Program finds success reaching crack addicts

Improvements seen on all fronts

A new study reports success in reducing risk and improving women’s housing and employment status after enrollment in a woman-focused HIV intervention program.

Researchers began designing an HIV prevention intervention for African American women who use crack in hopes of affecting deep behavioral change, beginning with reduced risk activity and reduced drug use, but also improving their life situation. At six months follow-up, the intervention appears to achieve its goals.

The woman-focused intervention was designed to be personalized with focus on each woman’s learning skills for taking care of herself, as well as reducing HIV risk behaviors and reducing drug and alcohol use, says Wendee M. Wechsberg, PhD, senior program director at RTI International in Research Triangle Park, NC.

Investigators studied the following groups:

1. three-month and six-month outcomes of the woman-focused HIV intervention;
2. a revised intervention modeled on the National Institute on Drug Abuse (NIDA) standard HIV prevention intervention;
3. delayed-treatment control group.1

Researchers see changes in behaviors 

Women were randomized to the three groups, and all showed striking decreases in daily crack use.

Women in all the groups reported significant decreases in reported unprotected sex and in trading sex for money and drugs.1 However, only the woman-focused intervention showed significant reduction in homelessness and a marked improvement in full-time employment, Wechsberg says.

"The woman-focused group did better in the areas that we wanted to emphasize, which were employment and not being homeless," she explains. "These are really important when you think about independence and self-sufficiency."

The NIDA standard HIV prevention intervention, which focuses on teaching women how to use female and male condoms, reducing sexual and drug risk, and going to drug treatment, succeeded in achieving significant reductions in crack use at six months relative to controls.1

However, even the control group changed behaviors, Wechsberg notes. "When we asked women in the control group why they changed their behaviors, they said it was because it was important to be in the study and we had asked them questions about it."

It will be interesting to see how the woman-focused intervention continues to affect risk behaviors and lifestyle changes over time, she says.

"The good news about this study is we have another five years of this work. What about the sustainability and durability of interventions because women can’t leave these drug-using communities?" Wechsberg asks.

More than 5% of the women who participated in the study were HIV-positive. The woman-focused intervention is a good prevention for HIV-positive women because it focuses on what a woman can do to take care of herself and stay healthy, she points out.

The study was conducted in intervention field sites, which provided a comfortable and safe environment for women to be questioned about their HIV risk behaviors. Women could leave their children with a baby sitter on site, get something to eat, pick up donated clothing and toiletries, and treat the place like a drop-in center, Wechsberg says.

"The study used the same staff and outreach workers and data collectors and interventionists for all three groups. The control group came in, did the data collection and received risk reduction kits and an incentive for their time, but they did not have the benefit of an intervention until the study was over."

The women participating in the NIDA standard intervention were taught about the risks of drug use, AIDS, sharing needles, and the benefits of drug treatment, she notes.

They also were taught about HIV testing and received training on how to properly use the male and female condoms. "The woman-focused intervention and the standard were equal doses of time," Wechsberg adds.

The woman-focused and NIDA standard interventions included two 30- to 40-minute sessions of individual counseling/education and two small group sessions, lasting 60 to 90 minutes.1

The woman-focused intervention went beyond the sexual and drug risk behaviors to encourage women to focus on other issues that affect African American women, including racism, domestic violence, education, work, etc., Wechsberg says.

For instance, the intervention taught the women that their addictions keep them in bondage, and it helped them to answer the question of what they could do as an African American woman to get out of that bondage, she explains.

Intervention facilitators told participants that HIV is affecting more black women than white women and encouraged them to ask themselves what it is about their lives and their struggles that leads to HIV infection, Wechsberg says. "How do they reframe how hard life is and empower them to make it better? We say, We’re not going to do it for you, but we’ll talk about your skills and you need to move forward and not be stuck in this bondage and with a sugar daddy, and so forth.’"

For many of the women participants, the experience of creating emotional bonds with fellow women was a new one, and they were excited about gaining some control in their lives, says Wechsberg.

Participants were asked to imagine their own life plan and think about the biggest change that will enable them to own their lives because the more they give it away, the more they drink and use drugs, she adds.

An outline of both the woman-focused and standard interventions are available in the article, published in July 2004 in the American Journal of Public Health.

Reference 

1. Wechsberg WM, Lam WKK, Zule WA, et al. Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. Am J Pub Health 2004; 94(7):1,165-1,173.