Sep 2014.

  59. de Boer MA, Celentano DD, Tovanabutra S, Rugpao S, Nelson KE, Suriyanon V. Reliability of self-reported sexual behavior in human immunodeficiency virus (HIV) concordant and discordant heterosexual couples in northern Thailand. Am J Epidemiol. 1998;147(12):1153–61.

    Article  PubMed  Google Scholar 

  60. Padian NS. Sexual histories of heterosexual couples with one HIV-infected partner. Am J Public Health. 1990;80(8):990–1.

    CAS  Article  PubMed Central  PubMed  Google Scholar 

  61. Sison JD, Gillespie B, Foxman B. Consistency of self-reported sexual behavior and condom use among current sex partners. Sex Transm Dis. 2004;31(5):278–82.

    Article  PubMed  Google Scholar 

  62. Upchurch DM, Weisman CS, Shepherd M, et al. Interpartner reliability of reporting of recent sexual behaviors. Am J Epidemiol. 1991;134(10):1159–66.

    CAS  PubMed  Google Scholar 

  63. NIMH Multisite HIV/STD Prevention Trial for African American. Couples Group. Concordant and discordant reports on shared sexual behaviors and condom use among African American serodiscordant couples in four cities. AIDS Behav. 2010;14(5):1011–22.

    Article  Google Scholar 

  64. King KM, Nguyen HV, Kosterman R, Bailey JA, Hawkins JD. Co-occurrence of sexual risk behaviors and substance use across emerging adulthood: evidence for state- and trait-level associations. Addiction. 2012;107(7):1288–96.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Quinn SC. AIDS and the African American woman: the triple burden of race, class, and gender. Health Educ Behav. 1993;20:305–20.

    CAS  Article  Google Scholar 

  66. Miller M, Neaigus A. Networks, resources and risk among women who use drugs. Soc Sci Med. 2001;52:967–78.

    CAS  Article  PubMed  Google Scholar 

  67. Des Jarlais DC, McCarty D, Vega WA, Bramson H. HIV infection among people who inject drugs: the challenge of racial/ethnic disparities. Am Psychol. 2013;68(4):274–85.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Sterk CE, Theall KP, Elifson KW. Effectiveness of a risk reduction intervention among African American women who use crack cocaine. AIDS Educ Prev. 2003;15(1):15–32.

    Article  PubMed  Google Scholar 

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Acknowledgments

For her assistance and expertise throughout the development of Safe Sistah, the authors would like to acknowledge Dr. Gina Wingood. Ms. Angela Wood was essential in the conduct of this study and we would also like to thank our community partner, Family and Medical Counseling Service, Inc. Finally, we would like to acknowledge the extraordinary women who participated in this study. This study was funded by a National Institute on Drug Abuse grant (2R44DA021425), Douglas W. Billings, Principal Investigator.

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Billings, D.W., Leaf, S.L., Spencer, J. et al. A Randomized Trial to Evaluate the Efficacy of a Web-Based HIV Behavioral Intervention for High-Risk African American Women. AIDS Behav 19, 1263–1274 (2015). https://doi.org/10.1007/s10461-015-0999-9

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  • DOI: https://doi.org/10.1007/s10461-015-0999-9

Keywords

  • HIV prevention
  • Web-based program
  • Health disparities
  • Sexual risk
  • African
  • American women