Community-Led HIV Intervention Program Helps Reduce AIDS Risk among Inner-City Women

An innovative HIV prevention program, in which inner-city women organized local health councils and neighborhood AIDS-prevention awareness events, led to a 50% increase in condom use and demonstrates that local leaders can effectively mobilize their neighbors to help fight the spread of AIDS/HIV.

"Women took it upon themselves to educate their neighbors about HIV and, in the end, became their communities' single most effective defense against AIDS," said Jeffrey A. Kelly, PhD, Director of the Medical College of Wisconsin Department of Psychiatry and Behavioral Medicine's Center for AIDS Intervention Research (CAIR) and principal investigator of the research study. Kathleen A. Sikkema, PhD, former Associate Professor of Psychiatry and Behavioral Medicine at CAIR, co-directed the study.

Findings from the study were reported in the January 2000 issue of the American Journal of Public Health. Funded by the National Institute of Mental Health, the study is the first randomized trial of a community-level HIV prevention intervention programs created specifically for low-income, minority women, a population disproportionately affected by HIV/AIDS.

CAIR conducted the study with 690 women living in 18 low-income housing developments in five United States cities: Milwaukee; Roanoke, Va.; Cleveland, Ohio; Rochester, N.Y.; and Tacoma, Wash. The study tested a 12-month community-level intervention with three overlapping phases.

In the first phase, women in the developments were asked through a survey to name five 'opinion leaders' -- women who they liked, trusted and who lived in the development. The most-nominated women were invited to attend a focus group on community health issues and a four-session workshop series that emphasized HIV and STD education and risk-reduction skills training.

In phase two, health workers assisted opinion leader women in forming Women's Health Councils to plan HIV prevention outreach activities and encourage other neighborhood women to attend risk reduction workshops in the developments.

During phase three, the health councils met regularly to organize and conduct HIV/AIDS awareness events tailored to neighborhood values and interests. These events included picnics featuring local HIV/AIDS prevention resource speakers, a family carnival featuring contests for women based on safer sex themes, musical events that highlighted AIDS prevention messages and a potluck dinner for women living with HIV infection. Members of the health councils also conducted smaller-scale activities such as woman-to-woman conversations focused on AIDS risk reduction, local AIDS Day walks and distribution of safer sex materials.

The effectiveness of this intervention was evaluated by surveying all women in all the developments concerning their risk behavior at the start of the program and one year after the intervention. "The intervention's strong impact was likely due to the combination of HIV risk reduction workshops and community events planned and carried out by well-liked and trusted women," said Dr. Kelly. "The women helped create and reinforce community-wide social norms that supported HIV risk reduction."

In addition to the increase in condom use at the one-year follow-up, intervention participants reported a significant reduction in unprotected sex and increased communication with male sexual partners about condoms.

The community-level intervention developed in this study holds much promise as a means of helping these women develop HIV risk reduction skills and redefining social and peer group norms to reinforce risk reduction changes.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.