Motivational interviewing-based interventions for reducing HIV and partner violence risk among women with HIV risk and recent criminal justice system involvement

Background: This randomized controlled trial with women at-risk for HIV and with recent criminal justice system involvement (n=530) evaluates two motivational interviewing-based (MI) interventions to reduce HIV or partner violence risk.

Methods: A convenience sample of participants recruited in jails, parole and probation and word-of-mouth were randomized into three groups: control, HIV prevention (HIV), or HIV and partner violence prevention (HIV/PV). Intervention participants received up to 12 weekly (mean=4.7) one-on-one sessions delivered by paraprofessionals trained in MI. Sessions included risk self-assessment, assessment of readiness to address risk, and stage-based discussions of behavior change. Interventions addressed HIV risk and life stability concerns, and partner violence risk for HIV/PV participants. Assessments at baseline, 3, 6, and 9 months measured unprotected intercourse and needle sharing in the last 30 days and violence in the last 3 months. Group differences at follow-up were evaluated using generalized estimating equations that controlled baseline differences.

Results: 84% completed the 9-month follow-up assessment. Compared to participants in the control group, participants in the intervention groups had significantly lower odds of unprotected intercourse at the 3, 6, and 9-month assessments (average OR=0.51) and significantly lower incidence rates of unprotected intercourse at the 6 and 9-month assessments (average incidence rate ratio=0.61). There were no significant differences in intimate partner violence between controls and participants in the HIV/PV group.

Conclusions: MI-based HIV prevention interventions delivered by paraprofessionals can reduce sexual risk behavior and exposure to violence. The addition of a partner violence prevention component was not associated with reductions in violence.