Risk Reduction Intervention For Women Research Articles

Pilot Test of an Integrated Sexual Risk Reduction Intervention for Women with a History of Childhood Sexual Abuse.

HIV and childhood sexual abuse (CSA) are intersecting public health problems for women. We pilot tested an integrated sexual risk reduction intervention for women with a history of CSA that addressed both the consequences of CSA [based on the Traumagenic Dynamics (TD) framework] and the antecedents of sexual risk behavior (based on the Information-Motivation-Behavioral Skills [IMB] model). Women with a history of CSA who were attending a public STI clinic (n=84) were randomly assigned to a five-session integrated TD/IMB (experimental) group intervention or to a time-matched IMB-guided sexual risk reduction (control) group intervention. Preliminary findings indicated that women in the integrated TD/IMB intervention reduced their average number of episodes of unprotected sex with a primary partner, their alcohol use, and their likelihood of being in a violent relationship, relative to women in the IMB-only group. Our findings suggest that sexual risk reduction interventions that address both the consequences of CSA and the antecedents of sexual risk behavior may be efficacious in reducing sexual risk behavior among women who were sexually abused.

Development and Refinement of a Targeted Sexual Risk Reduction Intervention for Women With a History of Childhood Sexual Abuse

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age=34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age=33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.

An Integrated HIV Risk Reduction Intervention for Women with a History of Intimate Partner Violence: Pilot Test Results.

There are few HIV risk reduction interventions to meet the unique needs of women who experience intimate partner violence (IPV). This pilot study tested the feasibility, safety, and preliminary effects of an integrated IPV-sexual risk reduction intervention for abused women. Fifty-five women were randomized to the supporting positive and healthy relationships (SUPPORT) intervention (n=27) or to a control group (n=28). Assessments were conducted pre- and post-intervention and at 3-month follow-up. Post-intervention, SUPPORT participants showed a significant decrease in frequency of unprotected sex and an increase in safer sex communications with steady and other sexual partners. Compared to the control group, SUPPORT participants reported a higher number of safer sex conversations with their steady partner at the 3-month follow-up, and fewer episodes of IPV at both assessments in comparison to baseline. They showed improvements in sexual relationship power at both follow-ups and in several hypothesized antecedents of HIV-risk behavior. These encouraging preliminary findings suggest the need for a larger clinical trial.

Ethnic differences in alcohol and drug use and related sexual risks for HIV among vulnerable women in Cape Town, South Africa: implications for interventions

BackgroundAlcohol and other drug (AOD) use among poor Black African and Coloured women in South Africa compounds their sexual risk for HIV. Given South Africa’s history of ethnic disparities, ethnic differences in sex risk profiles may exist that should be taken into account when planning HIV risk reduction interventions. This paper aims to describe ethnic differences in AOD use and AOD-related sexual risks for HIV among vulnerable women from Cape Town, South Africa.MethodCross-sectional data on 720 AOD-using women (324 Black African; 396 Coloured) recruited from poor communities in Cape Town were examined for ethnic differences in AOD use and AOD-related sexual risk behavior.ResultsEthnic differences in patterns of AOD use were found; with self-reported drug problems, heavy episodic drinking and methamphetamine use being most prevalent among Coloured women and cannabis use being most likely among Black African women. However, more than half of Black African women reported drug-related problems and more than a third tested positive for recent methamphetamine use. More than a third of women reported being AOD-impaired and having unprotected sex during their last sexual encounter. Coloured women had four-fold greater odds of reporting that their last sexual episode was AOD-impaired and unprotected than Black African women. In addition, close to one in two women reported that their sexual partner was AOD-impaired at last sex, with Coloured women having three-fold greater odds of reporting that their partner was AOD-impaired at last sex than Black African women.ConclusionsFindings support the need to develop and test AOD risk reduction interventions for women from both ethnic groups. In addition, findings point to the need for tailored interventions that target the distinct profiles of AOD use and AOD-related sex risks for HIV among Black African and Coloured women.

