AIDS and Behavior

Myers, Janet; Shade, Starley; Rose, Carol; Koester, Kimberly; Maiorana, Andre; Malitz, Faye; Bie, Jennifer; Kang-Dufour, Mi-Suk; Morin, Stephen

doi: 10.1007/s10461-010-9679-ypmid: 20229132

To support expanded prevention services for people living with HIV, the US Health Resources and Services Administration (HRSA) sponsored a 5-year initiative to test whether interventions delivered in clinical settings were effective in reducing HIV transmission risk among HIV-infected patients. Across 13 demonstration sites, patients were randomized to one of four conditions. All interventions were associated with reduced unprotected vaginal and/or anal intercourse with persons of HIV-uninfected or unknown status among the 3,556 participating patients. Compared to the standard of care, patients assigned to receive interventions from medical care providers reported a significant decrease in risk after 12 months of participation. Patients receiving prevention services from health educators, social workers or paraprofessional HIV-infected peers reported significant reduction in risk at 6 months, but not at 12 months. While clinics have a choice of effective models for implementing prevention programs for their HIV-infected patients, medical provider-delivered methods are comparatively robust.

Diallo, Dázon; Moore, Trent; Ngalame, Paulyne; White, Lisa; Herbst, Jeffrey; Painter, Thomas

doi: 10.1007/s10461-010-9672-5pmid: 20135214

SisterLove Inc., a community-based organization (CBO) in Atlanta, Georgia, evaluated the efficacy of its highly interactive, single-session HIV prevention intervention for black women, the Healthy Love Workshop (HLW). HLW is delivered to pre-existing groups of women (e.g., friends, sororities) in settings of their choosing. Eligible groups of women were randomly assigned to receive the intervention (15 groups; 161 women) or a comparison workshop (15 groups; 152 women). Behavioral assessments were conducted at baseline and at 3- and 6-month follow-ups. Among sexually active women at the 3-month follow-up, HLW participants were more likely than comparison participants to report having used condoms during vaginal sex with any male partner or with a primary male partner, and to have used condoms at last vaginal, anal or oral sex with any male partner. At the 6-month follow-up, HLW participants were more likely to report condom use at last vaginal, anal or oral sex with any male partner, and having an HIV test and receiving their test results. The study findings suggest that a single-session intervention delivered to pre-existing groups of black women is an efficacious approach to HIV prevention. This study also demonstrates that a CBO can develop and deliver a culturally appropriate, effective HIV prevention intervention for the population it serves and, with adequate resources and technical assistance, rigorously evaluate its intervention.

Markosyan, Karine; Lang, Delia; Salazar, Laura; DiClemente, Ralph; Hardin, James; Darbinyan, Nelli; Joseph, Jesse; Khurshudyan, Marietta

doi: 10.1007/s10461-010-9689-9pmid: 20373139

This study evaluated the efficacy of an HIV intervention among female sex workers (FSWs) randomized to an intervention or wait-list control. FSWs (N = 120) completed baseline, 3- and 6-month assessments. A health educator implemented 2-hour intervention emphasized gender-empowerment, self-efficacy to persuade clients to use condoms, condom application skills, and eroticizing safer sex. Over the 6-month follow-up, FSWs in the intervention reported more consistent condom use with clients (P = .004) and were more likely to apply condoms on clients (P = .0001). Intervention effects were observed for other psychosocial mediators of safer sex. Brief, gender and culturally congruent interventions can enhance HIV-preventive behaviors among FSWs.

Straten, Ariane; Cheng, Helen; Chidanyika, Agnes; Bruyn, Guy; Padian, Nancy

doi: 10.1007/s10461-010-9690-3pmid: 20352318

Vaginal practices may interfere with the use and/or the effectiveness of female-initiated prevention methods. We investigated whether vaginal practices differed by randomization group in a phase III trial of the diaphragm with lubricant gel (MIRA) in Sub-Saharan Africa (n = 4925), and if they were associated with consistent use of study methods. At baseline, vaginal practices were commonly reported: vaginal washing (82.77%), wiping (56.47%) and insertion of dry or absorbent materials (20.58%). All three practices decreased during the trial. However, women in the intervention group were significantly more likely to report washing or wiping during follow-up compared to those in the control group. Additionally, washing, wiping, and insertion, were all independently and inversely associated with consistent diaphragm and gel use and with condom use as well, regardless of study arm. A better understanding of the socio-cultural context in which these practices are embedded could improve educational strategies to address these potentially modifiable behaviors, and may benefit future HIV prevention interventions of vaginal methods.

