Abstract

Women prisoners, many of whom are poor or of color, have disproportionately high rates of HIV and other sexually transmitted diseases. Women prisoners are 15 times more likely to be HIV-infected than women in the general population. Prison facilities in the south have among the highest rates of HIV in the nation. The proposed study will adapt and tailor the existing evidence-based behavioral intervention, ?Project SAFE,? for use with incarcerated women in the south. Project SAFE was originally developed for and tested with women in STD clinics in the urban Southwest. The specific aims of the project are to: (1) Assess the fit between intervention delivery and the needs and resources of the North Carolina Department Of Corrections and the fit between intervention materials and the behavioral, social, and contextual conditions of incarcerated women?s lives that may contribute to continuing sexual risk behavior following release from prison; (2) Adapt and tailor the Project SAFE behavioral risk reduction intervention for HIV-negative, heterosexual women prisoners in the rural Southeastern U.S; (3) Pilot the adapted Project SAFE intervention; and (4) Test the adapted Project SAFE risk-reduction intervention with 598 incarcerated women to determine its efficacy in decreasing risk for non-viral STD infections (chlamydia, gonorrhea, and trichomonas), decreasing sexual risk behaviors and increasing risk reduction practices. A randomized two-group experimental design will be used: the experimental group will receive the adapted Project SAFE intervention and the control group will receive standard Department of Corrections counseling about STDs/HIV. Specific hypotheses to be tested are: (1) Women receiving the Project SAFE intervention will have a lower 12-month rate of non-viral STD infections (chlamydia, gonorrhea, and trichomonas) after release than women who did not receive the intervention; and (2) Women receiving the Project SAFE intervention will show greater improvement in enacting sexual protective practices (decreased number of unprotected sex acts, decreased number of concurrent sex partners) and decreased high risk sexual activities (sex with an infected partner, lack of mutual monogamy, unsafe sex, partner concurrency, douching after sex, sex exchange for drugs, sex while high) at 3, 6, and 12 months after release than women who did not receive the intervention. Approximately 30%-50% of participants are expected to live in rural communities and over 40% are expected to be African American.