| Programs
Tailored to Women |
| |
Women
are the fastest
growing group
of people being
infected with
HIV. Although
women account
for only one-quarter
of rural AIDS
cases, the rate
of infection
is increasing,
particularly
among African
American women
living in the
South. More
than 80% of
women diagnosed
with HIV in
2008 were infected
by exposure
from heterosexual
sex with a male
partner. Over
15% of rural
women diagnosed
with HIV in
2008 were
exposed to HIV
from injecting
drugs.[1]
Women of color
living in the
South have historically
had higher rates
of STDs, which
puts them at
greater risk
for HIV infection.
Much of women’s
vulnerability
comes from their
lack of power
to control the
behaviors of
their sexual
partners. Poverty,
homelessness,
illiteracy,
substance use,
and unemployment
may contribute
to rural women
staying in unhealthy
relationships
for economic
survival.[10]
Interventions
that encourage
women’s empowerment
and employment
are more common
in developing
countries than
the U.S. as
part of HIV
prevention efforts.
Women benefit
from having
the social support
and skills to
negotiate safer
sex practices.
Women who trade
sex for money
or drugs are
an especially
vulnerable group.
However, in
rural America,
these women
may be especially
difficult to
identify and
recruit into
an intervention
due to high
levels of stigma,
fear of arrest,
and a desire
to keep these
behaviors “hidden.”
Rural culture
laden with traditional
gender roles,
homophobia,
and racism may
also contribute
substantially
to women of
color being
at heightened
risk for HIV.
This section
presents adaptations
of several
evidence-based
interventions
that have been
developed for
Black women
of different
ages have
been tested
in rural areas.
SISTA for
African
American
Women
and Incarcerated
Women |
Target
Behaviors
and
Behavioral
Determinants
Unprotected
sex with a partner who
has power over the use of
condoms; lack of knowledge
and skills to negotiate
and use condoms, negotiate
relationships, make decisions;
perceived lack of power;
lack of racial or ethnic
pride.
Description
SISTA
(Sisters
Informing
Sisters
on Topics
about
AIDS) (DEBI) is
a group-level,
gender
and
culturally-tailored
intervention
designed
to increase
correct
and
consistent
condom
use
among
African
American
women.
Five
peer-led
group
sessions
are
conducted
by a
trained,
skilled,
female
facilitator.
Sessions
focus
on racial,
ethnic
and
gender
pride,
HIV/STD
knowledge,
and
the
development
of condom
negotiation
and
decision
making
skills.
Originally
designed
for
urban
women.
Adaptation
SISTA
has
been
adapted
for
use
in rural
communities
and
for
women
in rural
county
jails.
In western
Alabama,
the
local
women
preferred
having
the
five
2-hour
sessions
in one
week.
They
discuss
and
modify
the
time
of day
for
the
sessions
throughout
the
week
to accommodate
the
women’s
schedules.
On-site
HIV
testing
is offered
after
session
2.
In the
jails,
the
jail
sets
the
schedule
for
the
sessions.
Evidence
The
week-long
SISTA
project
in western
Alabama
is well-received
enough
to be
conducted
twice
every
month
in different
rural
towns. Evaluations
indicate
that
the
vast
majority
of the
women
found
the
information
beneficial
and
empowering.
The
participants
indicated
that
the
role
plays
and
scenarios
reflected
their
situations.
Participants
from
the
same
housing
projects
have
continued
to meet
independently as
an ongoing
support
group
after
the
intervention.
The
incarcerated women
noted
they
felt
empowered
to change
behaviors
when
released.
SISTA
evaluation
materials
for
each
session
are
administered
and
reviewed
by the
facilitator
to improve
the
next
session
but
data
for
all
programs
have
not
been
aggregated
or analyzed.
Recommendations
Work
with
housing
assistance
programs
in communities
and
directly
with
the
jails
to identify
women
who
might
benefit
from
SISTA.
Providing
relevant
information,
offering
transportation,
food,
and
prizes,
and
making
the
schedule
flexible
to fit
the
women’s
needs
all
help
make
attending
SISTA
important
to the
women,
which
in turn
increases
participation.
A thank
you
card
after
the
program
reminds
the
women
about
the
course
messages
and
about
resources
available
to them.
Where
Implemented
Western
Alabama
Contact
Information
Ann James
West
Alabama
AIDS
Outreach
205-759-8470
|
|
Target
Behaviors
and
Behavioral
Determinants
Unprotected
sex
with
a partner
who
has
power
over
the
use
of condoms;
lack
of knowledge
and
skills
to negotiate
and
use
condoms,
negotiate
relationships,
make
decisions;
perceived
lack
of power;
lack
of ethnic
pride.
