AIDS prevention in high-risk African American women: behavioral, psychological, and gender issues

Abstract

A three-year longitudinal intervention study was implemented to reduce high-risk drug and sexual behaviors in methadone-dependent African American women. Participants were recruited from four inner-city methadone maintenance programs and randomly assigned either to an eight-week peer counseling and leadership training group or to a control group. The 107 trainees and 97 controls completed pretests and posttests at two, four, and seven months. This paper focuses on final data related to the subjects' sexual beliefs, attitudes, knowledge, and behaviors that put them at risk for HIV/AIDS. Reasons for not using condoms are categorized and discussed. Despite the women's awareness of the seriousness of AIDS, perceived powerlessness to negotiate condom use, negative attitudes about the use of condoms, influence of drugs, and unavailablility of condoms interfered with safer sex practices. The inability of education alone to prevent many high-risk sexual behaviors suggests that more serious consideration be given to expanded distribution of condoms as well as needle exchange programs and legalization of illicit drugs.

PIP: The US Centers for Disease Control report that although African-American women comprise only 12% of the US female population, they account for 56.9% of AIDS cases in women. In 1994, 41% of women with AIDS reported IV-drug use and 38% reported heterosexual contact with a partner at risk for or known to have HIV infection or AIDS. Findings are presented from a 3-year study conducted to assess and reduce high-risk drug and sex behavior among methadone-dependent African-American women in Baltimore, Maryland. Through random assignment, 107 women received 8 weeks of peer counseling and leadership training, and 97 women formed the control group. The women were 20-59 years old of mean age 35.5. 84-90% were unemployed and 16% had been homeless within the preceding 6 months. Subjects completed pretests and post-tests at 2, 4, and 7 months. Despite the women's awareness of the seriousness of AIDS, their perceived powerlessness to negotiate condom use, negative attitudes about condom use, the influence of drugs, and the unavailability of condoms interfered with the practice of safer sex behavior. The authors believe that the inability of education alone to prevent many high-risk sexual behaviors is cause to give more serious consideration to expanding the distribution of condoms as well as needle exchange programs and the legalization of currently illicit drugs.