Joanis, Carol L.; Hart, Catherine W.

doi: 10.1007/s10461-009-9655-6pmid: 20049522

Vaginal microbicides could reduce incidence of HIV. However, the current method of delivering gel formulations (standard applicator) can result in acceptability concerns/issues. This study evaluated the concept of using a non-woven textile material (modified tampon) for vaginal drug delivery. The study was nested within a Phase I randomized safety trial of lime juice concentrations used intra-vaginally. Of 47 women completing the safety trial, 16 were interviewed about their experiences. Overall, women found the concept of non-woven materials for vaginal drug delivery acceptable for use in delivering yeast medications (13 of 16) and STI/HIV preventives (10 of 16).

Sherman, Susan; Srikrishnan, A.; Rivett, Katharine; Liu, Su-Hsun; Solomon, Suniti; Celentano, David

doi: 10.1007/s10461-010-9686-zpmid: 20352320

Female sex workers have been central in India’s HIV epidemic since it was first diagnosed among them in 1989. Female sex workers’ risk of HIV is primarily economically motivated. The Pi pilot study examined the feasibility and association of a microenterprise intervention, the tailoring of canvas bags, on sexual risk behaviors among female sex workers (N = 100) in Chennai. Women were randomized to an intervention or control arm. Between-group comparisons at baseline and at six-month follow-up were performed. Multivariate linear regression with bootstrapping was conducted to estimate the intervention effect. At baseline, women were a median of 35 years old, 61% were married and they had an average of two children. Intervention participants reported a significantly lower number of sex partners and significant increases in income at the 6-month follow-up compared to control participants. In a multivariate model, intervention participants had a significantly lower number of paying clients per month at follow-up compared to control participants. By graduation, 75% of intervention arm participants had made at least one sellable canvas bag and 6 months after the study’s end, 60% have continued involvement in bag production. The pilot study demonstrated that microenterprise interventions are successful in both providing FSWs with licit income opportunities and was associated with reductions in HIV risk behaviors.

Pollini, Robin; Lozada, Remedios; Gallardo, Manuel; Rosen, Perth; Vera, Alicia; Macias, Armando; Palinkas, Lawrence; Strathdee, Steffanie

doi: 10.1007/s10461-010-9674-3pmid: 20300820

Injection drug users (IDUs) may be denied purchase of sterile syringes even where purchase without a prescription is legal. This study examined barriers to over-the-counter (OTC) syringe purchase among IDUs in Tijuana, Mexico. A quantitative survey and subsequent focus groups were used to quantify barriers to purchase, identify their correlates and provide in-depth exploration of syringe purchase experiences. Of 627 IDUs, 81% purchased a syringe in the past 6 months and 16% were refused or overcharged. Factors independently associated with refusal/overcharging were homelessness, receptive syringe sharing, >5 uses per syringe, and number of lifetime abscesses. Few pharmacies sold syringes to IDUs, who adapted by limiting purchase attempts to pharmacies known to sell syringes consistently. Failed purchases occurred when drug withdrawal required purchase at unusual times or locations, often following release from jail. IDUs reported syringe sharing, syringe reuse, and searching through unsecured medical waste for syringes in response to failed purchase attempts. Interventions to expand OTC syringe sales to IDUs, particularly near detention facilities, will facilitate safer injection practices.

Shet, Anita; Arumugam, Karthika; Rodrigues, Rashmi; Rajagopalan, Nirmala; Shubha, K.; Raj, Tony; D’souza, George; Costa, Ayesha

doi: 10.1007/s10461-009-9658-3pmid: 20054634

Integration of mobile phone technology into HIV care holds potential, particularly in resource-constrained settings. Clinic attendees in urban and rural South India were surveyed to ascertain usage of mobile phones and perceptions of their use as an adherence aid. Mobile phone ownership was high at 73%; 26% reported shared ownership. A high proportion (66%) reported using phones to call their healthcare provider. There was interest in weekly telephonic automated voice reminders to facilitate adherence. Loss of privacy was not considered a deterrent. The study presents important considerations in the design of a mobile phone-based adherence intervention in India.