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Abstract
This dissertation evaluates an HIV/AIDS prevention intervention among women in the Philadelphia metropolitan area. I examine whether the prevention message of a counseling intervention, based on the Transtheoretical Model of Behavior Change, effectively reached women otherwise marginalized by society. The research question is whether women in the intervention group increased condom use with a main partner at a significantly higher rate than those in the standard group, who did not receive the intervention.
The 763 women in the study were drawn from ten sites: five drug treatment centers, three homeless shelters and two public housing developments. The sample was randomized into enhanced and standard groups by site type. The enhanced group was provided access to peer advocate counseling during the initial six months, in addition to Title X reproductive health services. The standard group received only Title X services. The women were followed for eighteen months, with interviews every six months. At each time wave, information was gathered on demographics, fertility history, risk behaviors and partner risk behaviors.
I find that both the enhanced and standard groups significantly reduced their risk behavior over the course of the eighteen-month study. The pattern of change for the enhanced group involved a sharp increase in condom use at 6 months, followed by a relapse at 12 months and a partial recovery by 18 months. The standard group followed a pattern of gradual increase over time, eventually equaling the level of condom use in the enhanced group by the end of the study. An intent-to-treat analysis results in a marginal intervention effect at six months (p = 0.06) and also at eighteen months (p = 0.05). Results from the women who actually received enhanced services reflect a significant intervention effect at six months (p = 0.01), but none at 18 months (p = 0.45). When examined by site type, the homeless shelters emerge as the only context where the intervention was significantly positive. Drug treatment centers reflect an adverse but insignificant effect of treatment, while the public housing developments report positive but insignificant effects.
