Program Components

• Clinical intervention
• Two, four-hour group sessions focused on preventing STIs , including HIV
• Interactive sessions, including role-playing and communication techniques as well as activities to promote cultural and gender pride
• $20.00 vouchers for participants' male partners for STI testing and treatment
• Four telephone conversations over one year

For Use With

• African American females, ages 15 through 21
• Sexually experienced young African American females
• Young African American females seeking sexual health services

Evaluation Methodology

• Quasi-experimental evaluation, with treatment and comparison conditions in Atlanta, GA, from March 2002 through August 2004
• African American female adolescents (ages 15 through 21) recruited at three sexual health clinics and randomized to treatment (n=348) and comparison (n=367) conditions
• Assessment at baseline (n=714) and at 6- (n=612) and 12-month (n=605) follow-up
• Audio computer-assisted self-assessment and self-collected vaginal swabs to assess STIs

Evaluation Findings

• Reduced incidence of STIs
• Increased condom use

Evaluators' Comments: We have severely underestimated the intransigence and adverse impact of the STD/HIV 'national health crisis' for African American individuals... Research is needed to develop innovative prevention approaches that target a broader range of social determinants associated with STD/HIV risk behaviors and disease and combination behavioral, medical, and structural strategies to optimize the efficacy of STD/HIV prevention interventions... Ultimately political resolve and leadership are critical for supporting a continuum of prevention science research and the development of service delivery systems that can eliminate the racial disparity in STDs and HIV.
Source: DiClemente, Wingood, Rose et al., 2009

Program Description

HORIZONS consists of three components: 1) two, four-hour group sessions focused on preventing STIs, including HIV; 2) vouchers that participants can give to their male sexual partners for $20.00 toward the cost of STI testing and treatment; and 3) four 15-minute phone conversations, conducted across one year, to reinforce the messages of the intervention session. The HORIZON sessions are based on social cognitive theory, the theory of gender and power, and previously published research on females seeking clinical services. Intervention sessions are interactive and designed to foster both cultural and gender pride. Sessions emphasized diverse factors that contribute to young women's STI/HIV risk, including personal, relationship, sociocultural, and structural factors. Participants role-play about informing partners of their (the young women's) STI status and also about encouraging partners to seek STI testing and treatment.

Evaluation Methodology

From March, 2002, until August, 2004, evaluators recruited female African American adolescents and young women from three clinics in downtown Atlanta, GA. Eligibility criteria included self-identifying as African American, being age 15 through 21, and having had vaginal sex within the previous 60 days. Young women who were currently married, pregnant, or attempting to become pregnant were excluded from the study. Young women who volunteered to participate were asked to return to the clinic to give informed consent and participate in baseline assessment. Parental consent was waived for those under age 18. Of eligible adolescents, 84 percent (n=715) enrolled and were randomized to intervention and control conditions. Participants received $50.00 for travel and child care so they could attend the sessions and complete the assessments.

Young women assigned to the intervention condition (n=348) received HORIZONS as described above. Young women assigned to the control condition (n=367) received enhanced usual care, including a one-hour session led by a trained African American female health educator, a culturally and gender-appropriate STI/HIV prevention video, and a group discussion. Control condition participants also received four phone calls, but only to update their contact information.

At baseline and at six- and 12-month follow-ups, young women in both intervention and control conditions completed audio computer-assisted self-interviews and provided self-collected vaginal swabs (later tested for Chlamydia, gonorrhea, and trichomonas). Eighty-six percent of participants (n=612) completed the six-month assessment; 84.5 percent (n=605) completed the 12-month follow-up assessment.

Baseline assessments indicated a high prevalence of sexual risk behaviors and STIs. On average, young women reported nine lifetime sex partners and 13 episodes of vaginal sex in the previous 60 days. Only 22 percent of the young women reported consistent condom use; 43 percent reported condom use at last sex. Nearly half (46 percent) had an STI: Chlamydia, 30 percent; trichomonas, 19 percent; and gonorrhea, 14 percent. To control for differences in key variables at baseline, these variables were included as covariates in subsequent analysis.

Outcomes

Behaviors

• Increased condom use – In the 14 days prior to follow-up assessments, intervention participants reported a higher proportion of sex acts protected by condoms (P=.004) compared to controls. Young women who participated in the intervention were also significantly more likely than controls to report: consistent condom use in the preceding 14 days (P=.04); consistent condom use in the preceding 60 days (P=.01); and condom use at most recent sex (P=.005).

Long-Term Impact

• Reduced incidence of STIs – Over the 12-month follow-up period, 42 young women in the intervention, compared with 67 controls, had an infection with Chlamydia (P=.04). When tested for recurrent Chlamydia infections, intervention youth were also significantly less likely than controls to have a recurrent infection (four among intervention youth; 14 among controls; P=.02).

For More Information, Contact

• Ralph J CiClemente, PhD – Emory University Rollins School of Public Health; This e-mail address is being protected from spambots. You need JavaScript enabled to view it