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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

Choices

BEST-EVIDENCE

Intervention Description

Target Population
Low-income heterosexually active women

Goals of Intervention

  • Prevent new sexually transmitted diseases (STDs)
  • Increase use of safer sex strategies such as abstinence, monogamy, and/or condom use

Brief Description

Choices is a small-group (510 women), skills training intervention designed to reduce STD infections and risky sex behaviors of women at risk for STDs, including HIV. The intervention focuses on skills that emphasize initial behavior change as well as the maintenance of behavior change over time. Motivational and decision-making exercises help women choose safer sex strategies best suited to their circumstances; and skill building exercises, using role plays, teach how to implement these successfully. Skills include using condoms correctly, negotiating safe sex with their partners, and creating lifestyle balance. The intervention also encourages women to evaluate their relationship choices, and explore how those choices affect their health and wellbeing.

Theoretic Basis
Relapse Prevention Model

Intervention Duration
16 weekly 2-hour group sessions

Intervention Setting
Community-based locations

Deliverer
Teams of female-male masters- and doctoral-level psychotherapists of differing ethnicities

Delivery Methods

  • Exercises
  • Goal setting
  • Group discussions
  • Lectures
  • Printed materials

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Intervention Package Information

An intervention package is not available at this time. Contact Dr. Blair Beadnell, University of Washington, School of Social Work, 4101 15th Avenue, NE, Seattle, WA 98105 USA, e-mail: blairb@u.washington.edu, for details on intervention materials.

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Evaluation Study and Results

The original evaluation study was conducted in Seattle-King County, Washington between 1994 and 1996. The study included a racially diverse sample of 287 women at high risk for acquiring HIV and other STDs.

Key Intervention Effects
Reduced new STDs

Study Sample

  • 54% White, 29% African American, 5% American Indian, 5% multi-racial, 3% Asian/Pacific Islander, 3% Hispanic, 1% other
  • 100% Female
  • Mean age of 30 years

Recruitment Settings
Clinics, service organizations, and media outlets

Eligibility Criteria
Women were considered eligible for the evaluation if they spoke English, were at least 18 years of age, and had sex with high-risk men during the previous 4 months.

Assignment Method
Women were randomly assigned to either the skills training intervention (n = 145) or to a health education comparison intervention (n = 142).

Comparison Group
The health education comparison intervention consisted of 16 weekly 2-hour group sessions. Topics included safer sex education, the impact of HIV on women, pregnancy decision-making, violence against women, coping and parenting, and communication with partners about safer sex. Community health educators delivered these topics through formal lectures and group discussions. Decision-making and skills building, active components in the experimental intervention, were avoided.

Relevant Outcomes Measured and Follow-up Time

  • Sexual risk behaviors during the prior 4 months were assessed before the intervention and at 4- and 12-month post-intervention follow-ups and were combined using a risk index.
  • STD diagnoses were confirmed before the intervention and incidence STDs were measured at the 12-month follow-up.

Participant Retention

  • Intervention:
    87% retained at 4 months
    84% retained at 12 months
  • Comparison:
    85% retained at 4 months
    82% retained at 12 months

Significant Findings
Over 12-months of follow-up, women in the skills training intervention group were significantly less likely to acquire a new STD than women in the comparison group (p = 0.05).

Considerations
Women in both intervention groups significantly reduced risky sex behaviors from baseline levels.

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References and Contact Information

  • Baker, S. A., Beadnell, B., Stoner, S., Morrison, D. M., Gordon, J., Collier, C., Knox, K., Wickizer, L., & Stielstra, S. (2003). Skills training versus health education to prevent STDs/HIV in heterosexual women: A randomized controlled trial utilizing biological outcomes. AIDS Education and Prevention, 15, 1-14.
  • Beadnell, B., Baker, S., Gordon, J., Collier, C., Morrison, D., & Ryan, R. (1997). Preventing sexually transmitted diseases (STD) and HIV in women: Using multiple sources of data to inform intervention design. Cognitive and Behavioral Practice, 4, 325-348.
  • Choices, A Women’s Health Project (1995). The Ladies Home Companion: Manual for the Skills Group. Seattle, WA: University of Washington, School of Social Work.

Researcher: Dr. Blair Beadnell
University of Washington, School of Social Work
4101 15th Avenue, NE
Seattle, WA 98105
e-mail: blairb@u.washington.edu

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