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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2001 Dec;78(4):593–604. doi: 10.1093/jurban/78.4.593

A brief sexual barrier intervention for women living with AIDS: Acceptability, use, and ethnicity

Deborah L Jones 1,✉, Stephen M Weiss 2, Robert Malow 3, Mary Ishii 2, Jessy Devieux 2, Heidi Stanley 2, Andrea Cassells 4, Jonathan N Tobin 4,5, Elizabeth Brondolo 4,6, Arthur LaPerriere 3, Jonell Efantis-Potter 2, Mary Jo O'Sullivan 2, Neil Schneiderman 2
PMCID: PMC3455871  PMID: 11796806

Abstract

Interventions aimed at reducing sexual transmission of human immunodeficiency virus/sexually transmitted diseases (HIV/STDs) have focused primarily on male condom use among seronegative men and women. However, female-controlled sexual barriers (female condoms and vaginal microbicides) offer women living with acquired immunodeficiency syndrome (AIDS) alternative methods to protect themselves and others from disease transmission. A pilot behavioral intervention was conducted to increase sexual barrier use and enhance and assess factors related to acceptability. Participants (N=178) were drawn from the Stress Management and Relaxation Training with Expressive Supportive Therapy (SMART/EST) Women's Project, a multisite phase III clinical trial for women living with AIDS (Miami, FL; New York City, NY; Newark, NJ). Intervention participants (n=89) were matched for age and ethnicity with control condition participants (n=89). Women were African American (52%), Haitian (15%), Hispanic (19%), Caucasian (10%), and other ethnicities (4%). The intervention condition received barrier products (male and female condoms and spermicides based on nonoxynol-9 in the form of vaginal gel, film, and suppositories) during three sessions held over 3 months. Data on barrier use and acceptability were analyzed at baseline and 3 and 9 months postintervention. Use of N-9 spermicides on a trial basis increased significantly by 3 months in the intervention conditions (22%–51%, P<.05). Cultural differences in acceptability were greatest between Haitian women and women in other ethnic groups. Exposure to this pilot behavioral intervention was associated with increased acceptability and use of chemical barriers without decreased use of male condoms.

