Talking Up Risky Behavior to Ward Off HIV

Educating people at high risk for HIV infection succeeds in getting them to engage in safer sex. Experts say the finding, reported in tomorrow's issue of Science, bodes well for reducing the rates of sexually transmitted diseases (STDs), particularly in developing countries.

U.S. populations currently at the highest risk for HIV infection are minority groups in low-income urban areas. African Americans, for example, accounted for 45% of new AIDS cases in 1997 and are contracting AIDS at about eight times the rate of whites. Hispanics made up 21% of new AIDS cases. Investigators with the Multisite HIV Prevention Trial at the National Institute of Mental Health in Rockville, Maryland, wanted to see if education programs could cut infection rates.

The team recruited 3706 men and women at inner city health clinics in five cities. Almost all the participants were African American or Hispanic; all had been treated in the past for STDs. Half the subjects were randomly assigned to attend seven small-group sessions, each at least 1.5 hours long, where they were counseled about risky sexual behavior. The others attended a single, 1-hour session that included a video on the topic. All were asked to fill out survey forms every 90 days describing their behavior and STD symptoms. The team relied on the questionnaires because, say the researchers, they feared that drawing blood or requiring HIV tests would cause many subjects to drop out.

A year later, participants in the longer programs reported having unprotected sex less than half as often as they had before the sessions and appeared to have a lower STD rate than the short-session group. Clinical records from the study period revealed that long-session patients were half as likely as the other subjects to be infected with gonorrhea. The STD symptoms reported on the subjects' questionnaires jibed with symptoms recorded by clinicians during the study. "We have a good sense that the data are being reported accurately," says Ellen Stover, chief of the NIMH division supporting the study.

"It's an exciting development," says Michael Merson of Yale University's School of Public Health. Merson, who formerly ran the World Health Organization's Global Programme on AIDS, says the study has implications for AIDS programs overseas, because it demonstrates that safe-sex education may help stem the spread of STDs in populations with inadequate health care.

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