Skip to main content

Advertisement

SpringerLink
Log in

A Mixed Methods Evaluation of the Effect of the Protect and Respect Intervention on the Condom Use and Disclosure Practices of Women Living with HIV/AIDS

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

This mixed methods study evaluated the efficacy of an intervention to increase HIV status disclosure and condom use among 184 women living with HIV/AIDS (WLH/A). Participants were recruited from an HIV clinic and randomly assigned to: (1) a comparison group, who received brief messages from their health care providers (HCPs), or; (2) an intervention group, who received messages from HCPs, a group-level intervention, and peer-led support groups. Participants completed risk surveys at baseline, 6-, 12-, and 18-months. Quantitative analyses using hierarchical generalized linear models within a repeated measures framework indicated that intervention participants had significantly higher odds of reporting condom use with sexual partners in months 6 and 18. Grounded Theory-based qualitative analyses suggested that the opportunity to discuss the social context of their lives in addition to HIV/AIDS, including continued stigma and fear related to disclosure, are also essential components of a prevention strategy for WLH/A.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aidala, A. A., Lee, G., Garbers, S., & Chiasson, M. A. (2006). Sexual behaviors and sexual risk in a prospective cohort of HIV-positive men and women in New York City, 1994–2002: Implications for prevention. AIDS Education and Prevention, 18(1), 12–32. doi:10.1521/aeap.2006.18.1.12.

    Article  PubMed  Google Scholar 

  • Amaro, H. (1995). Love, sex, and power: Considering women’s realities in HIV prevention. The American Psychologist, 50(6), 437–447. doi:10.1037/0003-066X.50.6.437.

    Article  CAS  PubMed  Google Scholar 

  • Barkan, S. E., Melnick, S. L., Preston-Martin, S., Weber, K., Kalish, L. A., Miotti, P., et al. (1998). The women’s interagency HIV study. Epidemiology (Cambridge, Mass.), 9(2), 117–125. doi:10.1097/00001648-199803000-00004.

    CAS  Google Scholar 

  • Bowleg, L., Lucas, K., & Tschann, J. (2004). “The ball was always in his court”: An exploratory analysis of relationship scripts, sexual scripts, and condom use among African American women. Psychology of Women Quarterly, 28, 70–82. doi:10.1111/j.1471-6402.2004.00124.x.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2008). HIV/AIDS among women. Retrieved September 1, 2008, from http://www.cdc.gov/hiv/topics/women/resources/factsheets/women.htm.

  • Charmaz, K. (2006). Constructing Grounded Theory, a practical guide through qualitative analysis. London: Sage.

    Google Scholar 

  • Collins, C., Morin, S. F., Shriver, M., & Coates, T. J. (2000). Designing primary prevention for people living with HIV (policy monograph series). University of California, San Francisco: AIDS Policy and Research Center & Center for AIDS Prevention Studies.

    Google Scholar 

  • Diaz, R. (2007). Impact on communities of color. National HIV Prevention Conference. Atlanta, GA.

  • DiClemente, R. J., Prochaska, J., & Gilbertini, M. (1985). Self-efficacy and the stages of change of smoking. Cognitive Therapy and Research, 9, 181–200. doi:10.1007/BF01204849.

    Article  Google Scholar 

  • Dworkin, S. L., & Ehrhardt, A. A. (2007). Going beyond “ABC” to “GEM”: Critical reflections on progress in the HIV/AIDS epidemic. American Journal of Public Health, 97(1), 13–18. doi:10.2105/AJPH.2005.074591.

    Article  PubMed  Google Scholar 

  • Ehrhardt, A. A., Exner, T., Miller, S., & Stein, Z. (1992). Sexual risk behavior and behavior change in heterosexual women and men. New York: HIV Center for Clinical and Behavioral Studies at the New York Psychiatric Institute.

    Google Scholar 

  • Fisher, J. D., Fisher, W. A., Cornman, D. H., Amico, R. K., Bryan, A., & Friedland, G. H. (2006). Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 41(1), 44–52. doi:10.1097/01.qai.0000192000.15777.5c.

