Reducing HIV and Partner Violence Risk Among Women with Criminal Justice System Involvement: A Randomized Controlled Trial of Two Motivational Interviewing-based Interventions

Abstract

Women with histories of incarceration show high levels of risk for HIV and intimate partner violence (IPV). This randomized controlled trial with women at risk for HIV who had recent criminal justice system involvement (n=530) evaluated two interventions based on Motivational Interviewing to reduce either HIV risk or HIV and IPV risk. Baseline and 3, 6, and 9-month follow-up assessments measured unprotected intercourse, needle sharing, and IPV. Generalized estimating equations revealed that the intervention groups had significant decreases in unprotected intercourse and needle sharing, and significantly greater reductions in the odds and incidence rates of unprotected intercourse compared to the control group. No significant differences were found in changes in IPV over time between the HIV and IPV group and the control group. Motivational Interviewing-based HIV prevention interventions delivered by county health department staff appear helpful in reducing HIV risk behavior for this population.

Substance Abuse, Violence, and HIV in Women: A Literature Review of the Syndemic

“…15,17,[22][23][24][25][26][27][28][29][30] Drug risk taking was variously defined as any injection drug use, recent injection drug use, any substance abuse (drugs or alcohol), or needle sharing. Sexual risk taking was described in terms of episodes of unprotected sex, having multiple sexual partners, or substance use during sex.…”

“…Two interventional trials among HIV-infected and high-risk populations are reviewed here. 26,30 Although the interventions described were somewhat effective at promoting condom use in the short term, it proved exceedingly more difficult to effectively intervene to reduce exposure to violence and needle sharing, retain these participants in the intervention, and provide durable benefits from the intervention.…”

Leveraging the U.S. Criminal Justice System to Access Women for HIV Interventions

“…HAPPEN was feasible and acceptable in part because of its flexibility and patient-centered focus but again was limited by accrual, attrition, and heterogeneity of the study sample. Another major gender-specific intervention referred HIV uninfected women from multiple CJ sites (jail, parole, probation) and enrolled those eligible in partnership with a county HIV prevention program (51). The HIV and IPV risk reduction intervention was based on motivational interviewing techniques and found to successfully and sustainably reduce condomless sex, needle sharing, and IPV compared to controls.…”

Intimate Partner Violence and Human Immunodeficiency Virus Risk Among Black and Hispanic Women

“…15,17 They also highlight the need for interventions that enhance women's sexual risk assessment skills, sexual communication skills, and condom use selfefficacy in tandem with providing IPV prevention strategies and exit plans. [44][45][46][47][48][49] Healthcare providers in clinical settings have the opportunity to address IPV and fear of IPV that some women may experience in negotiating safer sex. 17 In this analysis, IPV-physical violence and IPV-forced sex are independently associated with current or recent homelessness and non-injection drug use for participating women, consistent with previous reports.…”

“…An emerging line of IPV/HIV interventions teach women sexual risk prevention strategies (e.g., condom negotiations); IPV prevention strategies; and how to access community resources when experiencing IPV. [44][45][46] These types of efforts should be replicated and tailored for women of color in high-HIV incidence communities.…”