“Not on the agenda”: A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa

Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women’s use of health services

Factors That Influence HIV Risk among Hispanic Female Immigrants and Their Implications for HIV Prevention Interventions

Hispanics are the fastest growing minority group in North Carolina with increasing incidence of HIV infection. Gender roles, cultural expectations, and acculturation of women may explain some of Hispanic women's risks. The perspectives of Hispanic female immigrants and community-based providers were sought to identify services they offer, understand HIV risk factors, and support the adaptation of a best-evidence HIV behavioural intervention for Hispanic women. Two sets of focus groups were conducted to explicate risks and the opportunities to reach women or couples and the feasibility to conduct HIV prevention in an acceptable manner. Salient findings were that Hispanic female immigrants lacked accurate HIV/AIDS and STI knowledge and that traditional gender roles shaped issues surrounding sexual behaviour and HIV risks, as well as condom use, partner communication, and multiple sexual partnerships. Intervention implications are discussed such as developing and adapting culturally appropriate HIV prevention interventions for Hispanics that address gender roles and partner communication

Correlates of Male Condom Use Skills among High-Risk Women in South Africa

This exploratory study examines the performance of 295 South African women—who recently traded sex for goods or had unprotected sex—on a male condom use mastery index. Bivariate and multivariate logistic regression analyses were conducted to determine whether age, marital status, highest education obtained, male condom use at first penetrative sex, receiving prior demonstration of male condom use, recent sexually transmitted infection (STI) symptoms, and recently trading sex were significantly associated with index scores. Adjusted odds ratios indicated that age and STI symptoms were negatively associated with condom skills; women who were older and had a higher number of recent STI symptoms were more likely to have lower scores. Furthermore, participants executed, on average, approximately one-third of condom use steps correctly. These findings suggest a need for increased behavioral skills training for women engaging in sexual risk behaviors because many lack the skills required to use a male condom properly

Current Interventions to Reduce Sexual Risk Behaviors and Crack Cocaine Use among HIV-Infected Individuals

The dual global epidemics of crack cocaine use and HIV have resulted in a large number of people living with HIV who use crack cocaine, many of whom continue to engage in unprotected sex. Crack use also increases the rate of HIV progression. Consequently, there is an urgent need for effective interventions to decrease crack use and unprotected sex and to improve antiretroviral therapy (ART) adherence in this population. This article reviews the recent published literature on interventions for reducing crack use and unprotected sex among people living with HIV. Only a few intervention outcome studies targeting exclusively HIV positive crack cocaine users were identified, whereas other studies used a mixed sample. Some interventions focused on reducing crack use and several focused on reducing sex-risk behaviors. Consequently, there is a critical need for efficacious interventions that address crack use, risky sex and ART adherence among people living with HIV

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

Nonmedical prescription opioid use has been linked to hepatitis C virus (HCV) infection among people who inject drugs and with using high dead space syringes that retain more blood and transfer more HIV if shared. Little is known regarding its effects on sex risk behaviors

Experiences of Violence and Association with Decreased Drug Abstinence Among Women in Cape Town, South Africa

Drug abuse is a contributing factor in women’s HIV risk in low-income communities in Cape Town, South Africa. This study assessed whether experiencing violence is associated with reduced drug abstinence among adult women (n = 603) participating in a randomized field trial for an HIV prevention study in Cape Town. In relation to drug abstinence at 12-month follow-up, multivariable regression models were used to assess (1) baseline partner and non-partner victimization, and (2) victimization at 12-month follow-up among participants reporting baseline victimization. Baseline partner (AOR = 0.6; 95 % CI 0.4–0.9) and non-partner victimization (AOR = 0.6; 95 % CI 0.4–0.9) were associated with a reduced likelihood of drug abstinence at follow-up. Among participants who reported victimization at baseline, those no longer reporting victimization at follow-up did not differ significantly in drug abstinence compared with those who reported victimization at follow-up. The study findings highlight the lasting impact of victimization on women’s drug use outcomes, persisting regardless of whether violence was no longer reported at follow-up. Overall, the findings support the need for the primary prevention of violence to address the cycle of violence, drug use, and HIV among women in this setting

Initial Feasibility of a Woman-Focused Intervention for Pregnant African-American Women

African-American women who use crack are vulnerable to HIV because of the complex social circumstances in which they live. Drug-abuse treatment for these women during pregnancy may provide time for changing risk behaviors. This paper examines the initial 6-month feasibility of a women-focused HIV intervention, the Women's CoOp, adapted for pregnant women, relative to treatment-as-usual among 59 pregnant African-American women enrolled in drug-abuse treatment. At treatment entry, the women were largely homeless, unemployed, practicing unsafe sex, and involved in violence. Results indicated marked reductions in homelessness, use of cocaine and illegal drugs, involvement in physical violence, and an increase in knowledge of HIV from baseline to 6-month followup for both conditions. Findings suggest that the Women's CoOp intervention could be successfully adapted to treat this hard-to-reach population. Future studies should examine the efficacy of the pregnancy-adapted Women's CoOp for women not enrolled in drug-abuse treatment

The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township

This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence

Results of a Pilot Test of a Brief Computer-Assisted Tailored HIV Prevention Intervention for Use with a Range of Demographic and Risk Groups

There is a need for brief HIV prevention interventions that can be disseminated and implemented widely. This article reports the results of a small randomized field experiment that compared the relative effects of a brief 2-session counselor-delivered computer-tailored intervention and a control condition. The intervention is designed for use with African American, non-Hispanic white and Hispanic males and females who may be at risk of HIV through unprotected sex, selling sex, male to male sex, injecting drug use or use of stimulants. Participants (n=120) were recruited using a quota sampling approach and randomized using block randomization, which resulted in 10 male and 10 female participants of each racial/ethnic group (i.e. African-American, non-Hispanic white and Hispanic) being assigned to either the intervention or a control arm. In logistic regression analyses using a generalized estimating equations approach, at 3-month followup, participants in the intervention arm were more likely than participants in the control arm to report condom use at last sex (Odds ratio [OR] = 4.75; 95% Confidence interval [C.I.] = 1.70, 13.26; p = 0.003). The findings suggest that a brief tailored intervention may increase condom use. Larger studies with longer followups are needed to determine if these results can be replicated

Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions

The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women’s risk behavior, their roles in sexual relationships, and gender power dynamics, and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at three generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women