They were single and unemployed, urban men and women who used drugs but didn't use condoms, people whose actions put them at higher risk for getting HIV than anyone else in America.
Now the largest study of its kind has found that something as simple as talking can save their lives.
They attended seven two-hour sessions that taught them how to correctly use condoms and how to talk with their partners.
The participants also learned to understand what might be driving their risky sexual behavior and, in some cases, changed it.
The results, reported in today's issue of the journal Science, offer encouragement for anyone who ever tried to teach safe sex.
For up to a year after the sessions, the study's participants, including 700 Baltimore residents, doubled their regular use of condoms and posted lower rates of symptoms from sexually transmitted diseases, or STDs.
While efforts to educate and counsel people about safe sex are as old as the HIV epidemic, there has been little data to show whether these interventions work.
Smaller studies in other populations, such as gay men and adolescents, have shown similar principles to be effective.
But some in the medical community doubted that teaching and talking would change the behavior of these African-Americans and Hispanic-Americans, who hadn't been studied, researchers said.
The new study, run by the National Institute of Mental Health, indicates the skeptics were wrong.
"What was really moving was just how much people did respond,"said Ann O'Leary, an associate professor of psychology at Rutgers University. O'Leary ran group sessions.
"There was a sense that you were giving them something important, and that that doesn't happen very often in their lives."
The implications are significant, particularly as the AIDS epidemic is shifting, affecting an increasing number of minorities.
In 1997, according to the National Institutes of Health, 45 percent of all cases of AIDS in the United States were in African-Americans. That translates into a rate about eight times higher than among whites.
Among Hispanic-Americans, people are getting AIDS at four times the rate of whites.
"We all want to have a vaccine, but we don't have a vaccine now, and we're not going to have it tomorrow," said Dr. Michael H. Merson, dean of public health at Yale University School of Medicine and a former director of the World Health Organization's Global Program on AIDS.
"But that doesn't mean we can't move forward and achieve a great deal in this epidemic.
"The fact that you can achieve such success in these kinds of populations in this country gives us encouragement that we can achieve it all over the world," he said.
One of the study's more dramatic findings, among men recruited from public STD clinics, was that the rate of contraction of gonorrhea for those who completed the seven two-hour sessions was half that of men in a control group, who attended a single, one-hour session.
Dr. David D. Celetano, a professor of epidemiology at the Johns Hopkins School of Public Health, who led the Baltimore part of the project, said the next step will be to find easy ways for cities throughout the country, and the world, to use the program.
3,700 participated in study
Celetano and researchers from around the country started by focusing on areas with high rates of HIV: Baltimore, New York, northern New Jersey, Milwaukee, Atlanta and Los Angeles.
They enrolled more than 3,700 people age 18 and older who used public health clinics, had unprotected sex in the past 90 days and engaged in other risky behaviors.
About half were randomly assigned to the control group, who attended the one-hour session.
The other half were split up into groups of about eight people, separated by gender. They met twice weekly for sessions that did what few similar programs do: taught them basics and then let them practice.
Many participants had to let go of myths. Because they were tTC heterosexual, they didn't think they could get HIV. Others didn't know that they must use latex condoms to prevent transmission of STDs and that condoms have expiration dates that should be checked. The clients also wrongly believed that they could catch HIV by sharing a cup, a toilet, or a kiss.
Broaching the subject
Then the group worked on something harder: how to approach the subject of condoms with their partners.
Some women, if they flat-out asked, would be beaten by suspicious husbands or boyfriends, who might think they were cheating, said one Baltimore group leader, Myron Johnson.
People in the group role-played and practiced responses. Some discovered their boyfriends or girlfriends wanted to use condoms but were also afraid to broach the issue.
Eventually, the group arrived at such questions as why they had so many sex partners, or used drugs, or hadn't finished high school.
The answers came slowly.
One woman was haunted by her mother's telling her she was ugly. Another woman had been molested by an uncle and kept it secret for 25 years.
Other people didn't believe they were good for anything.
One participant from Brooklyn -- smart, assertive and a problem-solver -- was so impressive that O'Leary, the Rutgers psychologist, thought the woman would make a wonderful graduate student.
At the study's graduation ceremony, O'Leary was shocked to see her holding her framed diploma and saying, "This is the first time I ever finished anything."
Johnson, 43, a drug addiction counselor who supervised education on the local project, said more needs to be done to translate research results to the level where he works.
"Communication is a real big part of people protecting themselves," Johnson said, "but there's very few places where you can go and someone teaches you how."
Pub Date: 6/19/98