mental health AIDS

Fall 2007 Newsletter / Volume 9, Issue 1

HIV Prevention News

About Women

Jemmott, Jemmott, and O'Leary (2007) conducted a randomized controlled trial to test "the efficacy of brief HIV/sexually transmitted disease (STD) risk-reduction interventions for African American women in primary care settings" (p. 1034). "Designed to be educational but entertaining, culture sensitive, and gender appropriate, each intervention incorporated the 'Sister to Sister! Respect Yourself! Protect Yourself! Because You Are Worth It!' theme that encouraged the participants to respect and protect themselves, not only for their own sake, but also for their family and community" (p. 1035).

In this trial, 564 African American women who were recruited from a women's health clinic in Newark, New Jersey, were assigned to one of five conditions: a 20-minute one-on-one HIV/STD behavioral skill-building intervention,1 a 20-minute one-on-one HIV/STD information intervention,2 a 200-minute group HIV/STD behavioral skill-building intervention,3 a 200-minute group HIV/STD information intervention,4 or a 200-minute health intervention control group.5 "At 12-month follow-up, participants in [both] the [individual and group] skill-building interventions reported less unprotected sexual intercourse [during the previous 3-month period] than did participants in the information interventions ..., reported a greater proportion of protected sexual intercourse than did information intervention participants ... and control participants ..., and were less likely to test positive for an STD than were control participants ..." (p. 1034). According to Jemmott and colleagues, these results

support several tentative conclusions. They suggest that brief, culture-sensitive, cognitive-behavioral, skill-building interventions can reduce the HIV/STD risk behavior of African American women and that intervention-induced changes in such behavior can be sustained at relatively long-term follow-up, 12 months after implementation. The finding that the effects of the skill-building interventions in modestly reducing the rate of STDs paralleled the interventions' effects on self-reported behavior increases confidence in the results. This study, with its excellent retention rates, lends credence to the notion that, to achieve desired outcomes, HIV/STD behavioral interventions may not have to be long in duration and implemented over multiple sessions – characteristics that diminish their practicality in primary health care settings. The single-session interventions in this study are feasible in primary health care settings. Nurses and other primary care providers can implement them. (pp. 1039-1040)

What about interventions conducted in correctional settings? In an exploratory study, Staton-Tindall et al. (2007) conducted four focus groups with a nonrandom sample of 36 incarcerated, substance-using women.

Focus group findings suggested that a woman's HIV risk behavior is influenced by relationships in which drug and alcohol use … [is] common, sex is used as a strategy to manipulate a partner, trust is often derived from the perceived commitment [of the partner] or by certain partner characteristics, HIV and other STIs [sexually transmitted infections] are not viewed as potential consequences of risky behavior, and feelings of low self-esteem or self-worth become normalized in relationships. Because these experiences within past relationships are likely to shape the way that a woman engages in risky behavior in future relationships, HIV interventions for incarcerated women should focus not only on HIV risk behavior education and prevention but also on the dynamics of relationships (both present and future) that may increase a woman's vulnerability for HIV and other STIs. (pp. 161-162)

More specifically, findings suggest that

HIV interventions for women should be developed to target the context of relationships and relationship thinking patterns to maintain safe[r] sexual behaviors. These findings also suggest that there are inconsistencies between the ways a woman describes her behaviors in the context of relationships and her view of what is considered risky sex. In other words, a relationship can provide a sense of security and protection that trumps perceived risks associated with unprotected sex. Consequently, a woman may learn thinking patterns – or "risky relationship thinking myths" – that increase her risk for HIV or other STIs. (pp. 159-160)

In Connecticut, Ravi, Blankenship, and Altice (2007) surveyed a diverse sample of 1,588 incarcerated women with HIV-negative test results to examine the association between a history of interpersonal violence (i.e., physical violence and/or rape) and unprotected intercourse with male primary sex partners and nonprimary sex partners of either gender. The investigators found that "[e]xperiencing any violence was significantly associated with increased odds of unprotected sex with one's primary partner, even after controlling for race, history of sex work, drug use, employment status, and having other nonprimary partners. Of particular importance was having a history of physical violence. History of violence was not significantly associated with unprotected sex with nonprimary partners" (p. 210). These findings

highlight the importance of initiating and incorporating programs that comprehensively address violence against women and recognize its association with HIV risk among incarcerated female populations. Given the high prevalence of past history of violence among the women in ... [this] sample (65.0%), nearly half of whom had experienced physical abuse only, it is critical for prisons to offer women programs in violence prevention and, especially for those who have experienced violence, in coping with its physical and mental effects. Such programs can ... not only decrease women's future exposure to violence, but can also enable them to have greater control of their health and lifestyle decisions, thereby decreasing the behaviors that put them at risk for HIV as well. ... The study findings also have implications for program coordinators insofar as … [such findings] suggest both a means of identifying women who are at greater risk for HIV infection based on their disclosure of history of physical violence and a need to customize their assistance efforts accordingly. It is also imperative that prison-based HIV prevention interventions incorporate violence-associated issues in their programs. Education and practical suggestions regarding HIV risk and condom use negotiation, especially for survivors of violence, both increase personal safety and reduce the societal burden that HIV/AIDS carries with it for this high-risk population. (p. 215)

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 1 "The one-on-one intervention involved a 20-minute session that the facilitator tailored to the specific needs of each participant after conducting an HIV/STD risk assessment interview. The one-on-one HIV/STD skill-building intervention was designed to increase skills regarding condom use. It involved a review of the 'Sister to Sister' HIV/STD prevention behavioral skill brochure, video clips, condom demonstration, practice with an anatomical model, and role playing to increase self-efficacy and skills related to correct use of condoms and negotiation of condom use with a sexual partner" (p. 1035).

2 "The one-on-one HIV/STD information intervention was designed to increase knowledge about HIV/STD transmission and prevention and personal vulnerability to HIV/STDs. It involved a review of the 'Sister to Sister' HIV/STD prevention information brochure and a discussion of basic HIV/STD risk-reduction information. It did not provide behavioral skill demonstrations or practice" (p. 1035).

 3 "The group interventions consisted of a 200-minute session with 3 to 5 participants. The group HIV/STD behavioral skill-building intervention was designed to increase skills regarding condom use and to allay participants' concerns about the adverse effects of condom use on sexual enjoyment. Group discussion, brainstorming, videos, interactive exercises, games, condom demonstrations, practice with anatomical models, and role playing were used to increase self-efficacy and skills related to correct use of condoms and negotiation of condom use with a sexual partner" (p. 1035).

 4 "The group HIV/STD information intervention was designed to increase the perception of vulnerability to HIV/STDs and increase knowledge about HIV/STD transmission and prevention. Similar to the group skill-building intervention, this intervention involved group discussions, brainstorming, videos, interactive exercises, and games. However, it did not provide behavioral skill demonstrations or practice or address participants' beliefs about the adverse effects of condom use on sexual enjoyment" (p. 1035).

 5 "To reduce the likelihood that effects of the HIV/STD interventions could be attributed to nonspecific features, ... the control group received a general health promotion intervention. It focused not on HIV/STD risk behavior but on behaviors (diet, physical exercise, alcohol and tobacco use) associated with risk of heart disease, stroke, and cancer" (p. 1035).

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