Interventions for Sexually Active Heterosexual Women. In: Peterson JL, Diclemente RJ, editors. Handbook of HIV Prevention. Boston: Springer US; 2000. pp. 179-200. [DOI: 10.1007/978-1-4615-4137-0_9]

Testing the effectiveness of two psychosocial interventions - ACCENT and Didactic - to prevent HIV/AIDS behavioral risk factors in Mozambican women: a randomized controlled study

In Mozambique, women are the most affected by HIV/AIDS and heterosexual encounters remain the main route for HIV/AIDS. Condom use is the most effective method of HIV/AIDS prevention, and the intention to use and buy/get condoms has a significant role in safe sex behavior. This study aimed to evaluate the efficacy of two psychosocial interventions - the Didactic and ACCENT Interventions - to prevent HIV/AIDS among Mozambican Women. Participants were Mozambican women (n = 150), users of the gynecology clinic of the Central Hospital of Beira. The study design was a randomized controlled trial (RCT) with assignment to three groups: Didactic intervention, ACCENT intervention, and Control group. Measures were from an adaption of the Women's Health Questionnaire, which includes questions about sociodemographic, clinical, and behavioral variables related to HIV prevention/risk. There was a significant group effect on condom use and safer sex preparatory behaviors, F(2, 146) = 6.45, p = .002, with Bonferroni post-hoc tests showing differences between the ACCENT vs. Control groups and ACCENT vs. Didactic groups (all p = .022). There were no statistically significant time effects on both condom use and safer sex preparatory behaviors. Results are promising for HIV/AIDS prevention in Mozambican women at sexual risk, but replication is needed for generalizability of findings.

Testing the Effectiveness of Two Psychosocial Interventions on Socio-Cognitive Risk Factors for HIV/AIDS in Mozambican Women: A Randomized Controlled Trial

The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.

The process of risky sexual behaviors formation in women drug users: a protocol for a grounded theory study

Background

Drug use is an important underlying factor in risky sexual behaviors. Risky sexual behaviors can lead to STIs and HIV/AIDS, especially in women. For better understanding of the relationship between drug use and risky sexual behaviors in women, it is necessary to identify the process of the formation of these behaviors that is a multidimensional process influenced by multiple socio-cultural factors. Therefore, the present study aims to explore the process of risky sexual behaviors formation in women drug users.

Methods

This is a grounded theory qualitative study with Corbin and Strauss approach. The participants of the study are women drug users with risky sexual behaviors who, using purposeful sampling method, will be selected from the Counseling and Harm Reduction centers for vulnerable women, the Drug Rehabilitation centers affiliated to the Isfahan University of Medical Sciences, Therapeutic Community Rehabilitation centers, Drop in Centers affiliated to the Welfare Organization, Medium-term Residential centers (women’s camps), and Women’s Empowerment centers in Isfahan, Iran. Sampling will continue using snowball method and the strategy of maximum variation in terms of the age, occupation, education, duration of the drug use, and type of the drug. During the sampling process, theoretical sampling will gradually replace purposeful sampling, so that sampling will proceed based on the emergence of the theory and for understanding of the concept and, then, the next participants will be selected. Sampling will continue until data saturation is reached. Data will be collected using individual semi-structured in-depth interviews, observation, field notes, and memo writing. Data will be coded as they are collected, and the analysis will be performed at three levels of open, axial, and selective coding and based on the constant comparative analysis. The four criteria of credibility, dependability, transferability and confirmability will be used to ensure the trustworthiness of the data.

Discussion

The findings of the present study are expected to provide a better understanding of the process of risky sexual behaviors formation in women drug users. The findings may also lead to the identification of the barriers and factors contributing to the formation of such behaviors and, finally, will promote the reproductive and sexual health of these women. This study can also provide the guide and the ground for designing and conducting further studies in the related areas through using various qualitative and quantitative methods.

Women and HIV in the Twenty-First Century: How Can We Reach the UN 2030 Goal?

Women have always been part of the HIV/AIDS epidemic. As with other populations affected by HIV, for many years the only prevention strategy available was behavior change. Behavioral interventions for women were developed and evaluated, with some success. Because women did not control the use of male condoms, efficacious interventions needed to build skills for partner negotiation. Woman-controlled technologies such as the female condom and vaginal spermicide were unable to solve the problem of male control of the condom and enable the development of safe methods for women to protect themselves. The modern era of HIV prevention has produced biomedical solutions based on highly active retroviral chemoprophylaxis, which can be hidden from the male partner and thus eliminate his possible negative reactions. Pre-exposure prophylaxis holds promise for HIV prevention among women. This article reviews the literature on HIV prevention for women, including both successes and challenges.

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol

Background

The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of ‘Eban II,’ an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples.

Methods/design

This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use).

Discussion

This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings.

Trial registration

NCT00644163

Intimate partner violence and HIV among drug-involved women: contexts linking these two epidemics--challenges and implications for prevention and treatment

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.

Addressing the unique needs of African American women in HIV prevention

African American women continue to be disproportionately affected by the HIV/AIDS epidemic, yet there are few effective HIV prevention interventions that are exclusively tailored to their lives and that address their risk factors. Using an ecological framework, we offer a comprehensive overview of the risk factors that are driving the HIV/AIDS epidemic among African American women and explicate the consequences of ignoring these factors in HIV prevention strategies. We also recommend ways to improve HIV prevention programs by taking into consideration the unique life experiences of adult African American women.

