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Do hierarchical messages (i.e., prevention options presented by decreasing order of effectiveness) offer women more choices without diminishing either their perception of the primary method's efficacy or their willingness to use it? To find out, Miller, Murphy, Clark, Hamburger, and Moore (2004) randomly assigned 112 African American and Mexican American women at risk for HIV to groups receiving one of two onetime only HIV prevention messages: "use male condoms"; or "use male condoms; if not, use female condoms; if not, use spermicide."
Compared with women in the male-condom-only condition, a significantly smaller percentage of women who received the hierarchical message perceived male condoms as highly effective against HIV. Women currently not using male condoms who received the hierarchical ... message were less likely to consider using male condoms in the future. Among current male condom users, however, the hierarchical message did not influence intent to use male condoms. These data point to the need [to examine] both the intended and unintended effects of hierarchical health care messages. (p. 509)
Paxton, Myers, Hall, and Javanbakht (2004), who studied 155 African American, 153 European American, and 149 Latina women residing in Los Angeles County over a 2-year period, also urge careful examination by clinicians when responding to client need. HIV-positive women in their multiethnic sample (65% of the total) were more likely to report "more posttraumatic stress, chronic stress, negative health behaviors, drug use, and psychiatric history than HIV-negative women. European American and African American women were more likely to report a history of sexual trauma than Latina[s, and] history of trauma, ethnicity, drug and alcohol use, homelessness, and being HIV-positive were associated with greater likelihood of engaging in high-risk sexual behaviors, with history of trauma increasing the likelihood of engaging in [such] behaviors by 5.1%" (p. 405).
These results underscore the importance of considering multiple demographic and psychosocial risk factors in predicting and understanding the sources of variance in risky behaviors. They also suggest the need for tailoring sexual health programs to the unique needs of ethnic subgroup[s] of women who are impacted by [HIV]. This is particularly true for Latina and African American women who, despite sharing socioeconomic deprivation, appear to experience different risk pathways, with Latinas ... more likely to be infected within stable relationships, while the African American women were more socioeconomically marginalized and reported experiencing a heavier burden of early trauma. (p. 414)
With regard to early trauma, Wyatt et al. (2004) randomized a multiethnic sample of 147 women living with HIV to one of two conditions: an 11-session, "gender-specific, culturally congruent 'Enhanced Sexual Health Intervention (ESHI)' that was designed to reduce sexual risk and increase HIV medication adherence in HIV-positive women with histories of childhood sexual abuse " (CSA; p. 454) or an attention control condition. "This intervention integrated well-established components of sexual abuse treatment with successful elements of HIV interventions in both content and format" (p. 455) and was offered in both English and Spanish. In particular, "[t]he intervention offered cognitive strategies of sexual decision-making while managing symptoms associated with CSA (i.e., dissociation, depression, anxiety, and trauma symptoms) that are hypothesized as possible barriers to effective risk reduction" (p. 459). Wyatt and colleagues found that
[w]omen in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medication adherence in preventive interventions for women. (p. 453)
In fact, by incorporating strategies to reduce victimization into HIV prevention interventions, clinicians may be able to help women apply new skill sets beyond the original targeted behaviors. Theall, Sterk, and Elifson (2004) assessed post-intervention victimization among 333 female African American drug users who completed an HIV risk-reduction intervention. They found reductions in emotional, sexual, and physical abuse in the 6-month period following enrollment, particularly among women participating in the "enhanced" intervention. They observe that
culturally appropriate, woman-tailored, and theoretically based interventions may be effective at enhancing not only HIV preventive behavior among African American women who use illegal drugs, but also the likelihood of decreased victimization. Teaching women to stand up for themselves, to solve conflict, and to negotiate to achieve their goals should not be limited to main HIV risk behaviors such as unsafe drug use and sex. Instead, women should be encouraged to apply these skills to all aspects of their lives. (p. 406)
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Spring 2005 Newsletter
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