Woman-focused Intervention to reduce Substance Use and HIV Risk Behaviors
The overall objective of the Women's Health CoOp study is to obtain a better understanding of the relationship between alcohol and other drug use, violence against sex workers and HIV risk behaviors. The study also examines whether a woman-focused intervention can help women reduce risks associated with HIV while addressing personal goals that could affect their ability to change the course of their lives.
- Pilot test whether an HIV prevention intervention designed for use with African-American women who abuse crack cocaine in the United States could be adapted for use with Black South African sex workers who use cocaine and are at high risk for HIV and STIs.
- Conduct a small randomized trial of the adapted Woman-Focused intervention and a US standard intervention to reduce substance use and HIV risk behaviors.
- Focus group discussions to inform the adaptation of an intervention originally developed for USA African American Women
- Study participants randomized to Standard or Women-focused Intervention
- Standard intervention consisting of two private one-hour educational and skills building sessions held within two weeks. During both sessions, the interventionist used cue cards to provide information on HIV; drug and sexual risks; risk reduction methods including proper use of male and female condoms; how to talk with a partner about safer sex practices; the HIV antibody test; and steps that participants should take to prevent spreading the disease.
- The Woman-Focused intervention presented the same information as the Standard intervention but also included a more personalized assessment of each woman's drug and sexual risks that informed specific goals to help each woman negotiate risk-reduction by communicating the importance of condom use with sex partners. The women also learned violence prevention strategies such as staying sober to assess the situation, communication techniques in difficult situations and ways to exit a volatile situation if need be.
- In the Women-focused groups women significantly reduced their high levels of alcohol use and reduced drug use at 3- and 6-month follow-ups
- In the Women-focused groups women showed a significant increase at the 6-month follow-up in the percentage who were using condoms with their main partner at last sex act, and in the past 90 days, even under the influence of drugs
- In the Women-focused groups women had a continued decrease at 3- and 6-month follow-ups in violence perpetrated by their main partners
- The Woman-focused intervention effects were less encouraging with respect to the women's experiences of violence perpetrated by clients and their regular partners. As most often victims of sex-related violence, women typically have less personal and direct control in changing contexts of violence than male perpetrators. This finding suggests the need for greater involvement of partners and clients in HIV risk-reduction interventions among female sex workers.
- The pilot study outcomes suggest that brief interventions can and should be adapted but not without the involvement of the target population and community advisory members.