Women drug users are at significant risk of sexually transmitted HIV; however, interventions aimed at increasing condom use by this population have been relatively ineffective. The authors conducted a series of focus groups with 17 current and former drug-using women to identify (a) reasons for using versus not using condoms, (b) intervention strategies they believed would be most effective at increasing condom use, and (c) previous ineffective intervention strategies. Risk of HIV, sexually transmitted diseases, and pregnancy was the main reason given for using condoms. Many factors were identified that limited condom use, including lack of availability, substance use, and cost. Participants enthusiastically endorsed condom availability and AIDS awareness interventions, and suggested that no intervention was a waste of money. The authors discuss the limitations of the suggested interventions and recommend additional research to evaluate the efficacy of these strategies.
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References
1.
Ajzen, I., & Madden, T. J. (1986). Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22,, 453-474.
2.
Amaro, H., & Raj, A. (2000). On the margin: Power and women’s HIV risk reduction strategies. Sex Roles, 42(7/8), 723-749.
3.
Auerbach, J. D., & Coates, T. J. (2000). HIV prevention research: Accomplishments and challenges for the third decade of AIDS. American Journal of Public Health, 90(7), 1029-1032.
4.
Basch, C. (1987). Focus group interview: An underutilized research technique for improving theory and practice in health education. Health Education Quarterly, 14,, 411-448.
5.
Biernacki, P., & Waldorf, D. (1981). Snowball sampling: Problems and techniques of chain referral sampling. Social Methods Research, 10,, 141-163.
6.
Brook, D. W., Brook, J. S., Whiteman, M., Win, P. T., Masci, J. R., Roberto, J., et al. (1998). Psychosocial risk and protective factors for condom use among female injection drug users. American Journal on Addictions, 7(2), 115-127.
7.
Cecil, H., Perry, M. J., Seal, D. W., & Pinkerton, S. D. (1998). The female condom: What we have learned thus far. AIDS and Behavior, 2(3), 241-256.
8.
Centers for Disease Control. (1986). Additional recommendations to reduce the sexual and drug abuse-related transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR Morbidity and Mortality Weekly Report, 35,, 152-155.
9.
Centers for Disease Control and Prevention. (1996). Contraceptive method and condom use among women at risk for HIV infection and other sexually transmitted diseases—Selected U. S. sites, 1993-1994. MMWR Morbidity and Mortality Weekly Report, 45, 820-823.
10.
Centers for Disease Control and Prevention. (2001a). HIV and AIDS—United States, 1981-2000. MMWR Morbidity and Mortality Weekly Report, 50(21), 430-434.
11.
Centers for Disease Control and Prevention (2001b). U. S. HIV/AIDS reporting through June 2001. HIV/AIDS Surveillance Report, 13(1), 1-41.
12.
Chitwood, D. D., Griffin, D. K., Comerford, M., Page, J. B., Lai, S., & McCoy, C. B. (1995). Risk factors for HIV-1 seroconversion among injection drug users: A case-control study. American Journal of Public Health, 85,, 1538-1542.
13.
Cohen, D. A. (1999). Condom availability for HIV/STD prevention. AIDS Patient Care and STDs, 13(12), 731-737.
14.
Cohen, D. A., Farley, T. A., Bedimo-Etame, J. R., Scribner, R., Ward, W., Kendall, C., et al. (1999). Implementation of condom social marketing in Louisiana, 1993 to 1996. American Journal of Public Health, 89(2), 204-208.
15.
Cohen, D., Scribner, R., Bedimo, R., & Farley, T. A. (1999). Cost as a barrier to condom use: The evidence for condom subsidies in the United States. American Journal of Public Health, 89,, 567-568.
16.
Cottler, L. B., Leukefeld, C., Hoffman, J., Desmond, D., Wechsberg, W., Inciardi, J. A., et al. (1998). Effectiveness of HIV risk reduction initiatives among out-of-treatment non-injection drug users. Journal of Psychoactive Drugs, 30(3), 279-290.
17.
Davis, K. R., & Weller, S. C. (1999). The effectiveness of condoms in reducing heterosexual transmission of HIV. Family Planning Perspectives, 31(6), 272-279.
18.
Des Jarlais, D. C., Chamberland, M. E., Yancovitz, S. R., Weinberg, P., & Friedman, S. R. (1984). Heterosexual partners: A large risk group for AIDS. Lancet, 2,, 1346-1347.
