Prevention interventions for human immunodeficiency virus in drug-using women with a history of partner violence

Figures & data

Table 1 Human immunodeficiency virus risk environment model for drug-using women with histories of partner violence

Risk environment	Micro-environmental	Macro-environmental
Physical	• Homelessness	• Drug trafficking and distribution routes
	• Housing instability	• Deportation
	• Prisons/incarceration	• Geographical shifts in population
	• Drug use locations
Social	• Relationship and network dynamics	• Stigma and discrimination
	• Peer norms	• Social marginalization
	• Physical/sexual violence	• Exposure to conflict or disasters
	• Childhood sexual abuse	• Ethnic or racial disparities
	• Community attitudes	• Gender inequalities
	• Local policing practices (eg, police mistreatment, arrests)	• Social and cultural norms
Economic	• Cost of male and female condoms, syringes, medication	• Scarcity of health and social services revenue and spending
	• Few income generation and employment opportunities	• Employment practices
	• Survival sex work	• Economic development
	• Cost of health care
Political	Ensuring widespread coverage of:	Laws and policies governing:
	• HIV/STI testing and counseling	• Protection of human and health rights
	• Antiretroviral therapy	• Violence against women
	• Housing assistance for drug users, abused women	• Possession of drugs
	• Sterile needles and syringes	• Syringe access and exchange
	• Drug treatment	• Free highly active antiretroviral therapy coverage
	• Male and female condoms	• Drug treatment

Content for the risk environment model adapted from Rhodes and Simic¹⁴ and Strathdee et al.¹⁵

Abbreviations: HIV, human immunodeficiency virus; STI, sexually transmitted infections.

Table 2 Characteristics of selected HIV prevention interventions for drug-using women with histories of partner violence

Study	Behavioral theory	Sample	Integrated micro-environmental determinants	Outcomes
Amaro et al^Citation65 The Boston Consortium Model	• Empowerment theory	n = 342; women of all race/ethnicities in community-based substance abuse treatment; English and Spanish	• Trauma history • Mental health • Substance abuse/HIV • Economics • Family dynamics	↓ substance use ↓ mental health ↓ Post-traumatic stress disorder ↓ unprotected sex ↑ relationship power scores
Gilbert et al^Citation55 Relapse prevention and relationship safety	• Social cognitive theory • Empowerment theory	n = 34; enrolled in outpatient MMTP; Latina (~60%), African American, White	• IPV	↓ drug use ↓ minor physical/sexual IPV ↓ minor and severe psychological IPV
Gollub et al^Citation64 Women Fighting Infection Together* (Women FIT)	• Empowerment theory	n = 189; out-of-treatment drug users; 2/3 African American	• HIV risks • Economic stress • Violence, abuse, and violent sex	↑ knowledge of protection methods ↑ pre-post anatomy knowledge scores ↑ male/female condom use
Tross et al^Citation56 Safer Sex Skills Building*	• Social cognitive learning theory • Empowerment theory	n = 384; recruited from methadone or psychosocial treatment programs; All racial/ethnic groups	• Partner abuse • Female-male control issues • HIV risk behaviors	↓ unprotected sex acts
Sterk et al^Citation62 The Health Intervention Project*	• Social cognitive theory • Theory of reasoned action • Theory of planned behavior • Transtheoretical model of change • Theory of Gender and Power	n = 68; recruited using street-outreach from inner city neighborhoods; African American	• Gender dynamics • Economic stress • Gender norms • Power and control • HIV risk behaviors	↓ number of paying partners ↓ frequency of sex with paying partners ↓ crack use in risky settings
Wechsberg et al^Citation26 The Women’s Health CoOp*	• Empowerment theory	n = 620; out-of-drug-treatment African Americans	• HIV risk behaviors • Barriers of education, employment, housing, and parenting	↓ unprotected sex ↓ crack use Improvement in housing and employment status

Note:

* Integrated the promotion of the female condom, a biomedical approach.

Abbreviations: MMTP, methadone maintenance treatment program; IPV, intimate partner violence; HIV, human immunodeficiency virus.

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