GENDER-SPECIFIC INTERVENTIONS FOR WOMEN AND THEIR MALE PARTNERS

Grant Title: Increasing Dual Protection Among Low-Income Minority Women

Project Name: Project REACH (‘Research and Education About Contraceptive Health')

Funding Source/Mechanism and Project Period: NICHD R01; 1999 - present

Collaborating Institutions and Key Personnel:

HIV Center:
Principal Investigator: Theresa Exner, Ph.D.
Co-Principal Investigators: Joanne Mantell, Ph.D.; Susie Hoffman, Dr.P.H.
Co-Investigators: Zena Stein, M.D.; Jessica Adams-Skinner

Community HealthCare Network, New York, NY:
Site Principal Investigator: Evette Walker, M.D.
Study Nurse: Deborah Seton, L.P.N.

Project Overview: In many impoverished urban communities women are at significant risk for both unintended pregnancy and sexually transmitted diseases (STDs) including HIV. Inner-city family planning (FP) clinics within neighborhoods with high HIV/STD prevalence are natural settings to reach this at-risk population as they are important sites for gynecological and primary care services for women. Such clinics are in a unique position to help these women identify their risk and take preventive measures. Unfortunately, at-risk women often do not self-identify and frequently remain unidentified due to cursory clinic screening procedures.

Dual protection, a strategy for concurrent protection from both HIV/STDs and unintended pregnancy, is increasingly being recommended in family planning clinics. This initiative has met with limited success. Although Title IX-funded family planning clinics offer HIV counseling and testing, considerable gaps still exist in how family planning and HIV/STD services are integrated. Given the complex linkages among HIV/STDs, reproduction, and relationship issues, interventions that sensitize women to their risk and simultaneously address the goals of disease prevention and unintended pregnancy are needed now. These interventions must help to identify women at risk and provide structured decision-making counseling that considers women's individual situations and must fit within the constraints of resource-poor inner-city family planning clinics so that the interventions can be sustained as part of standard care.

This project seeks to demonstrate the potential efficacy of an individualized, clinic-based, provider-delivered intervention designed to increase adoption and maintenance of dual protection – i.e., methods that provide concurrent protection from both HIV/STDs and unintended pregnancy. The study, undertaken collaboratively with the Community Healthcare Network (CHN), a New York City consortium of clinics serving nine medically underserved high-STD/HIV areas, enrolled 101 low-income, primarily African American, Caribbean, and Latina 15-32 year-old HIV-seronegative women attending four CHN clinics. Data collection has been completed, and analysis of the trial is underway. We will compare our manualized Risk and Decision-Making (RAD) intervention against standard of care (SoC) immediately post-counseling and six months later.

Publications and Presentation Abstracts:
Exner, TM, Hoffman, S., Mantell, JE, Adams-Skinner, JA, Stein, Z, Walker, Y and Atkins, K. Impact of a brief counseling intervention on women's use of the female condom. Thirty-first Meeting of theInternational Academy of Sex Research, Ottawa, Canada, July 6-9, 2005

Mantell, JE, Hoffman, S, Weiss, E, Adeokun, L, Delano, G, Jagha, T, Exner, TM, Stein, ZA, Abdool Karim, Q, Scheepers, E, Atkins, K, and Weiss, E. 2001. The acceptability of the female condom: Perspectives of family planning providers in New York City, South Africa, and Nigeria. Journal of Urban Health 78:658-668.

Mantell, JE. Microbicide Acceptability issues for health care providers. Presented at the workshop Expanding Prevention Choices for Women and Men, Gay Men's Health Crisis, April 19, 2001.

Mantell JE, Hoffman S, Exner, TM, Stein ZA, Atkins K. (2003). Family planning providers' perspectives on dual protection. Perspectives in Sexual and Reproductive Health 35(2):71-78.

Update: 5/26/05