Compendium of Evidence-Based HIV Behavioral Interventions
Adolescent females diagnosed with a STD
Goals of Intervention
- Prevent recurrence of STDs
- Increase condom use
- Eliminate or reduce sex risk behaviors
Safer Sex is an individualized skills-building intervention designed to increase condom use, reduce other risky sexual behaviors and prevent recurrent STDs among female adolescents. The 1-session intervention begins with a 7-minute video to normalize condom use. The video highlights condom types, purchasing condoms, condom negotiation, and demonstrated condom use. Each participant completes a stage of change self-assessment exercise to identify their thoughts about changing their sexual risk behaviors. A female health educator reviews the video, discusses STD transmission and abstinence, and individualizes the session, based on the participant’s stage of change. Topics included imparting information about unsafe sex, risk perception, pregnancy, condoms, talking about sex, and pros and cons about condom use. Each participant can role-play condom use negotiation, if ready, and is shown how to use a female condom. Each participant is instructed in correct male condom use and allowed to practice with a penile model. Written materials about safer sex and condoms are provided. Follow-up boosters are conducted with the educator, at 1, 3, and 6 months after this initial session to discuss interim sexual behavior, review the intervention, view the video if interested, and provide condoms and written materials.
- Social Cognitive Theory
- Transtheoretical Model of Behavioral Change
- Motivational Interviewing
One session, over 30 minutes in length, followed by three booster sessions at 1, 3 and 6 months after randomization
Urban children’s hospital adolescent clinic and inpatient service
Female health educator
- Role play
- Risk Reduction Supplies (condoms)
- Printed Materials
An intervention package is not available at this time. Please contact Dr. Lydia Shrier, Division of Adolescent/Young Adult Medicine, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. email: SaferSex@childrens.harvard.edu for details on intervention materials.
The original evaluation was conducted in Boston, Massachusetts between 1996 and 1999.
Key Intervention Effects
- Reduced number of non-main sex partners
The baseline study sample of 123 participants is characterized by the following:
- 100% Female
- 49% African American, 18% Hispanic, 17% other, 14% White
- Median age of 17 years, range: 14-22 years
- Median education of 11 years, range 7-15 years
Urban children’s hospital adolescent clinic or inpatient service
Female adolescents and young adults were eligible if they were diagnosed with pelvic inflammatory disease or cervicitis, were not pregnant and did not receive treatment for an STD prior to laboratory confirmation.
Participants (N = 123) were randomized to 1 of 2 groups: Safer Sex intervention (n = 60) or standard of care comparison (n = 63).
The comparison group received standard care where STD education, including a discussion about STD transmission and condom use, was provided at the discretion of the treating clinician. Free condoms were offered at the end of the visit.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors (including having main and non-main sex partners in the past 6 months, condom use at last sex, frequency of condom use while having sex with main and non-main partners in the past 6 months) were measured at 1, 3, 6, and 12 months after enrollment.
- STD recurrence was measured at 12 months after enrollment.
- Given the repeated boosters at 1, 3, and 6 months after enrollment, the 3- and 6-month assessments translate to a 3-month follow-up after the previous booster; and the 12-month assessment translates to a 6-month follow-up after the complete intervention.
67% retained at 1 month
65% retained at 3 months
70% retained at 6 months (3 months after second booster)
50% retained at 12 months (6 months after intervention)
- Standard Care Comparison:
65% retained at 1 month
52% retained at 3 months
76% retained at 6 months (3 months after second booster)
54% retained at 12 months (6 months after intervention)
At 3 months after second booster, intervention participants were less likely than comparison participants to report having a non-main sexual partner (p = .01).
- This intervention fails to meet the best-evidence criteria due to small sample sizes.
- This significant finding was shown 3 months after the initial intervention session and two of the three planned booster sessions.
- While the intervention meets GOOD-EVIDENCE criteria based on the findings 3 months after the third booster, findings at other time points do not meet the criteria due to no statistically significant intervention effects on sex risk behaviors or STD recurrence, low retention rates, or small sample sizes.
- Reducing the number or type of sexual partners was not a primary outcome of interest.
- The primary relevant outcomes of interest, condom use and recurrence of STDs, were not found to be significantly different by study group at the .05 alpha level. At 6 months (a 3-month follow-up) there were slightly more intervention participants reporting condom use at last sex than comparison participants (p = .09). And, at 12 months (a 6-month follow-up), fewer intervention participants reported having a recurrent STD than comparison participants, although this was not statistically significant (p = .17).
- Although not considered as sufficient findings to meet the GOOD-EVIDENCE criteria, intervention participants had greater levels of sexual risk knowledge (p = .02) and positive attitudes toward condoms (p = .007) one month after the initial session and higher positive attitudes towards condoms (p = .007) at 6 months (a 3-month follow-up).
- The intervention and original research targeted youth at a children’s hospital, but included young adults up to 22 years old in the study sample.
- Shrier, L. A., Ancheta, R., Godman, E., Chiou, V. M., Lyden, M. R. & Emans, S. J. (2001). Randomized controlled trial of a safer sex intervention for high–risk adolescent girls. Archives of Pediatrics Adolescent Medicine, 155, 73-79.
Researcher: Dr. Lydia A. Shrier
Division of Adolescent/Young Adult Medicine, Children’s Hospital
300 Longwood Avenue
Boston, MA 02115