Adewale Troutman

A Brief, Clinic-Based, Safer Sex Intervention for Heterosexual African American Men Newly Diagnosed With an STD: A Randomized Controlled Trial

OBJECTIVE We evaluated the efficacy of a brief, clinic-based, safer sex program administered by a lay health adviser for young heterosexual African American men newly diagnosed with a sexually transmitted disease (STD). METHODS Subsequent to STD diagnosis, eligible men (N = 266; aged 18-29 years) were randomized to either a personalized, single-session intervention (delivered by a lay health adviser) or standard of care. We conducted behavioral assessments at baseline and 3 months postintervention (retention was 74.1%). We also conducted a 6-month clinic record review. RESULTS Compared to men randomized to the control condition, those receiving the intervention were significantly less likely to acquire subsequent STDs (50.4% vs 31.9%; P = .002) and more likely to report using condoms during last sexual intercourse (72.4% vs 53.9%; P = .008). They also reported fewer sexual partners (mean 2.06 vs 4.15; P < .001) and fewer acts of unprotected sex (mean 12.3 vs 29.4; P = .045). Based on a 9-point rating scale, men in the intervention group had higher proficiency scores for condom application skills (mean difference = 3.17; P < .001). CONCLUSION A brief clinic-based intervention delivered by a lay health adviser may be an efficacious strategy to reduce incident STDs among young heterosexual African American men.

An Event-specific Analysis of Condom Breakage Among African American Men at Risk of Hiv Acquisition

Background: African American men are at high risk of human immunodeficiency virus acquisition. Condom breakage is an understudied aspect of their sexual protective behavior. This study identified user errors leading to condom breakage using an event-specific analysis among young African American men newly diagnosed with a sexually transmitted disease (STD). Methods: Recruitment occurred in a publicly funded STD clinic located in a metropolitan area of the Southern United States. Of 296 African American men screened as eligible, 271 (91.5%) agreed to participate. Men completed a self-administered questionnaire. Men reporting condom use with men were excluded from the analysis, leaving an analytic sample of 264 men. The recall period was for the last time men used condoms for penile-vaginal sex (within the past 3 months). Results: More than one-fifth (21.2%) reported condom breakage. Each year of advancing age decreased the odds of breakage by 10% [adjusted odds ratio (AOR) = 0.90, 95% confidence interval (CI) = 0.81–0.99, P = 0.028]. Men who had used an oil-based lubricant were more than 3 times as likely to report breakage (AOR = 3.21, 95% CI = 1.48–7.00, P = 0.003) and those who completely unrolled the condom before putting it on were also about 3 times more likely to report breakage (AOR = 3.34, 95% CI = 1.76–6.50, P = 0.0001). The breakage rate for men indicating both errors, i.e., use of an oil-based lubricant and unrolling the condom before application, was 54.5% compared with 33.3% among those indicated either error, and 12.8% among those indicating neither error. Attributable risk for the 2 errors combined was 39%. Conclusions: Condom breakage among this sample of men at high risk for human immunodeficiency virus infection was common. This problem could be mitigated by counseling men to avoid the use of oil-based lubricants and by teaching them basic condom application skills.

Using computer technology for HIV prevention among African-Americans: development of a tailored information program for safer sex (TIPSS)

New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans--the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups.

Psychosocial Constructs Associated with Condom Use Among High-Risk African American Men Newly Diagnosed with a Sexually Transmitted Disease

BackgroundAfrican American men are disproportionately burdened by the US AIDS epidemic.PurposeThe purpose of this study was to determine associations between condom-related psychosocial constructs and condom use among a sample of young, heterosexual, African American men newly diagnosed with a sexually transmitted disease.MethodsThis cross-sectional study collected data from 266 men. Predictors included seven scale measures and 12 covariates. Unadjusted odds ratios were estimated followed by multivariable logistic regression.ResultsNearly one half (47.7%) used condoms at last sex. Five of the psychosocial measures had significant bivariate associations with condom use (p < 0.05). Specific attitudes toward condom use and partner-related barriers retained multivariable significance. Changes of one standard deviation in these measures increased the estimated odds of condom use by 40% (p = 0.021) and 55% (p = 0.002), respectively.ConclusionSpecific attitudes toward condom use and partner-related barriers may be particularly important constructs to consider when designing behavioral interventions for high-risk, heterosexual, African American men.

Young African American Men Having Sex With Multiple Partners Are More Likely to Use Condoms Incorrectly: A Clinic-Based Study

This study tested the research hypothesis that mens errors using condoms would be associated with having multiple sex partners. Specifically, men engaging in sex with three or more women were compared with those having sex with two or fewer women. Recruitment (N = 271) occurred in a publicly funded sexually transmitted disease (STD) clinic located in a metropolitan area of the Southern United States. All men were clinically diagnosed with an STD. They completed a self-reported questionnaire (using a 3-month recall period). Those reporting sex with men were excluded from the analysis. About one half of the men (48.5%) reported penetrative sex with three or more women. The authors found that among young African American men, newly diagnosed with an STD, reporting recent (past 3 months) sex with multiple partners may be emblematic of condom errors. These men may benefit from clinic-based, targeted counseling and education designed to foster improved quality of condom use.

Do protective behaviors follow the experience of testing positive for herpes simplex type 2

Objective: To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). Methods: Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). Results: Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group × time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. Conclusions: Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.