How Community Consultants Shaped An HIV Prevention Intervention for Criminal Justice-Involved Women

Background: Despite alarmingly high rates of HIV among criminal justice-involved women, few culturally tailored HIV prevention interventions have been developed to address the unique needs of this vulnerable population. Community-based participatory research (CBPR) promotes an orientation to research that fosters close collaboration with community partners in order to cultivate “indigenous knowledge” (Minkler & Wallerstein, 2003; Pinto et al, 2008). Women's voices in general have been historically subjugated within scientific development (Lorber, 1994), and justice-involved women represent a systematically disempowered group. This presentation discusses the formative and empowerment-driven process of engaging a group of female community consultants to inform the tailoring and multimedia translation of an HIV prevention intervention targeting justice-involved women.

Methods: The authors are part of a research team that is conducting an efficacy trial in which an effective woman-specific group-based HIV prevention intervention is being tailored for women under criminal justice supervision and translated into computer-based multimedia format. Building on CBPR principles, a group of women was recruited from court programs and drug treatment centers to serve as “consultants” to intervention adaptation. Women consultants met the eligibility criteria from the broader study, which included criminal justice involvement, drug use, and sexual risk behavior. Consultation meetings were organized and digitally recorded to address the following: How can the language and content of the intervention maintain its focus while being relevant to justice-involved women? What are additional barriers or supports to safer sex negotiation for women offenders? How can multimedia tools be incorporated in a way that engages and does not alienate the study population?

Results: Eight women were recruited and met with members of the research and multimedia team twice-monthly for four months; women gave informed consent and were compensated for their time. Consultant feedback was incorporated into an iterative process of intervention refinement. Several examples of this process are discussed, including: 1)Consultants choosing to role-play and edit a video script describing safer sex negotiation; 2)Consultants demonstrating how to discuss the issue of intimate partner violence and highlight its importance to HIV prevention; and 3)Feedback given as the result of consultants beta-testing multimedia components of HIV prevention activities. Two recurring themes that consultants identified as barriers to safer sex negotiation were intimate partner violence and having a sexual partner who is incarcerated; these themes were subsequently integrated into intervention materials. Consultant feedback indicates that multimedia activities can be powerful tools in skills training and retention, providing the activities are interactive and do not require high levels of literacy.

Conclusions: Because this group of women was viewed and treated as valued consultants rather than research subjects, they quickly became engaged and vocalized their frank opinions regarding intervention materials. By incorporating consultant feedback, the refined HIV prevention intervention is likely to have more relevance and impact on the study population. Select women from this consultant group were asked to serve as members of the community advisory board for the intervention study, which serves as an ongoing forum in which their views and experiences will inform intervention protocols.