HIV Prevention Intervention For Women Research Articles

Evaluation of an HIV prevention intervention for women living with HIV

ABSTRACT It is estimated that 23% of the adults and adolescents living with HIV in the United States are female. The Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC) funds evidence-based interventions (EBIs) to reduce HIV risk behaviors, including HIV prevention programs for people living with HIV and their partners. While EBIs have been shown to be effective in controlled research environments, there are limited data on intervention implementation in real-world settings. Women Involved in Life Learning from Other Women (WILLOW) is a four-session small-group intervention that targets heterosexual women aged 18–50 who are living with HIV. This evaluation assessed changes in participants’ HIV knowledge, attitudes, beliefs and risk behaviors. A repeated measures design was used to collect participant risk behaviors at baseline, and again at three and six months post-intervention. Changes in attitudes, beliefs, and risk behaviors were assessed using generalized estimating equations. After participation in WILLOW, participants reported increased HIV knowledge, attitudes and beliefs, being more supportive of condom use, and reduced prevalence of HIV risk behaviors. Findings suggest that the WILLOW intervention can be successfully delivered by community-based organizations to reduce HIV risk behaviors among members of this high-risk population.

Motivations and barriers to uptake and use of female-initiated, biomedical HIV prevention products in sub-Saharan Africa: an adapted meta-ethnography

BackgroundWomen bear a disproportionate burden of HIV throughout the world prompting extensive research into HIV prevention products for women which has met with varied success. With an aim of informing future policy and programming, this review examines the barriers and motivations to the uptake and use of female initiated products in sub-Saharan countries.MethodsWe conducted a systematic review as an adapted meta-ethnography of qualitative data focused on actual use of products. After deduplication, 10,581 and 3861 papers in the first and second round respectively were screened. Following the PRISMA guidance, 22 papers were selected and synthesized using Malpass’s definitions of first, second, and third order constructs. First order constructs, consisting of participant data published in the selected papers, were extracted and categorised by second and third order constructs for analysis. A weight of evidence review was conducted to compare and assess quality across the papers.ResultsThe 22 papers selected span 11 studies in 13 countries. We derived 23 s order constructs that were translated into seven overarching third order constructs: Sexual Satisfaction, Trust, Empowerment and Control, Personal Well-being, Product use in the social-cultural environment, Practical Considerations, Risk Reduction, and Perceptions of Efficacy. Relationships and trust were seen to be as or more important for product use as efficacy. These constructs reveal an inherent inter-relationality where decision making around HIV prevention uptake and use cannot be binary or mono-faceted, but rather conducted on multiple levels. We developed a framework illustrating the central and proximal natures of constructs as they relate to the decision-making process surrounding the use of prevention products.ConclusionsHealth systems, structural, and individual level HIV prevention interventions for women should adopt a holistic approach. Interventions should attend to the ways in which HIV prevention products can serve to reduce the likelihood of HIV transmission, as well as help to protect partnerships, enhance sexual pleasure, and take into account woman’s roles in the social environment. Stigma, as well as sexuality, is likely to continue to influence product uptake and use and should be prominently taken into account in large-scale interventions.Trial registrationNot applicable.

Vaginal Ring Containing Dapivirine Helps Protect Against HIV Infection in Women

Finding an effective HIV prevention intervention for women in sub-Saharan Africa has been challenging. Three trials have failed to demonstrate efficacy

Supplemental Material for Adapting an Evidence-Based HIV-Prevention Intervention for Women in Domestic Violence Shelters

Supplemental Material for Adapting an Evidence-Based HIV-Prevention Intervention for Women in Domestic Violence Shelters

Predictors of Condom Use Among Iranian Women at Risk of HIV.

Sexual transmission of HIV/AIDS is increasing in Iran and is the main route of infection among women. In order to foster the development of future HIV prevention interventions for women, researchers need to understand the factors that influence sexual risk reduction behaviors in this group. The aim of this study was to explore the predictors of condom use among women at risk of HIV and develop a model of condom use in a sample of women at risk of HIV. We cross-sectionally examined predictors of condom use among 200 women at risk of HIV. Women were recruited from drop-in centers and voluntary counseling and testing centers in Tehran. Condom use among women at risk of HIV was examined using path analysis, and fit indices showed a good fit for the model. Condom use self-efficacy, social support, and less stereotypic gender roles influenced sexually protective behaviors of women at risk of HIV. Our results can provide a basis for future gender-specific intervention programs among women at risk of HIV. Researchers, practitioners, and organizations that play a central role in protecting the health of this population can make use of these results for the benefit of sexual and reproductive health programs.

