What Works for Women and Girls

Promising Strategies:5. Sex-segregated group sessions for IDUs can result in increased condom use and safe injectionpractices.A study from 2005 to 2006 at Shu Policlinic Needle Exchange Program in a city alonga major drug trafficking route in Kazakhstan found a comparison between 40 coupleswho had single gender group sessions with female and male partner IDUs results inincreased condom use and safe injection practices compared with 40 couples who didnot have single gender group sessions. None were HIV-positive. Adapted from an HIVprevention intervention with heterosexual couples in the US, in-depth interviews wereconducted with IDUs in Kazakhstan to adapt the intervention to Kazakhstan. Afterconsent was obtained with one partner, this partner was asked to invite his or her mainpartner to participate. If both partners agreed to participate, they were included unlessone reported violence. All couples received training consisting of practicing couplescommunication, problem solving and assertiveness skills. At each session, participantsset a risk reduction goal for the week and this is reviewed at the following session.However, the intervention group had two sessions designed to help women anticipateand manage partner negative reactions in response to requests to use condoms or notto share needles. Current and past drug and alcohol use was assessed using the USNational Institute of Drug Abuse’s Risk Behavioral Assessment, validated internationally(NIDA, 1991 cited in Gilbert et al., 2010) and condom negotiation self-efficacy wasassessment with a five-item scale (Wingood and DiClemente, 1998 cited in Gilbertet al., 2010). All partners reported living together and 41 of 80 reported having children.At baseline, participants reported using condoms only 2% of the time they hadvaginal sex (an average of 20 sexual acts) with their study partner in the last 30 days.All reported injecting drugs and participants reported sharing needles with an averageof 3.7 different people in the past 30 days and indicated using unclean needles 63% ofthe times they injected in the past 30 days. Those participants who had single gendergroup sessions were significantly more likely to report a higher proportion of condomuse during vaginal sex with their study partners and a lower number and proportion ofinjection acts in which syringes were shared at three month follow-up, after adjustingfor age, education and sex. In addition, those couples who had single gender groupsessions were significantly more likely to increase condom use self-efficacy and couplecommunication skills. Future research with large randomized trials using biologicalmarkers in warranted. “Although no participants tested positive for HIV, if HIV entersthe risk networks of IDUs, the pervasive patterns of drug-related and sexual HIV riskbehaviors suggest that HIV will spread rapidly” (Gilbert et al., 2010: 175). (Gray III)(sexual partners, IDU, needles, Kazakhstan)WHAT WORKS FOR WOMEN AND GIRLS97