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This study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21-29 years of age, seeking services at Planned Parenthood in Atlanta, GA. Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR = 5.9; p < 0.039) and were more likely to use condoms consistently for oral sex (OR = 13.83; p < 0.037). This relatively brief intervention provides preliminary support that an evidence-based group-based HIV prevention intervention for young African-American women can be adapted to a computer-based HIV intervention. [ABSTRACT FROM AUTHOR]

Examines the effectiveness of an intervention to reduce HIV transmission risk behaviors and sexually transmitted diseases among HIV-positive women in Georgia and Alabama. Risk of unprotected vaginal intercourse; Condom use; HIV-preventive psychosocial and structural factors among women living with HIV.

Objective: This trial evaluated the efficacy of an HIV-intervention condition, relative to a health-promotion condition, in reducing incidence of nonviral sexually transmitted infections (STIs; Chlamydia, gonorrhea, and trichomoniasis), oncogenic human papillomavirus (HPV) subtypes 16 and 18, sexual concurrency, and other HIV-associated behaviors over a 12-month period., Design: Randomized-controlled trial. Data analysts blinded to treatment allocation., Setting: Kaiser Permanente, GA., Subjects: A random sample of 848 African American women., Intervention: The two 4-hour HIV intervention sessions were based on Social Cognitive Theory and the Theory of Gender and Power. The intervention was designed to enhance participants' self-sufficiency and attitudes and skills associated with condom use. The HIV intervention also encouraged STI testing and treatment of male sex partners and reducing vaginal douching and individual and male partner concurrency., Main Outcome Measure: Incident nonviral STIs., Results: In generalized estimating equations' analyses, over the 12-month follow-up, participants in the HIV intervention, relative to the comparison, were less likely to have nonviral incident STIs (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.40 to 0.96; P = 0.033) and incident high-risk HPV infection (OR = 0.37; 95% CI: 0.18 to 0.77; P = 0.008) or concurrent male sex partners (OR = 0.55; 95% CI: 0.37 to 0.83; P = 0.005). In addition, intervention participants were less likely to report multiple male sex partners, more likely to use condoms during oral sex, more likely to inform their main partner of their STI test results, encourage their main partner to seek STI testing, report that their main partner was treated for STIs, and report not douching., Conclusions: This is the first trial to demonstrate that an HIV intervention can achieve reductions in nonviral STIs, high-risk HPV, and individual concurrency.

Objectives: To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)-preventive behaviors and psychosocial mediators., Design: A randomized controlled trial of an HIV prevention program., Setting: Clinic-based sample in Atlanta, Georgia., Participants: African American adolescent females (N = 715), aged 15 to 21 years, seeking sexual health services. Participants completed an audio computer-assisted self-interview and provided self-collected vaginal specimens for STD testing. Intervention Intervention participants received two 4-hour group sessions and 4 telephone contacts over a 12-month period, targeting personal, relational, sociocultural, and structural factors associated with adolescents' STD/HIV risk, and were given vouchers facilitating male partners' STD testing/treatment. Main Outcome Measure Incident chlamydial infections., Results: Over the 12-month follow-up, fewer adolescents in the intervention had a chlamydial infection (42 vs 67; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.42 to 0.98; P = .04) or recurrent chlamydial infection (4 vs 14; RR, 0.25; 95% CI, 0.08 to 0.83; P = .02). Adolescents in the intervention also reported a higher proportion of condom-protected sex acts in the 60 days preceding follow-up assessments (mean difference, 10.84; 95% CI, 5.27 to 16.42; P < .001) and less frequent douching (mean difference, -0.76; 95% CI, -1.15 to -0.37; P = .001). Adolescents in the intervention were also more likely to report consistent condom use in the 60 days preceding follow-up assessments (RR, 1. 41; 95% CI, 1.09 to 1.80; P = .01) and condom use at last intercourse (RR, 1.30; 95% CI, 1.09 to 1.54; P = .005). Intervention effects were observed for psychosocial mediators of STD/HIV-preventive behaviors., Conclusion: Interventions for African American adolescent females can reduce chlamydial infections and enhance STD/HIV-preventive behaviors and psychosocial mediators of STD/HIV-preventive behaviors. Trial Registration clinicaltrials.gov Identifier: NCT00633906.