19.
Donoghoe, M. C., Stimson, G. V., Dolan, K., & Alldritt, L. (1989). Changes in HIV risk behavior in clients of syringe-exchange schemes in England and Scotland. AIDS, 3(5), 267-272.
20.
Ehrhardt, A. A., & Exner, T. M. (2000). Prevention of sexual risk behavior for HIV infection with women. AIDS, 14(Suppl. 2), S53-S58.
21.
El-Bassel, N., Witte, S. S., Gilbert, L., Sormanti, M., Moreno, C., Pereira, L., et al. (2001). HIV prevention for intimate couples: A relationship-based model. Families, System, & Health, 19(4), 379-395.
22.
European Study Group on Heterosexual Transmission of HIV. (1992). Comparison of female to male and male to female transmission of HIV in 563 stable couples. British Medical Journal, 304,, 809-813.
23.
Fenaughty, A. M. (2003). Perceptions of power equality among drug-using women. Women & Health, 37,, 91-107.
24.
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
25.
Freeman, R. C., Rodriguez, G. M., & French, J. F. (1994). A comparison of male and female intravenous drug users’ risk behaviors for HIV infection. American Journal of Drug and Alcohol Abuse, 20,, 129-157.
26.
Gibson, D. R., McCusker, J., & Chesney, M. (1998). Effectiveness of psychosocial interventions in preventing HIV risk behavior in injecting drug users. AIDS, 12,, 919-929.
27.
Gielen, A. C., Fogarty, L. A., Armstrong, K., Green, B. M., Cabral, R., Milstein, B., et al. (2001). Promoting condom use with main partners: Abehavioral intervention trial for women. AIDS and Behavior, 5(3), 193-204.
28.
Gilbert, L., El-Bassel, N., Schilling, R. F., Wada, T., & Bennet, B. (2000). Partner violence and sexual HIV risk behaviors among women in methadone treatment. AIDS and Behavior, 4(3), 261-269.
29.
Gollub, E. L. (1995). Women-centered prevention techniques and technologies. In A. O’Leary & L. S. Jemmott(Eds.), Women at risk: Issues in the primary prevention of AIDS (pp. 43-82). New York: Plenum.
30.
Higgins, D. L., Galavotti, C., O’Reilly, K. R., Schnell, D. J., Moore, M., Rugg, D. L., et al. (1991). Evidence for the effects of HIV antibody counseling and testing on risk behaviors. Journal of the American Medical Association, 266(17), 2419-2429.
31.
Inciardi, J. (1995). Crack, crack house sex, and HIV risk. Archives of Sexual Behavior, 24,, 249-269.
32.
Isreal, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19,, 173-202.
33.
Johnson, B. L., von Haeften, I., Fishbein, M., Kasprzyk, D., & Montano, D. (2001). Factors influencing IDU and non-IDU female commercial sex workers’ intentions to always use condoms for vaginal sex with their regular partner. Psychology, Health & Medicine, 6 (2), 207-222.
34.
Kasprzyk, D., Montano, D. E., & Fishbein, M. (1998). Application of an integrated behavioral model to predict condom use: Aprospective study among high HIV risk groups. Journal of Applied Social Psychology, 28(17), 1557-1583.
35.
Kegeles, S. D., Hays, R. B., Coates, T. J. (1996). The Mpowerment Project: Acommunity-level HIV prevention intervention for young gay men. American Journal of Public Health, 86,, 1129-1136.
36.
Kelly, J. A., Murphy, D. A., Sikkema, K. J., McAuliffe, T. L., Roffman, R. A., Solomon, R. J., et al. (1997). Randomised, controlled community-level HIV prevention intervention for sexual-risk behaviour among homosexual men in US cities. Lancet, 350,, 1500-1505.
37.
Kenski, K., Appleyward, J., von Haeften, I., Kasprzyk, D., & Fishbein, M. (2001). Theoretical determinants of condom use intentionsfor vaginalsex with a regular partner among male andfemale injecting drug users. Psychology, Health & Medicine, 6(2), 179-189.
38.
Kim, M. Y., Marmor, M., Dubin, N., & Wolfe, H. (1993). HIV risk-related sexual behaviors among heterosexualsin New York City: Associations with race, sex, and intravenous drug use. AIDS, 7,, 409-414.
39.
