AIDS and Behavior

, Volume 1, Issue 2, pp 93–124 | Cite as

A Review of HIV Interventions for At-Risk Women

  • Theresa M. Exner
  • David W. Seal
  • Anke A. Ehrhardt


This paper reviews published reports on primary prevention of sexual transmission of HIV with women from the beginning of the AIDS epidemic through March 1996. All reviewed interventions were conducted in the United States, Canada or Puerto Rico and the reports described a psychological, behavioral, or educational component specifically to address sexual risk reduction and included a behavioral evaluation component. Manual and computer searches identified 47 studies that targeted women and provided a female-specific analysis of intervention effects. Sixteen of the 47 studies fulfilling more rigorous methodological reporting standards were considered separately. Overall, the findings demonstrate that HIV prevention programs can be effective in reducing risky sexual behavior among at-risk women. Program effectiveness varied by intervention type, session duration, and whether studies included women alone or both men and women. The most efficacious HIV prevention programs were specifically directed toward women, focused on relationship and negotiation skills, and involved multiple, sustained contacts. Evidence also indicated that community-level interventions hold promise. This review includes a methodological critique, identification of research gaps, and recommendations for future intervention research with women.

HIV prevention heterosexual transmission at-risk women sexual behavior change HIV intervention methodology 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Altman, L. K. (1995). AIDS is now the leading killer of Americans from 25 to 44. The New York Times 1995(January 31), C7.Google Scholar
  2. Ashworth, C. S., DuRant, R. H., Gaillard, G., and Rountree, J. (1994). An experimental evaluation of an AIDS educational intervention for WIC mothers. AIDS Education and Prevention, 6, 154–162. ei]Auerbach, W. Y., Wypijewska, C., and Brodie, H. K. H. (Eds.). (1994). AIDS and Behavior. Washington, DC: National Academy Press.Google Scholar
  3. Bevier, P., Ewing, W., Hildebrandt, D., Castro, K., and Chiasson, M. A. (1991). Effect of counseling on HIV risk behaviors in patients at a New York City sexually transmitted disease clinic. In VII International Conference on AIDS, Vol. 7 (Abstract No. W.D.4281, p. 458).Google Scholar
  4. Birkel, R. C., Golaszewski, T., Koman, J. J., Singh, B. K., Catan, V., and Souply, K. (1993). Findings from the Horizontes acquired immune deficiency syndrome education project: The impact of indigenous outreach workers as change agents for injection drug users. Health Education Quarterly, 20, 523–538.Google Scholar
  5. Blumstein, P. W., Dawes, R. M., Lindenbaum, S., Rudkin-Miniot, L., Sorensen, J. K., Turner, C. F., and Wiley, J. (1990). Methodological issues in AIDS surveys. In H. G. Miller, C. F. Turner, and L. E. Moses (Eds.), AIDS, The second decade (pp. 359–472). Washington, DC: National Academy Press.Google Scholar
  6. Booth, R. E., and Watters, J. K. (1994). How effective are risk-reduction interventions targeting injecting drug users? AIDS, 8, 1515–1524.Google Scholar
  7. Calsyn, D. A., Saxon, A. J., Freeman, G., and Whittaker, S. (1992a). Ineffectiveness of AIDS education and HIV antibody testing in reducing high-risk behaviors among injection drug users. American Journal of Public Health, 82, 573–575.Google Scholar
  8. Calsyn, D. A., Saxon, A. J., Wells, E. A., and Greenberg, D. M. (1992b). Longitudinal sexual behavior changes in injecting drug users. AIDS, 6, 1207–1211.Google Scholar
