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Fidelity Moderates the Association Between Negative Condom Attitudes and Outcome Behavior in an Evidence-Based Sexual Risk Reduction Intervention for Female Sex Workers

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Annals of Behavioral Medicine

Abstract

Background

Intervention fidelity and participant-level variables, such as negative attitudes towards condoms, are important variables to consider in the successful implementation of evidence-based HIV prevention interventions. Mujer Segura is an intervention that has been shown to be efficacious at reducing condomless sex for female sex workers (FSWs) in Mexico [1].

Purpose

We examined main effects of fidelity, negative condom attitudes, and their interaction on the effectiveness of the Mujer Segura intervention at reducing condomless sex at intervention follow-up.

Methods

Of the FSWs recruited from 13 cities across Mexico, 528 participated in the Mujer Segura intervention. We measured negative condom attitudes at baseline (comprising of beliefs and outcome evaluations) and condomless sex with clients at baseline and 6-month follow-up. Fidelity was measured by a fidelity checklist completed by independent raters; the sum of potentially 43 total elements completed by the counselor constituted fidelity.

Results

Complete fidelity was found in only 15.1% (n = 73) of sessions. There was no significant main effect of intervention fidelity on condomless sex with clients at follow-up. There was a significant and positive main effect of negative condom attitudes and a significant two-way interaction. At lower levels of fidelity, negative condom attitudes predicted greater condomless sex acts, whereas at higher levels of fidelity, the effect of condom attitudes became weaker. The results also indicated that the interaction between negative condom attitudes and fidelity were driven primarily by negative condom beliefs, as opposed to negative condom outcome evaluations.

Conclusions

Ensuring treatment fidelity in an HIV prevention intervention is particularly important when participants have negative attitudes towards condoms.

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Author information

Authors and Affiliations

  1. Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA

    Eileen V. Pitpitan PhD

  2. Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA

    Claudia V. Chavarin MD, Shirley J. Semple PhD, Gregory A. Aarons PhD & Thomas L. Patterson PhD

  3. Evaluation and Research Department, Mexican Foundation for Family Planning (MexFam), Mexico City, DF, Mexico

    Doroteo Mendoza MD

  4. Centro Nacional para la Prevención y Control del VIH/SIDA (CENSIDA), Mexico City, Mexico

    Carlos Magis Rodriguez MD, PhD

  5. Universidad Autonoma de Ciudad Juarez, Ciudad Juarez, Chihuahua, Mexico

    Hugo Staines MD

Authors
  1. Eileen V. Pitpitan PhD
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  2. Claudia V. Chavarin MD
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  3. Shirley J. Semple PhD
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  4. Doroteo Mendoza MD
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  5. Carlos Magis Rodriguez MD, PhD
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  6. Hugo Staines MD
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  7. Gregory A. Aarons PhD
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  8. Thomas L. Patterson PhD
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Corresponding author

Correspondence to Thomas L. Patterson PhD.

Ethics declarations

All procedures involving human participants, including the informed consent process, were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.

Funding

This study was funded by the National Institute of Mental Health (grant number R01 MH087054, T. L. Patterson, P.I.). In addition, preparation of the manuscript was supported by a career development award to the first author from the National Institute on Drug Abuse (K01 DA036447, E. V. Pitpitan, P.I.).

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Eileen V. Pitpitan, Claudia V. Chavarin, Shirley J. Semple, Doroteo Mendoza, Carlos Magis Rodriguez, Hugo Staines, Gregory A. Aarons, and Thomas L. Patterson declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Pitpitan, E.V., Chavarin, C.V., Semple, S.J. et al. Fidelity Moderates the Association Between Negative Condom Attitudes and Outcome Behavior in an Evidence-Based Sexual Risk Reduction Intervention for Female Sex Workers. ann. behav. med. 51, 470–476 (2017). https://doi.org/10.1007/s12160-016-9861-1

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  • DOI: https://doi.org/10.1007/s12160-016-9861-1

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