Kline, A., Kline, E., & Oken, E. (1992). Minority women andsexual choice in the age of AIDS. Social Science & Medicine, 34(4), 447-457.
40.
Kotranski, L., Semaan, S., Collier, K., Lauby, J., Halbert, J., & Faighan, B. A. (1998). Effectiveness of an HIV risk reduction counseling intervention for out-of-treatment drug users. AIDS Education and Prevention, 10(1), 19-33.
41.
Krueger, R. A. (1998). Analyzing and reporting focus group results. Thousand Oaks, CA: Sage.
42.
Latkin, C. A., Mandell, W., Vlahov, D., Oziemkowska, M., & Celentano, D. D. (1996). The long-term outcome of a personal network-oriented HIV prevention intervention for injection drug users: The SAFE study. American Journal of Community Psychology, 24,, 341-364.
43.
Lewis, D. K., & Watters, J. K. (1994). Sexual behavior and sexual identity in male injection drug users. Journal of Acquired Immune Deficiency Syndromes, 7,, 190-198.
44.
Minuk, G. Y., Bohme, C. E., Bowen, T. J., Hoar, D. I., Cassol, S., Gill, M. J., et al. (1987). Efficacy of commercial condoms in the prevention of hepatitis B virus infection. Gastroenterology, 93(4), 710-714.
Parker, R., & Ehrhardt, A. A. (2001). Through and ethnographic lens: Ethnographic methods, comparative analysis, and HIV/AIDS research. AIDS and Behavior, 5(2), 105-114.
47.
Pinkerton, S. D., Johnson-Masotti, A. P., Holtgrave, D. R., & Farnham, P. G. (2001). Using cost-effectiveness league tables to compare interventions to prevent sexual transmission of HIV. AIDS, 15,, 917-928.
48.
Piot, P. (2002, July). Keeping the promise. Paper presented at the opening ceremonies of the Fourteenth International AIDS Conference, Barcelona, Spain.
49.
Prochaska, J., Redding, C., Harlow, L., Rossi, J., & Velicer, W. (1994). The transtheoretical model of change and HIV prevention: A review. Health Education Quarterly, 21,, 471-486.
50.
Rhodes, T., Stimson, G. V., & Quirk, A. (1996). Sex, drugs, intervention, and research: From the individual to the social. Substance Use and Misuse, 31(3), 375-407.
51.
Rotheram-Borus, M. J., Cantwell, S., & Newman, P. A. (2000). HIV prevention programs with heterosexuals. AIDS, 14(Suppl. 2), S59-S67.
52.
Sanchez, J., Gotuzzo, E., Escamilla, J., Carillo, C., Moreya, L., Stamm, W., et al. (1998). Sexually transmitted infections in female sex workers: Reduced by condom use but not by a limited periodic examination program. Sexually Transmitted Diseases, 25(2), 82-89.
53.
Schulz, A. J., Krieger, J., & Galea, S. (2002). Addressing social determinants of health: Community-based participatory approaches to research and practice. Health Education & Behavior, 29(3), 287-295.
54.
Sikkema, K. J., Kelly, J. A., Winett, R. A., Solomon, L. J.Cargill, V. A., Roffman, R. A., et al. (2000). Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. American Journal of Public Health, 90,, 57-63.
55.
Sormanti, M., Pereira, L., El-Bassel, N., Witte, S., & Gilbert, L. (2001). The role of community consultants in designing an HIV prevention intervention. AIDS Education and Prevention, 13(4), 311-328.
56.
Watters, J. K., & Biernacki, P. (1989). Targeted sampling: Options for the study of hidden populations. Social Problems, 36,, 416-430.
57.
Williams, J. L., Christensen, C. J., Cagle, H. H., & Homan, C E. (2001). Brief report on the effect of providing single versus assorted brand name condoms to hospital patients: Adescriptive study. BMC Public Health, 1(1), 5-5. (Also available at http://www.biomedcentral.com/1471-2458/1/5)
58.
Williams, M., McCoy, H. V., Bowen, A., Saunders, L., Freeman, & Chen, D. (2001). An evaluation of a brief HIV risk reduction intervention using empirically derived drug use and sexual risk indices. AIDS and Behavior, 5(1), 31-43.
59.
Wingood, G., & DiClemente, R. (1997). The effects of an abusive primary partner on condom use and sexual negotiation practices of African-American women. American Journal of Public Health, 87,, 1016-1018.