  9. Catania, J. A., Gibson, D. R., Chitwood, D. D., and Coates, T. J. (1990a). Methodological problems in AIDS behavioral research: Influences of measurement error and participation bias in studies of sexual behavior. Psychological Bulletin, 108, 339–362.Google Scholar
  10. Catania, J. A., Kegeles, S. K., and Coates, T. J. (1990b). Towards an understanding of risk behavior, An AIDS risk reduction model (ARRM). Health Education Quarterly, 17, 53–72.Google Scholar
  11. Catania, J., Coates, T., Stall, R., Turner, H., Peterson, J., Hearst, N., Dolcini, M. M., Hudes, E., Gagnon, J., Wiley, J., and Groves, R. (1992). Prevalence of AIDS-related risk factors and condom use in the United States. Science, 258, 1101–1106. ia]Centers for Disease Control and Prevention. (1996). US AIDS Cases reported through December, 1995. HIV/AIDS Surveillance Report, 7, 1–39.Google Scholar
  12. Cohen, D. A., Dent, C., MacKinnon, D., and Hahn, G. (1992a). Condoms for men, not women: Results of brief promotion programs. Sexually Transmitted Diseases, 19, 245–251.Google Scholar
  13. Cohen, D. A., MacKinnon, D. P., Dent, C., Mason, H. R. C., and Sullivan, E. (1992b). Group counseling at STD clinics to promote use of condoms. Public Health Reports, 107, 727–731.Google Scholar
  14. Cohen, D., Reardon, K., Alleyne, D., Murthy, S., and Linton, K. (1995). Influencing spermicide use among low-income minority women. Journal of the American Medical Women's Association, 50, 11–13.Google Scholar
  15. Cohen, J. (1988). Statistical power for the behavioral sciences (2nd ed.), New York: Lawrence Erlbaum Associates.Google Scholar
  16. Corby, N., Barchi, P., Wolitski, R., Smith, P., and Martin, D. (1990). Effects of condom skills training and HIV-testing on AIDS prevention behaviors among sex workers. VI International Conference on AIDS, Vol. 6 (Abstract No. S.C.714, p. 267).Google Scholar
  17. Corby, N., Wolitski, R., Rhodes, F., and O'Reilly, K. (1993). Evaluation of a theory-based intervention to increase condom use among commercial sex workers. In XI International Conference on AIDS, Vol. 9 (Abstract no. PO-C14-2899, p. 700).Google Scholar
  18. Deren, S., Beardsley, M., Tortu, S., Davis, R., and Clatts, M. (1993a). Behavior change strategies for women at high risk for HIV. Drugs and Society, 7, 119–128.Google Scholar
  19. Deren, S., Tortu, S., and Davis, W. R. (1993b). An AIDS risk reduction project with inner-city women. In C. Square (Ed.), Women and AIDS: Psychological perspectives. London: Sage Publications.Google Scholar
  20. Des Jarlais, D. C., Friedman, S. R., and Casriel, C. (1990). Target groups for preventing AIDS among intravenous drug users: 2. The ‘hard’ studies. Journal of Consulting and Clinical Psychology, 58, 50–56.Google Scholar
  21. de Vincenzi, I. (1994). A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. New England Journal of Medicine, 331, 341–346.Google Scholar
  22. DiClemente, R. J., and Wingood, G. M. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association, 274, 1271–1276.Google Scholar
  23. Ehrhardt, A. A., Fishbein, M., Washington, E., Smith, W., Holmes, K. K., and the NIAID Study Group on Integrated Behavioral Research for Prevention and Control of Sexually Transmitted Diseases. (1990). Issues in designing behavioral interventions. Sexually Transmitted Diseases, 17, 204–207.Google Scholar
  24. El-Bassel, N., and Schilling, R. F. (1992). 15-month followup of women methadone patients taught skills to reduce heterosexual HIV transmission. Public Health Reports, 107, 500–504.Google Scholar
  25. El-Bassel, N., Ivanoff, A., Schilling, R. F., Gilbert, L., Borne, D., and Chen, D. (1995). Preventing HIV/AIDS in drug-abusing incarcerated women through skills building and social support enhancement, Preliminary outcomes. Social Work Research, 19, 131–141.Google Scholar
