Violence and HIV Risk Among Women

The two foremost health problems impacting young adult women are STDs/HIV infection and
intimate partner violence (IPV). STDs pose a significant public health issue in the US,
particularly among women. The consequences of some STDs are more severe for women, and
include infertility, pelvic inflammatory disease, and brain, cardiovascular, and organ
damage. Women with STDs are at increased risk for HIV. The proportion of AIDS cases among US
adult and adolescent women has more than tripled since 1985. Approximately 12,000 US women
are infected with HIV annually, primarily through heterosexual contact. Also, in the US HIV
is particularly affecting women of color and those in low-income urban areas.

IPV also affects many women. While the causal links between IPV and HIV risk or infection
have not yet been established, emerging empirical evidence has drawn connections between IPV
with HIV risk. Several researchers have highlighted the importance of developing sexual risk
reduction interventions that address the growing concern of gender-based violence against
women. Also, scholars are calling for HIV prevention programs aimed at women to be more
comprehensive; for example, by combining them with STD screening or with programs designed
to reduce violence against women. Despite this call, there are very few empirically tested
interventions for prevention and treatment targeting women who are at risk for STDs/HIV and
experience IPV in their intimate relationships. To address high risk sexual behaviors among
women who experience gender-based violence in their intimate relationships, I have adapted
an existing information-motivation-behavioral skills (IMB) STD/HIV prevention intervention
for reducing high sexual risk-taking behaviors. The STD/HIV and IPV comprehensive
intervention will address both sexual risk reduction and IPV risk; the intention is to help
women to acquire knowledge, skills, and strategies that will reduce their risk for both
STDs/HIV and IPV.

Aim 1: To assess the feasibility and acceptability of the adapted IMB STD/HIV prevention
intervention by implementing the intervention with a sample of women who are at risk for
HIV/STDs and experience IPV. To achieve this aim:

1. 120 women who are at risk for HIV/STDs and have experienced IPV will be randomized
either to receive the experimental prevention intervention or to attend a structurally
similar drop-in enhanced support group at a domestic violence agency.

2. Enrollment, attendance, and attrition data will be used to determine the feasibility of
the intervention.

3. The acceptability of the intervention will be appraised by analyzing pre- and
post-intervention acceptability ratings completed by subjects and interventionists.

Aim 2: To gather preliminary evidence of the efficacy of the theoretically guided
intervention using a controlled design. To achieve this aim:

1. Women in the experimental and control groups will be assessed at baseline,
post-intervention, and at a 3-month follow-up.

2. Outcome analyses to calculate effect sizes for use in future power analyses for a
larger RCT of the proposed intervention will include measures on primary variables of
hypothesized risk antecedents, standard measures of protected and unprotected sex, and
secondary variables such as mental health, self esteem, and IPV experiences.

Inclusion Criteria:

Women will be eligible to participate in the research study if they meet the following
criteria:

- between ages 18 and 49;

- heterosexually active;

- have experienced intimate partner violence in the last three months;

- have engaged in risky sexual behavior in the past three months;

- not currently pregnant or trying to become pregnant; and

- physically and psychologically capable of providing informed consent. All subjects
will be required to provide written informed consent prior to enrolling in the study.

Exclusion Criteria:

Persons who meet one or more of the following criteria will be excluded from the study:

- men;

- women who have active psychosis or impaired mental status (confirmed with a
Mini-Mental Status Exam);

- are unable to understand spoken English;

- are less than 18 years old or greater than 49 years old;

- are currently pregnant or trying to become pregnant

- women who are exclusively in same-sex relationships.