Pilot Test of an Adapted, Evidence-Based HIV Sexual Risk Reduction Intervention for Homeless Women

Abstract

Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.

Behaviour change techniques in brief interventions to prevent HIV, STI and unintended pregnancies: A systematic review

“…Table 1 describes the main characteristics of the included studies. Most studies were RCTs (n = 28), quasi-experimental studies (n = 4) [ 24 – 27 ], secondary analyses of RCTs (n = 2) [ 28 , 29 ] and three had other experimental study designs (n = 3) [ 30 – 32 ]. The majority of the studies were conducted in the USA (including Puerto Rico) (67.5%) and South Africa (13.5%) [ 29 , 33 – 36 ].…”

“…In three studies, the settings were a University clinical psychology laboratory and an HIV/AIDS prevention, treatment and research unit [ 18 , 37 , 43 ]. In one study the settings were temporary service sites services for homeless women [ 27 ].…”

“…In most of the studies, participants were STI clinic patients (n = 16), young people or adolescents (n = 5) [ 18 , 37 , 43 , 55 , 59 ], people living with HIV (PLWH) (n = 5) [ 24 , 25 , 33 , 42 , 45 ], men who have sex with men (MSM) (n = 7) [ 26 , 28 , 41 , 44 , 46 , 49 , 56 ], female sex workers (FSW) (n = 2) [ 38 , 39 ], PICT (provider-initiated HIV testing and counselling) patients n = 1 [ 32 ], and homeless women n = 1 [ 27 ]. Sample size ranged from 79 [ 27 ] to 38,635 participants [ 47 ].…”

“…STI reported diagnoses, reduction in the rate of pregnancies, HIV/STI incidence, STI reinfection), behavioural (i.e. number of unprotected vaginal and anal sex acts, percentage of safe sex behaviour, unprotected anal intercourse with steady and with non-steady partners) [ 25 , 26 ], or a combination of both [ 27 , 35 , 38 , 48 , 49 , 52 , 53 , 55 – 59 ]. With a 6 months median, follow-ups ranged from 1 month [ 27 , 43 ] to 30 months [ 25 ].…”

“…number of unprotected vaginal and anal sex acts, percentage of safe sex behaviour, unprotected anal intercourse with steady and with non-steady partners) [ 25 , 26 ], or a combination of both [ 27 , 35 , 38 , 48 , 49 , 52 , 53 , 55 – 59 ]. With a 6 months median, follow-ups ranged from 1 month [ 27 , 43 ] to 30 months [ 25 ]. Nine studies reported a 12-months follow-up, 12 studies reported a 6-months follow-up, three indicated a 9-months follow-up [ 50 , 51 , 59 ], one had a 7 months-follow-up [ 55 ], two had a 4-months follow-up [ 18 , 37 ], three studies indicated a 3-months follow-up [ 36 , 44 , 45 ] and two studies indicated a 1-month follow-up [ 27 , 43 ].…”