Background. We tested an original, woman-focused intervention, based on body empowerment, and female-initiated barrier methods, including the female condom (FC) and cervical barriers. Methods. Eligible women were >= 18 years of age, HIV seronegative, and active drug users, reporting 30% or greater unprotected sex acts. Both controls (C) and intervention (I) participants received enhanced HIV/STI harm reduction counseling. I participants underwent 5 additional weekly group sessions. We compared change in frequency of unprotected vaginal intercourse across arms at 12 months. Results. Among 198 enrolled women, over 95% completed followup. Two-thirds were African-American; most of them used crack, had a primary partner, and reported sex exchange. In paired t-tests from baseline to followup, the frequency of unprotected vaginal sex dropped significantly for I (primary , nonprimary ) and C (primary , nonprimary ) arms with all partners. The difference in change across arms was of borderline significance for primary partner ( ); no difference was seen for nonprimary partner ( ). Use of male condom and FC increased with both partner types over time, but more consistently among I women. Conclusion: The “value-added” impact of the intervention was observed mainly with primary partners. Body knowledge with routine FC counseling should be incorporated into interventions for drug-using women. 1. Introduction Women have among the highest rates of new HIV infections globally and the rate of new infections has not lessened in recent years [1–4]. African Americans account for 66% of new HIV infections among all US women [5]—over 5 times their proportion representation (12%) in the population. One in 30 African-American women can expect to acquire HIV infection during their lifetime [6]; the vast majority of these are through heterosexual intercourse. Crack-using African-American women are a distinct, hard-to-reach population for whom empowerment to reduce HIV/STI risk takes on additional complexities due to the entangled dependencies of drugs, partnerships with men (who are often drug involved) for material support for women and their children, and constant threat of violent reprisal [4, 7–9]. Concurrent infection with STI is considered to be endemic among African-American, drug-using, HIV+ women [10]. Women’s biological inequality in vulnerability to sexually transmitted infection (STI) can be addressed with greater availability and use of male and female condoms (FC). In addition to challenges in the diffusion of available protection technologies, however, gender
References
[1]
Joint United Nations Programme on HIV/AIDS (UNAIDS), “UNAIDS global report: report on the global AIDS epidemic,” 2010, http://www.unaids.org/globalreport/global_report.htm.
[2]
White House Office of National AIDS Policy, “National HIV/AIDS strategy for the United States,” Washington, DC, USA, The White House, 2010, http://aids.gov/federal-resources/national-hiv-aids-strategy/nhas.pdf.
[3]
S. L. Hodder, J. Justman, D. F. Haley et al., “Challenges of a hidden epidemic: HIV prevention among women in the United States,” Journal of Acquired Immune Deficiency Syndromes, vol. 55, supplement 2, pp. S69–S73, 2010.
[4]
F. R. Lashley, “Transmission and Epidemiology of HIV/AIDS: a Global View,” Nursing Clinics of North America, vol. 41, no. 3, pp. 339–354, 2006.
[5]
Centers for Disease Control (CDC) and Department of Health and Human Services Public Health Service, “Disparities in diagnoses of HIV infection between Blacks/African-Americans and other racial/ethnic populations —37 states, 2005–2008,” Morbidity and Mortality Weekly Report, vol. 60, no. 4, pp. 93–98, 2011.
[6]
K. Fenton, “HIV in the United States today: The numbers. National Summit on HIV Diagnosis, Prevention, Access to Care,” 2010, http://www.hivforum.org/storage/hivforum/documents/2010Summit/Presentations/101117_pl_01_03_fenton.pdf.
[7]
A. Lansky, J. T. Brooks, E. Dinenno, J. Heffelfinger, H. I. Hall, and J. Mermin, “Epidemiology of HIV in the United States,” Journal of Acquired Immune Deficiency Syndromes, vol. 55, 2, pp. S64–S68, 2010.
[8]
N. El-Bassel, A. Terlikbaeva, and S. Pinkham, “HIV and women who use drugs: double neglect, double risk,” The Lancet, vol. 376, no. 9738, pp. 312–314, 2010.
[9]
Centers for Disease Control (CDC) and Department of Health and Human Services Public Health Service, “Cases of HIV infection and AIDS in the United States and dependent areas,” HIV/AIDS Surveillance Report no. 19, 2007.
[10]
M. Miller, Y. Liao, M. Wagner, and C. Korves, “HIV, the clustering of sexually transmitted infections, and sex risk among African American women who use drugs,” Sexually Transmitted Diseases, vol. 35, no. 7, pp. 696–702, 2008.
[11]
P. P. French, M. Latka, E. L. Gollub, C. Rogers, D. R. Hoover, and Z. A. Stein, “Use-effectiveness of the female versus male condom in preventing sexually transmitted disease in women,” Sexually Transmitted Diseases, vol. 30, no. 5, pp. 433–439, 2003.
[12]
A. Peters, W. Jansen, and F. van Driel, “The female condom: the international denial of a strong potential,” Reproductive Health Matters, vol. 18, no. 35, pp. 119–128, 2010.
[13]
T. M. Exner, J. M. Tesoriero, H. B. Battles et al., “A randomized controlled trial to evaluate a structural intervention to promote the female condom in New York State,” AIDS and Behavior, vol. 16, no. 5, pp. 1121–1132, 2012.
[14]
United Nations Fund for Population Activities (UNFPA), “HIV prevention gains momentum: Success in female condom programming,” 2011, http://www.unfpa.org/public/home/publications/pid/7668.
[15]
C. M. Lyles, L. S. Kay, N. Crepaz et al., “Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004,” American Journal of Public Health, vol. 97, no. 1, pp. 133–143, 2007.
