title: Efficacy of SISTA South Africa on sexual behavior and relationship control among isiXhosa women in South Africa: results of a randomized-controlled trial.
abstract: BACKGROUND
  The HIV epidemic has a devastating impact among South African women. The current study evaluated the efficacy of SISTA South Africa, a culturally congruent HIV intervention for isiXhosa women in South Africa, which was adapted from SISTA, an HIV intervention for African American women.
  
  
  METHODS
  A randomized-controlled trial recruited 342 isiXhosa women aged 18-35 years. Participants were randomized to the general health comparison or the SISTA South Africa intervention. Xhosa-speaking peer health educators tailored the SISTA South Africa curriculum, while maintaining the core elements of the original SISTA intervention. Participants completed assessments at baseline and 6 months follow-up.
  
  
  RESULTS
  Relative to participants in the comparison, participants in the HIV intervention reduced the frequency of unprotected vaginal intercourse acts (adjusted mean difference = 1.06; P = 0.02), were more likely to report not desiring dry sex (adjusted odds ratio = 0.229; 95% confidence interval = 0.10 to 0.47; P = 0.0001), and were more likely to perceive that their main sexual partner did not desire dry sex (adjusted odds ratio = 0.24; 95% confidence interval = 0.11 to 0.52; P = 0.0001). In addition, women randomized to the intervention also reported an increase in HIV knowledge, greater relationship control, and had more opposing attitudes toward HIV stigma. The HIV intervention did not reduce sexually transmitted infection incidence.
  
  
  CONCLUSIONS
  This trial demonstrates that an HIV intervention, which is adapted to enhance its gender and cultural relevance for rural isiXhosa women, can reduce self-reported sexual risk behaviors and enhance mediators of HIV among this vulnerable population.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30342, USA. gwingoo@emory.edu
authors.forename: Gina M
authors.initials: GM
authors.lastname: Wingood
authors.forename: Priscilla
authors.initials: P
authors.lastname: Reddy
authors.forename: Delia L
authors.initials: DL
authors.lastname: Lang
authors.forename: Dorina
authors.initials: D
authors.lastname: Saleh-Onoya
authors.forename: Nikia
authors.initials: N
authors.lastname: Braxton
authors.forename: Sibusiso
authors.initials: S
authors.lastname: Sifunda
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: DiClemente
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012309:Risk-Taking; D012424:Rural Population; D012725:Sexual Behavior; D013019:South Africa / Q000453:epidemiology; D016387:Women's Health; D055815:Young Adult