Q&A: Intervention reduces STIs among Black women in community supervision programs
Click Here to Manage Email Alerts
A culturally tailored intervention reduced the incidence of sexually transmitted infections among Black women with a history of drug use who were in a probation, parole or alternative-to-incarceration program, data showed.
The randomized clinical trial was conducted from November 18, 2015, to August 20, 2019. Among the 352 participants (mean age, 32.4 years; self-identified as Hispanic or Latina, 22.5%), 172 women were randomly assigned to the Empowering African-American Women on the Road to Health (E-WORTH) intervention and 180 women were randomly assigned to receive one 30-minute session about HIV testing and prevention. The E-WORTH intervention included a 1-hour individual HIV testing and orientation session and four weekly 90-minute group sessions.
During a 12-month follow-up period, researchers found that E-WORTH participants had 54% lower odds for a positive STI test (OR = 0.46; 95% CI, 0.25-0.88) and reported 38% fewer acts of condomless intercourse (incidence rate ratio = 0.62; 95% CI, 0.39-0.97) compared with participants in the HIV testing-only control group.
Healio Primary Care spoke with study coauthor Dawn Goddard-Eckrich, EdD, the associate director of the Social Intervention Group at Columbia University, to learn more about the intervention and its potential impact on public health.
Healio Primary Care: Can you discuss the E-WORTH intervention in more detail, and why it is so important for the intervention to address factors like systemic racism along with HIV/STI education in this population?
Goddard-Eckrich: Black women in community supervision programs had 23.1 times the rate of new HIV and STIs compared to non-Hispanic white women and are the largest segment of the criminal justice system (probation, parole and alternative-to-incarceration programs) who are heavily impacted by concentrated epidemics of HIV and STIs.
The disproportionately high HIV infection rates among Black women are due to myriad factors rooted in structural racism. These factors include provider discrimination, racial inequities in access to HIV treatment, residential segregation, segregated social and sexual network, racialized drug laws and mass incarceration. Racialized drug laws and racialized policing practices have led to a vast overrepresentation of Black individuals in community supervision programs. Not that the justice-involved women don’t accept any responsibility, but it helps put some things into context and understanding the role that social determinants like poverty, education, etc. have on HIV/STI transmission and rates.
Healio Primary Care: What impact might widespread adoption of this intervention or similar programs have on public health?
Goddard-Eckrich: Interventions like E-WORTH can really help Black women advocate for themselves and communicate with their providers about HIV/STDs. Having interventions developed specifically for Black women is critical in the adoption and successful implementation and uptake. E-WORTH is just the beginning. Culturally tailored interventions need to be developed for all areas, including substance abuse, intimate partner violence, COVID-19 vaccination and chronic disease.
Healio Primary Care: Are there plans to continue offering the E-WORTH intervention in New York to the women in the study population?
Goddard-Eckrich: We will be working on a dissemination plan with our partners like the Department of Probation and Fortune Society. With COVID-19, things may not move as quickly as we had originally planned, but there is enthusiasm to make this a program that will be offered and available to Black women on probation in New York City and other community corrections. E-WORTH will most likely be an app as we think of the next phase of the intervention. COVID-19 has really made us realize the need for more virtual, online interventions.
Healio Primary Care: How can organizations implement the E-WORTH intervention?
Goddard-Eckrich: We are not at that stage yet so stayed tuned. Potential implementers are welcome to get in touch with the Social Intervention Group team to ask about implementation:
principal investigators — Louisa Gilbert, PhD, and Nabila El-Bassel, PhD;
first author and original project director — Karen Johnson, PhD; and
coinvestigator and project director — Dawn Goddard-Eckrich, EdD.
Healio Primary Care: What is the key take-home message of the findings for primary care providers?
Goddard-Eckrich: Culture, communication, validation and community matters. Our intervention was nonjudgmental and we took the time to work with our participants, and when we look at some of the other data we have, it is clear that stigma plays a big role in Black women’s health. That needs to be addressed.
It is OK to use interventions as a vehicle to achieve behavior change, and sometimes we have to meet people where they are.