  26. Fisher, J. D., and Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111, 455–474.Google Scholar
  27. Flaskerud, J. H., and Nyamathi, A. M. (1990). Effects of an AIDS education program on the knowledge, attitudes and practices of low income black and Latina women. Journal of Community Health, 15, 343–355.Google Scholar
  28. Fritz, R., and Schaffer, T. (1992). How effective are AIDS education programs for high-risk populations? An evaluation of 4 AIDS prevention programs in Chicago, USA. VIII International Conference on AIDS, Vol. 8 (Abstract No. PoC 4545, p. C335).Google Scholar
  29. Gibson, D. R., Wermuth, L., Lovelle-Drache, J., Ham, J., and Sorensen, J. L. (1989). Brief counseling to reduce AIDS risk in intravenous drug users and their sexual partners: Preliminary results. Counseling Psychology Quarterly, 2, 15–19.Google Scholar
  30. Harris, R. M., Kavanagh, K. H., Hetherington, S. E., and Scott, D. E. (1992). Strategies for AIDS prevention: Leadership training and peer counseling for high-risk African-American women in the drug user community. Clinical Nursing Research, 1, 9–24.Google Scholar
  31. Hobfoll, S. E., Jackson, A. P., Lavin, J., Britton, P. J., and Shepherd, J. B. (1994). Reducing inner-city women's AIDS risk-activities: A study of single, pregnant women Health Psychology, 13, 397–403.Google Scholar
  32. Hunt, D., Rhodes, W., Hammett, T., Smith, C., Teitelbaum, S., Gross, M., Harrold, L., and Sifre, S. (1992). Methodological issues in evaluating community-based HIV prevention programs: A case study. In VIII International Conference on AIDS, Vol. 8 (Abstract No. PoC 449, p. C326).Google Scholar
  33. Ickovics, J. R., Morrill, A. C., Beren, S. E., Walsh, U., and Rodin, J. (1994). Limited effects of HIV counseling and testing for women. Journal of the American Medical Association, 272, 443–448.Google Scholar
  34. Kalichman, S. C., and Coley, B. (1995). Context framing to enhance HIV-antibody-testing messages targeted to African-American women. Health Psychology, 14, 247–254.Google Scholar
  35. Kalichman, S. C., Kelly, J. A., Hunter, T. L., Murphy, D. A., and Tyler, R. (1993). Culturally tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: Impact on risk sensitization and risk reduction. Journal of Consulting and Clinical Psychology, 61, 291–295.Google Scholar
  36. Kavanagh, K. H., Harris, R. M., Hetherington, S. E., and Scott, D. E. (1992). Collaboration as a strategy for acquired immunodeficiency syndrome prevention. Archives of Psychiatric Nursing, 6, 331–339.Google Scholar
  37. Kelly, J. A., Murphy, D. A., Washington, C. D., Wilson, C. D., Koob, J. J., Davis, D. R., Ledezma, G., and Davantes, B. (1994). HIV/AIDS prevention for women seen in urban primary care clinics: Effects of intervention to change high-risk sexual behavior patterns. American Journal of Public Health, 84, 1918–1922.Google Scholar
  38. Landis, S. E., Earp, J. L., and Koch, G. G. (1992). Impact of HIV testing and counseling on subsequent sexual behavior. AIDS Education and Prevention, 4, 61–70.Google Scholar
  39. Last, J. M. (1986). Scope and methods of prevention. Public health and preventive medicine (12th edn.). Norwalk, CT: Appleton-Century-Croft.Google Scholar
  40. Levine, O. H., Britton, P. J., James, T. C., Jackson, A. P., Hobfall, S. E., and Lavin, J. P. (1993). The empowerment of women: A key to HIV prevention. Journal of Community Psychology, 21, 320–334.Google Scholar
  41. Magura, S., Kang, S., Shapiro, J. L., and O'Day, J. (1995). Evaluation of an AIDS education model for women drug users in jail. The International Journal of the Addictions, 30, 259–273.Google Scholar
