Young Black Women Benefit from Combination Program that Addresses Sexual Health and Alcohol Use

Young Black women increased safe sex practices and drank less following a series of workshops conducted on weekends that focused on preventing sexually transmitted infections (STIs) and reducing alcohol use, according to a study published in the American Journal of Preventive Medicine.

Ralph DiClemente, PhD, of the department of social and behavioral sciences at the School of Global Public Health at New York University, New York, NY and colleagues conducted a randomly assigned, parallel-group comparative treatment efficacy trial.

The study enrolled 560 African American or Black women from community settings outside night clubs, at public transit stops, and in malls in Atlanta, GA from January 2012 to February 2014.

Women were between the ages of 18 and 24 who had reported drinking and having unprotected vaginal or anal sex.

DiClemente and colleagues used a previously established, culturally tailored program that addressed STI prevention called Horizons, a CDC-designated best practices HIV prevention program, as a framework to which they added curriculum regarding alcohol use.

Women were assigned to 1 of the following groups: the Horizons group that met for 5 hours on 2 consecutive Saturdays and had sexual health programming only; the Horizons+, which followed the Horizons group but also added a 1-hour session on alcohol use that used motivational enhancement therapy; and a control group that had a 1-hour session that included a video, a question-and-answer session, and a discussion group.

After the sessions, the Horizons and Horizons+ groups received calls and texts messages as reminders of what was learned.

Researchers used follow-up assessments to gather data on safe sex, STIs, and drinking, including binge drinking. Alcohol use saw a significant reduction according to the authors, with the Horizons group seeing a 48% decrease, and a 59% decrease in binge drinking in the Horizons+ group.

While the Horizons group did not differ from the control group in terms of rates of safer sex, the Horizons+ group reported a 45% greater chance of safe sex. Researchers said STI incidence was not reduced, probably because the study population’s rates were low from the start.

“The expanded intervention focusing on risky drinking creates a framework for addressing challenges and problem-solving within sexual partnerships; our findings suggest that using a combined approach of sexual health promotion and alcohol reduction, which reinforce each other, can significantly reduce both risky sex and drinking,” DiClemente said in an NYU news release.

Study co-author Janet E. Rosenbaum, PhD, of the department of epidemiology and biostatistics at the school of public health at SUNY Downstate Health Sciences University in Brooklyn, NY, told Contemporary OB/GYN® that “gynecologists should address even moderate substance use as a risk factor for unprotected sex.” She said that many women in this study engaged in moderate alcohol use; the majority scored normally on alcohol use disorder screen (AUDIT).

However, “the intervention that addressed both safe sex and alcohol use was effective in reducing unprotected sex and increasing condom use,” she explained. Rosenbaum recommended that women be advised to drink with friends rather than possible romantic partners.

Rosenbaum said that because about half of STIs are asymptomatic, “outreach to young women in community settings that includes STI testing can identify infections that might otherwise be undiagnosed.” She added that when Black women do the outreach, the results are most effective.

“Many young Black women attending family planning clinics may seldom use alcohol, less than 3 times in 90 days,” Rosenbaum said. “After initial recruitment efforts at family planning clinics found few women who used alcohol 3 times in 90 days, the intervention team moved recruitment to community settings such as subway stops near local colleges, shopping areas, and by leaving flyers on windshields of cars parked outside dance clubs.”

She noted that about 25% of the young women recruited in these community settings tested positive for an STI that may have otherwise gone undetected if the women had not received community outreach.

“This intervention was about 10 hours long, spread over 2 Saturdays,” Rosenbaum said. “Clinicians can encourage community groups, colleges, and public health departments to adopt effective interventions like this, in order to supplement the brief counseling in clinic.”

Reference

DiClemente RJ, Rosenbaum JE, Rose ES, et al. Horizons and group motivational enhancement therapy: HIV prevention for alcohol-using young black women, a randomized experiment [published online ahead of print, 2021 Feb 23]. Am J Prev Med. 2021;S0749-3797(21)00056-8. doi:10.1016/j.amepre.2020.11.014.