Effect of an adapted evidence-based, gender-focused intervention on condom use among at-risk women in Pretoria, South Africa

Background: This paper presents results of a woman-focused intervention designed to reduce women's sexual risk behaviors and empower women to communicate with their sexual partners in South Africa.

Methods: The NIAAA study recruited women who recently reported engaging in unprotected sex or sex trading, and 585 women were randomized into either a woman-focused group or a standard group. Participants were administered repeated measures at baseline, 3- and 6-months. Several subscale scores from the questionnaires were examined to determine whether there were differences in risk behaviors with one's main partner depending on sex worker status and intervention group. Condom use during last vaginal sex with main sex partner was the predictor. Logistic analyses were conducted in three waves—including only women who tested negative for HIV (39%); including only women who tested positive for HIV (32%); and including those who refused to be tested (29%).

Results: Condom negotiation was significantly associated with condom use with main partners at the 3- and 6-month follow-up for HIV-positive and HIV-negative participants, and participants who refused to be tested. Moreover, women who tested positive for HIV or refused to be tested who were assigned to the woman-focused group were significantly more likely to report condom use at six-month follow-up.

Conclusions: Such findings indicate that gender-based interventions for women may result in increased condom negotiation skills which may lead to more protective behaviors. Future interventions may need to devote more time to empowerment activities in order to further address HIV risk among South African women.