PHENOMENAL WOMAN: THE DEVELOPMENT OF A PROGRAM WITH THE DUAL GOALS OF SUBSTANCE ABUSE RELAPSE AND HIV PREVENTION

Authors: Cathy Irizarry, Chantay Jones, Dr. Constance West, Dr. Brenda Adjei, & Danielle Nordlund (Presenter: Dr. Constance West)

International AIDS Conference July 25, 2012

Presentation Outline Background

Agency Overview HIV Risk in Served Populations

Methods: Formative Phase Major Activities Lessons Learned & Decisions Made

Results Content and Structure of Intervention Preliminary Outcomes

Conclusions

Background

Greenhope Services for Women, Inc.

Established in 1975

Located in East Harlem, New York City (U.S.A.)

Provides a wide array of services to women (particularly, African-American and Hispanic women with substance abuse issues and criminal justice system involvement)

HIV Risk Factors for Population Served

In general, substance abusers (particularly, injection drug users, commercial sex workers, and females) have been found to be at increased risk for infection with HIV and other STI’s.

HIV infection rates among individuals involved in the U.S. criminal justice system can be 2 to 5 times larger than that in the surrounding community (NIDA, 2010).

HIV Prevalence Rates: New York

•* New York City's AIDS case rate is almost 3 times the U.S. average.

•*During the first half of 2011, African-American and Hispanic women accounted for 93% of new HIV/AIDS cases among New York City women.

•Source: New York Department of Health and Human Hygiene (2012)

Addressing the HIV Prevention Needs of Greenhope Clients: Brainstorming the Intervention

1• Greenhope had been implementing an evidence-based HIV

prevention intervention (i.e., SISTA), but realized that this program did not adequately address the issues specific to women in substance abuse treatment/recovery

2• Greenhope also researched another evidence-based

program, “Helping Woman Recover”, a substance abuse treatment program by Stephanie S. Covington

3• Aspects from Greenhope’s Domestic Violence and Trauma

treatment groups were considered during brainstorming ideas for the new initiative

4• The knowledge of the 2 programs (i.e., SISTA and Helping

Women Recover) motivated Greenhope to develop an intervention that would address HIV prevention and substance abuse treatment needs simultaneously

Securing Funding for the Proposed HIV Prevention Program

In 2010, Greenhope received funding under the GENERATIONS (GEN III) Program

3 Proposed Target Populations HIV-Negative Incarcerated Women (Riker’s Island) HIV-Negative Women at Greenhope HIV+ Women

2 Proposed Implementation Sites Riker’s Island (prison) Greenhope Facility

Methods

Focus Groups & Key Informant Interview• 3 Focus Groups

(42 Participants, Total)

• 1 at Rikers Island Prison • 2 at Greenhope• SISTA graduates

• SISTA-naïve clients

• 1 Key Informant Interview with SISTA Facilitator

Site Visit & Ongoing Technical Assistance

• Site Visit with TA Team

• Weekly Technical Assistance (TA) Conference Calls

Review of Existing Curricula

• SISTA• Helping Women Recover (HWR)

• Charm School• Project PREPARE

• Other HIV prevention curricula

Formative Phase Activities

Formative Phase Findings & Key Decisions: Target Population

Formative Phase Findings Key Decisions MadeRiker’s Island limited number of Greenhope staff members allowed in the prison, and sometimes did not allow staff members to have access to inmates.

Not feasible for prison site (Riker’s Island). Limit target population to Greenhope clients, and implementation site to the Greenhope facility.

Greenhope clients in later phases of the residential SA program have already participated in a large number of group-based programming, and expressed little interest in a new program. In addition, they frequently have off-site appointments that would conflict with the group session schedule.

Include Greenhope clients in the Orientation Phase only (within 30 days of admission). These clients have no off-site privileges and do not frequently attend off-site appointments.

GEN III specifically funds HIV prevention efforts directed at HIV-negative women and girls.

Focus exclusively on HIV-negative women

Formative Phase Findings & Key Decisions:Selection & Adaptation of CurriculumFormative Phase Findings Key Decisions MadeWomen participating in numerous groups at Greenhope

Select components to eliminate redundancy

Women wanted something different – Need to incorporate and develop novel activities to distinguish new program from other Greenhope programs

Include/Develop innovative, interesting, and engaging activities

SISTA does not address specific issues of women in substance abuse recovery process (specifically, the issue of sober sex as being a new concept and integrating the 12-step model into HIV prevention). Greenhope clients were reported to have contracted STI’s and have “pregnancy scares” after obtaining “passes” allowing them to leave the facility (even after participating in SISTA)

Integrated SISTA and Helping Women Recover with other HIV prevention curricula, combined with innovative components developed by Greenhope staff.

