Sexually transmitted diseases (STDs) remain highly prevalent. Global estimates suggest 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis,1
whereas U.S. estimates suggest 19 million new infections, each year.2,3
HIV, the most feared STD, undermines the health of 33 million people worldwide, with 1.1 million people infected domestically. The annual incidence of HIV in the U.S. is 56,300, a rate that has remained stable for the past decade.4
Importantly, 84% of new HIV infections result from sexual behavior.5
STDs can lead to pelvic inflammatory disease, chronic pelvic pain, infertility, cervical and oropharyngeal cancer among women, and epididymitis, urethritis, and oropharyngeal cancer among men.2, 6, 7
Untreated HIV leads to AIDS; current HIV treatments are not curative, require lifelong adherence to costly medications, and incur troublesome side effects. Clearly, HIV and the other STDs remain prevalent, and result in premature morbidity and mortality.
The HIV-STD nexus is important because (1) STDs facilitate the transmission of HIV;8, 9
thus, STD prevention and treatment provides a cornerstone of HIV prevention. (2) Clients attending STD clinics often engage in risky sexual practices that heighten risk for HIV (e.g., unprotected sex and sexual partner concurrency),10-12
and find partners from social networks burdened with STDs.13
(3) Clients at urban STD clinics are disproportionately African-American, a population sub-group with the highest incidence of HIV (45% of new HIV infections5
). (4) Clients attending STD clinics are more likely to be infected with HIV.14
Given these facts, STD clinics provide an opportune venue for sexual risk reduction and HIV prevention programs.
Sexual risk reduction programs in STD clinics typically feature one of two approaches. Brief interventions usually involve clinic-based, individual counseling.15
Such interventions can be tailored to individuals, but are constrained by time, space, and staffing limitations, and usually offer only minimal skills training – an intervention component recognized as essential for sustained behavior change.16-19
In contrast, intensive interventions permit more thorough skills training and are usually conducted in small groups, which allows for peer support and role-play partners, and greater efficiency.20, 21
However, intensive interventions are often limited by low client motivation (e.g., ambivalence about the need for risk reduction) and poor attendance.
Despite the promise of brief and intensive interventions, the incidence of HIV in the U. S. has remained stable for the past decade,5
suggesting the need for improved intervention approaches. To our knowledge, no one has investigated the combined use of brief and intensive interventions to reduce sexual risk behavior, even though this integration has been efficacious in the context of substance use treatment.22
In the sexual health context, brief motivational interventions might stimulate initial change and help patients to recognize the benefits of attending intensive (skills-based) interventions. A brief motivational intervention also might prepare patients to profit from an intensive intervention and, thereby, optimize response to the latter. In summary, the combined use of a brief, clinic-based intervention with a more intensive intervention may optimize long-term sexual risk reduction.
This randomized controlled trial (RCT) was designed to evaluate a two-step approach to sexual risk reduction. The first step included: (a) a brief informational intervention (B-INFO), or (b) a brief motivational intervention (BMI). We envisioned the B-INFO arm as a high quality “standard” care control condition that meets HIV post-test counseling requirements; and, we hypothesized that receiving a BMI would motivate increased condom use, and improve attendance at a subsequent intensive intervention.22
The second step involved: (a) an intensive informational, motivational, and behavioral skills training (I-IMB) workshop, (b) an intensive informational (I-INFO) workshop (that served as a time-matched comparison intervention), or (c) a no workshop control. We hypothesized that inclusion of skills exercises in the I-IMB workshop would promote more behavior change relative to an intensive informational workshop or no workshop.16
In addition, we tested hypotheses that the combination of the BMI and I-IMB interventions would lead to greater risk reduction relative to the other intervention combinations, and that improvement would be greatest at a 3-month follow-up with a gradual dilution of intervention effects from 3 to 12 months.23