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Compendium of Evidence-Based HIV Behavioral Interventions

Video Opportunities for Innovative Condom Education and Safer Sex (VOICES/VOCES)

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Intervention Description

Target Population
African American and Hispanic STD clinic patients

Goals of Intervention

  • Prevent new STD infections
  • Increase condom use

Brief Description

VOICES/VOCES is a single-session, culturally specific, video-based intervention for STD clinic patients. The small group session (3-8 patients) is gender and ethnic matched and is conducted by a gender-matched facilitator in either English or Spanish. Groups of participants first review one of the culturally appropriate STD prevention videos, “Let’s Do Something Different” for African Americans and “Porque Si” for Hispanics. Both videos provide accurate risk information and corrected misinformation, portray positive attitudes about condom use, and model gender- and culturally-specific strategies for encouraging condom use. Interactive group discussions following the video reinforce the STD and HIV prevention message. Participants are encouraged to talk about problems they have experienced when trying to use condoms and discuss strategies to increase condom use.  All participants are offered a selection of free condoms at the clinic and a coupon for free condoms at an area pharmacy.

Theoretic Basis

  • Health Belief Model
  • Theory of Reasoned Action

Intervention Duration
One 20-minute video followed by one 25-minute group discussion session

Intervention Settings
Inner-city public STD clinic

Deliverer
Gender-matched facilitators

Delivery Methods

  • Video
  • Group Discussion
  • Risk Reduction Supplies (condoms)
  • Printed Materials

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Intervention Package Information

An intervention package was developed with funding from CDC’s Replicating Effective Programs (REP) Project. The intervention package and training are available through CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.

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Evaluation Study and Results

The original evaluation study was conducted in the South Bronx, New York City between 1991 and 1994.

Key Intervention Effects

  • Reduced new STD infections

Study Sample
The baseline study sample of 3,348 STD clinic patients is characterized by the following:

  • 62% African American, 38% Hispanic
  • 60% Male, 40% Female
  • Mean age of 30 years
  • 56% completed high school education

Recruitment Settings
Inner-city public STD Clinic

Eligibility Criteria
STD clinic patients were eligible if they were over the age of 17 and were registered at the clinic during the study period

Assignment Method
Clinic days were randomized to 1 of 3 groups: Video + Group Discussion intervention, Video Only intervention, or comparison. The resulting proportions of participants assigned to each group were 30%, 30% and 40%, respectively.

Comparison Group
The comparison group received regular STD clinic services, free condoms, and a condom coupon which could be redeemed at an area pharmacy.

Relevant Outcomes Measured and Follow-up Time
New STD infections were monitored using the disease surveillance database for a period of 1 to 24 months with an average of 17 months follow-up.

Participant Retention
Passive follow-up was conducted by matching patient record to the notifiable disease surveillance database maintained by the New York City Department of Health, suggesting approximate 100% success rate of matching records.

Significant Findings
Analyses pooled data from both VOICES/VOCES interventions (Video + Group Discussion and Video Only) to test intervention effects:

  • The rate of new STD infections over a 24-month period was significantly lower among men receiving the intervention than men in the comparison group (p < .04).
  • Among men who had multiple sex partners at baseline, the intervention groups had a significantly lower rate of new STD infections over a 24-month period compared to the comparison group (p < .025).

Considerations

  • Both Video Only and Video + Group Discussion interventions are highlighted here because the analyses combined both groups when compared to the comparison group and there were no significant differences in rates of new STD infections between the two intervention groups.
  • The VOICES/VOCES interventions are effective in reducing new STD infections among men, but not among women. However, a more recent effectiveness trial of the VOICES/VOCES Video + Group Discussion intervention demonstrated a significant intervention effect on reducing new STD infections among men and women combined (p < .01), and particularly for women (p < .001).
  • VOICES/VOCES participants were significantly more likely to redeem their coupon for free condoms at a private pharmacy than comparison participants (p < .05). The intervention effect on condom redemption was found to be significant when comparing Video Only and Video + Discussion intervention groups separately to the comparison group.
  • When comparing Video Only and Video + Discussion intervention groups separately to the comparison group, the significant intervention effect on condom redemption was observed for each of the following subgroups: African-American men, African-American women, Hispanic men, and Hispanic women (all p’s < .05).
  • Neumann et al., 2011 conducted a replication study at 2 public sexually transmitted disease clinics in New York City and San Juan, PR between 2004 and 2006. 
    • Among the overall sample, intervention participants showed a significantly lower risk for new STD infections than comparison participants (HR= 0.78, 95% CI [0.64-0.95], p=0.016, Table 3).
    • Among participants at the New York site, intervention participants showed a significantly lower risk for new STD infections than comparison participants (HR=0.67, 95% CI [0.52-0.86], p=.0001).
    • These findings meet PRS Good Evidence criteria.

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References and Contact Information

  • O'Donnell, C. R., O'Donnell, L., San Doval, A., Duran, R., & Labes, K. (1998). Reductions in STD infections subsequent to an STD clinic visit: Using video-based patient education to supplement provider interactions. Sexually Transmitted Diseases, 25, 161-168.
  • O'Donnell, L. N., San Doval, A., Duran, R., & O'Donnell, C. (1995). Video-based sexually transmitted disease patient education: Its impact on condom acquisition. American Journal of Public Health, 85, 817-822.
  • Neumann, M.S., O'Donnell, L., Schillinger, J., San Doval, A., Blank, S., & O'Donnell, C. (2007). Results of an Effectiveness Trial to Evaluate a Replication of the VOICES/VOCES/VOCES HIV Prevention Intervention. [Abstract]. 2007 National HIV Prevention Conference.
  • Neumann, M. S., O’Donnell, L., San Doval, A., Schillinger, J., Blank, S., Ortiz-Rios, E., . . . O’Donnell, C.R. (2011). Effectiveness of the VOICES/VOCES sexually transmitted disease/human immunodeficiency virus prevention intervention when administered by health department staff: Does it work in the “real world”? Sexually Transmitted Diseases, 38, 133-139.

Researcher: Dr. Lydia O'Donnell
Education Development Center Inc.
55 Chapel Street
Newton, MA 02458-1060
email: lodonnell@edc.org

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