If women living with HIV are to maintain their psychosocial equilibrium, they will need to adapt to the physical, psychological, emotional and sexual challenges of living with HIV. However, consistent condom use among women living with HIV remains low; with less than half reporting consistent condom use. There are several compelling clinical and public health reasons to enhance consistent condom use and reduce the risk of sexually transmitted diseases (STDs) among women living with HIV. STDs may play a role in the progression of HIV-1 infection. High risk sexual behavior may also increase the hazard of exposure to a more virulent HIV-1 strain. Thus, reducing high risk behavior could redeem risk of rapid disease progression by avoiding virulent HIV superinfection. Furthermore, the public health significance of promoting consistent condom use among women living with HIV is evident in the reduced risk of HIV infection among seronegative sexual partners, the reduced risk of HIV reinfection among seropositive sexual partners and the reduced risk of perinatal transmission. Evidence for the efficacy of consistent condom use is also compelling. Recent studies indicate that condoms, when used correctly and consistently, effectively prohibit the transmission of viral pathogens, including HIV. Women living with HIV are a population in urgent need of sexual risk- reduction interventions. Presently, there are no secondary interventions designed to reduce risk taking or enhance coping skills in women living with HIV. The proposed study will randomly assign women living with HIV to either a peer-advocate facilitated 8-session intervention (Project CARE: Coping and Risk Reduction Education), emphasizing both sexual risk reduction and coping effectiveness or a health promotion comparison condition. The 8-session intervention is grounded in elements of Social Cognitive Theory, Stress & Coping Theory and the Theory of Gender and Power. Project CARE will provide behavioral skills training and coping effectiveness training to address the sexual challenges and emotional stresses in women living with HIV. The proposed intervention will identify, recruit and train indigenous women living with HIV as Peer Advocates to implement the intervention. Peer Advocates will implement the 8-session intervention by conducting home visits. Home visits will avoid the structural barriers of transportation and child care. Following completion of the 8-session intervention, women will be instructed in maintaining contact with their Peer Advocate through the use of a 1-800 telephone line. Regularly scheduled telephone contacts will reinforce prevention messages, support maintenance of newly adopted behavior and reduce feelings of social isolation. The proposed intervention utilizes objective biological markers as measures of high-risk sexual behavior, and observational assessments to rake skills acquisition. This study also proposes a 12-month follow-up period to provide a better assessment of the effectiveness of the intervention to sustain behavior change which is essential since changes in risk behaviors must be enduring if they are to be meaningful.
| Mikhail, Isis S; DiClemente, Ralph; Person, Sharina et al. (2004) Association of complementary and alternative medicines with HIV clinical disease among a cohort of women living with HIV/AIDS. J Acquir Immune Defic Syndr 37:1415-22 |
