Abstract #45  -  Adapting an Evidence-Based Woman-Focused HIV Prevention Intervention for Vulnerable Women in Multiple Settings
Authors:   Presenting Author:   Dr. Wendee Wechsberg - RTI International
Additional Authors:  Dr. William  Zule, Ms. Rachel Middlesteadt-Ellerson, Ms. Felicia Browne, Dr.  Michelle Kaufman, Ms.  Winnie Luseno, Dr. Tracy Kline, Ms.  Amy  Hernandez,
Aim: The Women’s CoOp is a woman-focused HIV prevention intervention funded by the National Institute on Drug Abuse (NIDA) since 1998. This intervention aims to reach African American women who use crack cocaine in order to reduce risk and to help empower women with risk reduction strategies. In 2007, the Centers of Disease Control and Prevention (CDC) designated the Women’s CoOp as an evidence-based HIV intervention. Through funding from NIDA, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Child Health and Human Development (NICHD), and the CDC, this intervention has been adapted and field tested, with several adaptations currently underway. Adaptation studies were conducted in South Africa with sex workers and vulnerable drug-using women. In Russia, a study was conducted with women who are injecting drug users; and in the United States with pregnant African American women in substance abuse treatment. The Women’s CoOp is also being adapted for couples who spend time in drinking venues in South Africa, with out-of-school African American teens, and for Latinas. All of these vulnerable populations are at risk for HIV through the interconnectedness of substance use, sexual risk, victimization and gender role expectations.
Method / Issue: The methods and core elements of the Women’s CoOp studies are the hallmarks of all the projects. Formative methods are used initially to adapt the basic intervention to each cultural setting and population. Focus groups, in-depth interviews, expert panels, and community advisory boards (CABs) help to direct these efforts. Although this phase is iterative in nature, once pretested, translations and manuals are prepared. The core elements include knowledge about substance abuse, sexually transmitted infections, HIV, gender roles, relationships, skills to enhance communication about safer sex, as well as demonstration of and practice with male and female condoms, multiple sessions, the use of cue cards, personalized goal setting, and referrals to services. The success of these projects is predicated on the linkages built with stakeholders—such as members of local agencies—serving on CABs. Because the intervention has been delivered in different settings, it was developed to be implemented in one-on-one and group formats, as well as to be portable for treatment settings. The research designs of the adapted Women’s CoOp studies have been empirically tested using randomized controlled designs with equal attention groups and treatment-as-usual groups.
Results / Comments: Across the adapted studies, the findings show that the Women’s CoOp reduces risk behaviors relative to the attention control groups. Reductions in substance abuse and sexual risk are consistent, in addition to increased sexual negotiation with main sex partners. Reductions in violence demonstrate the importance of addressing contextual factors for these vulnerable women.
Discussion: The findings from the Women’s CoOp studies indicate that developing a standard method for adapting an evidence-based HIV intervention for women will facilitate reaching vulnerable female populations and help to reduce risk and the further spread of HIV and other transmittable diseases. It is essential to retain the core elements in all of the adaptations to maintain the integrity of the intervention.
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