Background: This study sought to document the prevalence of recent gender-based violence (rGBV) among seropositive women and to determine the association between rGBV and pregnancy, sexually transmitted infections (STIs), condom use, and negotiation of sexual practices., Methods: A total of 304 seropositive women recruited from HIV clinics in the southeastern United States who reported being sexually active in the previous 6 months with 1 partner were included in analyses. Gender-based violence during the previous 3 months, condom use, and negotiation of sexual practices were assessed. Biologic samples for pregnancy and STI testing were collected., Results: A total of 10.2% of women reported a history of rGBV. rGBV was related to inconsistent condom use practices, pregnancy, and abuse stemming from requests for condom use. No associations were found between rGBV and negotiation of sexual practices and STIs., Conclusions: The prevalence of rGBV among HIV-positive women emphasizes the need for screening of abuse and highlights the need for the design and implementation of integrated intervention approaches necessary in addressing the needs of this population.

Background: Evidence suggests that unplanned/unwanted pregnancy may be an important antecedent of negative birth outcomes, such as low birth weight. This study identified correlates of perceiving a current pregnancy as both unplanned and unwanted among unmarried African-American adolescents aged 14-20 years., Methods: One hundred seventy pregnant adolescents were recruited during their first prenatal visit. Adolescents completed a face-to-face interview administered in private examination rooms. Adolescents also completed an in-depth self-administered survey. Measures were selected based on two potential influences: (1) relationships with boyfriends and (2) parent/family involvement. Age and parity were also assessed. Contingency table analyses were used to identify significant bivariate associations. Correlates achieving bivariate significance were entered into a forward stepwise logistic regression model., Results: Pregnancy was reported as unplanned and unwanted by 51.2% of the study population. In a multivariate analysis, adolescents indicating lower levels of parental involvement were about twice as likely (adjusted odds ratio [AOR]=2.05; 95% confidence interval [CI], 1.1-3.9, p<0.03) to report that their pregnancy was unplanned and unwanted. Adolescents who already had a child (AOR=2.3; 95% CI, 1.3-5.7, p<0.009) and those younger than 18 years old (AOR=2.3; 95% CI, 1.1-4.5, p<0.02) were more than twice as likely to report that their pregnancy was unplanned and unwanted. A variable assessing whether each adolescent's current boyfriend conceived the pregnancy approached significance (AOR=2.33; 95% CI, 0.99-5.46, p=0.052)., Conclusions: Findings provide initial evidence for specifically targeting intensified prenatal care programs to teens perceiving their pregnancy as unplanned and unwanted.

Background: African American adolescent females have been understudied with regard to their continued sexually transmitted disease (STD) risk behavior during pregnancy. Preintervention studies of this population are especially important because the sequelae of STDs during pregnancy can be particularly problematic., Objective: This exploratory study identified correlates of engaging in relatively frequent penile-vaginal sex, unprotected by a condom, among inner-city African American adolescents during their first or second trimester of pregnancy., Study Design: Baseline data collected as part of an HIV prevention study were used. Adolescents at their first prenatal visit completed a self-administered survey and face-to-face interview. Only adolescents reporting a current boyfriend were included in this exploratory analysis (n = 144). Significant bivariate correlates were assessed for multivariate significance., Results: Significant bivariate correlates of relatively frequent unprotected vaginal sex were older age (P < 0.02), primiparity (P < 0.03), not being enrolled in school (P < 0.02), not residing with at least one parent (P < 0.001), reported infrequent sexual communication (communicating about sex) with the boyfriend (P < 0.01), spending at least 30 hours each week with the boyfriend (P < 0.001), reporting that the age of the current relationship was at least 2 years (P < 0.04), and using marijuana in the past 30 days (P < 0.03). Three correlates retained significance in the multivariate model: not residing with at least one parent (adjusted odds ratio [AOR] = 2.24; P < 0.04), spending at least 30 hours with the boyfriend each week (AOR = 3.70; P < 0.002), and infrequent sexual communication with the boyfriend (AOR = 2.88; P < 0.008)., Conclusion: Given the potential of STDs to complicate pregnancy outcomes, clinic-based and community-based programs addressing relational dynamics and relational obstacles to safer sex may be warranted, particularly for adolescents not residing with parents.