The biobehavioral Women's Health CoOp in Pretoria, South Africa: study protocol for a cluster-randomized design.

BackgroundSouth Africa has 6.4 million adults over the age of 15 living with HIV. Gender inequality issues continue to drive the HIV epidemic in South Africa, where Black African women bear the greatest HIV burden. Limited access to services; little capacity to negotiate sex and condom use; and other legal, social, and economic inequities make women highly vulnerable to HIV infection. Behavioral interventions have been shown to decrease risk behaviors, but they have been less successful in reducing HIV incidence. Conversely, biomedical prevention strategies have proven to be successful in reducing HIV incidence, but require behavioral interventions to increase uptake and adherence. Consequently, there is a need for integrated approaches that combine biomedical and behavioral interventions. Effective combination prevention efforts should comprise biomedical, behavioral, and structural programming proven in randomized trials that focuses on the driving forces and key populations at higher risk of HIV infection and transmission.Methods/DesignThis prospective, geographically clustered randomized field experiment is enrolling participants into two arms: a control arm that receives standard HIV testing and referral for treatment; and an intervention arm that receives an evidence-based, woman-focused behavioral intervention that emphasizes risk reduction and retention, the Women’s Health CoOp. We divided the city of Pretoria into 14 mutually exclusive geographic zones and randomized these zones into either the control arm or the intervention arm. Outreach workers are recruiting drug-using women from each zone. At baseline, eligible participants complete a questionnaire and biological testing for HIV, recent drug use, and pregnancy. Follow-up interviews are completed at 6 and 12 months.DiscussionThe biobehavioral intervention in this study merges an efficacious behavioral HIV prevention intervention for women with biomedical prevention through HIV treatment as prevention using a Seek, Test, Treat and Retain strategy. This combination biobehavioral intervention is designed to (1) improve the quality of life and reduce HIV infectiousness among women who are HIV positive, and (2) reduce HIV risk behaviors among women regardless of their HIV status. If efficacious, this intervention could help control the HIV epidemic in South Africa.Trial registrationTrial registration no: NCT01497405.

Adaptation of an Evidence-Based HIV Prevention Intervention for Women with Incarcerated Partners: Expanding to Community Settings

High rates of incarceration in urban, low income communities may exacerbate women's risk of HIV infection by decreasing the number of available male sexual partners and disrupting long-term partnerships. The Health Access Program for Prevention, Empowerment, and Networking for Women (HAPPEN) was established to address the HIV prevention needs of women partnered with incarcerated or recently released men in community settings. HAPPEN is an adaptation of the evidence-based HIV prevention intervention Health Options Mean Empowerment (HOME) project. HOME was designed specifically for women visiting their incarcerated male partners and was delivered at a prison visiting center. Recruitment and program implementation for HAPPEN occurred at community-based organizations serving women with histories of substance abuse, intimate partner violence and incarceration, and provided health education, HIV testing, and linkage to health care and social services. This paper describes the process of adapting HOME using input from target organization stakeholders and target population members.

Influence of Partner Type on Condom Use

The current study examined sexual risk reduction practices of inner-city African American women. Specifically, the intersection of condom use and partner type is examined through the effectiveness of a single session, one-to-one behavioral skills and motivational enhancement HIV prevention intervention for women at risk for HIV. At pre-intervention, women with non-regular partners reported higher frequency condom use than those with regular partners. Similar results were found for women with multiple partners, in that higher rates of condom use were reported with non-regular partners compared to regular partners. Findings suggest that further investigation into the effectiveness of negotiated safety for women at risk is needed.

Adding the Female Condom to HIV Prevention Interventions for Women with Severe Mental Illness: A Pilot Test

We evaluated the efficacy of a gender-specific intervention to reduce sexual risk behaviors by introducing female-initiated methods to urban women with severe mental illness. Seventy-nine women received 10 sessions of an HIV prevention intervention or a control intervention. The primary outcome was unprotected oral, anal, or vaginal intercourse, expressed using the Vaginal Episode Equivalent (VEE) score. Knowledge and use of the female condom were also assessed. Women in the HIV prevention intervention showed a three-fold reduction in the VEE score at the 3-month follow-up compared to the control group, but the difference was not significant. These women were significantly more likely to know about female condoms, have inserted one and used it with a sexual partner at the 3-month follow-up and to have inserted it at 6months compared to controls. The female condom may be a useful addition, for a subset of women with SMI, to comprehensive HIV prevention programs.

