The rates of HIV infection and AIDS cases among women in the United States have increased significantly in the last decade. Thanks in large part to the work of advocacy groups and to action by the U.S. Congress, there has been some progress in making HIV/AIDS research and services more responsive to women's needs (e.g., including women in clinical drug trials and revising the Centers for Disease Control definition of AIDS to include infections typical in women). However, little progress has been made in addressing the need for prevention of HIV infection among women. This article examines how researchers using behavioral approaches to HIV prevention have largely ignored how gender, women's social status, and women's roles affect sexual risk behaviors and the ability to take steps to reduce risk of infection. Additional factors to be considered in theories that guide future HIV/AIDS prevention programs are examined.

Women's ability to negotiate safer sexual practices, particularly condom use, is a vital component of HIV/STD prevention strategies. Gender-based power imbalances may constrain women's negotiation ability, yet few empirical studies have tested the hypothesis that sexual relationship power constitutes a key factor in condom use negotiation. In this investigation, a new measure - the Sexual Relationship Power Scale (SRPS) - was applied. Data were collected from 388, mostly Latina, women at an urban community health centre in Massachusetts. Women with high levels of relationship power were five times as likely as women with low levels to report consistent condom use, after controlling for sociodemographic and psychosocial variables (p < 0.05). Population attributable risk estimates indicate that 52% of the lack of consistent condom use among women can be attributed to low sexual relationship power. The strong association between the Sexual Relationship Power Scale and consistent condom use supports the hypothesis that relationship power plays a key role in safer sex decision making. These findings underscore the importance of including the issue of relationship power in the design and implementation of programmes that promote sexual and reproductive health, as well as research investigating condom use and HIV risk.

Violent incidents were assessed as part of a prospective study of 1,243 pregnant women. Participants were predominantly poor, urban, minority group women. Seven percent (n = 92) of women reported physical or sexual violence during pregnancy.Most of the women (94 percent) knew their assailant. Victims of violence were at greater risk of having a history of depression and attempted suicide, having more current depressive symptoms, reporting less happiness about being pregnant, and receiving less emotional support from others for the current pregnancy. Comparisons of victims and non-victims showed that victims were more IntroductionA substantial proportion of women in the general population experience abuse and violence.'-8 Two recent studies6,7 indicate that 4 to 8 percent of pregnant women experience abuse during pregnancy and that this problem may be largely unreported to health care providers. Since the risk of abuse is higher for women in young adulthood and this time coincides with women's most active childbearing years,9 the experience of violence and abuse during pregnancy deserves special attention.In spite of the prevalence of violence experienced by women, and its damaging impact on women's health and mental health, few studies have attempted to identify the factors associated with violence during pregnancy. One such study found little difference between abused and non-abused pregnant women in race, age, marital status, employment or educational status.6 Another study7 found that, compared to non-abused women, women who experienced abuse during pregnancy were of lower socioeconomic status, higher parity, more likely to be single, and had a history of depression or other psychiatric symptoms. Abused women were also more likely to report alcohol use, and a trend in the data indicated that they may also have higher levels of illicit drug use.7 While this preliminary finding is consistent with previous associations between alcohol and drug use and family violence in the general population,8 methodological problems such as small numbers of abused women in the sample and reliance on self-reported drug use'0 limit firm conclusions about the role of these factors during pregnancy.The aims of the present analysis are: to describe the prevalence and patterns of violent incidents during pregnancy; to describe the association between demographic and psychosocial characteristics and violence during pregnancy; to investigate the association between the experience of violence during pregnancy and the use of alcohol and illicit drugs by pregnant women and their partners; and to investigate the association between the experience of violence

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Objective To examine efficacy of a brief behavioral intervention to promote condom use among female sex workers (FSWs) in two Mexico-U.S. border cities. Methods 924 FSWs aged ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez having recent unprotected sex with clients were randomized to a 30 minute behavioral intervention integrating motivational interviewing and principles of behavior change, or a didactic control condition. At baseline and six months, women underwent interviews and testing for HIV, syphilis, gonorrhea and chlamydia. Results Comparing intervention versus control groups, we observed a 40% decline in cumulative STI incidence (p=0.049). Incidence density for the intervention vs. control was 13.8 vs 24.92 per 100 person years (py) for STIs combined (p=0.034), and 0 vs. 2.01 per 100 py for HIV (p<0.001), with concomitant increases in total numbers and percentages of protected sex acts and decreases in total numbers of unprotected sex acts with clients (p<0.05). Conclusions This brief behavioral intervention shows promise in reducing HIV/STI risk behaviors among FSWs in two Mexican-U.S border cities, and may be transferable to other resource-constrained settings.

Culturally appropriate interventions are needed to identify and treat ulcerative sexually transmitted infections and reduce HIV risks associated with stimulants among FSWs in the Mexico-US border region.

Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.

IPV perpetration was common among our sample and was associated with increased sexual risk behaviors. Urban community health centers may offer an important venue for reaching this at-risk population.