Condom Use Nearly Triples, Columbia Social Work Researchers Find

The largest randomized, controlled HIV prevention study conducted in the United States has found that even among persons considered hardest to reach, interventions can more than double regular use of condoms and cut high-risk sexual behaviors in half.

The findings, reported in the June 19 issue of Science magazine, are particularly encouraging because they show how intervention reduced high-risk behavior in a sample of an underserved population. The study is unique among large trials of group HIV-prevention interventions in its examination of change in self-reported sexual risk practices, such as consistent use of condoms, as well as in objective indicators provided by reviewing participantsŐ STD clinic charts.

The National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial enrolled 3,706 African-American and Hispanic women and men - because rates of HIV infection and AIDS are substantially higher among racial and ethnic minority populations - in 37 inner-city, community-based clinics. Researchers in seven sites in five metropolitan areas recruited participants from three distinct populations at risk of acquiring HIV and other sexually transmitted diseases (STDs): men and women in public STD clinics and women attending public primary health care clinics. Virtually all of the participants were African-American or Hispanic; most were single, unemployed, and treated previously for STDs, and all were at high behavioral risk for HIV.

NIMH initiated the Multisite HIV Prevention Trial in 1990 in response to directives from Congress to develop a risk reduction intervention based on current best practices in HIV prevention, and to test its efficacy with understudied and disadvantaged populations at multiple sites across the U.S.

Those who attended HIV prevention sessions that focused on motivation and skills to reduce high-risk sexual behaviors reported significant reductions across a range of sexual risk indicators over a one-year period. In men, the seven-session intervention reduced the incidence of gonorrhea - an indicator of unprotected sexual behavior - by half. Other findings:

In the 90 days preceding the baseline assessment, only 23 percent of the intercourse of those who attended the HIV risk-reduction sessions was protected by condoms. Condom use increased to 63 percent of all intercourse at the three-month follow-up assessment, and never fell below 60 percent at the six- and twelve-month follow-ups. At baseline, no study participants had been consistent condom users, or sexually abstinent, over the course of the previous 90 days. At the twelve- month follow-up, 43 percent of those who attended the risk-reduction sessions were consistently using condoms or were abstinent. Only 28 percent of those who attended the risk-reduction sessions reported experiencing symptoms indicative of an STD at one or more of the follow-up evaluations, compared to 35 percent of those who reported such symptoms after attending only a one-hour AIDS education session.

"Reducing high risk behaviors is still the best way to prevent new HIV infections, said NIMH Director Steven E. Hyman, M.D. "NIMH has identified an effective strategy that could be adopted by public health and community organizations all across America. If these behavioral changes were maintained for even one year, there would be a profound, cost-effective, public health impact in the communities that adopted this program."

At the Columbia site, principal investigator Robert Schilling worked closely with Nabila El-Bassel, Andre Ivanoff and Susan Witte, all Columbia University School of Social Work faculty. The team recruited more than 600 individuals from STD clinics and health service organizations in the Bronx and Harlem. Participants randomly assigned to the intervention (Project LIGHT: "Living in Good Health Together") were expected to attend seven 90-120 minute HIV risk reduction sessions, scheduled twice weekly. Behavioral assessments of participants were conducted at baseline and at three, six and 12 months.

"Overall, the findings indicate that the skills-training intervention was successful in reducing HIV-related sexual risks over a one-year period," Professor Schilling said. "Although it is important that strategies be developed to maintain longer-term behavior change, gains lasting even one year would still have a substantial impact on public health. The study's results support the feasibility of behavioral skill-based interventions in settings serving persons at high risk for HIV as one strategy to reduce HIV transmission."

In addition to Columbia, the other sites were Rutgers University, Emory University, Johns Hopkins University, The Medical College of Wisconsin, Milwaukee; UCLA and UC-Irvine, Irvine, Calif.

The study was coordinated by NIMH and the Research Triangle Institute in Durham, North Carolina. NIMH is one of the 18 institutes that make up the National Institutes of Health (NIH), which is part of the Department of Health and Human Services.

The Social Intervention Group at Columbia's School of Social Work is focused on the design, development and testing of socio-behavioral interventions to ameliorate health and social problems, particularly those affecting low income urban communities.