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Ralph J. DiClemente, PhD; Gina M. Wingood, ScD, MPH

JAMA. 1995;274(16):1271-1276.

Abstract
Objective.
—To evaluate the efficacy of a community-based social skills human immunodeficiency virus (HIV) prevention intervention to enhance consistent condom use.

Design.
—A randomized, single-blind controlled trial.

Setting.
—Bayview-Hunter's Point neighborhood of San Francisco, Calif, a predominantly African-American community that is economically disadvantaged.

Participants.
—A sample of 128 sexually active, heterosexual, African-American women 18 through 29 years of age was recruited using street outreach techniques. Participants completed a structured baseline interview; 100 women (78.1%) completed 3-month follow-up interviews.

Intervention.
—Women randomized to the social skills intervention completed five sessions that emphasized ethnic and gender pride, HIV risk—reduction information, sexual self-control, sexual assertiveness and communication skills, proper condom use skills, and developing partner norms supportive of consistent condom use. Women randomized to the HIV education condition participated in a single session that provided HIV risk—reduction information. Women randomized to the delayed HIV education control condition received no HIV risk—reduction information until all follow-up interviews were completed.

Main Outcome Measures.
—Consistent condom use, HIV risk—reduction knowledge, sexual self-control, sexual assertiveness, sexual communication, and partner norms supportive of consistent condom use.

Results.
—Compared with the delayed HIV education control condition, women in the social skills intervention demonstrated increased consistent condom use (adjusted odds ratio [OR], 2.1; 95% confidence interval [CI], 1.03 to 4.15; P=.04), greater sexual self-control (adjusted OR, 1.9; 95% CI, 1.00 to 3.60; P=.05), greater sexual communication (adjusted OR, 4.1; 95% CI, 1.67 to 10.01; P=.002), greater sexual assertiveness (adjusted OR, 1.8; 95% CI, 1.01 to 3.27; P=.05), and increased partners' adoption of norms supporting consistent condom use (adjusted OR, 2.1; 95% CI, 1.08 to 3.87; P=.03). No statistically significant differences in outcome variables were observed between the HIV education condition relative to the delayed HIV education control condition.

Conclusion.
—Community-based HIV risk—reduction programs that are gender relevant and culturally sensitive and provide social skills training can effectively enhance consistent condom use.

(JAMA. 1995;274:1271-1276)

Author Affiliations
From the School of Public Health, Department of Health Behavior (Drs DiClemente and Wingood); School of Medicine, Department of Pediatrics, Division of Adolescent Medicine (Dr DiClemente); Center for AIDS Research (Drs DiClemente and Wingood); and the Center for Health Promotion (Drs DiClemente and Wingood), University of Alabama, Birmingham.

Footnotes
Reprint requests to the School of Public Health, Department of Health Behavior, 1825 University Blvd, Suite 121, Birmingham, AL 35294-2010 (Dr DiClemente).

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