Study prompts women to discuss condom use
Study prompts women to discuss condom use
Control group’s condom use also increased
A recent demonstration project aimed at reducing HIV infection among at-risk women highlights how difficult it is to effect significant community behavioral changes. Researchers measured an increase in condom use among the project’s participants, but a similar increase was also found in the study comparison group.1
"We are somewhat disappointed, as we had hoped for greater effects on actual condom use," says Jennifer L. Lauby, PhD, senior research associate with the Philadelphia Health Management Corp. in Philadelphia. Lauby was one of the principal investigators for the community-level HIV prevention intervention for inner-city women, sponsored by the Centers for Disease Control and Prevention in Atlanta.
The comparison group probably had been effected by spillover from the intervention, as well as national campaigns to increase condom use, Lauby speculates.
On the positive side, the study showed that women in the intervention groups were more likely to talk with their partners about using condoms and to convince them to use condoms, Lauby says.
"So it seems like we did have an impact, especially on the many women who had never thought about using a condom in the past," Lauby says.
Study among first to target at-risk women
On the study’s measure of condom use during most recent sex with the person’s main partner, the intervention community group’s reported condom use rose from 27% at baseline to 43% at follow-up. The comparison group’s reported condom use rose from 27% to 40% in the same time period. Both increases are significant, Lauby says.
The study asked participants several questions about their condom use, including these:
• When you have vaginal sex with your (main/ other) partner, how often do you use a condom?
• How long have you been using a condom every time you have sex with your (main/other) partner?
• How often do you talk with your main partner about condoms?
• The last time you had vaginal sex with your (main/other) partner, was a condom used?
"Since we saw an increase in condom use in both the intervention and comparison communities, we couldn’t say it was caused solely by our intervention," Lauby says.
The study grew out of a desire among HIV/ AIDS researchers to target women for prevention efforts, because so many of the previous CDC projects focused on gay and bisexual men and injection drug users.
Project utilized stages of change’ model
"Our project was one of the first to use some of the prevention techniques already developed and adapt these for use with women," Lauby says. "Our intervention was based on the "stages of change" model, so basically we tried to develop materials for women at different stages. Some were in precontemplation’ and not using condoms; some were using them occasionally." (See related story in AIDS Alert, May 1999, pp. 49-55.)
The project developed messages to cover the whole range of stages of change, she adds.
The stages of change model predicts that a person changes his or her behavior only after going through the following five behavioral stages:
• precontemplation — a person isn’t even thinking about making a change;
• contemplation — a person intends to make a change sometime in the near future;
• ready for action — a person makes a change inconsistently;
• action — a person makes the change consistently for one to five months;
• maintenance — a person makes a change consistently for at least six months.
The condom use project targeted at-risk women in four communities in public housing or low-income neighborhoods of Philadelphia, Pittsburgh, and Portland, OR. In the targeted communities, investigators looked for women who could serve as peer volunteers. These were female leaders who would meet a couple of afternoons a week and take time to speak with other people in their communities, handing out brochures and condoms.
An important part of the intervention was material that told role model stories about women within the targeted communities. The stories were true but used pseudonyms.
Finding women who had made a change
"We interviewed women in the community who told us their story," Lauby says. "We were looking for women who had a change from one stage to another, such as they started to think about using condoms when they hadn’t thought about it before."
Staff included full-time outreach workers who were trained in the stages of change model. Lasting 2.5 years, the project targeted 1,000 to 4,000 women between the ages of 15 and 35 in each of the four communities.
"To evaluate the intervention, we did cross-sectional surveys every year in the intervention and comparison communities," Lauby says. "We didn’t follow the same people over time, but did a baseline interview before the intervention in 1993 and then had annual surveys through 1996, after the intervention was finished."
The mean age of the women participating in the study was 25, and 73% were African-American; 65% had received public assistance within the past year; 10% had injected drugs; 43% had used street drugs within the past six months; 17% had engaged in sex for money or drugs; and 27% had two or more sexual partners in the past six months.
The percentage of women who said they never use condoms with their main partner was 49.9% at baseline in the intervention groups and 47.7% in the comparison community. At follow-up, the number of women saying they never use condoms had dropped to 28.1% in the intervention group and 35.1% in the comparison group.
The percentage of women in the intervention group who said they never talk with their main partner about condoms was 41% at baseline and 23.2% at follow-up. In the comparison group, those numbers were 36.9% at baseline and 32.1% at follow-up.
The intervention group women who reported condom use during their most recent sex act with a partner other than their main partner rose from 56.7% at baseline to 77.3% at follow-up. In the comparison community, this figure rose from 56.7% to 62%.
The project successfully reached a large number of women in the target communities, as evidenced by the survey showing that 64% recalled having read material or having talked with someone from the project.
Reference
1. Lauby JL, Smith PJ, Stark M, et al. A community-level HIV prevention intervention for inner-city women: Results of the Women and Infants Demonstration Projects. Am J Public Health 2000; 90:216-222.
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