A randomized controlled trial of a computer-based intervention to increase internal condom use among African American women

This randomized controlled trial evaluated whether HALO (Healthy Alternatives, Loving Ourselves), a brief computer-delivered intervention, increases internal condom (IC) use for HIV/STI prevention among African American women compared to print materials. We recruited 102 women aged 18–50 at risk for HIV from a Washington DC clinic and randomized them to HALO ( n = 52) or control ( n = 50). Participants completed surveys assessing IC use, knowledge, attitudes, and self-efficacy at baseline, 2 months, and 4 months post-intervention. Women assigned to HALO reported significantly higher rates of IC-protected vaginal sex acts over the study interval (condition × slope estimate = 0.04, SE = 0.02, 95% CI [0.00, 0.09], p = .050). The proportion of vaginal sex acts protected by ICs increased from 4.8% at baseline to 21.1% at 2 months among HALO participants versus 7.3% among controls. At 4 months, these proportions were 15.7% and 7.2%, respectively. HALO participants reported more frequent use of insertion strategies ( p = .00), more favorable IC attitudes ( p = .00), and greater self-efficacy ( p = .01). Participants’ views of ICs enhancing sexual experiences ( p = .00) and providing protection ( p = .00) improved significantly. Among African American women attending an urban clinic, this computer-based intervention was associated with increased IC use and improved attitudes over 4 months. Future research should examine longer-term outcomes and implementation strategies to expand access to female-initiated HIV/STI prevention options, including adaptations for diverse populations such as transgender women.