• R J DiClemente and G M Wingood.
• School of Public Health, Department of Health Behavior, University of Alabama, Birmingham 35294-2010, USA.
• JAMA. 1995 Oct 25; 274 (16): 127112761271-6.

ObjectiveTo evaluate the efficacy of a community-based social skills human immunodeficiency virus (HIV) prevention intervention to enhance consistent condom use.DesignA randomized, single-blind controlled trial.SettingBayview-Hunter's Point neighborhood of San Francisco, Calif, a predominantly African-American community that is economically disadvantaged.ParticipantsA 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.InterventionWomen 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 MeasuresConsistent condom use, HIV risk-reduction knowledge, sexual self-control, sexual assertiveness, sexual communication, and partner norms supportive of consistent condom use.ResultsCompared 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.ConclusionCommunity-based HIV risk-reduction programs that are gender relevant and culturally sensitive and provide social skills training can effectively enhance consistent condom use.

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