    Article  PubMed  Google Scholar 

  • Fogarty, L. A., Heilig, C. M., Armstrong, K., Cabral, R. J., Galavotti, C., Gielen, A. C., et al. (2001). Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women. Public Health Reports, 116(Supplement 1), S103–S119. doi:10.1093/phr/116.S1.103.

    Article  Google Scholar 

  • Gielen, A. C., Ghandour, R. M., Burke, J. G., Mahoney, P., McDonnell, K. A., & O’Campo, P. (2007). HIV/AIDS and intimate partner violence: Intersecting women’s health issues in the United States. Trauma, Violence & Abuse, 8(2), 178–198. doi:10.1177/1524838007301476.

    Article  Google Scholar 

  • Gielen, A. C., McDonnell, K. A., Burke, J. G., & O’Campo, P. (2000). Women’s lives after an HIV-positive diagnosis: Disclosure and violence. Maternal and Child Health Journal, 4(2), 111–120. doi:10.1023/A:1009522321240.

    Article  CAS  PubMed  Google Scholar 

  • Gilbert, P., Ciccarone, D., Gansky, S. A., Bangsberg, D. R., Clanon, K., McPhee, S. J., et al. (2008). Interactive “video doctor” counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings. PLoS ONE, 3(4), e1988.

    Article  PubMed  Google Scholar 

  • Golden, M., Wood, R. W., Buskin, S. E., Fleming, M., & Harrington, R. D. (2007). Ongoing risk behavior among persons with HIV in medical care. AIDS and Behavior, 11(5), 726–735. doi:10.1007/s10461-007-9244-5.

    Article  PubMed  Google Scholar 

  • Hedeker, D., & Gibbons, R. (1997). Application of random effects pattern mixture models for missing data in social sciences. Psychological Methods, 2(1), 64–78. doi:10.1037/1082-989X.2.1.64.

    Article  Google Scholar 

  • Kalichman, S. C. (2004). Positive prevention, reducing HIV transmission among people living with HIV/AIDS. New York: Kluwer.

    Google Scholar 

  • Kalichman, S. C., Rompa, D., Cage, M., DiFonzo, K., Simpson, D., Austin, J., et al. (2001). Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventive Medicine, 21(2), 84–92. doi:10.1016/S0749-3797(01)00324-5.

    Article  CAS  PubMed  Google Scholar 

  • Kvale, S. (1996). Interviews: An introduction to qualitative research interviewing. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Maman, S., & Medley, A. (2004). Gender dimensions of HIV status disclosure to sexual partners: Rates, barriers and outcomes. Geneva: World Health Organization.

    Google Scholar 

  • Morrow, K., Costello, T., & Boland, R. J. (2001). Understanding the psychosocial needs of HIV-positive women: A qualitative study. Psychosomatics, 42(6), 497–503. doi:10.1176/appi.psy.42.6.497.

    Article  CAS  PubMed  Google Scholar 

  • Patterson, T. L., Shaw, W., & Semple, S. (2003). Reducing the sexual risk behaviors of HIV-positive individuals: Outcomes of a randomized controlled trial. Annals of Behavioral Medicine, 25, 137–145. doi:10.1207/S15324796ABM2502_10.

    Article  PubMed  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods. Thousand Oaks, CA: Sage.

    Google Scholar 

  • Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Boland, R. J., Weiss, J., et al. (2004). Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: A multi-clinic assessment. AIDS (London, England), 18, 1179–1186. doi:10.1097/00002030-200405210-00011.

    Google Scholar 

  • Sandelowski, M., Lambe, C., & Barroso, J. (2004). Stigma in HIV-positive women. Journal of Nursing Scholarship, 36(2), 122–128. doi:10.1111/j.1547-5069.2004.04024.x.

    Article  PubMed  Google Scholar 

  • Sikkema, K. J., Hansen, N. B., Kochman, A., Tarkeshwar, N., Nuefeld, S., Meade, C. S., et al. (2007). Outcomes from a group intervention for coping with HIV/AIDS and childhood sexual abuse: Reductions in traumatic stress. AIDS and Behavior, 11, 49–60. doi:10.1007/s10461-006-9149-8.

