Solutions for Heterosexuals
Heterosexuals also constitute a high risk factor for AIDS; 24.9% of AIDS transmission in Erie County is through heterosexuals. Specifically, women signify a high risk factor, through 2004 females represented 26% of AIDS cases; however, 29.6% of newly diagnosed cases are female, representing a 3.6% increase. A 2003 study by Baker revealed the success of skills training in reducing risky sexual behavior and acquisition of new STDs. Women possessing heterosexual risk for the transmission of HIV/STD were placed in either a skills training or health education condition, both of which consisted of 16 weekly 2-hour group sessions. Women in the skills training intervention engaged in safer sex education, understanding sexual rights, setting personal goals for safer sex, use of role-play, and developing healthy relationships with low risk men led by psychotherapists, whereas women in the health education condition received didactic presentation on women’s health ld by community health educators. The skills training group revealed a 13% decrease in risky sexual acts over a period of 12 months, while the health education group displayed a 9% decrease in risky acts. 8.6% of the women in the skills condition acquired a new STD over 12 months; 15.4% in the health education condition. Women in the skills group were approximately 50% less likely to acquire a new STD post-intervention and demonstrated nearly a 6% increase in risk reduction skills and 10% decrease in self-reported risky acts over the course of 12 months. Women in the skills training group proved capable of maintaining improvements in risky acts and risk reduction skills at 12 months, whereas health education group proved incapable of retaining progress. As revealed in this study, behavior change interventions, specifically skills training to “prevent heterosexual transmission of STD/HIV” are both “feasible and effective.” This study can be applied to Erie County because its sample population is similar to the heterosexual women at risk in Erie County. 54% reported sex with a casual partner, while 54% reported annual household incomes of $10,400 or less. Areas with the highest AIDS rates also report the lowest median household income; 14203 has an income of $9,400, while 14201 has an income of $14,642. AIDS clinics in Erie County can implement skills training to increase risk reduction among heterosexual women. Clinics can hold weekly therapeutic discussion sessions focused on skills such as positive aspects of safer sex, developing coping skills, and building social support for safer sex. Meeting on a weekly basis would ensure follow up, enabling health professionals to assess maintenance of risk reduction (Baker 2003).
Risks posed and faced by men must also be addressed in order to reduce heterosexual transmission. A 2003 study by Crepaz and Marks involving seropositive men associated disclosure of HIV positive status and discussion of safer sex resulted in higher prevalence of protected sex. Disclosers demonstrated increased likelihood than non-disclosers to have discussed condom use (78% vs. 51%), talked about safe sexual activities (57% vs. 37%), and agreed about safer sex with their most recent at risk partners (57% vs. 29%). In addition, 84% of the individuals who disclosed HIV positive status and discussed condom use engaged in safer sex; 94% of the individuals who disclosed and discussed safe sexual activities engaged in safer sex. 93% of the people who disclosed and agreed about safer sex participated in safer sex. This study reveals that the combination of disclosing HIV status and discussion of safer sexual activities to be an effective strategy for engaging in less risky acts. In order to replicate this reduction in Erie County, AIDS clinics can offer post-test counseling emphasizing the importance of disclosure of positive status to sexual partners and provide individuals with knowledge of safer sex practices, which can be passed on to partners. Skill-building training that “enhances…ability and motivation to communicate and negotiate effectively with sex partners” should also be offered at the AIDS clinics; such training should “be led by peers or professionals” and “utilize behavioral modeling and modification techniques.” The clinics can combine medical care with behavioral skills training and counseling; emphasis on sexual communication should be targeted particularly to “those who have tested HIV-positive recently” (Crepaz and Marks, 2003).
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