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Compendium of Evidence-Based HIV Behavioral Interventions

Women’s Co-Op

BEST-EVIDENCE

Intervention Description

Target Population
African American women who use crack and are not in drug treatment

Goals of Intervention

  • To reduce sex risk behaviors (including trading sex for money or drugs and unprotected sex) and drug use (i.e., number of days using crack)
  • To increase employment and housing status

Brief Description

The Women’s Co-Op is a woman-focused intervention that incorporates gender- and culture-specific skills training for crack-using African American women. The first 2 sessions are delivered to women individually, and focus on pre- and post-test counseling for HIV. Session 1 includes a personal HIV risk assessment, and provides women with skills training on condom and dental dam use and syringe cleaning. Session 2 includes receipt of HIV test results, the development of an individualized risk assessment plan, and a repeat of the skills training from Session 1. The final 2 sessions are delivered to small groups of 2 to 5 women, and use a support-based format to help women develop skills that can reduce their risk of HIV. These sessions include the development of communication and problem solving skills that increase women’s sense of power and ability to cope with stress.


Theoretic Basis
  • African American Feminism
  • Empowerment Theory

Intervention Duration
Four sessions delivered over 6 weeks. Sessions 1 and 2 lasted 30–40 minutes each, and Sessions 3 and 4 lasted 60–90 minutes each.

Intervention Setting
Church basements and residential buildings

Deliverer
African American female living in the community

Delivery Methods

  • Counseling
  • Goal setting
  • Printed materials
  • Supplies

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Intervention Package Information

An intervention package is not available at this time. Contact Dr. Wendee Wechsberg, RTI International, 3040 Cornwallis Drive, P.O. Box 12194 Research Triangle Park, NC 27709-2184, e-mail: wmw@rti.org, for details on intervention materials.

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Evaluation Study and Results

The original evaluation study was conducted in Wake County and Durham County, North Carolina between 1999 and 2002. The analysis sample included 620 African American women who completed at least one follow-up interview.

Key Intervention Effects
Reduced any unprotected sex

Study Sample

  • 100% African American
  • 100% Female
  • Mean age of 37 years

Recruitment Settings
Outreach targeted inner-city neighborhoods identified as having high levels of illicit drug use and violence.

Eligibility Criteria
Women were considered eligible for the evaluation if they were at least 18 years of age, reported engaging in unprotected sex during the previous 90 days, admitted using crack on at least 13 of the past 90 days, and not in substance abuse treatment within the past 30 days.

Assignment Method
Women were enrolled and randomly assigned following intake to 1 of 3 groups: Women’s Co-Op (n = 261), Standard-R intervention (n = 253), or delayed treatment control (n =248).

Comparison Group
The Standard-R intervention included 2 sessions delivered to individuals and 2 sessions delivered to small groups over 6 weeks. The 2 individual sessions focused on HIV pre- and post-test counseling, and the 2 group sessions emphasized general health education on nutrition, hygiene, physical health, and breast self-examination. The delayed treatment control was invited to attend the Standard-R intervention after the evaluation was completed.

Relevant Outcomes Measured and Follow-up Time

  • Any unprotected sex, any trading sex for money or drugs, and the number of days using crack during the prior 30 days were measured at 3 and 6 months after randomization.
  • The follow-up time points translate to approximately 1.5- and 4.5-months post-intervention.

Participant Retention

  • Women’s Co-Op Intervention:
    71% retained at 1.5 months
    77% retained at 4.5 months
  • Standard-R intervention:
    74% retained at 1.5 months
    71% retained at 4.5 months
  • Delayed treatment control:
    77% retained at 1.5 months
    76% retained at 4.5 months

Significant Findings
At 4.5 months post-intervention, women in the Women’s Co-Op intervention group were significantly less likely to report any unprotected sex compared to women in the delayed treatment control group (p = 0.03).

Considerations
The Women’s Co-Op intervention was also associated with significant decreases in sex trading, mean number of crack-use days, and homelessness, as well as a significant increase in full-time employment compared to the delayed treatment control at the 1.5– month post-intervention follow-up. All of these outcomes were targeted by the intervention.

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References and Contact Information

  • Wechsberg, W.M., Lam, W.K., Zule, W.A. et al. (2004). Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African American crack abusers. American Journal of Public Health, 94, 1165–1173.
  • Wechsberg, W.M., Lam, W.K., Zule, W. et al. (2003). Violence, homelessness, and HIV risk among crack-using African-American women. Substance Use and Misuse, 38, 669–700.

Researcher: Dr. Wendee Wechsberg
RTI International
3040 Cornwallis Drive, P.O. Box 12194
Research Triangle Park, NC 27709-2184 USA.
e-mail: wmw@rti.org

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