    Article  PubMed  Google Scholar 

  • Simbayi, L. C., Kalichman, S. C., Strebel, A., Cloete, A., Henda, N., & Mqeketo, A. (2007). Disclosure of HIV status to sex partners and sexual risk behaviors among HIV-positive men and women, Cape Town, South Africa. Sexually Transmitted Infections, 83(1), 29–34. doi:10.1136/sti.2006.019893.

    Article  CAS  PubMed  Google Scholar 

  • Teti, M., Bowleg, L., & Lloyd, L. (2008). “Don’t ever stop these groups”: The role of group interventions for women living with HIV/AIDS (manuscript submitted for publication).

  • Teti, M., Rubinstein, S., Lloyd, L., Aaron, E., Merron-Brainerd, J., Spencer, S., et al. (2007). The protect and respect program for women living with HIV/AIDS. AIDS and Behavior, 11(Suppl 1), 106–116. doi:10.1007/s10461-007-9275-y.

    Article  Google Scholar 

  • The Healthy Living Project Team. (2007). Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: The healthy living project randomized controlled study. Journal of Acquired Immune Deficiency Syndromes, 44(2), 213–221. doi:10.1097/QAI.0b013e31802c0cae.

    Article  Google Scholar 

  • Wilson, T. E., Gore, M. E., Grange, S. J., Greenblatt, R., Cohen, M. H., Minkoff, H. L., et al. (2004). Changes in sexual behavior among HIV-infected women after initiation of HAART. American Journal of Public Health, 94(7), 1141–1146. doi:10.2105/AJPH.94.7.1141.

    Article  PubMed  Google Scholar 

  • Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior, 27(5), 539–565. doi:10.1177/109019810002700502.

    Article  CAS  Google Scholar 

  • Wingood, G. M., DiClemente, R. J., Mikhail, I., Lang, D. L., McCree, D. H., Davis, S., et al. (2004). A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl 2), S58–S67. doi:10.1097/01.qai.0000140603.57478.a9.

    PubMed  Google Scholar 

  • Zierler, S., & Krieger, N. (1997). Reframing women’s risk: Social inequalities and HIV infection. Annual Review of Public Health, 18, 401. doi:10.1146/annurev.publhealth.18.1.401.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors give special thanks to their supportive collaborators at HRSA, EPPEC, the Partnership Comprehensive Care Practice, and the School of Public Health at Drexel University. We are especially grateful to all of the women who participated in Protect and Respect. This research was supported by grant number 03048 from the Health Resources and Services Administration (HRSA) special projects of national significance (SPNS) program. This publication’s content is solely the responsibility of the authors and do not represent the official view of HRSA or the SPNS program.

Author information

Authors and Affiliations

  1. Drexel University School of Public Health, 1505 Race Street, Bellet Building, Floor 11, Philadelphia, PA, 19102, USA

    Michelle Teti & Marla Gold

  2. Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, PA, 19102, USA

    Lisa Bowleg & Susan Rubinstein

  3. Department of Education, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Russell Cole

  4. University of Texas School of Public Health, Houston, TX, 77030, USA

    Linda Lloyd

  5. Pennsylvania/MidAtlantic AIDS Education and Training Center, Philadelphia, PA, 19107, USA

    Susan Spencer & Ann Ricksecker

  6. Drexel College of Medicine, Philadelphia, PA, 19102, USA

    Erika Aaron

  7. Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, 19102, USA

    Zekarias Berhane

Authors
  1. Michelle Teti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa Bowleg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Russell Cole
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Lloyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Susan Rubinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Susan Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Erika Aaron
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ann Ricksecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zekarias Berhane
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marla Gold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelle Teti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Teti, M., Bowleg, L., Cole, R. et al. A Mixed Methods Evaluation of the Effect of the Protect and Respect Intervention on the Condom Use and Disclosure Practices of Women Living with HIV/AIDS. AIDS Behav 14, 567–579 (2010). https://doi.org/10.1007/s10461-009-9562-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-009-9562-x

Keywords

Search

Navigation