Mediators of the Relation Between Childhood Sexual Abuse and Women’s Sexual Risk Behavior: A Comparison of Two Theoretical Frameworks

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood, but little research has investigated processes that might mediate this relation. The purpose of this study was to investigate whether constructs suggested by the traumagenic dynamics (TD) model (a theory of the effects of CSA) or constructs suggested by the information-motivation-behavioral skills (IMB) model (a theory of the antecedents of sexual risk behavior) better mediated the relation between CSA and sexual risk behavior in adulthood. Participants were 481 women attending a sexually transmitted infection clinic (66% African American) who completed a computerized survey as well as behavioral simulations assessing condom application and sexual assertiveness skills. Forty-five percent of the sample met criteria for CSA and CSA was associated with sexual risk behavior in adulthood. In multiple mediator models, the TD constructs mediated the relation between CSA and the number of sexual partners whereas the IMB constructs mediated the relation between CSA and unprotected sex. In addition, the TD constructs better mediated the relation between CSA and the number of sexual partners; the TD and IMB constructs did not differ in their ability to mediate the relation between CSA and unprotected sex. Sexual risk reduction interventions for women who were sexually abused should target not only the constructs from health behavior models (e.g., motivation and skills to reduce sexual risk), but also constructs that are specific to sexual abuse (e.g., traumatic sexualization and guilt).

Effectiveness of an HIV Prevention Program for Women Visiting Their Incarcerated Partners: The HOME Project

Having an incarcerated partner presents a unique HIV risk for women, particularly low-income women of color. We developed a population-specific risk reduction intervention for women visiting men in prison that was peer educator-based and included individual and community-level intervention components. Women who were assessed prior to the intervention period had a positive association between the number of unprotected penetrative intercourse (UPI) episodes prior to their partners’ incarceration and the number of UPI episodes following partners’ release from prison. However, this association was negated among women assessed during the intervention. Intervention participants also were more likely to be tested for HIV, to have partners who got tested, and to talk with their partners about significantly more HIV-related topics. Conducting intervention and evaluation activities with women visiting incarcerated men is feasible and is a useful model for reaching more at-risk women.

Alcohol Consumption, Drug Use, and Condom Use Among STD Clinic Patients

Research on the association between substance use and sexual risk behavior has yielded a complex pattern of findings. Such inconsistent findings may reflect method variance, including factors such as gender of the participant, nature of the sexual event, partner characteristics, and type of substance used. The purpose of this study was to investigate the association between substance use and unprotected sex independently for alcohol, drugs, or combined substance use and to examine partner characteristics as a moderator of this association. Participants (N = 1,419; 48% women) were recruited from a publicly funded sexually transmitted disease clinic and were asked to complete an audio computer-assisted self-interview regarding their most recent sexual experience, including nature of the event, substance use, and partner characteristics. Analyses showed that alcohol use was related to condom use when gender and partner type were considered; thus, for women, but not for men, partner type interacted with alcohol consumption such that condom use was less likely when alcohol consumption preceded sex with nonprimary partners (drinking was unrelated to condom use with primary partners). Subsequent analyses examining partner substance use showed that women, but not men, who reported both they and their nonprimary partners were drinking during sex were less likely to use a condom. At the event level, alcohol consumption among sexually transmitted disease clinic patients is associated with condom use, but this association differs by gender and partner characteristics. Findings suggest the need to strengthen substance-use components in sexual risk reduction interventions for women and their partners.

HIV/AIDS Risk Reduction Intervention for Women who have Experienced Intimate Partner Violence

A growing body of literature highlights the association between women who have experienced intimate partner abuse (IPA) and their heightened risk for HIV/AIDS (human immune deficiency syndrome/ acquired immune deficiency syndrome) infection. Finding HIV risk reduction strategies that are contextually relevant for this population is an important public policy priority. This qualitative study researched women who have experienced intimate partner abuse in order to develop a HIV/AIDS risk reduction intervention unique to their circumstances. This pilot study explored the critical components of such an intervention among a racially/ethnically stratified (African-American, Mexican-American and Anglo) sample of women (n=43) who have experienced IPA. Focus groups were conducted and transcribed, and a content analysis was used to identify major themes. In all five focus groups, participants viewed the research as interesting, good, beneficial, and/or important based on their perceptions of risk for infection. Respondents felt that they knew of ways to protect themselves from infection in non-abusive relationships; however, acknowledged the difficulties of doing so given the context of their abusive relationships. Examining the racial/ethnic differences across focus groups showed that the language used by women is quite variable. The ways in which survivors define rape, sexual abuse, and their own experiences are all unique; however, their actual experiences have many similarities. Discussed at length are the topics participants shared as critical in informing the design of an intervention and the relevance of the findings to social work clinical practice is explained.