  42. McCoy, H. V., Dodds, S. E., and Nolan, C. (1990a). AIDS intervention design for program evaluation: The Miami community outreach project. Journal of Drug Issues, 20, 223–243.Google Scholar
  43. McCoy, C. B., Chitwood, D. D., Khoury, E. L., and Miles, C. E. (1990b). The implementation of an experimental research design in the evaluation of an intervention to prevent AIDS among IV drug users. Journal of Drug Issues, 20, 215–222.Google Scholar
  44. McCoy, C. B., Rivers, J. E., and Khoury, E. L. (1993). An emerging public health model for reducing risk behavior among injecting drug users and their sexual partners. Drugs and Society, 7, 143–160.Google Scholar
  45. McCusker, J., Stoddard, A. M., Zapka, J. G., and Lewis, B. F. (1993). Behavioral outcomes of AIDS educational interventions for drug users in short term treatment. American Journal of Public Health, 83, 1463–1466. ia]MMWR. (1995). Update: AIDS among women—United States, 1994. Morbidity and Mortality Weekly Report, 41(February 10), 94–95, 101.Google Scholar
  46. Neaigus, A., Sufian, M., Friedman, S. R., Goldsmith, D. S., Stepherson, B., Mota, P., Pascal, J., and DesJarlais, D. C. (1990). Effects of outreach intervention on risk reduction among intravenous drug users. AIDS Education and Prevention, 2, 253–271.Google Scholar
  47. Nyamathi, A. M., Leake, B., Flaskerud, J., Lewis, C., and Bennet, C. (1993). Outcomes of specialized and traditional AIDS counseling programs for impoverished women of color. Research in Nursing and Health, 16, 11–21.Google Scholar
  48. Nyamathi, A. M., Flaskerud, J., Bennett, C., Leake, B., and Lewis, C. (1994). Evaluation of two AIDS education programs for impoverished Latina women. AIDS Education and Prevention, 6, 296–309.Google Scholar
  49. Nyamathi, A. M., Bennett, C., and Leake, B. (1995). Predictors of maintained high-risk behaviors among impoverished women. Public Health Reports, 110, 600–606.Google Scholar
  50. Oakley, A., Fullerton, D., and Holland, J. (1995). Behavioral interventions for HIV/AIDS prevention. AIDS, 9, 479–486.Google Scholar
  51. O'Donnell, L., San Doval, A., Duran, R., and O'Donnell, C. R. (1995a). The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients. Sexually Transmitted Diseases, 22, 97–103.Google Scholar
  52. O'Donnell, L., San Doval, A., Duran, R., and O'Donnell, C. R. (1995b). Predictors of condom acquisition after an STD clinic visit. Family Planning Perspectives, 27, 29–33.Google Scholar
  53. O'Donnell, L., San Doval, A., Duran, R., and O'Donnell, C. (1995c). Video-based sexually transmitted disease patient education: Its impact on condom acquisition. American Journal of Public Health, 85, 817–822.Google Scholar
  54. Padian, N. S., O'Brien, T. R., Chang, Y., Glass, S., and Francis, D. P. (1993). Prevention of heterosexual transmission of human immunodeficiency virus through couple counseling. Journal of Acquired Immune Deficiency Syndrome, 6, 1043–1048.Google Scholar
  55. Powers, B., Penn, S., Aldrich, M. R., Little, S., Biernacki, P., and Feldman, H. W. (1990). AIDS risk reduction among female IVDUs and female sexual partners of IVDUs. 1988–1989, In VI International Conference on AIDS, Vol. 6 (Abstract No. 3077, p. 421).Google Scholar
  56. Prochaska, J., DiClemente, C., and Norcross, J. (1992). In search of how people change. American Psychologist, 47, 1102–1114.Google Scholar
  57. Quirk, M. E., Godkin, M. A., and Schwenzfeier, E. (1993). Evaluation of two AIDS prevention interventions for inner-city adolescent and young adult women. American Journal of Preventive Medicine, 9, 21–26.Google Scholar
  58. Rhodes, F., Wolitski, R. J., and Thornton-Johnson, S. (1992). An experiential program to reduce AIDS risk among female sex partners of injection-drug users. Health and Social Work, 17, 261–272.Google Scholar
