Evaluation of a sexually transmitted disease/human immunodeficiency virus prevention train-the-trainer program

Military Medicine, Apr 2001 by Booth-Kewley, Stephanie

In this study, a behavioral intervention known as the STD/HIV Intervention Program (SHIP) was implemented at the Navy preventive medicine technician (PMT) school as a "train-the-trainer" course. Course evaluation questionnaires were administered to PMT, students immediately after the training. Follow-up interviews evaluating the SHIP course were conducted with PMTs (N = 73) 1 year after the training. PMT students were fairly satisfied with SHIP overall, as well as with specific components of the course. As hypothesized, the SHIP train-the-trainer course was considered useful by most PMTs in their first duty assignments after completing PMT school.

Introduction

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is undoubtedly the most important infectious disease epidemic of the late 20th century. As of 1997, the Centers for Disease Control and Prevention estimated that about 270,000 people in the United States had AIDS.1 Because HfV/AIDS and other sexually transmitted diseases (STDs) are transmitted through risky behaviors, they can be prevented by means of appropriate behavioral changes. People can learn to avoid the behaviors that place them at risk for HIV and STDs or to engage in safer variants of these behaviors (e.g., use condoms). At present, behavior change constitutes one of the primary means of preventing HIV/AIDS and other STDs. Consequently, there is a clear need for research on the effectiveness of behavioral interventions to prevent STDs/HIV in a wide variety of populations.

Behavioral interventions have been shown to reduce rates of unprotected sexual intercourse in a number of different populations.2-5 A growing body of scientific evidence indicates that although not all interventions have an impact on behavior, changes in risky behavior can occur as a result of well-designed interventions.6,7 A meta-analysis demonstrated that cognitivebehavioral HIV interventions significantly reduce HIV risk behaviors with small to moderate effect sizes.8 Moreover, a National Institutes of Health Consensus Panel concluded that behavioral interventions to reduce HIV/AIDS are effective and should be widely disseminated.9

Several authors have pointed out that HIV interventions grounded in psychological theory are generally more effective than interventions lacking a theoretical basis.10,11 A dominant theory in the HIV risk behavior literature is the information-- motivation-behavioral skills (IMB) model.10,12 Developed specifically to explain HIV risk behavior, this model of behavior change assumes that there are three main determinants of risk reduction: (1) information, (2) motivation, and (3) behavioral skills. The IMB model states that for individuals to change their behavior, they need information, motivation, and behavioral skills to facilitate the change. "Information" refers to basic knowledge about STD/HfV transmission and prevention. "Motivation" refers to personal attitudes about preventive behaviors (e.g., condom use) as well as perceived normative support for such behaviors. "Behavioral skills" for preventing STDs/HIV include social skills, appropriate assertiveness, and communication skills.

Although a substantial number of studies have implemented and evaluated behavioral interventions to prevent STDs/HIV, these studies have focused on civilian rather than military populations. Well-designed, multiple-component behavioral interventions to prevent STDs and HIV in the military have been lacking. Unsafe sex among military personnel is of concern because certain segments of the military population may be at high risk for STDs/HIV as a result of their demographic characteristics (e.g., young age and predominantly male gender), frequent deployments, and assignments to foreign countries with high rates of HIV. Previous studies of deployed military personnel have documented a number of factors that contribute to STD acquisition, including sexual contact with sex workers, heavy alcohol use, and inconsistent use of condoms, and have also found fairly high rates of sexual contact with sex workers (e.g., 42% for a 6-month period) in this population.13 Clearly, there is a need to develop and evaluate STD/HIV prevention programs tailored for U.S. military populations.

Since 1994, the Naval Health Research Center (NHRC), San Diego, California, has conducted research designed to prevent STDs and HIV among military personnel. In the first NHRC project, an intervention called the STD/HIV Intervention Program (SHIP) was developed and tested in a group of Marines on a Western Pacific deployment.14 The evaluation of this behavioral intervention indicated that it was successful in leading to a significant reduction in risky sexual behaviors and a reduction in alcohol use in the intervention group (Marines who were exposed to SHIP) compared with the control group (similar Marines who were not exposed to SHIP). Based on these results, it seemed feasible to use this intervention with other military populations.