Description
Reinvention
of
SISTA
(Sisters
Informing
Sisters
on
Topics
about
AIDS) (DEBI)
This
group-level,
gender
and
culturally-tailored
intervention,
was
originally
designed
to increase
correct
and
consistent
condom
use
among
African
American
women.
In this
case
it has
been
reinvented
for
use
with
Native
American
women.
Five
peer-led
group
sessions
are
conducted
by a
skilled,
Native
American
female
facilitator.
Sessions
focus
on ethnic
and
gender
pride,
HIV/STD
knowledge,
and
skills
training
around
sexual
risk
reduction
behaviors
such
as negotiating
condom use
and
decision
making.
The
intervention
is based
on Social
Learning
theory
as well
as the
Theory
of Gender
and
Power.
Adaptation
Although
the
five
sessions
and
most
of
the
core
content
have
been
retained
in
the
reinvention,
much
of
the
intervention
has
been
redesigned
to
reflect
Native
American
culture
and
the
power
distribution
in
American
Indian
heterosexual
relationships.
The
CDC
suggests
that
any
adaptation
of
a
DEBI
that
includes
the
addition
or
subtraction
of
activities
(such
as
replacing
African-American
poetry
readings
with
Native American
stories)
be
considered
a
reinvention
and
collect
evaluation
data
to
test
the
efficacy
of
the
reinvented
intervention.
Evidence
The
original
research
showed
that
women
who
completed
the
intervention
were
more
likely
than
a
comparison
group
to
use
condoms.
Evaluation
evidence
from
the
reinvention
is
in
the
process
of
being
collected
but
is
not
yet
available.
Recommendations
Using
a
facilitator
who
is
the
same
gender,
race/ethnicity,
and
age
and
is
trained
in
the
intervention
encourages
women
to
be
engaged
in
the
activities
of
this
intervention.
Reinvention
is
a
time-consuming
process
that
starts
with
information
about
the
target
population.
It
requires
pilot
testing
and
revision
before
implementation.
Matching
the
cultural
values
in
the
intervention
with
the
cultural
values
of
the target
audience
is
essential.
Where
Implemented
Indian
reservations
in rural
Montana
Contact
Information
Montana
Department
of Public
Health
and
Human
Services
406-444-2457
|
|
Target
Behaviors
and
Behavioral
Determinants
Correct
and
consistent
condom
use
with
casual
or
non-main
partners;
increased
communal
caring
behavior
demonstrated
by
peers
discussing
safer
sex,
psychosocial
issues
such
as
low
levels
of
self
esteem,
experience
of
discrimination,
and
cultural
pride;
reduced
sex
under
the
influence
of
alcohol
or
other
drugs;
self-efficacy
to
talk
to
partners
about
condom
use;
decrease
in
number
of
sexual
partners.
Description
This
community-level
DEBI
intervention
uses
community
assessment,
trained
peer
advocates,
and
the
creation
and
distribution
of
culturally
relevant
role
model
stories
and
risk
reduction
materials
tailored
to
the
population’s
stage
of
change.
The
intervention’s
goal
is
to
move
women
at
high-risk
for
unprotected
sex
with
casual
or
non-main
partners toward
safer
behaviors.
Outreach
is
done
in
bars
and
clubs
in
Anchorage
and
is
culturally
relevant
for
Alaska
Native
and
multi-cultural
women.
Peer
Advocates
from
the
target
audience
distribute
glossy
role
model
stories
and
free
condoms
to
friends
in
bars
and
clubs.
Evidence
The
project
has
created
and
published
7 role
model
stories
in 1.5
years
of implementation
and
has
overcome
initial
resistance
of the
target
audience.
All
of the
stories
encourage
these
women
to become
more
aware
of their
risk
and
contemplate
behavior
change.
The
project
has
been
funded
to conduct
a rigorous
evaluation
of the
outcomes.
Recommendations
Make
role model
stories
small
enough
to fit
in a woman’s
purse
and print
with color
and glossy
finish
to compete
with other
materials
in a bar
setting.
Stories
need to
reflect
the multi-cultural
backgrounds
of the
women
and have
subtle
suggestions
for small
changes,
like talking
to
partners
about
using
a condom.
Peer Advocates
should
work in
teams
for safety. By
going
to the
women
where
they congregate,
the program
reaches
the target
audience
and avoids
extra
costs
for a meeting
space,
transportation,
and childcare.
The intervention
requires
a large
enough
town to
have enough
venues
and at-risk
population.
Where
Implemented
Urban
Alaska
Contact
Information
Michael
Covone
Alaska
Native
Health
Consortium
mrcovone@anthc.org
907
729-2907
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