Results

The Naming of “Phenomenal Woman”

Phenomenal Women Overview HIV Prevention Program for Women in

Recovery Dual Goals of reducing sexual and substance abuse risk

behaviors Target Population

HIV-negative, African American and Latino female offenders (>age 18)

Ex-offenders who have substance abuse/dependence issues and at high risk for HIV

Recently released from prison and/or mandated to treatment as alternative to incarceration

Greenhope residents complete Phenomenal Woman during Orientation Phase (within 30 days of admission to Greenhope’s residential SA treatment program) OR while living in Greenhope housing and receiving intensive outpatient SA treatment

Phenomenal Woman Overview (Cont’d)

Implementation Strategy Location: Sessions held on-site at Greenhope Planned cohort size: 10-12 participants Intervention designed to consist of 5 two-hour

group sessions (conducted over 5 consecutive days), followed by a two-hour booster session held 45 days after program completion

Program designed to be implemented by a program coordinator with assistance from a part-time peer group facilitator.

Overview of Goals/Session Topics

Session 1: Self - Enhance women’s sense of self

Session 2: Sex - Increase knowledge about HIV/STI’s, sexual anatomy, and sexuality

Session 3: Sober and Safe Sex - Increase women’s self efficacy in engaging in, communicating about, and negotiating sober and safe sex behaviorsSession 4: Spirituality - Increase women’s awareness about their spirituality, teach them relaxation exercises, and enhance their awareness of the role and use of spirituality in their recovery and sexual decision-making.Session 5: Review/Celebration – Reinforce topics covered in previous sessions

Booster -Session 6 : Review key topics covered in PW and follow-up on participants experiences and achievement of goals

How is Phenomenal Woman Different?

Dual Purpose Engages all 5 senses Intensity (2 hours per day, 5 consecutive days) Power of Repetition

Positive Woman’s Music Affirmation Sheets Poetry and Prayer Relaxation Exercises

(Including, use of aromatherapy and meditation rocks)

Phenomenal Woman: Core ElementsCore Element(s) OriginAffirmation Sheets (Sessions 1-5) Helping Women Recover (As Modified by

Greenhope Staff with Input from Evaluator and TA Provider)

Condom Demonstration & Negotiation Techniques

SISTA

Safe & Sober Sex Discussion Helping Women Recover

Female Anatomy & HIV/STI Education SISTA

Use of Music (positive/relaxing) at the Start/End of Sessions (Sessions 1-5)

Generated by Greenhope Staff (with Input from Evaluator and TA Provider)

Meditation/Spirituality Exercises (rock, water, walk)

Helping Women Recover

Poetry readings SISTA45-Day Goal Action Plan (Exercise Completed at Session #5, and Revisited at Booster Session)

Generated by Greenhope Staff (with Input from Evaluator and TA Provider)

Phenomenal Woman Conceptual Model

Preliminary Results: Pilot/Implementation Phases

Pilot Phase (n=21participants) High retention rates: 19/21 completed full intervention (90%) High participant satisfaction rates: Average = 3.69 (Range 1-4) High fidelity: 120/140 activities implemented as planned (86%)

Implementation Phase (n= 76 participants) High participant retention rates

100% across five initial sessions 72% at booster session

Statistically significant increases in participants’ sense of self and knowledge of sexual anatomy.

Trends for enhanced attitudes toward condom use and relapse prevention (although not statistically significant)

Phenomenal Pictures and Quotes!!!

“I really enjoyed the group and it was very informative, wouldn’t change a thing.”

“I learned how to communicate more about having safer sex with my partner.”

I learned not to regret what you did in the past and learned to love yourself…remember I'm a

Phenomenal Woman.”

Conclusions

Greenhope’s Phenomenal Woman Program Provides an example of effectively developing

and delivering curricula through the adaptation of evidenced-based HIV and SA relapse prevention curricula combined with the creation of new components to more adequately address the specific needs of a target population

Maximized participant retention rates through high levels of administrative support

Holds considerable promise for dissemination to other agencies with similar target populations.

Acknowledgements: Funders & Collaborative Partners

Contact Information

Constance West, Ph.D.

Technical Assistance Provider

Sankofa ServicesAtlanta, GA 30038

cacwest@bellsouth.net

(404) 483-8841

Felicia Johnson, B.A.

Coordinator of HIV Services

Greenhope Services for Women, Inc.435 East 119th St.New York, NY 10035

fjourdain@greenhope.org

(212) 996-8633 x1116

Cathy Irizarry, B.A.

Clinical Supervisor

Greenhope Services for Women, Inc.418 East 119th St.New York, NY 10035

cirizarry@greenhope.org

(212) 860-6650

Brenda Adjei, M.P.A., Ed.D.

Independent Evaluator

Rockville, MD 20850

adjeib@gmail.com

(917) 208-6460

Questions & Answers