The Protect and Respect Program: A Sexual Risk Reduction Intervention for Women Living with HIV/AIDS

In 2003 the Centers for Disease Control and Prevention (CDC) launched a new HIV prevention strategy that focused prevention efforts on people living with HIV. In response to a Health Resources and Services Administration (HRSA)/Special Projects of National Significance (SPNS) initiative, a program development team in Philadelphia created the Protect and Respect program. The program integrates multiple-level prevention strategies and is tailored to address the strengths of HIV-positive women and the challenges they face to implementing behavior changes. The goal of Protect and Respect is to decrease sexual behavior that puts HIV-positive women at risk for sexually transmitted infections (STIs) and puts others at risk for HIV transmission. The three components of the program are: brief HIV prevention messages delivered by clinicians in the context of routine medical visits; a group-level intervention (GLI) delivered by a Health Educator; and a Peer-led support group. This paper details the process of developing the three program components and describes the valuable lessons learned through the development and implementation process.

Cost-Effectiveness of a Community-Level HIV Risk Reduction Intervention for Women Living in Low-Income Housing Developments

We conducted a cost-effectiveness analysis of a multi-site community-level HIV prevention trial that enrolled women living in 18 low-income housing developments in 5 U.S. cities. A mathematical model of HIV transmission was used to estimate the number of HIV infections averted and quality-adjusted life years (QALYs) saved by the community-level intervention, based on data obtained from community-wide sexual behavior surveys at baseline and 12-month follow-up. Results indicated that the intervention prevented approximately 1 infection per 3500 women reached by the intervention, at a total cost of 174,845 dollars. The cost per QALY saved by the intervention was 37,433 dollars and the cost per HIV infection averted was 732,072 dollars. The community-level intervention was moderately cost-effective in comparison with other HIV prevention programs for at-risk women. Synergistic approaches to HIV prevention that combine community-level sexual norm change interventions with more intensive risk reduction programs for high-risk women are needed. EDITORS' STRATEGIC IMPLICATIONS: The authors present a promising and efficient community-level HIV prevention approach, with effects beyond the limited scope of individual or small group interventions. This paper represents an example of how an analysis of cost-effectiveness can provide policymakers with information needed for difficult decisions about prevention resource allocations.

A gender-specific HIV/STD risk reduction intervention for women in a health care setting: Short- and long-term results of a randomized clinical trial

This study assessed the short- and long-term effect of a gender-specific group intervention for women on unsafe sexual encounters and strategies for protection against HIV/STD infection. Family planning clients (N = 360) from a high HIV seroprevalence area in New York City were randomized to an eight-session, a four-session or a control condition and followed at one, six and 12 months post-intervention. Using an intention-to-treat analysis, women who were assigned to the eight-session group had about twice the odds of reporting decreased or no unprotected vaginal and anal intercourse compared to controls at one month (OR = 1.93, 95% confidence interval [CI] = 1.07, 3.48, p = 0.03) and at 12-month follow-up (OR = 1.65, 95% CI = 0.94, 2.90, p = 0.08). Relative to controls, women assigned to the eight-session condition reported during the previous month approximately three-and-a-half (p = 0.09) and five (p < 0.01) fewer unprotected sex occasions at one- and 12-month follow-up, respectively. Women in the eight-session group also reduced the number of sex occasions at both follow-ups, and had a greater odds of first time use of an alternative protective strategy (refusal, outercourse, mutual testing) at one-month follow-up. Results for the four-session group were in the expected direction but overall were inconclusive. Thus, gender-specific interventions of sufficient intensity can promote short- and long-term sexual risk reduction among women in a family planning setting.

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.