Challenges of Sustaining Long-Term Behavior Change in Crack Use and Sexual Risk Among Southern African-American Women
Wechsberg, W. M., Lam, W. K., Zule, W. A., Riehman, K. S., & Ellerson, R. M. (2005, December). Challenges of Sustaining Long-Term Behavior Change in Crack Use and Sexual Risk Among Southern African-American Women. Presented at American Public Health Association Annual Meeting, Philadelphia, PA.
The number of HIV cases in North Carolina (NC) has increased three years in a row, particularly among poor women. Among African-American women, the majority of these cases occur through heterosexual contact at rates 14 times higher than for white women. Many of these women have multiple partners and substance abuse problems. A prevention/intervention study to reach African-American crack-using women at risk for HIV was started in 1998 and again in 2004. The original study identified many successes in changing risk behavior but also identified contextual issues of housing and employment as potential barriers for women to reach autonomy. Preliminary longitudinal follow-up data (between 2 and 6 years later) with 223 women show that between baseline of the original project and re-enrollment in the continuation study, significantly fewer women used crack in the past month (97% to 80%), with 26% reporting that they have stopped using crack at the time of re-enrollment. Over half (56%) reported having gotten involved in self-help groups. At re-enrollment, the proportion of women reporting homelessness did not change (about 25%) since 6-month follow-up in the original study, however fulltime employment dropped overall from 21% to 10% during this time period. Although frequency of substance use decreased, women reported needing more services, including substance abuse treatment, educational services, and housing. Unless contextual issues are addressed, these women will have few opportunities to improve their future. Substance abuse issues and HIV will continue to rise in this population in the South affecting the next generation as well.