Reducing HIV Risk Behaviors and Increasing Sexual Communication Skills in African American Women with At-Risk Male Partners

Sergio Avina, JWCH Institute, Inc.; Nina Harawa, Charles R. Drew University of Medicine and Science
Social and Behavioralal

Racial/ethnic disparities in the U.S. HIV/AIDS epidemic have been most apparent among women. Since the early 1980s, African American women have accounted for at least six of every ten female AIDS cases, while composing just 13% of the population. National HIV/AIDS rates among Black women are currently 24 and 4.1 times those of White and Latina women. The majority of these HIV/AIDS cases have been attributed to heterosexual sex, often with a male of unknown HIV risk who may have had sex with other men or injected drugs (IDUs). The risk of transmission from bisexual men is particularly relevant in California, where men who have sex with men compose more than 60% of all HIV/AIDS cases and heterosexual transmission from IDUs plays a relatively minor role in the epidemic. Sociocultural factors that uniquely impact African American heterosexual partnerships call for HIV risk-reduction interventions that are specifically designed for African American women with at-risk male partners (i.e., behaviorally bisexual or drug-using partners, those with unknown HIV risk histories, etc.). We propose to develop and evaluate the Females of African American Legacy Empowering Self (FemAALES) Project, a novel and culturally congruent intervention guided by the Theory of Reasoned Action and Planned Behavior, the Critical Thinking and Cultural Affirmation (CTCA) Model, and the Empowerment Theory. This small-group intervention involves six two-hour group sessions lead by an ethnically and gender-matched facilitator and uses online technologies to reinforce concepts, foster social support, and provide low-cost opportunities for sustained intervention exposure. The primary aims are to: (1) develop and test the FemAALES intervention based on formative research and review of local data and published literature and to (2) reduce HIV-related sexual risk behaviors and (3) increase sexual negotiation skills and racial/ethnic and gender pride among African American women with at-risk male partners. In addition, we will explore the intervention’s impact on the frequency of sex under the influence of drugs. FemAALES will be fully developed and implemented in three phases. Phase 1 will involve formative research to guide and develop the intervention curriculum, including conducting and analyzing three focus groups with the target population and one with community service providers. Phase 2 will involve a pilot test of the intervention with two groups of FemAALES participants and one group of waitlisted controls. In the full trial, controls will be waitlisted to later receive Healthy Alternatives for Reducing the Risk for HIV Infection Project (HARRP) -- an untested and non-risk, gender, or ethnic group-specific intervention currently being used by the applicant organization. Phase 3 will involve a preliminary test of both interventions with a total of 120 African American women evenly randomized to the FemAALES and waitlisted HARRP conditions. Participants will be assessed at baseline, post- and three months following intervention completion. Bivariate and multiple regression analyses will be used to examine changes in the outcomes of interest among the intervention conditions (FeMAALES, waitlist, and HARRP), mediating effects, and dose- response associations. Study findings will be used to seek funding for a large-scale intervention trial and will be disseminated throughout California for use by policy makers, researchers, and other community organizations.