In busy clinic settings it is difficult to implement and maintain HIV/STD prevention programs that involve counseling and/or multiple sessions. 
Clinic waiting rooms provide an often-overlooked opportunity for delivering prevention information in high-risk populations.  Waiting room interventions can deliver a dose of prevention to clinic patients at a teachable moment, when they are waiting to see a health provider and thinking about their health risks.

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This collaborative research project investigated whether a brief waiting room intervention would reduce incident STD infections and impact risk behavior among STD clinic patrons.

Staff from all sites (see Research Collaborators) worked collaboratively with filmmaker Jesse Moss to develop a 23-minute video, Safe in the City that models a variety of condom negotiation skills with heterosexual, gay, and bisexual characters of several races.

In this structural intervention, we showed the video and displayed related posters in alternating months to patrons in three publicly funded STD clinic waiting rooms in Denver, Long Beach, and San Francisco over a 20-month period. The intervention group was comprised of patrons who were in the waiting rooms when the video was shown. The control group was comprised of patrons who were in the waiting rooms during the non-video months and who received standard clinic services (e.g., patient education print materials, basic television programming) absent of the Safe in the City video-based intervention.


We compared new lab-confirmed incident STD infections (gonorrhea, chlamydia, trichomoniasis, primary and secondary syphilis and HIV) among the intervention and control groups up to 24 months after initial visit (N=38,635), using medical record and surveillance data. Process measures assessed the quality and acceptability of the intervention program.


Safe in the City intervention was associated with a 9% reduction in new STDs. The largest effect sizes were observed among those >= 25 years old (15%) and those who were heterosexual (16%). Large effect sizes were also seen in males and those with a baseline STD. This reduction in STDs can have significant public health benefit. This easy-to-implement, low cost intervention has the potential to reach large numbers of STD clinic patients.

PLoS Medicine Article
2006 National STD Prevention Conference Abstract

Research Collaborators

Centers for Disease Control and Prevention
Lee Warner, Andrew Margolis, Jocelyn Patterson, Craig Borkowf, Gale Burstein, Ann O'Leary, David Purcell, Thomas Peterman, Terry Wang, Fan Zhang, Bob Byers

Denver Public Health
Cornelis Rietmeijer, John Douglas, Sheana Bull, Sheana Bull, Doug Richardson, Mark Foster, Stuart Cooper, Julie Caine, Rebecca Rothbard, Terry Sapp-Jones

UCSF, Center for AIDS Prevention Studies and the San Francisco Department of Public Health
Jeffrey Klausner, Gregory Greenwood, Carolyn Hunt, Elizabeth Varela, Kevin Filocamo, David Bandy, Edwin Ramos-Soto

Education Development Center, Inc.
Lydia O'Donnell, Alexi San Doval, Athi Myint-U, Richard Duran, Carl O'Donnell

Long Beach, California State University & Department of Health and Human Services
Kevin Malotte, Shelley Vrungos, Nettie DeAugustine, Chris Kau, Inez Denson, Marina Ohlson Smorick, and Ann Marie Bernhard