1. The WiLLOW Program Gina M. Wingood Ralph J. DiClemente Emory University Funded by NIMH (1 R01 MH54412) Family Consortium on HIV/AIDS

2. Colleagues Isis Mikhail, MD, DrPH, MPH 1 Donna Hubbard-McCree, PhD, MPH 2 Susan Davies, PhD, MPH 1 Delia Lang, PhD, MPH 2 Edward Hook, III, MD, MPH 3 Angela Caliendo, PhD, MD 4 Special thanks to all the young women who participated in the WiLLOW program and all the dedicated staff who made this program possible ______ 1 School of Public Health, University of Alabama at Birmingham 2 Emory University, Rollins School of Public Health 3 School of Medicine, University of Alabama at Birmingham 4 School of Medicine, Emory University

3. The WiLLOW Program W = Women i = Involved in L = Life L = Learning from O = Other W = Women

4. WiLLOW The WiLLOW program originates from the belief that historically women have learned about life and about how to cope with life’s challenges by having relationships with other women. These interactions, connections, and friendships are important sources of inspiration and evolve into a sense of support, kinship and sisterhood that are the essence of WiLLOW.

5. Objectives To test the efficacy of a sexual risk-reduction and coping enhancement program for women living with HIV to: (a) enhance coping skills, (b) improve quality of life, (c ) increase safer sex, (d) reduce (STDs) over a 12-month follow-up

6. Eligibility Criteria Women Living with HIV 18 – 50 years of age All were receiving clinical care Reported having unprotected vaginal sex in the past 6 months Provided written informed consent

7. - HIV positive -Female -Receiving Clinical Care Eligible -Sexually active - 18- 50 Not Eligible Can Attend - Sessions - Follow-ups Baseline Assessment (N=383) Sexual Risk Red. Intervention Adherence Comparison 6-mo FU 6-mo FU Unable to Participate 12-mo FU 12-mo FU Research Design: Randomized Controlled Trial

8. Recruitment Sites Recruited for 3 years from 1997 – 2000 at several sites: Atlanta - Ponce de Leon Clinic - Health Department Alabama - Birmingham - 1917 clinic - Montgomery - Montgomery AIDS Outreach - Mobile - Anniston - Health Department – Cooper Green clinic

9. Data Collection Data collected at baseline, 6- and 12-months follow-up. Type of DataData SourceData 1.Self-reportInterviewOutcomes, Mediators, Mod. 2.BiologicalVaginal SwabsSTDs: CT,GC,TV 3.BiologicalEmit II Urine ScreenCurrent Drug Use 4.BiologicalPregnancy ScreenPregnancy 5.Clinical Medical Chart CD4, VL, OI 6.Direct Observation Condom Use SkillsMeasure of Condom Skills

10. Intervention Logistics - A trained health educator and peer educator co- facilitated implementing the program sessions - 4 sessions: Sexual risk reduction & coping - 4 sessions: Adherence comparison - All sessions were 4 hours in length

11. Compensation Transportation to and from each session Catered lunch Child care $50 compensation Personal Gifts

12. Involving Community Based Organizations in Prevention Programs Sista Love: An ASO that provides prevention education to women living with HIV Jerusalem House : An ASO that provides housing to women living with HIV HIV Specialty Clinic Advisory Boards : Women living with HIV who were peer advocates of prevention, education and care Local Domestic Violence Shelters

13. Transactional Model of Stress and Coping (Folkman & Lazarus) Stressful events are defined as person-environment transactions in which a stressor is mediated by two processes, an individual's appraisal of the potential threat of the stressor (primary appraisal) and their appraisal of their personal resources and their perceived ability cope to with the stressor (secondary appraisal).

14. Session 1: Enhancing Gender Pride Discuss joys of being a woman – compassionate, strong, nurturing, integrity Discuss challenges of being a women – reliance on males, multiple roles Goal setting – planning for the future Values – freedom, faith, family

15. Session 1: Social Support Identified who is in their social support network Defined types of support social support Identified types of social support provided by members Who they would like to bring into their social support network

17. Session 1: Social Support Benefits of Social Support Barriers to Social Support Qualities of a Supportive Person Reducing Burnout of Support Givers

18. Session 2: Stressors What Stresses You Out???? -Children -Relationships -Financial -Their health

19. Session 2: Coping with Stress STRESSOR Is it Changeable? YesNo Change what you DO THINK

20. Changing What You Think R = Relax E = Express yourself L = Let others help A = Allow positive thoughts X = eXercise

21. Coping Strategies Coping Strategy Activity Gift RelaxRelaxation tapeRelaxation tape,candle,oils Express emotionsTalking,WritingPrePaid telephone cards, stationary, journal Let others helpSocial supportSocial support network Allow + thoughts+ Affirmations+ Affirmation Willow tree eXerciseWalk, DanceCD or cassette tapes of: Electric slide/Macarena

22. Session 3: Change What You Do-- Communication Assertive Communication Use of “I statements” Refusing unsafe sexual advances Initiating conversations on safer sex Negotiating safer sex

23. Session 4: Condoms & Relationships Proper and consistent condom use skills O = Open P = Pinch R = Roll A = After sex H = Hold Using condoms protects their health as well as partners Safer Sex Jeopardy – reinforced factural knowledge

24. Thank You Wingood GM, DiClemente RJ. The WiLLOW Program. Eds. Pequegnat W, Szapocznik J. Working with families in the era of HIV/AIDS. Sage Publications, Inc. Pp. 281-301. Healthy relationships/Unhealthy relationships Local domestic violence services