A Tailored Minimal Self-Help Intervention to Promote Condom Use in Young Women: Results from a Randomized Trial

Young sexually active women are an important risk group for HIV and STDs. The proportion of new AIDS cases in women in the United States has increased from 7 percent in 1983 to 23 percent in 1999. The greatest proportionate increase in AIDS cases occurred among women under age 25. The current study evaluated the efficacy of a theory-based tailored minimal self-help intervention to increase condom use among young women at risk for HIV and STDs.

The researchers used a randomized controlled trial in two U.S. managed-care settings: Group Health Cooperative, a mixed-model health care system in Washington state, and the Duke Health System, a network of affiliated practices, clinics, and hospitals based in Durham, N.C. The study targeted non-monogamous sexually active women ages 18-24 at risk for heterosexual HIV/STD acquisition. Between June 1999 and April 2000, the researchers screened potential participants, who had to be unmarried, to have had sexual intercourse with a male partner within the past 6 months, and who were not pregnant, nor were in a monogamous relationship of more than 12 months' duration.

Participants' mean age at baseline was 21; 31 percent were non-white; 32 percent reported a prior pregnancy; 27 percent reported an STD history; and 36 percent reported binge drinking in the past month. More than half (56.5 percent) had two or more sex partners during the previous year; 91 percent reported having intercourse during the previous three months, and 19 percent reported having a primary sex partner.

The scientists randomly divided the sample of 1,210 young women into two groups: intervention or usual care. Participants in the intervention group received two rounds of individually tailored materials. Following the baseline survey, researchers sent them a 12-page booklet, Insights, a self-help publication containing "information especially selected for you based on your answers to a recent women's health survey," according to the accompanying cover letter. The intervention packet also contained a "safe sex" kit including male and female condoms, a condom carrying case, and instructions on using condoms. After the three-month survey, intervention participants got a tailored booster feedback newsletter, Extra Insights, and a condom packet.

Eighty-five percent of the sample completed the six-month follow-up. Nearly all participants in the intervention group (96 percent) recalled receiving one or both of the packets. Of those who read the materials, 66 percent found them personally relevant. Sixty-two percent felt the materials encouraged them to use condoms, and 59 percent of those who were sexually active reported using the condoms included in their packet.

"At the six-month follow-up, the odds of using condoms during the prior three months with any partner and with a primary partner were significantly higher for intervention than for usual care participants," the authors wrote. They found 10 percent greater overall condom use and 12 percent greater use with primary partners for the intervention group.

"Young women at risk for heterosexual acquisition or transmission of HIV/STD are in need of effective interventions," they concluded. "Our purpose in undertaking this trial was to conduct an initial rigorous evaluation of tailored minimal self-help interventions as HIV/STD prevention strategies with this target population. The encouraging findings provide evidence of efficacy and of applicability to diverse communities and settings."