The Effect of Structured Writing on HIV+ Black Women: Self-Advocacy, Stigma, Healthcare Adherence

Abstract

Background: The HIV epidemic disproportionately affects heterosexual Black women in the United States There are no interventions that target HIV-positive Black women with complex co-morbid psychological and physical conditions by using structured writing as a way to disclose emotions related to these experiences and effect change in at risk behaviors. Purpose: To test the efficacy of a structured writing intervention with seropositive Black women. Methodology: A peer-led RCT pre- and post-test design at 6 weeks and 6 months, guided by the Ecological Model (Bronfenbrenner, 1979; 2004) and the Theory of Silencing the Self (Jack, 1991). Outcome measures included safe sex expectancy (behaviors, intentions, attitudes), self-advocacy, healthcare adherence, and stigma. Comparisons were made of paired 6-session interventions, ie, structured writing using film clips of a commissioned local film called Women's Voices Women's Lives as a focal point and usual care support group. Findings: Retention was 82% in a hard to recruit and retain sample, (n=75). Positive effects across time comparing intervention and usual care using GLM repeated measures on selected outcomes: decreased “silencing the self” behaviors significant for time (p=015) and type (p=000); decreased negative self image for time (p=000) and type (p=000); decreased stigma for time (p=000) and type (p=014); significant mean differences between intervention and usual care across time for condom use and safe sex practices. Summary Concluding Statement: Although the intervention affected self advocacy in sexual relationships and safe sex expectancy, there is less than the ideal of consistent use of condoms and safe sex practices. These findings highlight the importance of addressing skill-building combined with structured writing as a way to boost the effect disclosure of emotions with behavior change.