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Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria

  • Africa and AIDS
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This paper describes an HIV prevention intervention designed in the US that was adapted and implemented in South Africa. Using an experimental design, 93 women who reported recent substance use and sex trading were randomly assigned to a modified Standard HIV intervention or to a Woman-Focused HIV prevention intervention. Eighty women completed the one-month follow-up interview. Participants reported high rates of sexual risk and violence at baseline. At follow-up, findings showed decreases in the proportion of women reporting unprotected sex and the daily use of alcohol and cocaine. Daily alcohol and cocaine use decreased more for women receiving the Woman-Focused intervention. Although violence continued to be a problem, at follow-up Woman-Focused participants reported being victimized less often than women receiving the Standard intervention. This study demonstrates the feasibility of implementing cross-cultural behavioral HIV prevention interventions, and supports the need for future studies of women's contextual issues and the effectiveness of targeted interventions.

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  • Abt Associates (2000). The impending catastrophe: a resource book on the emerging HIV/AIDS epidemic in South Africa. Parklands, South Africa: Henry J. Kaiser Family Foundation for Abt Associates South Africa.

    Google Scholar 

  • Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, New Jersey: Prentice-Hall.

    Google Scholar 

  • Campbell, C., and Mzaidume, Z. (2001). Grassroots participation, peer education, and HIV prevention by sex workers in South Africa. American Journal of Public Health, 91(12), 1978–1986.

    PubMed  CAS  Google Scholar 

  • Campbell, C. (2000). Selling sex in the time of AIDS: the psycho-social context of condom use by sex workers on a Southern African mine. Social Science & Medicine, 50(4), 479–494.

    Article  CAS  Google Scholar 

  • Dorrington, R., Bourne, D., Bradshaw, D., Laubscher, R., and Timaeus, I. M. (2001). The impact of HIV/AIDS on adult mortality in South Africa: Technical Report. [Online]. Available:

  • Franzen, B. (1998). Substance abuse and HIV/AIDS in southern Africa. Urban Health & Development Bulletin, 1(4), 27–29.

    Google Scholar 

  • Human Sciences Research Council (HSRC) (2002). South African national HIV prevalence, behavioral risks and mass media. Cape Town, South Africa: Human Sciences Research Council.

  • Jewkes, R. K., Levin, J. B., and Penn-Kekana, L. A. (2003). Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Social Science & Medicine, 56(1), 125–134.

    Article  Google Scholar 

  • Karim, Q. A., Karim, S. S., Soldan, K., and Zondi, M. (1995). Reducing the risk of HIV infection among South African sex workers: socioeconomic and gender barriers. American Journal of Public Health, 85(11), 1521–1525.

    Article  PubMed  CAS  Google Scholar 

  • Leggett, T. (2001). Rainbow vice: the drugs and sex industries in the new South Africa. Claremont, South Africa: New Africa Books Ltd.

    Google Scholar 

  • Parry, C. D. H., Bhana, A., Plüddemann, A., Myers, B., Siegfried, N., Morojele, N. K., Flisher, A. J., and Kozel, N. J. (2002). The South African Community Epidemiology Network on Drug Use (SACENDU): description, findings (1997–99) and policy implications. Addiction, 97 969–976.

    Article  PubMed  Google Scholar 

  • Statistics South Africa (2002). Causes of death in South Africa 1997-2001: advance release of recorded causes of death (P0309.2). Pretoria, South Africa: Statistics South Africa.

  • UNAIDS (2002). Report on the global HIV/AIDS epidemic. Geneva, Switzerland: UNAIDS.

  • UNAIDS/WHO (2002). HIV/AIDS epidemic update. Geneva, Switzerland: UNAIDS.

  • Wechsberg, W. M. (1998). Facilitating empowerment for women substance abusers at risk for HIV. Pharmacology Biochemistry and Behavior, 61 158.

    Google Scholar 

  • Wechsberg, W. M., Desmond, D., Inciardi, J. A., Leukefeld, C. G., Cottler, L. B., and Hoffman, J. (1998). HIV Prevention Protocols: Adaptation to Evolving Trends in Drug Abuse. Journal of Psychoactive Drugs, 30(3), 291–298.

    Google Scholar 

  • Wechsberg, W. M., Lam, W. K., Zule, W., Hall, G., Middlesteadt, R., and Edwards, J. (2003). Violence, homelessness, and HIV risk among crack-using African-American women. Substance Use & Misuse, 38 669–700.

    Article  Google Scholar 

  • Wechsberg, W. M., Zule, W., Lam, W. K., and Bobashev, G. (2004). Efficacy of a woman-focused intervention to reduce HIV risk and increase self-sufficiency among African-American crack abusers. American Journal of Public Health 94(6), 1165–1173.

    Google Scholar 

  • Wingood, G. M., and DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27(5), 539–565.

    Article  PubMed  CAS  Google Scholar 

  • Wojcicki, J. M. (2002). Commercial sex work or ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal area, South Africa. Culture, Medicine and Psychiatry, 26(3), 339–370.

    Google Scholar 

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We wish to acknowledge the financial support provided by the National Institute on Drug Abuse (NIDA) grant R01 DA11609. We thank Dionne Jones (NIDA project officer), Grace Hall, Kara Riehman, Teri Swezey, William Zule, and Jeff Novey of RTI for helpful comments. We also wish to thank all the women participants, field staff, and community advisory board members for their involvement in this study.

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Correspondence to Wendee M. Wechsberg PhD.

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Wechsberg, W., Luseno, W., Lam, W. et al. Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria. AIDS Behav 10, 131–137 (2006).

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