Background:
Most effective HIV/STD interventions require well-trained staff and considerable resources and can be difficult to implement and sustain over time. Brief structural interventions may provide a feasible alternative.

Objective:
To evaluate the effectiveness of a video shown in STD clinic waiting rooms to decrease new infections.

Method:
All STD clinic patients in 3 cities (Denver, Long Beach, San Francisco) received one of two waiting room conditions: (1) intervention consisted of a theory-based 23-minute soap-opera style video modeling couples overcoming barriers to safer sexual behaviors, or (2) control consisted of the standard waiting room environment. Condition assignment alternated in 4-week blocks between December 2003 and August 2005. Medical records and STD surveillance registries were reviewed to identify incident laboratory-confirmed infections (gonorrhea, chlamydia, trichomoniasis, syphilis, HIV). Proportional hazards regression was conducted to compare STD incidence between conditions over time.

Result:
Analyses included 38,635 patients (N=19,562 intervention, 19,073 control). Patients were predominantly male (70%), racial/ethnic minorities (54%), and ≤30 years of age (55%). Approximately 16% had a laboratory-diagnosed STD at their initial clinic visit. Study conditions were comparable on demographic and behavioral characteristics at baseline. During an average 12-month follow-up, 2,030 patients (5.3%) had an incident STD. Patients had significantly fewer STD in the intervention versus control condition (adjusted Hazard Ratio (aHR)=0.90, 95% Confidence Interval (CI)=0.81-0.99). Intervention effects were strongest among patients who were male (aHR=0.82, 95% CI=0.73-0.93) and diagnosed with baseline STD (aHR=0.83, 95% CI=0.70-0.98).

Conclusion:
Showing a brief video in these STD clinic waiting rooms reduced new infections. The inclusion of all clinic patients in the evaluation of this simple intervention suggests that these results are widely generalizable.

Implications:
Clinic waiting room videos have the potential to reach large numbers of STD patients who may be unable or unmotivated to attend more intensive programs.