One in 32 African American women will be diagnosed with HIV in her lifetime compared to 1 in 526 White women. Beyond abstinence, the most effective way to prevent HIV is the male condom. Because condoms are male-controlled, women are often unable to negotiate their use. This is especially true for African American women, who are often socialized to be sexually passive and deferential to men. In addition, high incarceration rates and mortality among Black men creates a sex ratio imbalance that exacerbates power differentials. The female condom (FC), an intravaginal nitrile sheath, provides women with more control over HIV prevention and is as effective as the male condom at preventing HIV, STIs, and pregnancy. Furthermore, inconsistent users of the male condom achieve higher rates of protected sex acts by combining the two barrier methods. While FC use in the U.S. is currently low, FC education and training increases women's attitudes toward and use of female condoms. Black women in particular may benefit from FC education because they are more likely than other women to increase FC use after receiving training. In addition, FCs are more often used with primary partners, the most common source of HIV infection for African American women. To harness the promise of FC, scalable FC interventions that reach and educate large numbers of women are greatly needed. The Centers for Disease Control (CDC) conducts ongoing reviews of the scientific literature to identify evidence-based HIV behavioral interventions (EBIs) that may be effective for particular populations. Of the 73 EBIs identified, only one - Female Condom Skills Training (FEMIT) - is focused on providing education and training on the female condom (FC). To enhance the reach of this EBI, we intend to develop C- FEMIT, a computer-enabled version of the FEMIT intervention. Because EBIs that are tailored to the life- context of the individual are most effective, C-FEMIT will be tailored to the needs of African American women, a unique, high-risk group that accounts for the majority of HIV infections among women. This project is also designed to overcome two barriers to the implementation of EBIs. First, to manage the challenges faced by providers when integrating EBIs into clinical practice, we will develop a provider module designed to address intervention, coordinator, and organizational barriers. Second, lack of fidelity to the core elements of EBIs is common and leads to poorer outcomes. In collaboration with its creator, we will adapt the core elements of FEMIT, resulting in an intervention delivered with perfect fidelity. Utilizing these strategies, we hope to develop the first female condom EBI that is that is effective, provider-responsive, and scalable. Phase I prototype development will be informed by formative research with treatment service providers and input from our expert consultants. Next, the prototype will undergo usability testing and a prototype review with African American women seeking services at a community-based provider of HIV/STI services. Finally, treatment service providers will rate the functionality and content of the provider module.
This project aims to develop a computer-based female condom education and training program for African American women who have sex with men. This project will allow clinics to provide an empirically validated HIV prevention intervention to their clients without creating additional demands on their already overburdened staff. The skills contained in this program will help African American women reduce unprotected sex acts, and ultimately prevent the spread of HIV, by adding an additional barrier method - the female condom - to their arsenal of protection strategies.