A Randomized Controlled Trial to Reduce HIV Transmission Risk Behaviors and Sexually Transmitted Diseases Among Women Living With HIV -- The WiLLOW Program

According to CDC, the authors noted, the number of women with HIV/AIDS almost tripled between 1993-2002, compared to slightly less than a doubling of the number of men living with AIDS over the same period. Efforts to reduce risk behaviors, according to the study, have focused on providing HIV testing and counseling and produced only modest reductions in sexual risk behaviors among people with HIV.

The current study evaluated the efficacy of a sexual risk reduction and social network intervention, WiLLOW (women involved in life learning from other women), to reduce HIV sexual-transmission risk behaviors and STDs and to enhance psychosocial mediators and structural factors associated with preventive behaviors among 366 women living with HIV.

From September 1997 to December 2000, researchers recruited participants from 7 of the largest clinics and health departments offering medical care to women with HIV in Georgia and Alabama. Women ages 18-50 who sought HIV/AIDS care at study recruitment sites were eligible if they were sexually active in the previous 6 months and provided informed written consent. The women had been living with HIV for an average of 5 years, had a mean age of 34.7 years and 84.2 percent were black. Although 63.7 percent had completed high school, 70.2 percent did not work and 83.3 percent had 1 or more children.

The authors conducted a randomized controlled trial to assess the WiLLOW intervention: 4 4-hour interactive group sessions implemented over consecutive weeks. Each session included 8-10 participants, was implemented by a trained female health educator, and was co-facilitated by an HIV-positive female peer educator. "To reduce the likelihood that the effects of the intervention could be attributed to group interaction or Hawthorne effects, participants randomized to the health promotion condition also received 4 4-hour interactive group sessions administered over consecutive weeks," the authors explained. "These sessions addressed medication adherence, nutrition, and provider interaction skills. Before implementing the main trial, both conditions were field tested with women living with HIV and modified based on participant feedback."

The investigators collected data at baseline and at 6- and 12-month follow-ups. The WiLLOW intervention emphasized gender pride, maintaining current and identifying new network members, HIV transmission knowledge, communication and condom use skills and healthy relationships. Of the 366 participants, 190 were randomized to the WiLLOW intervention and 176 to the comparison group.

The study found that women in the WiLLOW intervention, relative to the comparison group, reported fewer episodes of unprotected vaginal intercourse, were less likely to report never using condoms, had a lower incidence of bacterial infections, reported greater HIV knowledge and condom use self-efficacy, more network members, fewer beliefs that condoms interfere with sex, fewer partner-related barriers to condom use and demonstrated greater skill at using condoms. "This is the first trial to demonstrate that an intervention can reduce HIV transmission risk behaviors and enhance psychosocial mediators and structural factors associated with HIV-preventive behaviors among women living with HIV," the authors wrote. "Moreover, this trial observed an intervention effect on the reduction of incident bacterial STDs among these women. Because STDs facilitate HIV transmission, small reductions in incident STDs could yield substantial reductions in HIV morbidity and its associated treatment costs."

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