Keywords: Acceptability, Ethnicity, HIV/AIDS, Sexual barriers, Women

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References

  • 1.Centers for Disease Control and Prevention HIV and AIDS—United States, 1981–2000. MMWR Morb Mortal Wkly Rep. 2000;50(21):2–6. [Google Scholar]
  • 2.Marlink R, Kao H, Hsieh E. Clinical care issues for women living with HIV and AIDS in the United States. AIDS Res Hum Retroviruses. 2001;17:1–33. doi: 10.1089/088922201750056753. [DOI] [PubMed] [Google Scholar]
  • 3.Wilson T, Augenbraun M. Sexually transmitted disease among women with HIV infection: a missed opportunity for intervention. AIDS Read. 1999;9:573–577. [PubMed] [Google Scholar]
  • 4.Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999;75:3–17. doi: 10.1136/sti.75.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Royce RA, Sena A, Cates W, Cohen MS. Sexual transmission of HIV. N Engl J Med. 1997;336:1072–1078. doi: 10.1056/NEJM199704103361507. [DOI] [PubMed] [Google Scholar]
  • 6.Puisis M, Levine WC, Mertz KJ. Overview of sexually transmitted diseases. In: Puisis M, editor. Clinical Practice in Correctional Medicine. St. Louis, MO: Mosby; 1998. pp. 127–133. [Google Scholar]
  • 7.Stamm WE, et al. Chlamydia trachomatis infections of the adult. In: Holmes KK, Sparling PF, Mardh PA, et al., editors. Sexually Transmitted Diseases. 3rd ed. New York, NY: McGraw-Hill; 1999. pp. 18–27. [Google Scholar]
  • 8.Women and HIV Prevention: Methods of Personal Protection. New York, NY: New York State Department of Health AIDS Institute; 1992. [Google Scholar]
  • 9.Gollub E, French P, Loundou A, Latka M, Rogers C, Stein ZA. A randomized trial of hierarchical counseling in a short, clinic-based intervention to reduce the risk of sexually transmitted diseases in women. AIDS. 2000;14:1249–1255. doi: 10.1097/00002030-200006160-00023. [DOI] [PubMed] [Google Scholar]
  • 10.Latka M, Gollub EL, French PP, Stein ZA. Male-condom and female-condom use among women after counseling in a risk-reduction hierarchy for STD prevention. Sex Transm Dis. 2000;27:431–437. doi: 10.1097/00007435-200009000-00002. [DOI] [PubMed] [Google Scholar]
  • 11.Stein Z, Saez H, el-Sadr W, et al. Safer sex strategies for women: the hierarchical model in methadone treatment clinics. J Urban Health. 1999;76:62–72. doi: 10.1007/BF02344462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Malow RM, Ziskind D, Jones D. Use of female controlled microbicidal products for HIV risk reduction. AIDS Care. 2000;12:593–596. doi: 10.1080/095401200750003761. [DOI] [PubMed] [Google Scholar]
  • 13.Wilson TE, Massad LS, Riester KA, et al. The sexual, contraceptive and drug use behaviors of women with HIV and those at high risk for infection: the results from the Women's Interagency HIV Study. AIDS. 1999;13:591–598. doi: 10.1097/00002030-199904010-00008. [DOI] [PubMed] [Google Scholar]
  • 14.Kalichman SC. HIV-AIDS: prevalence, predictors, and emerging clinical interventions. Clin Psychol Sci Pract. 2000;7:32–47. doi: 10.1093/clipsy/7.1.32. [DOI] [Google Scholar]
  • 15.Wingood GM, DiClemente RJ. HIV sexual risk reduction interventions for women: a review. Am J Prev Med. 1996;12:209–217. [PubMed] [Google Scholar]
  • 16.Wingood GM, DiClemente RJ. The effects of an abusive primary partner on the condom used and sexual negotiation practices of Afican American women. Am J Public Health. 1997;87:1016–1018. doi: 10.2105/AJPH.87.6.1016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Amaro H. Love, sex and power. Considering women's realities in HIV prevention. Am Psychol. 1995;50:437–447. doi: 10.1037/0003-066X.50.6.437. [DOI] [PubMed] [Google Scholar]
  • 18.Kalichman SC, Kelly JA, Hunter TL, Murphy DA, Tyler R. Culturally tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: impact on risk sensitization and risk-reduction. J Consult Clin Psychol. 1993;61:291–295. doi: 10.1037/0022-006X.61.2.291. [DOI] [PubMed] [Google Scholar]
  • 19.Bentley ME, Morrow KM, Fullem A, et al. Acceptability of a novel vaginal microbicide during a safety trial among low-risk women. Fam Plann Perspect. 2000;32:184–188. doi: 10.2307/2648235. [DOI] [PubMed] [Google Scholar]
  • 20.Hammett TM, Mason TH, Joanis CL, et al. Acceptability of formulations and application methods for vaginal microbicides among drug-involved women: results of product trials in three cities. Sex Transm Dis. 2000;27:119–126. doi: 10.1097/00007435-200002000-00011. [DOI] [PubMed] [Google Scholar]