Considering HIV Risk and Intimate Partner Violence Among Older Women of Color: A Descriptive Analysis

This study describes the types of intimate partner violence (IPV) and sexual HIV-risk factors reported by a sample of 139 African American and Latina women ages 50 and older receiving care in outpatient clinics of an urban medical center. Additionally, we obtained estimates of the associations between experiencing IPV in a primary heterosexual relationship and the following HIV-risk behaviors among our sample of older minority women: (a) having multiple sexual partners, (b) STD history, (c) partner-related risk (i.e., having a partner who has multiple sexual partners, is HIV-infected, injecting drugs, and/or has an STD), and (d) self-perception of risk for HIV infection. Results indicate that many of these women are engaged in sexual risk behaviors, and such behaviors are associated with increased likelihood of IPV for this cohort. Implications for health care professionals are discussed.

Intimate partner violence and HIV risks: a longitudinal study of men on methadone

Whereas research has suggested that drug-involved men are at disproportionately high risk of engaging in transmission risk behaviors for HIV and of perpetrating intimate partner violence (IPV) against women, only a few cross-sectional studies have examined the relationship between IPV and HIV/sexually transmitted infection (STI) transmission risks among heterosexual, drug-involved men. This study builds on previous cross-sectional research by using a longitudinal design to examine the temporal relationships between perpetration of IPV and different HIV/STI transmission risks among a random sample of 356 men on methadone assessed at baseline (wave 1), 6 months (wave 2), and 12 months (wave 3). The findings indicate that (1) perpetration of IPV in the past 6 months at wave 1 was associated with having more than one intimate partner, buying sex, and sexual coercion at subsequent waves and that (2) non-condom use, injecting drugs, and sexual coercion at wave 1 were associated with subsequent IPV. The temporal relationships between perpetration of IPV and HIV risks found in this study underscore the need for HIV prevention interventions targeting men on methadone to consider IPV and HIV risks as co-occurring problems.

Perceived social support and HIV/AIDS medication adherence among African American women

HIV/AIDS incidence is increasing more quickly among women than any other segment of the population. The typical woman with HIV/AIDS is young, in her late 20s, economically challenged, and of childbearing age. Adherence to HIV therapies is critical if patients are to achieve and maintain virologic suppression. The author recruited HIV/AIDS-infected African American women from an outpatient clinic to investigate the women's perceptions of social support and how it affected their medication adherence. She collected data through tape-recorded interviews using a semistructured guide and journaling over a 2-week period. Facilitators of adherence included supportive family members and having young children. Barriers to adherence included perceived stigma, feeling unloved or uncared for, relationship turbulence, and having a husband who was also HIV positive. Although participants reported being "fairly" satisfied with the quality of support they received, emotional support and often instrumental support were most desired and wanted.

Association of sexual revictimization with sexuality and psychological function

This study explores the associations of sexual revictimization (experiencing sexual abuse in childhood and adulthood) in a sample of 230 African American women who are low-income. Data indicate that women who experience sexual revictimization are more at risk for emotional stress and psychological pathology than women with no history of abuse. In addition, women who are revictimized appear to be at greater risk for emotional problems than women sexually abused only as a child or sexually assaulted only as adults. Revictimization also appears to be associated with an increased probability of engaging in prostitution, even higher than women with childhood- or adult-only victimization, who showed increased probability when compared to women never abused. Finally, women who are revictimized showed increased HIV risk, in that they were 4 times less likely than other women to consistently use condoms, but no more likely to be in monogamous relationships or less likely to have multiple partners.

Culturally competent HIV prevention strategies for women of color in the United States

Many studies suggest that aspects of culture be included in human immunodeficiency virus (HIV) education efforts in the United States. Few, however, clearly identify specific strategies that respond to the unique cultural issues of women of color. This article reviews the literature for culturally competent HIV prevention efforts for women of color--Latina, African American, Asian Pacific Islander, and Native American--and synthesizes components that need to be addressed in programs and interventions. Findings suggest that for programs to be culturally competent, both race/ethnicity and gender, along with population-specific, culturally based attitudes, beliefs, and behaviors, must be considered in interpersonal and organizational strategies.

Deconstructing the relationship between intimate partner violence and sexual HIV risk among drug-involved men and their female partners

This study, based on data from a random sample of 322 men on methadone, examines whether traditional male gender role beliefs, male substance use, and couple drug-involvement lead to male psychological dominance, which in turn leads to perpetration of intimate partner violence (IPV) and sexual HIV risk behavior. Structural equation modeling indicated that male psychological dominance is directly associated with perpetrating both physical IPV and sexual HIV risk; however, physical IPV did not lead to sexual HIV risk as predicted originally. Stronger endorsement of traditional male gender role beliefs was associated with male psychological dominance. Couple drug-involvement was also directly associated with male psychological dominance as well as sexual HIV risk. Male substance use led to couple drug-involvement, but not to physical or sexual HIV risk as hypothesized. Study findings highlight the significance of couple drug-involvement and male psychological dominance as pathways leading to physical IPV and sexual HIV risk behavior. Implications for HIV prevention efforts targeting drug-involved men and their sexual partners are discussed.

Improving safer sex measures through the inclusion of relationship and partner characteristics

This article describes the development of a safer sex algorithm, which considers the characteristics of a woman's relationship and the HIV risk profile of herself and her primary partner. A sample of 306 low-income, predominantly African American women was recruited to participate in a study of the effectiveness of a sexual health seminar. These women were interviewed three times, at one month prior to seminar administration, three months after the seminar and again nine months after the seminar. Data from these women indicate that using an algorithm that considers the probability of HIV transmission between partners decreases the measured prevalence of unsafe sex in this population by about 17% and lowers the estimate of the average number of unsafe incidents by about four incidents in three months. The algorithm results in measures with adequate levels of temporal stability, which are similar to the more commonly used measure, vaginal or anal intercourse without a condom.