Results from an Adapted Evidence Based Intervention for Reducing HIV Sexual Risk Behavior for Women in Domestic Violence Shelters

Introduction:There is a need for evidence based interventions (EBIs) for reducing HIV risk among women in domestic violence shelters. Key stakeholders assisted with adapting an HIV prevention EBI, Sisters Informing Sisters on Topics of AIDS, for women in domestic violence shelters. This study reports on the following from that adapted interventions implementation: 1) the impact of the intervention on the shelter residents’ HIV knowledge and condom use self-efficacy, 2) the facilitators’ self-efficacy for implementing the intervention and their perceptions of the interventions usability (i.e., acceptability, systems support, understanding, and feasibility), and 3) the shelter residents’ satisfaction with the intervention.

Methods:The adapted, manualized intervention, called SISTA Survivor, consists of two, three-hour group sessions. The intervention was implemented five times at three domestic violence shelters, which were located in two of the top ten United States with high rates of HIV. Each intervention session was facilitated by two case managers from the shelters who attended an 8-hour training for SISTA Survivor. Thirty two residents provided informed consent, attended both intervention sessions, and completed pre- and post-intervention questionnaires. Seven case managers facilitated the intervention and completed survey questionnaires. A two-way mixed [implementations 1-5 by time (pre/post)] MANOVA was used to test whether the five intervention implementations differed in their impact on residents’ HIV knowledge and condom use self-efficacy from before and after the intervention.

Results: There was no significant interaction between the five intervention implementations and changes in HIV knowledge or condom use self-efficacy. There was a significant main effect for time F (2, 26) =12.71, p=.00, partial eta squared=.49 and both the HIV knowledge and condom use self-efficacy post-intervention scores were significantly higher than the pre-intervention scores. Facilitators self-efficacy was below average (Mean=15.43; Max=25). Facilitators’ perceptions of the interventions acceptability were high (M=4.64; Max=6), but their understanding of the intervention (Mean=4.07; Max=6), views of the intervention’s feasibility ((Mean=4.14; Max=6), and ability to independently implement the intervention (Mean=2.81; Max=6) were poor. Residents were highly satisfied with the intervention (Mean=33.66; SD=3.58; Max=35).

Conclusions: Shelter residents showed significant improvements in their HIV knowledge and condom use self-efficacy after receiving the intervention even though the case managers who implemented the intervention didn’t feel efficacious in administering it. Greater intervention gains may be achieved by improving facilitators’ self-efficacy for the intervention and this may be achieved by helping facilitators better understand the intervention and by providing them with better system supports.