A Randomized Controlled Trial of an HIV Sexual Risk—Reduction Intervention for Young African-American Women

OBJECTIVE: To evaluate the efficacy of a community-based social skills human immunodeficiency virus (HIV) prevention intervention to enhance consistent condom use. DESIGN: A randomized, single-blind controlled trial. SETTING: Bayview-Hunter's Point neighborhood of San Francisco, Calif, a predominantly African-American community that is economically disadvantaged. PARTICIPANTS: A sample of 128 sexually active, heterosexual, African-American women 18 through 29 years of age was recruited using street outreach techniques. Participants completed a structured baseline interview; 100 women (78.1%) completed 3-month follow-up interviews. INTERVENTION: Women randomized to the social skills intervention completed five sessions that emphasized ethnic and gender pride, HIV risk-reduction information, sexual self-control, sexual assertiveness and communication skills, proper condom use skills, and developing partner norms supportive of consistent condom use. Women randomized to the HIV education condition participated in a single session that provided HIV risk-reduction information. Women randomized to the delayed HIV education control condition received no HIV risk-reduction information until all follow-up interviews were completed. MAIN OUTCOME MEASURES: Consistent condom use, HIV risk-reduction knowledge, sexual self-control, sexual assertiveness, sexual communication, and partner norms supportive of consistent condom use. RESULTS: Compared with the delayed HIV education control condition, women in the social skills intervention demonstrated increased consistent condom use (adjusted odds ratio OR, 2.1; 95% confidence interval CI, 1.03 to 4.15; P = .04), greater sexual self-control (adjusted OR, 1.9; 95% CI, 1.00 to 3.60; P = .05), greater sexual communication (adjusted OR, 4.1; 95% CI, 1.67 to 10.01; P = .002), greater sexual assertiveness (adjusted OR, 1.8; 95% CI, 1.01 to 3.27; P = .05), and increased partners' adoption of norms supporting consistent condom use (adjusted OR, 2.1; 95% CI, 1.08 to 3.87; P = .03). No statistically significant differences in outcome variables were observed between the HIV education condition relative to the delayed HIV education control condition. CONCLUSION: Community-based HIV risk-reduction programs that are gender relevant and culturally sensitive and provide social skills training can effectively enhance consistent condom use.