educate individuals at high risk of HIV infection manages to get them to engage in safe sex. Experts say the discovery, reported in tomorrow's issue Science , bodes well for reducing rates of sexually transmitted diseases (STDs), especially in developing countries.
U.S. populations present the greatest risk of HIV infection are minority groups in urban low-income areas. African Americans, for example, accounted for 45% of new AIDS cases in 1997 and contract AIDS at about eight times the rate of whites. Hispanics accounted for 21% of new AIDS cases. Investigators from the HIV prevention trial multisite at the National Institute of Mental Health in Rockville, Maryland, wanted to see if the education programs could reduce infection rates.
The team recruited 3706 men and women in health centers in the inner city over five cities. Almost all participants were African-American or Hispanic; all were treated in the past for STDs. Half the subjects were randomly assigned to attend seven meetings in small groups, each of at least 1.5 hours, where they received counseling on sexual risk behaviors. Others attended a single session, which included a one hour video on the subject. All were asked to fill out survey forms every 0 days describing their behavior and symptoms of STDs. The team is based on questionnaires because, say the researchers, they feared that the blood or to require HIV tests cause many subjects to give up.
A year later, participants in longer programs reported having unprotected sex at least half as often as they had before the sessions and seemed to have an STD rates lower than the group short session. The clinical records of the study period showed that patients with long-session were half as likely as other subjects to be infected with gonorrhea. STD symptoms reported on the questionnaires subjects jibed with symptoms recorded by clinicians in the study. "We have a sense that data is reported accurately," says Ellen Stover, head of the NIMH Division supporting the study.
"This is an exciting development," said Michael Merson School of Public Health Yale University. Merson, who formerly ran the World Programme of the World Health Organization AIDS, says study has implications for AIDS programs abroad because it demonstrates that the sex safety education can help stem the spread of STDs in populations with inadequate health care.
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