[16]
W. M. Wechsberg, S. P. Novak, W. A. Zule et al., “Sustainability of intervention effects of an evidence-based HIV prevention intervention for African American women who smoke crack cocaine,” Drug and Alcohol Dependence, vol. 109, no. 1–3, pp. 205–212, 2010.
[17]
W. M. Wechsberg, W. K. K. Lam, W. A. Zule, and G. Bobashev, “Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers,” American Journal of Public Health, vol. 94, no. 7, pp. 1165–1173, 2004.
[18]
C. E. Sterk, K. P. Theall, and K. W. Elifson, “Effectiveness of a risk reduction intervention among African American women who use crack cocaine,” AIDS Education and Prevention, vol. 15, no. 1, pp. 15–32, 2003.
[19]
R. Connell, “Theorising gender,” Sociology, vol. 19, no. 2, pp. 260–272, 1985.
[20]
N. Wallerstein, “Powerlessness, empowerment, and health: implications for health promotion programs,” American Journal of Health Promotion, vol. 6, no. 3, pp. 197–205, 1992.
[21]
Boston Women’s Health Book Collective (BWHBC), Our Bodies, Ourselves, New York, NY, USA, Simon and Schuster, 1971.
[22]
E. L. Gollub, Z. Stein, and W. El-Sadr, “Short-term acceptability of the female condom among staff and patients at a New York City hospital,” Family Planning Perspectives, vol. 27, no. 4, pp. 155–158, 1995.
[23]
E. L. Gollub, P. French, M. Latka, C. Rogers, and Z. Stein, “Achieving safer sex with choice: studying a women's sexual risk reduction hierarchy in an STD clinic,” Journal of Women's Health and Gender-Based Medicine, vol. 10, no. 8, pp. 771–783, 2001.
[24]
E. L. Gollub, E. L. Brown, M. Savouillan, J. Waterlot, and G. Coruble, “A community-based safer-sex intervention for women: results of a pilot study in south-eastern France,” Culture, Health and Sexuality, vol. 4, no. 1, pp. 21–41, 2002.
[25]
E. L. Gollub, K. M. Morrow, K. H. Mayer et al., “Three city feasibility study of a body empowerment and HIV prevention intervention among women with drug use histories: women FIT,” Journal of Women's Health, vol. 19, no. 9, pp. 1705–1713, 2010.
[26]
L. Van Damme, G. Ramjee, M. Alary et al., “Effectiveness of COL-1492, a nonoxynol-9 vaginal gel, on HIV-1 transmission in female sex workers: a randomised controlled trial,” The Lancet, vol. 360, no. 9338, pp. 971–977, 2002.
[27]
E. L. Gollub, K. Armstrong, T. Boney et al., “Correlates of trichomonas prevalence among street-recruited, drug-using women enrolled in a randomized trial,” Substance Use and Misuse, vol. 45, no. 13, pp. 2203–2220, 2010.
[28]
E. L. Gollub, E. Cyrus-Cameron, K. Armstrong, T. Boney, and S. Chhatre, “Basic body knowledge in street-recruited, active drug-using women enrolled in a “body empowerment” intervention trial,” AIDS Care, vol. 25, no. 6, pp. 732–737, 2013.
[29]
S. A. Sanders, M. Reece, D. Herbenick, V. Schick, B. Dodge, and J. D. Fortenberry, “Condom use during most recent vaginal intercourse event among a probability sample of adults in the United States,” Journal of Sexual Medicine, vol. 7, supplement 5, pp. 362–373, 2010.
[30]
J. E. Mantell, B. S. West, K. Sue et al., “Health care providers: a missing link in understanding acceptability of the female condom,” AIDS Education and Prevention, vol. 23, no. 1, pp. 65–77, 2011.
[31]
E. L. Gollub, “A neglected population: drug-using women and women's methods of HIV/STI prevention,” AIDS Education and Prevention, vol. 20, no. 2, pp. 107–120, 2008.
[32]
E. L. Gollub and Z. Stein, “Living with uncertainty: acting in the best interests of women,” AIDS Research and Treatment, vol. 2012, Article ID 524936, 9 pages, 2012.
[33]
C. F. Turner, L. Ku, S. M. Rogers, L. D. Lindberg, J. H. Pleck, and F. L. Sonenstein, “Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology,” Science, vol. 280, no. 5365, pp. 867–873, 1998.
[34]
B. T. Mausbach, S. J. Semple, S. A. Strathdee, J. Zians, and T. L. Patterson, “Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: results from the EDGE,” Annals of Behavioral Medicine, vol. 34, no. 3, pp. 263–274, 2007.
[35]
S. A. Strathdee and J. K. Stockman, “Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions,” Current HIV/AIDS Reports, vol. 7, no. 2, pp. 99–106, 2010.
[36]
S. D. Baral, S. Str？mdahl, and C. Beyrer, “The potential uses of preexposure prophylaxis for HIV prevention among people who inject drugs,” Current Opinion in HIV and AIDS, vol. 7, no. 6, pp. 563–568, 2012.
[37]
Q. A. Karim, S. S. A. Karim, J. A. Frohlich et al., “Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women,” Science, vol. 329, no. 5996, pp. 1168–1174, 2010.
[38]
Microbicide Trials Network (MTN), “Daily HIV Prevention Approaches Didn’t Work for African Women in the VOICE Study,” 2013, http://www.mtnstopshiv.org/node/4877.
[39]
L. Van Damme and M. Szpir, “Current status of topical antiretroviral chemoprophylaxis,” Current Opinion in HIV and AIDS, vol. 7, no. 6, pp. 520–525, 2012.