Barriers and facilitators of HIV prevention with heterosexual Latino couples: Beliefs of four stakeholder groups.

Although HIV prevention interventions for women are efficacious, long-term behavior change maintenance within power-imbalanced heterosexual relationships has been difficult. To explore the feasibility, content, and format of an HIV intervention for Latino couples, the authors conducted 13 focus groups with HIV/AIDS researchers, service providers, and heterosexual men and women in Puerto Rico, the Dominican Republic, and Mexico. Reasons that participants thought that men should be involved in prevention efforts included promotion of shared responsibility, creation of a safe environment for open conversation about sex, and increased sexual negotiation skills. Perceived barriers to men's involvement included cultural taboos, sexual conservatism associated with Catholicism and machismo, and power-imbalanced relationships. Participants stressed the need for recruitment of men within naturally occurring settings or by influential community leaders. Participants indicated that couples-level interventions would be successful if they used strong coed facilitators, included both unigender and mixed-gender discussion opportunities, and addressed personally meaningful topics. Implications of these findings are discussed.

The Diffusion of a Community-Level HIV Intervention for Women: Lessons Learned and Best Practices

Abstract Early in the HIV/AIDS epidemic in the United States, relatively few women were diagnosed with HIV infection and AIDS. Today, the epidemic represents a growing and persistent health threat to women in the United States, especially young women and women of color. In 2005, the leading cause of HIV infection among African American women and Latinas was heterosexual contact. In addressing HIV prevention needs among women, community-level strategies are needed to increase consistent condom use by women and their partners and to change community norms to support safer sex behaviors. The Real AIDS Prevention Project (RAPP) is a community-based HIV prevention intervention for women and their partners. RAPP is based on a community mobilization model that involves a combination of activities, including street outreach, one-on-one discussions called stage-based encounters, role model stories, community networks, and small group activities. The objectives of RAPP are to increase consistent condom use by women and their partners and change community norms associated with perceptions of condom use and high-risk behaviors in an effort to make safer sex practice more acceptable. This paper describes the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) effort to nationally diffuse RAPP from March 2003 through May 2007 and lessons learned from that diffusion experience. The paper specifically discusses (1) collaborating and planning with researchers, (2) a diffusion needs assessment that was designed to assess prior implementation experiences among select agencies, (3) developing the intervention package, (4) developing and piloting training for community-based organizations (CBOs), (5) a rollout of national trainings for health departments and community-based organizations interested in implementing RAPP, and (6) ongoing quality assurance activities and the provision of technical assistance and support. RAPP has been proven effective in reducing HIV transmission risk behaviors and improving communication and negotiation skills necessary for African American women and Latinas to reduce their risk for HIV infection and improve their overall health status.

Bringing it Home: Design and Implementation of an HIV/STD Intervention for Women Visiting Incarcerated Men

Incarceration has been identified as a key variable to be addressed in halting the HIV epidemic among African Americans. Our research team has been conducting and evaluating HIV prevention interventions for prisoners and their families since the early 1990s, including interventions specifically tailored to the needs of women with incarcerated partners. This article describes the development and implementation of a multicomponent HIV prevention intervention for women with incarcerated partners, and presents qualitative data from women who participated as peer educators in this intervention. Women with incarcerated partners reported low rates of condom use and HIV testing combined with a lack of information about prison-related HIV risks. We found that peer education is a feasible intervention to reach women with incarcerated partners and that flexibility and inclusiveness are important factors in designing intervention programs for this population.

HIV and intimate partner violence among methadone-maintained women in New York City