  59. Rivera, M., Norwood, C., Adderley, B., and Felipe, L. (1994). Stages of women's condom use. In X International Conference on AIDS, Vol. 10 (Abstract No. PD0655, p. 369).Google Scholar
  60. Rosenberg, M. J., and Gollub, E. L. (1992). Commentary: Methods women can use that may prevent sexually transmitted disease, including HIV. American Journal of Public Health, 82, 1473–1478.Google Scholar
  61. Santelli, J. S., Celentano, D. D., Rozsenich, C., Crump, A. D., Davis, M. D., Polacsek, M., Augustyn, M., Rolf, J., McAlister, A. L., and Burwell, L. (1995). Interim outcomes for a community-based program to prevent perinatal HIV transmission. AIDS Education and Prevention, 7, 210–220.Google Scholar
  62. Schilling, R. F., el-Bassel, N., Schinke, S. P., Gordon, K., and Nichols, S. (1991). Building skills of recovering women drug users to reduce heterosexual AIDS transmission. Public Health Reports, 106, 297–304.Google Scholar
  63. Sikkema, K. J., Winett, R. A., and Lombard, D. N. (1995). Development and evaluation of an HIV-risk reduction program for female college students. AIDS Education and Prevention, 7, 145–159.Google Scholar
  64. Smith, E. A., and Dickson, L. L. (1993). The impact of a condom desensitization program on female college students. Health Values, 17, 21–31.Google Scholar
  65. Tross, S., Abdul-Quader, A. S., Simons, P. S., Sanchez, M., and Silvert, H. M. (1993). Evaluation of a peer outreach HIV prevention program for female partners of injecting drug users (IDUs) in New York City (NYC). In IX International Conference on AIDS, Vol. 9 (Abstract No. PO-D13-3737, p. 840).Google Scholar
  66. Tross, S., Krauss, B., Abdul-Quader A. S., Rapkin, B., Rosenbluth, L., Simons, P. S., Sanchez, M., and Andia, J. (1995). Changing consistent condom use norms among inner city female partners of injection drug users: The companera program HIV prevention newsletter distribution/peer outreach project. Unpublished manuscript.Google Scholar
  67. Turner, J. C., Korpita, E., Mohn, L. A., and Hill, W. B. (1993). Reduction in sexual risk behaviors among college students following a comprehensive health education intervention. Journal of American College Health, 41, 187–193.Google Scholar
  68. Turner, J. C., Garrison, C. Z., Korpita, E., Waller, J., Addy, C., Hill, W. R., and Mohn, L. A. (1994). Promoting responsible sexual behavior through a college freshman seminar. AIDS Education and Prevention, 6, 266–277.Google Scholar
  69. Vogler, M., Dugan, T., and Seidlin, M. (1989). Changes in sexual and reproductive behavior in heterosexual couples after HIV testing. In V International Conference on AIDS, Vol. 5 (Abstract No. T.A.P.101. p. 115).Google Scholar
  70. Washington, C. D., Kelly, J. A., Murphy, D. A., Wilson, T. S., Davantes, B., & Ledezma, G. (1993). Effects of group behavior change intervention for high-risk women seen in urban primary health care clinics. In IX International Conference on AIDS, Vol. 9 (Abstract No. PO-C22-3143, p. 741).Google Scholar
  71. Wild, J., Young, P., Rosenshine, N., and Klein, H. (1994). The WHEEL Project: Assessing a community-based model for preventing HIV/AIDS among women. In X International Conference on AIDS, Vol. 10 (Abstract No. 062D, p. 22).Google Scholar
  72. Zenilman, J. M., Erickson, B., Fox, R., Reichart, C. A., and Hook, E. W. (1992). Effect of HIV post test counseling on STD incidence. Journal of the American Medical Association, 267, 843–845.Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Theresa M. Exner
    • 1
  • David W. Seal
    • 1
  • Anke A. Ehrhardt
    • 1
  1. 1.HIV Center for Clinical and Behavioral Studies, New York State Psychiatric InstituteColumbia UniversityNew York

Personalised recommendations