Partnering with Domestic Violence Shelters to Prevent HIV Among Abused Women and Examining the Multilevel Context

Introduction: There is a need to adapt evidence based interventions (EBIs) for reducing HIV for women in domestic violence (DV) shelters, involve shelter residents and workers in the adaptation process, and understand the multilevel context within DV shelters where EBIs may be implemented. This paper will 1) provide an overview of a NIDA-funded pilot study that adapted an EBI for reducing HIV risk behavior for women in DV shelters and 2) describe some of the individual-, facilitator-, and organizational-level factors that were assessed in order to better understand the context of the interventions implementation.

Methods:The eight step ADAPT-ITT framework was used to adapt an EBI for reducing HIV sexual risk behavior, Sisters Informing Sisters About Topics on AIDS (SISTA), for women in DV shelters and the adapted intervention was implemented by case managers from three DV shelters with shelter residents. Survey measures were administered to shelter residents (n=32) and shelter workers (n=11) to assess resident-, facilitator-, and organizational-characteristics. Measures given to residents included the Conflict Tactics Scale, Dissociative Experiences During Sexual Behavior Scale, and Posttraumatic Checklist for DSM-V. Measures given to shelter workers included the Effectiveness and Evidence Based Practice Questionnaire, the Implementation Citizenship Behavior Scale, and the Psychological Climate Inventory.

Results: Shelter residents and workers observed exercises from the original SISTA intervention and provided feedback on how to adapt the exercises for women in DV shelters. Ten changes were made to adapt SISTA for women in DV shelters based upon that feedback. Among the 32 shelter residents who received the adapted intervention, 84% had unprotected anal or vaginal sex with their abusive partner during the past year and 56% had a partner make them have sex without a condom. Shelter case managers who had never facilitated an intervention for victims of DV before (66%) were more likely than workers who had facilitated such an intervention to 1) report that they would adopt a therapy or intervention that was new to them if it was required by their agency, supervisor, or state and 2) keep informed of evidence-based policies, procedures, practices, and related evidence-based practice agency communications. Mean scores for organizational innovation (Mean=3.83; SD=0.72; max=3) and support (Mean=3.73; SD=0.92; max=5) and leadership trust and support (Mean=3.98; SD=0.45; Max=5) were average.

Conclusions: The individual-, facilitator-, and organizational-factors described may affect the implementation of the adapted SISTA intervention for women in DV shelters and warrant further study.