Journal of Behavioral Medicine

, Volume 38, Issue 2, pp 194–203 | Cite as

Mediators of behavior change resulting from a sexual risk reduction intervention for STI patients, Cape Town, South Africa

  • Eileen V. PitpitanEmail author
  • Seth C. KalichmanEmail author
  • Randi L. Garcia
  • Demetria Cain
  • Lisa A. Eaton
  • Leickness C. Simbayi


Theory-based sexual risk reduction interventions are often demonstrated effective, but few studies have examined the mechanisms that mediate their behavior changes. In addition, critical contextual factors, such as alcohol use, are often not accounted for by social cognitive theories and may add to the explanatory value of intervention effects. The purpose of this study is to examine the underlying mechanisms driving condom use following a brief sexual risk reduction intervention grounded in the information, motivation, behavioral skills (IMB) model of behavior change. We examined IMB theoretical constructs and alcohol-related contextual factors as potential mediators in separate models. Patients (n = 617) from an STI clinic in Cape Town, South Africa were randomly assigned to either a brief risk reduction intervention or an education-only control condition. We assessed IMB, and alcohol-related variables at baseline, 3, 6, 9, and 12 months and modeled IMB constructs and alcohol-related factors as mediators of behavior change. Results of growth-curve mediational modeling showed that 1 year after counseling, the intervention indirectly affected sexual risk behavior through alcohol-related constructs, but not IMB constructs. Alcohol use and related factors play critical roles in explaining HIV and STI risk reduction intervention effects. Interventions that directly address alcohol use as a factor in sexual risk behavior and behavior change should be the focus of future research.


HIV/AIDS Sexual risk Condom use Mediational modeling 



National Institutes of Health Grant R01-MH074371-04 supported this research. Preparation of this manuscript was supported by a National Institute on Drug Abuse K01 Mentored Career Development Award (K01 DA036447-01) awarded to the first author.

Conflict of interest

Eileen V. Pitpitan, Seth C. Kalichman, Randi L. Garcia, Demetria Cain, Lisa A. Eaton, and Leickness C. Simbayi declare that they have no conflicts of interest.

Human and animal rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Eileen V. Pitpitan
    • 1
    Email author
  • Seth C. Kalichman
    • 2
    Email author
  • Randi L. Garcia
    • 2
  • Demetria Cain
    • 2
  • Lisa A. Eaton
    • 2
  • Leickness C. Simbayi
    • 3
  1. 1.Division of Global Public Health, Department of MedicineUniversity of California San DiegoSan DiegoUSA
  2. 2.Department of PsychologyUniversity of ConnecticutStorrsUSA
  3. 3.Human Sciences Research CouncilCape TownSouth Africa

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