The PI completed a pilot study with women at risk in Pretoria, South Africa in November 2002. Results suggest that AOD use, behavioral risk, and violence are intertwined risk factors for HIV infection for these young women of childbearing age. Several important findings emerged from this research. Women routinely used alcohol and other substances as a disinhibitor prior to their involvement. Use of alcohol and other substances increases HIV risk through failure to engage in safer practices. Other factors that increase HIV risk for women are a function of the culture, such as a long history of multiple partners for men, dominance and violence toward women. Such cultural norms diminish women's ability to ask for safer physical encounters with their partners. The ramifications of cultural conventions coupled with data from the pilot study suggest the need to adapt and test brief interventions found to be effective with women in the US. Thus, the proposed study builds on data from the preliminary study and is designed to reach a large sample of women via a full-scale field experiment. This multi-method study will include biological testing for pregnancy and HIV, qualitative and quantitative research, and repeated measures to determine the effectiveness of two interventions to reduce AOD use, risk behaviors, and related violence. Outreach workers will recruit 900 women at high risk for HIV within the Gauteng Province (Pretoria) of South Africa to test two brief HIV interventions (a woman-focused intervention and a generic intervention), with repeated measures at 3- and 6-month follow-ups.
The specific aims of the proposed study are as follows:
Aim 1. To examine women's patterns of AOD use and HIV risk and the associations of these patterns with partners (e.g., boyfriends, other men), health status (e.g., HIV status, STIs, TB, pregnancy, psychological distress), and barriers to HIV risk reduction (e.g., related violence, other physical violence).
Aim 2. To compare the effectiveness of a woman-focused HIV prevention intervention with a generic HIV prevention intervention to reduce AOD use, HIV risk behaviors, and related violence.
Aim 3. To examine the moderating and mediating effects of such factors as abuse history, HIV status, AOD use, psychological distress, and relationship power on the effectiveness of the HIV prevention interventions.
