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 interventions that reach and educate large numbers of women are greatly needed. The CDC conducts ongoing reviews of the scientific literature to identify effective evidence- based HIV behavioral interventions (EBIs). Of the 73 EBIs identified, only one. Female Condom Skills Training (FEMIT) is focused on providing FC education and training to women. To enhance the reach of this EBI, we intend to develop HALO, a computer-enabled version of the FEMIT intervention. Because EBIs that are tailored to the life-context of the individual are most effective, HALO will be tailored for Africa American women, a unique, high-risk group that accounts for the majority of HIV infections among women. While the scalability of computer-based programs allows for efficient dissemination, clinics still face major barriers when trying to deliver empirically validated interventions. As such, we will develop a companion program for providers called HALO in your Clinic. This program has two main goals: (1) train providers in FC use so that they are able to offer additional education to clients who use the HALO program and (2) prepare clinics to address potential implementation barriers at the intervention and organizational levels. The results of Phase I strongly support the feasibility and potential effectiveness of the programs far exceeding the four usability benchmarks established in the Phase I proposal. In Phase II, we will complete development of HALO and HALO in Your Clinic. We will then test the effectiveness of HALO in a randomized controlled trial with 120 African American women. Participants will be randomly assigned to receive either the HALO program or treatment as usual. Before, and at two points after random assignment, participants' sexual behavior, including male and female condom use, and partner communication will be assessed.
This project aims to develop and test two computer-based programs: HALO, a computer-based female condom education and training program for African American women, and HALO in Your Clinic, designed to teach service providers female condom skills and help them adopt and integrate computer-based interventions into their clinical offerings. 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. In addition, the skills contained in HALO 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.