Protect & Respect helps HIV+ women with condoms
Focus is on addressing their life issues too
A new model HIV/AIDS prevention program uses a group skills-building and peer-group led model to build on HIV clinicians' risk reduction messages to disadvantaged women who are HIV positive.
The Protect and Respect intervention has the goal of increasing condom use among women who are coping with poverty, unemployment, domestic violence, substance use, and other socioeconomic issues.
The intervention showed higher self-reports of condom use at six months and 18 months among women who received the intervention when compared with women who received only brief messages from their HIV providers.1
"The intervention had several strategies, including messages from health care providers and from an educational group and a peer support group," says Michelle Teti, MPH, DrPH, an assistant professor in the School of Health Professions at the University of Missouri in Columbia, MO. Teti was the principal investigator on the Protect and Respect study.
Its success prompted an invitation for including the intervention in a list of model HIV/AIDS prevention programs by the HIV/AIDS Prevention Program Archive (HAPPA), established by the Sociometrics Corporation and under the sponsorship of the National Institute for Allergy and Infectious Diseases (NIAID).
HAPPA's model programs can be found at the website: www.socio.com/happa.php.
The key to the program's success is its focus on addressing the challenges and obstacles in the HIV-positive women's lives, Teti says.
"When you work with women living with HIV you find they are dealing with protecting other people from HIV infection, but also protecting themselves," she explains. "This population is poor and comes from neighborhoods that are poor and violent."
The women have personal crises that need to be handled before they can focus on practicing safer sex.
"I think it's important to know that HIV is really only one of the things they're dealing with on a daily basis," Teti adds.
Skills group, peer leaders
The intervention can be implemented with an HIV clinic's existing resources, so long as there is someone available to lead the skills group and a peer who can lead the peer-led support group, she notes.
HIV providers should be trained to initiate a brief dialogue with their patients about risk, safe sex, and disclosing their serostatus to partners.
The skills group part of the intervention focused on these topics:
- Identifying strengths and life challenges
- Teaching problem-solving skills
- Discussing ways to have safe sex
- Learning how to talk to partners about HIV status
- Developing healthy relationships
- Setting individual goals for changing behavior.
The peer-led support group was designed to be flexible and able to focus on a particular topic of interest to the women attendees, regardless if it was directly related to HIV care and prevention. For instance, the peer group might spend an entire discussion talking about developing healthy relationships, Teti says.
"For the peer-level intervention, the topics were decided by peer leaders and were a way to reinforce the messages about condom use that were given in the group-level intervention," says Lisa Bowleg, PhD, an associate professor in the department of community health and prevention at the School of Public Health at Drexel University in Philadelphia, PA.
"If women want to talk about something that's not related to HIV but is pertinent to their lives then there should be a space for that," Bowleg says.
"What we learned from qualitative data, recording groups and listening to what these women talked about is that the issues of HIV status are much bigger than we realize," she adds. "There's an issue of stigma, so peer support and learning from other women works."
With a peer-led support group, women who are living within a violent relationship might learn how to leave this relationship.
"The peer group model is important for training and teaching women how to protect themselves from further infection and other risks," Bowleg says.
- Teti M, Bowleg L, Cole R, et al. A mixed methods evaluation of the effect of the protect and respect intervention on the condom use and disclosure practices of women living with HIV/AIDS. AIDS Behav. 2010;14(3):567-579.