Focus on the Future


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Presented by Richard Crosby, PhD, DDI Endowed Professor and Chair, Department of Health Behavior, University of Kentucky at the 2012 National Chlamydia Coalition meeting.

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Focus on the Future

  1. 1. It ’ s about their future! <ul><li>Like all of us, young African American men attending public STD clinics need to believe in their future – they need to see beyond “ today ” and this session which is about to occur must keep that principle in the forefront! </li></ul>
  2. 2. It ’ s unfair! <ul><li>CDC calls HIV/AIDS “ a disease of African Americans ” – they note that this is a crisis for African Americans and the nation must mobilize an effective response effort. </li></ul><ul><li>Young African American men need to know that they are the single largest population in the US at risk of HIV – this awareness sets the stage for a behavioral response. </li></ul>
  3. 3. African American Men and HIV
  4. 4. More…
  5. 5. More… <ul><li>Chlamydia Rate for White Men Rate for African American Men </li></ul><ul><li>20 - 24 years old 334.4 2515.5 </li></ul><ul><li>25 - 29 years old 167.3 1442.3 </li></ul><ul><li>Gonorrhea </li></ul><ul><li>20 - 24 years old 95.7 2715.5 </li></ul><ul><li>25 - 29 years old 72.1 1214.2 </li></ul>
  6. 6. Missed Opportunity? <ul><li>In most populations studied, about 1 of every 6 persons diagnosed with a treatable (i.e., bacterial or parasitic) STD will be reinfected within 12 months. </li></ul><ul><li>What are we doing about this? </li></ul>
  7. 7. Condoms <ul><li>Condom use remains the #1 HIV prevention strategy worldwide! </li></ul><ul><li>When used correctly condoms provide extremely effective protection against HIV and a host of other sexually transmitted diseases. </li></ul>
  8. 8. “ Condom Sense ”
  9. 9. Let ’ s be Practical (please) <ul><li>Programs that last several sessions (and several hours) are seldom practical in a clinic setting. </li></ul><ul><li>The ideal program would be short (about the length of a high school class period) and it would be delivered in a single session. </li></ul>
  10. 10. Focus on the Future <ul><li>The brief program is guided by the Information-Motivation-Behavioral Skills model and by Social Cognitive Theory. </li></ul><ul><li>Delivery of the program is based on a lay health advisor model. </li></ul>
  11. 11. Focus… <ul><li>Key Principles </li></ul><ul><li>Unconditional respect for men </li></ul><ul><li>Options and know how </li></ul><ul><li>Practice is good </li></ul><ul><li>Condoms can feel better </li></ul><ul><li>Protect your future </li></ul>
  12. 12. Key Formative Work <ul><li>the “ fit and feel ” of condoms; </li></ul><ul><li>condom brand and size; </li></ul><ul><li>application problems; </li></ul><ul><li>availability of condoms and lubricants; </li></ul><ul><li>commitment to condom use </li></ul>
  13. 13. Objective 1 <ul><li>Rapport and respect </li></ul>
  14. 14. Objective 2 <ul><li>SCUES review </li></ul>
  15. 15. Objective 3 <ul><li>Inquire about past negative experiences with condoms </li></ul>
  16. 16. Objective 4 <ul><li>Guided application practice </li></ul>
  17. 17. Objective 5 <ul><li>Access and erection issues </li></ul>
  18. 18. Objective 6 <ul><li>Fit and feel </li></ul>
  19. 19. Closing <ul><li>Men are asked to think of one thing they learned and discuss that with friends. </li></ul><ul><li>Men should be challenged to use condoms consistently and correctly in response to the AIDS burden that unfairly impacts young African Americans. </li></ul>
  20. 20. Efficacy Trial Results <ul><li>266 African American men were enrolled and followed for 3 months after being assessed and randomized to intervention or control conditions. </li></ul>
  21. 21. Subsequent Studies of FOF <ul><li>NIMH-funded trial in 2 US cities (teens) </li></ul><ul><li>NIMH-funded trial in Jackson, MS (MSM) </li></ul><ul><li>CDC REP Trials in New York, Philadelphia, Atlanta, and Alabama </li></ul><ul><li>*Nothing yet with women </li></ul>
  22. 22. Next move? <ul><li>FOF will be placed on a web-based program in 2012 and tested using a Diffusion-based model, with Facebook. </li></ul><ul><li>Thank you for your interest in FOF! </li></ul>
  23. 23. Condom Use: Last Sex <ul><li>Intervention = 72.4% </li></ul><ul><li>Control = 53.9% </li></ul><ul><li>P = .008 </li></ul>
  24. 24. UVS past 3 months <ul><li>Intervention mean = 12.3 times </li></ul><ul><li>Control mean = 29.4 times </li></ul><ul><li>P = .045 </li></ul>
  25. 25. Demonstrated Application Scores <ul><li>On a 9-point rating scale the mean diference was 3.17 (favoring the intervention group): P <.0001 </li></ul>
  26. 26. Number of Sex Partners <ul><li>This was a surprise finding (but a good one!) </li></ul><ul><li>Intervention mean = 2.06 </li></ul><ul><li>Control mean = 4.15 </li></ul><ul><li>P <. 001 </li></ul>
  27. 27. 6-month Chart Review <ul><li>Intervention incidence = 31.9% </li></ul><ul><li>Control incidence = 50.4% </li></ul><ul><li>P = .002 </li></ul><ul><li>*This was any STD </li></ul>