Increasing HIV/STI Prevention Among Women on Probation: New Study
Over one million women in the United States are currently on probation, parole or under some form of community supervision. An estimated 14 percent of these women are currently infected with HIV. The reasons for this high prevalence rate include drug involvement and an increased likelihood of engaging in risky sexual behaviors—sometimes trading sex for money, drugs or a place to stay.
The Social Intervention Group of the Columbia School of Social Work has just now completed a study addressing the needs of this vulnerable population, with funding from the National Institute on Drug Abuse. Led by Professor Nabila El-Bassel and Associate Professor Louisa Gilbert, the study, known as Project WORTH (stands for Women on the Road to Health), marks the first full-scale randomized clinical trial to study the efficacy of HIV prevention for women under community supervision in New York City in order to reduce their risks of exposure to the HIV virus and STIs, increase HIV testing, and link women to HIV care and other services.
The study, which is reported this month in PLOS ONE, randomly assigned 306 women from community supervision settings to receive either HIV/STI prevention intervention or a wellness promotion intervention. Of the 204 women assigned to the HIV/STI prevention intervention, 101 were enrolled in a four-session traditional group-based HIV/STI prevention and testing intervention and 103 participated in a four-session multimedia group-based HIV/STI prevention and testing intervention.
Although both HIV interventions covered the same content, those enrolled in the traditional arm received the material from a trained professional while those participating in the multimedia arm were presented with material by computer/tablet- based tools. At the 12-month follow-up, those who had received the traditional or multimedia intervention were more likely to report that they had reduced their sexual risk behaviors and increased their access to HIV care, compared to women in the wellness promotion control arm.
These findings suggest that even a brief HIV intervention can help drug-involved vulnerable women under community supervision to reduce the behavior that puts them at risk for HIV as well as seek the health care they need. What is unique about the study is that it provided two evidence-based HIV intervention modalities for women to gain knowledge of the risks they are facing and acquire the skills that are needed to lead healthier lives.
Although both forms of intervention proved to be successful, the multimedia intervention has a number of advantages over the traditional one. It is more cost effective and can therefore be replicated and on a wide scale, even reaching areas with limited access to social services and trained professionals. In addition, reliance on a multimedia tool ensures a higher degree of intervention fidelity.
Dr. El-Bassel said: “I am pleased that the results showed that both multimedia and face-to-face intervention modalities worked quite well in reducing HIV risks and helping women to access the care that they need. The women who participated in the study were enthusiastic about the opportunity to learn and felt empowered to stay healthy and protect themselves from HIV, STIs, and HCV. The interventions are now ready to be scaled up to community supervision programs in other cities for women affected by HIV.”
In the scale-up of the study, women may choose one of these two intervention options, depending on whether they prefer learning through a traditional setting or a self-paced, computerized program.
Image: Characters from the mulitmedia, computer-based intervention known as Project Worth.