Research That Matters (January 17 - 20, 2008)

The lifestyle of alcohol and drug dependent women often places them at increased risk for psychological and medical sequelae. HIV/STD infection is no exception. While participation in substance abuse treatment has been found to be effective in reducing drug use, it has demonstrated a relatively low success rate in reducing sexual risk behaviors. Rather, socio-cultural and contextual factors are seen as barriers to condom use and sexual negotiation (Amaro & Raj, 2000). One promising approach, is “Safer Sex Skill Building” (SSB), a 5-session, manual-driven intervention by Schilling and colleagues (1993) that has been utilzed by the NIDA Clinical Trials Network (CTN). However, it was developed primarily for women with illicit drug problems with less attention given to alcohol use disorders and their contribution to high risk sexual behaviors. This focus group study is the first phase of a NIAAA funded R03 pilot HIV prevention project to develop and pilot test an enhanced curriculum (SSB+A) in a sample of women with alcohol use disorders in residential substance abuse treatment, and utilze this feedback to further modify the intervention prior to conducting a small randomized clinical trial comparing SSB+A to a one session standard HIV education group. This study reports on responses of the participants to the SSB+A curriculum. The sample consisted of nine (6 African American, 3 Caucasian) women who reported alcohol use problems at intake and who were screened as being at high risk for HIV/AIDS. Women were informed of the study and volunteered to participate in one of two 5 session SSB+A groups plus two focus groups. For each cohort, the first focus group was scheduled 2-3 days following the second SSB+A session. The second focus group was scheduled after the final SSB+A session. Focus group leaders, who were women's health researchers not otherwise connected with the study, utilized open-ended and semi-structured questions to elicit participant feedback on the intervention. Data consisted of notes recorded by the two focus group leaders and transcribed tape recordings of focus group sessions. Additionally, comments made about the intervention during the 5 session SSB+A groups were recorded by co-leaders and were analyzed separately. All data were independently coded by researchers using constant comparative method. Themes that emerged were the importance of a) role play exercises that reflect realistic relationship situations, b) being able to talk openly about “tricking” and substance use, c) having detailed educational material on HIV and other STD's including practice with female condoms, and, d) women's use of alcohol and drugs for different purposes depending in part on the nature of the relationship. These results underscore the need for multiple session, culturally appropriate HIV prevention interventions that address the life demands and social problems that women face.

Amaro, H., & Raj, A. (2000). On the margin: Power and women's HIV risk reduction strategies. Sex Roles, 42(7/8), 723-749.

Schilling, R.F., El-Bassel, N., Gilbert, L., & Glassman, M. (1993). Predictors of changes in sexual behavior among women on methadone. American Journal of Drug and Alcohol Abuse, 19(4), 409-417.