'Healthy Relationships' empower HIV-infected women and encourage safer sex habits
Condom use, adherence increased
A Washington, DC, HIV prevention intervention targets a population of mostly African-American women who come from such abusive backgrounds that their risky behaviors even place their children at risk of mother-to-child (MTC) transmission.
"In the CDC's recently released numbers, 56 adolescents who are HIV positive contracted the virus at birth," says Abby Charles, program coordinator for prevention with positives program (PROSPER) at The Women's Collective in Washington, DC.
"So mother-to-child transmission is still a significant concern in DC," Charles says. "We recently implemented screening during pregnancy, but we need to provide these women information on the importance of maintaining care and getting into care."
The Women's Collective in 2003 formed Healthy Relationships, a prevention program for HIV positive women, using Ryan White Title I funding, Charles notes.
The program expanded into the PROSPER empowerment intervention, with additional funding from the Johnson & Johnson's Generations program, she adds.
"The Johnson & Johnson's grant gave us a lot of flexibility, and that's why we were able to fund PROSPER in addition to Healthy Relationships," Charles explains.
Together, the two programs educate HIV-infected women about how to engage in safer behaviors, and they help to eliminate barriers to HIV care and to improve the women's self esteem.
"Healthy Relationships is an effective tool to get information across to people with regard to safer sex," Charles says. "It helps build skills for disclosure and discusses barriers to disclose or to use condoms."
PROSPER encourages these women, who often have been abused much of their lives, to put their own health and needs first by being responsible for condom use, she adds.
"We use gender and ethnic pride to build up self-value," Charles says. "We discuss co-infection and re-infection and why it's important for you to use a condom and prevent spreading HIV."
The program also discusses medical adherence and the importance of taking HIV medicine, and women are educated about mother-to-child transmission.
The program resulted in positive outcomes. At baseline, 11 percent of the women reported using condoms every time they had vaginal, anal, and oral sex. After attending the sessions, 39 percent of the women reported using condoms each time, Charles says.
Also, at baseline, 39 percent of women said they had disclosed their HIV status in all situations where it might have prevented someone from being infected with HIV. After the sessions, 84 percent of women reported that they had disclosed their HIV status in all such situations, Charles says.
Women attend five sessions that are based on the Healthy Relationships curriculum, and there are an additional five sessions based on PROSPER. The groups are held twice a week on Mondays and Thursdays for a five-week period.
"Ideally, the maximum number of women attending is 15, but we've had groups that started with seven and ended with 17," Charles says.
Here's how the program works:
1. Discuss women's health in general and mother-to-child transmission.
"We talk about the importance of pap smears and talk about other diseases that affect African-American women, like hypertension and diabetes," Charles says.
"We find that women who have HIV don't think about their nutrition as much as they should," she notes. "So we encourage all populations to think about the pieces to their health, including exercise, breast cancer, and cervical cancer."
A physician discusses MTC transmission and obstetrics/gynecological issues.
2. Make the women feel special.
The room in which the group meets has dimmed lights, candles, and rose petals, Charles says.
"We serve the women food, and many of these women have never been in a restaurant before, so it's empowering for them to have the experience of being served," Charles explains.
The women receive a small gift at each session. These include condoms, dental dams, and lubricants, as well as bath and body lotions, CDs, journals, inspirational books, pedicure sets, nail polish, and other items will help a woman pamper herself, Charles says.
"We also try to provide massages and acupuncture," she adds. "For the last meeting, we provide makeovers for the women, including makeup, hand massages, and facials."
3. Discuss condom use.
"We bring in a safe sex presenter who gives women a thorough look at each condom, how it feels, the different textures, different lubrication," Charles says.
Also, an education presenter discusses sexually transmitted diseases (STDs) and shows women pictures of what they look like.
4. Promote medication adherence.
A medical adherence specialist or nurse practitioner discusses the importance of treatment adherence in the women's lives.
"We talk about the importance of advocating for yourself with your medical provider," Charles says. "And we do a number of different activities and exercises, using pictures of family members who are important to them and who would like to see them around."
The photos are a tool for reminding the women why it's important to maintain their medication regimen, and the pictures are used to help build their self esteem, she adds.
5. Teach how to disclose HIV status.
As part of the focus on ethnic pride and self-esteem building, the session teaches women how to disclose their HIV status to their potential sexual partners.
"For each session, we start with an empowering poem that is written about women of color," Charles says.
Session presenters tie the poem to disclosure and to having safer sex, Charles says.
"We ask them, 'How does that poem speak to you where you are?'" she says.
The combined Healthy Relationships and PROSPER program is a good example of why it's important for HIV prevention programs to have some built-in flexibility, Charles notes.
"Each population is so different, and sometimes they need three or five more sessions for which funding is important," Charles says. "For our population, using a pampering approach for women definitely builds empowerment and facilitates behavior change."
Empowerment also helps women understand why the HIV prevention information is so important for their lives, she says.
"Women often are homemakers and child care workers, and it's difficult to get them to come to a group session," Charles explains. "So we provide child care, which is helpful, but it's the pampering that gets them to come back."
A Washington, DC, HIV prevention intervention targets a population of mostly African-American women who come from such abusive backgrounds that their risky behaviors even place their children at risk of mother-to-child (MTC) transmission.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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