AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #220 - Preliminary outcomes of a randomized controlled trial of a feminist HIV intervention for vulnerable women in Cape Town, South Africa
Authors: Presenting Author: Dr Wendee Wechsberg - RTI International
Additional Authors: Dr. Tracy Kline, Ms. Felicia Browne, Ms. Rachel Middlesteadt-Ellerson, Ms. Tara Carney, Dr. Bronwyn Myers, Dr. William Zule, Dr. Charles Parry, Dr. Rachel Jewkes,
Aim: This 5-year study, funded by the U.S. National Institute on Child Health and Human Development, supports an adapted best-evidence women-focused behavioral intervention to help women reduce substance abuse, sexual risk, and victimization relative to a control group and a nutrition intervention as an attention-control group. As a feminist intervention, the Western Cape Women’s Health CoOp intervention also offered strategies for developing personal power, for strengthening negotiating skills, and for preventing sexual violence.
Method / Issue: This three-group randomized controlled trial trained outreach workers and peer leaders to recruit 720 women; at 6 months 82% of the sample completed follow-up, with similar attrition across the groups. A proportionate population-based design sampled women from 15 Western Cape Township communities. Eligibility included alcohol and other drug use in the past 3 months and sexual activity in the past 30 days. All participants received biological testing for substance abuse, HIV, and self-reported behavioral measures at baseline and at follow-up.
Results / Comments: The mean age of participants was 23 years. Among participants, 55% were Coloured and 45% were Black, in accordance with population demographics. Participants reported giving birth a mean of 1.5 times and having approximately two children living with them on average. At 6-month follow-up, biological indicators showed that marijuana use decreased overall, with the greatest reduction in the Women-Focused group. Methamphetamine and Mandrax use decreased slightly over time consistently across intervention conditions. The number of sex partners did not change over time and the number of women having unprotected sex with their main partner also remained consistent at 6-month follow-up. However, the number of times the women were having sex with their main partner decreased slightly overall. Victimization by main partner decreased overall across intervention groups. Instances of rape also showed a marked decrease over time. Almost 4% of participants reported forced sex at baseline, whereas at the 6-month follow-up, no participants reported having been raped.
Discussion: To date, the findings indicate trends that support the Women-Focused condition as well as some risk reduction in the nutrition group. However even voluntary counseling and testing showed modest reductions in drug use. Sexual encounters decreased overall across the groups and are not explained at this follow-up. All women were given risk-reduction kits after undergoing HIV testing. The 12-month follow-up assessment is ongoing and will provide additional data to help determine intervention differences. However, the peer leaders who conducted the interventions and maintained the field site, offered transportation, childcare and meals were also excellent role models. Feedback from our reception book indicated that being at the field site and being treated with dignity by the staff was an inspiration. Explicating intervention effects from the peer role models and the site’s comforts will be essential to have a true understanding of the outcomes.
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