Intimate partner violence (IPV) has been recognized as a risk factor for HIV and sexually transmitted infections (STIs) among women, particularly among those who are drug involved. This study examines the temporal relationships between sexual and/or physical partner violence (IPV) and sexual risk of HIV/STI transmission in a longitudinal study with a random sample of 416 women enrolled in methadone maintenance treatment programs in New York City. Two hypotheses are tested: whether sexual risk-related factors or risk reduction behavior leads to subsequent IPV (H1); and whether IPV decreases likelihood of subsequent risk reduction behavior (i.e., requesting to use condoms) or increases likelihood of certain sexual risk-related factors (i.e., inconsistent condom use, having unprotected anal sex, having more than one partner, exchanging sex for drugs or money, having had an STI, being HIV positive, having a partner who engaged in HIV risk) (H2). Participants were interviewed at three waves: baseline, six months and twelve months. Hypotheses were examined using propensity score matching and multiple logistic regression analyses. The prevalence rate of any physical or sexual IPV was 46% at baseline. Findings for H1 indicate that women who reported always using condoms at wave 2 were significantly less likely than women who reported inconsistent or no condom use to experience subsequent IPV at wave 3. Similarly, increased risk of IPV at wave 3 was associated with self-reported STIs (OR=2.0, p = . 03 ), and unprotected anal sex (OR= 2.0, p < . 01 ); always requesting that partners use condoms was associated with a significant decrease in subsequent IPV (OR=.18, p < . 01 ). Findings for H2 suggest that IPV at wave 2 decreased the subsequent likelihood of always using condoms at wave 3 (OR=.41, p < . 01 ) and always requesting that a partner use condoms (OR=.42, p = . 02 ). The implications of the findings for HIV prevention interventions for women on methadone are discussed.

Meta-analysis of the effectiveness of HIV prevention interventions for women

The present study is a meta-analysis of the effectiveness of HIV prevention interventions for women in the USA. Twenty-four articles from 1989-1997 were included. We evaluated five ethnic groupings (All Ethnicities Combined, African-American, White, Hispanic and a Mixed Ethnicity group) over four time periods (post-test, less than two months after the intervention, 2-3 months after the intervention and 6-24 months after the intervention) on three HIV-related sexuality outcome variables (HIV/AIDS knowledge, self-efficacy and sexual risk reduction behaviour). The HIV interventions appear effective at improving knowledge about HIV/AIDS and increasing sexual risk reduction behaviours for all ethnicities examined at all follow-up periods, with one exception. The findings for self-efficacy are less consistent. The interventions were less consistently effective for African-American women, for whom significant improvements in feelings of self-efficacy were only seen six months or longer after the intervention. The present analysis elucidates ethnic differences which may have previously been obscured while demonstrating convincingly that HIV interventions are generally effective for women of many different ethnicities.

HIV Prevention in Single, Urban Women: Condom-Use Readiness

To understand women's readiness to use condoms and their perceived pros and cons for condom use. Comparative, descriptive design guided by the Transtheoretical Model. Data were collected at two urban primary health care centers in western New York. 364 single urban women with steady (main) or other (casual, concurrent, multiple, new) sexual partners. Most participants were young (mean age of 27 years), economically disadvantaged women of color. Each participant completed an anonymous questionnaire that included items for the stage of change algorithm, decisional balance of the pros and cons of condom use, sexual history, and HIV risk information. Most women were in the early stages of change (not intending to use condoms), but those with other partners were further along in the stages of change for condom use than those with steady partners. The pros or advantages of condom use differed for these women depending on partner type. The change in the balance between the pros and cons occurred as theoretically predicted for women with steady and other partners. Effectiveness of HIV prevention interventions for women may be enhanced if they are tailored to both readiness to change and partner type.

HIV Sexual Risk Reduction Interventions for Women: A Review

AIDS has emerged as a serious public health threat for women. Reducing the risk for HIV infection among sexually active women requires the adoption of preventive strategies that effectively inhibit viral transmission. However, there is a paucity of published literature describing interventions targeted toward women and even fewer published reports evaluating their effectiveness. We conducted a search of HIV prevention interventions for women using the MEDLINE, ERIC and PSYCHLIT on-line computer database for the years January 1984-May 1995 to assess the effectiveness of interventions in increasing condom use during sexual intercourse. Interventions efficacious at increasing condom use applied a social psychological model of behavior to guide the development and implementation of the intervention, used randomized controlled designs to evaluate program efficacy, emphasized gender-related influences, were peer-led, and used multiple intervention sessions. While these findings are promising, methodologic limitations preclude any definitive assessment of programmatic efficacy. One challenge for future studies is to corroborate and extend these findings using rigorous methodologic research designs to evaluate programmatic efficacy, in particular, longer follow-up to assess stability of treatment effects over time. Another challenge is to understand the implications of previous research for the development of more gender-relevant interventions. The urgency of the HIV epidemic demands that the development and evaluation of HIV-prevention interventions tailored toward women remain a public health priority. Medical Subject Headings (MeSH): women, HIV/AIDS, interventions, prevention.