Brief, Clinic-Based, Peer-led Intervention Helps Reduce Subsequent STDs in African American Men
• Science Update
A brief, one-time intervention delivered by a trained peer health advisor was an effective and low-cost method for reducing new infections among young, heterosexual, African American men diagnosed with a sexually transmitted disease (STD), according to an NIMH-funded study. Such programs may help reduce STD-related health disparities, which currently affect a disproportionate number of African American men in the United States. The study was published in the April 2009 supplemental issue of the American Journal of Public Health.
Studies show that African American men are at greater risk for AIDS and STDs than other populations in the United States. However, there is little research on ways to prevent the spread of such diseases among heterosexuals of any race or ethnic origin.
Richard Crosby, Ph.D., of the University of Kentucky, and colleagues tested a brief, clinic-based intervention designed to reduce STDs in young, heterosexual, African American men who had been newly diagnosed with an STD. The researchers randomly assigned 226 men who had gone to a public STD clinic for treatment to either the intervention or a control group. All participants received basic information from nurses about proper condom use, per guidelines from the Centers for Disease Control and Prevention. They also completed a questionnaire and were given condoms before leaving the clinic. These procedures represented the standard of care given to men in the control group.
In addition to the standard of care, men in the intervention group received a 45-50 minute intervention that taught them how to select and use condoms properly, encouraged them to feel good about using condoms, and equated condom usage with an investment in their future. A peer health advisor—a person from the participants' community who received three days of training—delivered the intervention and responded to the men's questions and concerns.
The researchers conducted a follow-up assessment of the men three months later and reviewed the clinic's medical records after six months to evaluate treatment outcomes.
Results of the Study
Overall, 32 percent of the men in the intervention group had acquired another STD by the six-month follow-up, compared to 50 percent of the men in the control group. Men in the intervention also reported having fewer sexual partners than men in the control group (2 vs. 4), significantly fewer acts of unprotected sex (12 vs. 29), and were significantly more likely to report using condoms during their most recent sexual encounter (72 percent vs. 54 percent).
The study shows that even a brief intervention that does not require lengthy follow-up or extensive resources can lower STD infection rates among this population. The researchers also suggest that such an intervention may indirectly provide a protective benefit for African American women, who are the typical partners of African American men, and help reduce the prevalence of STDs in African Americans overall. Providing the intervention in a clinic or other health settings that screens for STDs and the use of a peer health advisor may help to keep costs low as well, enabling wider dissemination and implementation into clinical practice, especially in underserved or hard-to-reach communities.
Future studies are needed to adapt and evaluate this type of intervention in other regions or populations to help limit the spread of STD and HIV infections.
Crosby R, DiClemente RJ, Charnigo R, Snow G, Troutman A. A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD: a randomized controlled trial . Am J Public Health. 2009 Apr;99 Suppl 1:S96-103. PMID: 19218185.
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