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STD intervention successful in at-risk minority women (1-11-99)

Nine to 12 hours of culturally meaningful, risk-reduction training can dramatically lower minority women's chance of contracting chlamydial infection and gonorrhea, two sexually transmitted diseases (STDs).

That's the conclusion of a new University of Texas Health Science Center at San Antonio study, conducted with the San Antonio Metropolitan Health District and set for release Thursday (Jan. 14) in The New England Journal of Medicine. The National Institute of Allergy and Infectious Diseases (NIAID) funded the project.

The study is the first to find significant STD risk reduction in Mexican- and African-American women using disease as the outcome variable.

The finding is critical as health care professionals, social scientists, and others scramble for ways to stem the rising tide of STDs, including HIV/AIDS. "Women with STD are more vulnerable to contracting HIV if exposed," said the study's principal investigator, Rochelle N. Shain, Ph.D., Professor of Obstetrics & Gynecology at the Health Science Center. "Moreover, the same types of behavior that lead to STD can also lead to heterosexually acquired HIV infection."

Researchers in the Health Science Center's departments of obstetrics & gynecology and microbiology evaluated 424 Mexican-American women and 193 African-American women. Patients entering the study were at risk because they already were under treatment for one of four non-viral STDs--chlamydial infection, gonorrhea, syphilis or trichomoniasis. Unlike viral infections such as herpes, non-viral infections can be cured with a drug regimen.

The women studied were relatively young (the majority was 24 or younger) and were characterized by low levels of income and education.

Half of the women (the intervention group) were randomly selected to attend small-group sessions of three to four hours for three consecutive weeks. "These sessions were gender- and culture-specific," Dr. Shain said. The other half (the control group) underwent conventional STD risk counseling--a single session lasting approximately 15 minutes. "The small-group intervention significantly decreased chlamydial infection and gonorrhea among the women at six and 12 months' follow-up."

All participants underwent STD screening and interview at study entry, and again at six and 12 months. The study ended at 12 months. During the entire trial, 38 percent fewer women in the intervention group tested positive for either chlamydia or gonorrhea than did women in the control group.

The small-group sessions encouraged women to recognize their personal risk, make a commitment to reduce it, and carry through by seeking and enacting solutions. These included having only one sex partner, avoiding unprotected sex, and not having sex with untreated or incompletely treated partners.

Extensive qualitative data were collected on target populations before patient enrollment. These data helped researchers to design effective intervention strategies for each ethnic group and identify barriers to change.

Co-authors from the Health Science Center are Jeanna M. Piper, M.D., Associate Professor of Obstetrics & Gynecology; Sondra T. Perdue, Dr.P.H., Associate Professor of Microbiology; and Jane Dimmitt Champion, Ph.D., Assistant Professor of Family Nursing Care and formerly from the microbiology department. Co-authors from other institutions are Edward R. Newton, M.D., Chairman of Obstetrics & Gynecology at East Carolina University; Reyes Ramos, Ph.D., an independent consultant in San Antonio; and Fernando A. Guerra, M.D., M.P.H., Director of the San Antonio Metropolitan Health District. Drs. Newton and Ramos are former Health Science Center faculty and Dr. Guerra is Clinical Professor of Pediatrics.

Contact: Will Sansom

See related story: Facts about STDs and Minority Women (1-11-99)