Cognitive Behavioral Skills Training for HIV Prevention in Zambia

Category 1

Use of group based cognitive behavioral skills training on HIV risk and prevention in gender specific groups to change sexual behaviors among sero-discordant couples.

Goal of the Practice
  • Acceptability and use of vaginal chemical barriers (male and female condoms, vaginal lubricants) among HIV-positive Zambian women and their sexual partners
  • Efficacy of cognitive behavioral skills sessions to change risk behaviors among men and women
Core Components
  • A series of gender-specific Zambian focus groups were held to culturally tailor the intervention and assessment tools.
  • Women were randomized to one of two conditions, single or multiple (four) group. Women were encouraged but not required to invite their male partners to attend sessions and those men that did attend were also exposed to same intervention as the women.
  • Closed, structured gender-concordant (women or men) intervention groups were led by trained gender-congruent counselors.
  • The four cognitive behavioral skill training sessions on HIV and STI prevention and transmission, communication, conflict resolution, sexual negotiation were compared with a traditional health education individual format, which included identical information on HIV/STI transmission hierarchical counseling and skill training to facilitate product use. Sexual risk behavior, strategies, attitudes and knowledge were assessed at baseline, 6, and 12 months.
  • All participants were provided with sexual barrier products (male and female condoms) as well as vaginal lubricant products.
Noteworthy Results
  • Those sexually active at baseline and at six-months in the group arm used sexual barriers (F1,82 = 4.6, p<0.05) and male condoms (F1,67=13.5, p < 0.001) p < 0.001) more often than those in the individual arm, increasing from 'some of the time' to 'most of the time.'
  • There were no differences between arms in levels of female condom use (F1,66 = 0.03, p = 0.86), lubricant use (F1,66 = 0.01, p = 0.91) or use of lubricants with condoms (F1,65 = 3.43, p = 0.07). All participants increased use of female condoms (t1,87 = -8.88, p <0.001), lubricants in with condoms (t 1,86 =-5.15, p <0.001) and lubricants alone (t 1,87 = -11.77, p <0.001) from 'never' to 'some of the time."
  • 19% of males reported using alcohol before sex, 10% reported using alcohol to cope, and negative coping was associated with sexual risk behavior. In contrast, 1% of women reported using alcohol before sex, and 15% used alcohol as an HIV-coping strategy. Consistent barrier use was reported by 48% of women and 74% of men.
  • Men increased their risk avoidance intentions and AIDS-related knowledge to equal those of their partners at 12 months, while maintaining positive condom attitudes.
  • Women with greater partner involvement had higher rates of condom use, more positive attitudes regarding condom use, greater safer sex intentions and less risk behavior.
Lessons Learned
  • The importance of involving male partners to increase sexual communication within couples.
  • The need for longer-term programs to sustain condom use and that group interventions may be adjuncts to prevention for HIV-positive women in addition to the traditional individual health education.
  • Groups sessions on sensitive topics such as sexual negotiation and condom use seem to be acceptable in the Zambian traditional cultural framework more so than the single session individual or couples counseling of existing VCT techniques.
  • From a public health standpoint, groups represent a cost effective use of resources, reaching larger numbers of women with lower numbers of staff.
Focus Areas
Gender
Prevention
Implemented By
Barry University, Miami Shores, USA
Participating Organization
  • University Teaching Hospital in Lusaka
  • Community clinics providing referrals
  • KARA Counseling
  • The National Association for Zambian People Positive
Region
Africa
Country
Zambia
Environment
Clinic/Health facility
Setting
Urban
Target Population
People Living with HIV (PLWH)
Scope
100 - 500
Implementation Years
01/2004 - 01/2005