Adapting an Evidenced Based Intervention for Reducing HIV Sexual Risk Behavior for Women in Domestic Violence Shelters

Introduction:  Women who experience intimate partner violence (IPV) are vulnerable for contracting HIV by virtue of high-risk heterosexual sex. However, there are no evidenced based interventions (EBIs) for reducing HIV risk that specifically target female victims of IPV. Furthermore, a HIV prevention EBI for women in domestic violence shelters could be widely disseminated since domestic violence shelters are located in every state. Since developing new EBIs entails substantial costs, it may be more cost effective to adapt HIV prevention interventions that have been shown to be effective for new target populations. This study describes the process of adapting a HIV prevention EBI, Sisters Informing Sisters About Topics on AIDS (SISTA), for women in domestic violence shelters.

Methods: Two domestic violence shelters participated in the adaptation process, which was guided by the ADAPT-ITT framework and the following: 1) a needs assessment for a HIV prevention EBI at the participating shelters, 2) feedback from key stakeholders who observed exercises from the original SISTA intervention and indicated whether to retain original exercises or adapt them for the new target population, and 3) feedback from topical experts. Also, the availability of the female condom was evaluated in order to evaluate the sustainability of this HIV prevention method in the adapted intervention.  

Results: The majority of shelter staff (84-100%) reported that there were currently no HIV prevention services being implemented at their shelter. Changes made to adapt SISTA for women in domestic violence shelters and promote its implementation included: reducing the duration of the intervention, incorporating poems aimed to enhance pride of being a survivor of IPV, revising materials so that they do not focus exclusively on African American women, including information about HIV risk among women who experience IPV, including safety planning, and providing participants with materials to promote their financial education. Less than 1% of local businesses that sell/provide contraception reported selling/providing the female condom so this HIV prevention method was not widely promoted in the adapted HIV prevention intervention, named SISTA Survivor.

Conclusions: SISTA Survivor retains core elements of SISTA while also integrating education and exercises aimed to enhance abused women’s awareness about the intersection of IPV and HIV. Next steps will include implementing the SISTA Survivor and assessing trainers’ knowledge, attitudes, beliefs and self-efficacy for implementing SISTA Survivor as well as shelter staff and residents’ perceptions of the acceptability, adaptability and appropriateness of SISTA Survivor for women in domestic violence shelters.