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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

Women Involved in Life Learning from Other Women (WiLLOW)

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Intervention Description

Target Population
Sexually–active, female clinic patients living with HIV

Goals of Intervention

  • Reduce HIV transmission risk behaviors
  • Reduce sexually transmitted diseases (STDs)
  • Enhance HIV-preventive psychosocial and structural factors

Brief Description

The WiLLOW intervention is a small group, skill-training intervention for women living with HIV. Through interactive discussions within groups of 8–10 women, the intervention emphasizes gender pride and informs women how to identify and maintain supportive people in their social networks. The intervention enhances awareness of HIV transmission risk behaviors, discredits myths regarding HIV prevention for people living with HIV, teaches communication skills for negotiating safer sex, and reinforces the benefits of consistent condom use. WiLLOW also teaches women how to distinguish between healthy and unhealthy relationships, discusses the impact of abusive partners on safer sex, and provides information about local shelters for women in abusive relationships

Theoretic Basis

  • Social Cognitive Theory
  • Theory of Gender and Power
Intervention Duration
Four 4-hour sessions delivered over 4 consecutive weeks

Intervention Setting
A community site set up to deliver the intervention and an HIV service clinic

Deliverer
Trained female health educator and female peer educator living with HIV

Delivery Methods
  • Demonstration
  • Group Discussion
  • Lecture

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Intervention Package Information

An intervention package and training are currently being developed with funding from CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.

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Evaluation Study and Results

The original evaluation study was conducted in Anniston, Birmingham, and Montgomery, Alabama and in Atlanta, Georgia between 1997 and 2002. The study sample included 366 women living with HIV, 64% of whom had a high school education.

Key Intervention Effects
  • Reduced unprotected vaginal sex
  • Reduced new STDs
  • Increased condom use

Study Sample

  • 84% African American, 15% White,1% Other
  • 100% Female
  • Mean age of 35 years

Recruitment Settings
Clinics and health departments providing medical care to women living with HIV/AIDS

Eligibility Criteria
Women were eligible if they were between the ages of 18 and 50 years, sought medical care for HIV/AIDS at the study recruitment site, were sexually active in past 6 months, and provided written informed consent.

Assignment Method
Women were randomly assigned to either the WiLLOW intervention group (n = 190) or to a Health Promotion comparison group (n = 176).

Comparison Group
The Health Promotion comparison intervention consisted of four 4-hour interactive group sessions delivered over 4 weeks by a trained female health educator and a peer educator. This intervention addressed medication adherence, nutrition, and provider interaction skills.

Relevant Outcomes Measured and Follow-up Time

  • Sexual risk behaviors during the previous 30 days (including number of unprotected vaginal sex acts and percentage of participants never using a condom) were measured at the 6- and 12-month follow-ups.
  • Incident STDs, including chlamydia or gonorrhea, were measured at the 6- and 12-month follow-ups.

Participant Retention

  • WiLLOW Intervention:
    93% retained at 6 months
    85% retained at 12 months
  • Health Promotion Comparison:
    94% retained at 6 months
    90% retained at 12 months

Significant Findings

  • At the 6- and 12-month follow-ups, women who received the WiLLOW intervention reported significantly fewer episodes of unprotected vaginal sex and were significantly less likely to report never using condoms than women in the Health Promotion comparison.
  • Over the 12-month follow-up, women in the WiLLOW intervention were significantly less likely to acquire new bacterial STDs (chlamydia and gonorrhea) than women in the Health Promotion comparison.

Considerations
None

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References and Contact Information

  • Wingood, G.M., DiClemente, R.J., Mikhail, I., et al. (2004). A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: The WiLLOW program. Journal of Acquired Immune Deficiency Syndromes, 37, S58–S67.

Researcher: Dr. Gina M. Wingood
Rollins School of Public Health, Emory University
1518 Clifton Road, NE, BSHE/Room 556
Atlanta, GA 30322
e-mail: gwingoo@sph.emory.edu

 

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