The goal of this project is to test the acceptability and efficacy of the Reality (TM) Vaginal Pouch (the female condom) in a population of Delaware women at high risk for HIV and other STD acquisition and transmission and recently released from incarceration. The methodology entails a 3-year exploratory design. A sample of 250 women inmates (projected to include 68% African-American, 26% white, and 6% Latina) will be recruited over fifteen months to participate in a comprehensive health and HIV education program 30 to 45 days prior to release. The comprehensive health and HIV education program will include sessions on how to use the female condom. Female and male condoms will be distributed to all participants free of charge after release from incarceration for a 12-month follow-up period. All respondents will be interviewed using the Risk Behavior Assessment (RBA) and the Risk Behavior Follow-up Assessment (RBFA) previously developed and tested in coordination with NIDA's Community Research Branch. The RBA and RBFA include questions addressing sociodemographic information, drug use patterns, sex activities, HIV/STD high risk activities, HIV/STD risk reduction behavior, economic factors, living situation, and health care status. The instruments will be modified to include questions about self-efficacy of reducing HIV/STD risk, female condom use, knowledge and use of health care resources, social influences and environmental factors. The original RBA and RBFA instruments are included in the Appendix. Interviews will be conducted at baseline (prior to beginning the education program), and at 1, 2, 3, 6, and 12 months after release from incarceration. All respondents will receive HIV and other STD testing at the 6 and 12-month interviews and will be paid a stipend at each of the six contact points. In addition, pre- and post-tests will be administered to respondents as part of the education program to assess the effectiveness of the program. A process evaluation of the development and implementation of the education program is included. Multivariate analyses will be conducted, including hypothesis testing and examination of correlates. This study will provide data important for assessing the acceptability and efficacy of a woman-controlled method of STD/HIV risk reduction.In addition, the study will assess the effect of an education program on risk behavior reduction and will provide important knowledge on the correlates of STD/HIV risky sex activities among women.