  • 21.Cohen D, Reardon K, Alleyne D, Murthy S, Linton K. Influencing spermicide use among low income minority women. J Am Med Womens Assoc. 1995;50:11–13. [PubMed] [Google Scholar]
  • 22.Roddy RE, Cordero M, Cordero C, Fortney JA. A dosing study of nonoxynol-9 and genital irritation. Int J STD AIDS. 1993;4:165–170. doi: 10.1177/095646249300400308. [DOI] [PubMed] [Google Scholar]
  • 23.Rustomjee R, Karim SSA, Laga H, Stein Z. Phase I trial ofnonoxynol-9 flm among sex workers in South Africa. AIDS. 1999;13:1511–1515. doi: 10.1097/00002030-199908200-00011. [DOI] [PubMed] [Google Scholar]
  • 24.Folstein MF, Folstein SE, McHugh P. Mini-Mental Status Exam: a practical method for grading the cognitive state of patients or the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  • 25.Power C, Selnes O, Grim J, McArthur J. HIV dementia scale: a rapid screening test. J Acquir Immune Defic Syndr. 1995;8:273–278. doi: 10.1097/00042560-199503010-00008. [DOI] [PubMed] [Google Scholar]
  • 26.Spitzer RL, Williams JB, Gibbon M, First MB. Structured Clinical Interview for DSM-III-R-Nonpatient Version for HIV Studies. New York, NY: New York State Psychiatric Institute, Biometrics Research Department; 1998. [Google Scholar]
  • 27.Karnofsky D, Abelmann W, Craver L, Burchenal J. The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer. 1948;1:634–652. doi: 10.1002/1097-0142(194811)1:4&#x0003c;634::AID-CNCR2820010410&#x0003e;3.0.CO;2-L. [DOI] [Google Scholar]
  • 28.Malow RM, Corrigan SA, Cunningham SC, West JA, Pena JM. Psychosocial factors associated with condom use among African-American drug abusers in treatment. AIDS Educ Prev. 1995;5:244–253. [PubMed] [Google Scholar]
  • 29.Malow RM, West JA, Corrigan SA, Pena JM, Cunningham SC. Outcome of psychoeducation for HIV risk reduction. AIDS Educ Prev. 1994;6:113–125. [PubMed] [Google Scholar]
  • 30.Corrigan SA, Thompson KE, Malow RM, Sorenson JL. A psychoeducational approach to prevent HIV transmission among IV drug users. Psychol Addict Behav. 1992;6:114–119. doi: 10.1037/h0080617. [DOI] [Google Scholar]
  • 31.Meyer-Bahlberg HFL, Ehrhardt AA, Exner TM, Gruen RS. Sexual Risk Behavior Assessment Schedule: Adult (SERBAS-A-DF-4) Manual. New York, NY: Columbia University, Department of Psychiatry; 1990. [Google Scholar]
  • 32.McKinnon K, Cournos F, Meyer-Bahlberg HF, et al. Reliability of sexual risk behavior interviews with psychiatric patients. Am J Psychiatry. 1993;150(6):972–974. doi: 10.1176/ajp.150.6.972. [DOI] [PubMed] [Google Scholar]
  • 33.Raymond E, Alvarado G, Ledesma L, et al. Acceptability of two spermicides in five countries. Contraception. 1999;60:45–50. doi: 10.1016/S0010-7824(99)00060-8. [DOI] [PubMed] [Google Scholar]
  • 34.International Working Group on Vaginal Microbicides Recommendations for the development of vaginal microbicides. AIDS. 1996;10:1–6. [PubMed] [Google Scholar]
  • 35.Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychol Bull. 1999;125:90–132. doi: 10.1037/0033-2909.125.1.90. [DOI] [PubMed] [Google Scholar]
  • 36.Ehrhardt AA, Yingling S, Zawazki R, Martinez-Remirez N. Prevention of heterosexual transmission of HIV: barriers or women. J Psychol Hum Sexuality. 1992;5:37–67. [Google Scholar]
  • 37.Gupta GR, Weiss E. Women's lives and sex: implications for AIDS prevention. Cult Med Psychiatry. 1993;17:399–412. doi: 10.1007/BF01379307. [DOI] [PubMed] [Google Scholar]
  • 38.Steiner MJ, Glover LH, Bou-Saada I, Piedrahita C. Increasing barrier method use among oral contraceptive users at risk of STDs: Which approach is best? Sex Transm Dis. 1998;25:139–143. doi: 10.1097/00007435-199803000-00006. [DOI] [PubMed] [Google Scholar]
  • 39.Farr GA, Acosta Castro LA, Disantostefano R, Claassen E, Olguin F. Use of the spermicide and impact of prophylactic condom use among sex workers in Santa Fe de Bogota, Columbia. Sex Transm Dis. 1996;23:206–212. doi: 10.1097/00007435-199605000-00008. [DOI] [PubMed] [Google Scholar]
  • 40.Fontanet AL, Saba J, Chandlying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS. 1998;12:1851–1859. doi: 10.1097/00002030-199814000-00017. [DOI] [PubMed] [Google Scholar]
  • 41.Sobo EJ. Psycho-social benefits of unsafe sex. Cult Med Psychiatry. 1993;17:455–485. doi: 10.1007/BF01379310. [DOI] [PubMed] [Google Scholar]
  • 42.Ward MC. A different disease: HIV/AIDS and health care for women in poverty. Cult Med Psychiatry. 1990;17:413–430. doi: 10.1007/BF01379308. [DOI] [PubMed] [Google Scholar]

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