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For women, the high-risk sex script of condomless sex to maintain relationships with men is concerning, particularly in regard to heterosexual HIV acquisition. This secondary analysis of data from a clinical trial evaluated the effect of a 12-episode, web-based video series intervention, entitled Love, Sex, and Choices, versus a text message control on lowering the high-risk sex script. The sample comprised 238 predominately urban Black women, ages 18-29, having HIV sex risk behavior. Data were collected at baseline and 6 months post-intervention. The Sex Script Video Response score was used to measure a high-risk sex script. HIV sex risk behavior was measured by Vaginal Equivalent Episodes with high-risk partners. At baseline, lower education, younger age at first sexual intercourse, and alcohol/non-injection drug use before sex were positively associated with a high-risk sex script. At baseline, as the high-risk sex script increased by one log unit, sex risk behavior increased by 0.47 log units (p < 0.001), equivalent to a 60% increase in the geometric mean of sex risk behavior. ANCOVA analysis indicated that from baseline to 6-months post intervention, lowering the high-risk sex script by one unit was associated with an additional reduction of 0.26 units in sex risk behavior. Compared to the text messages, the LSC video series was associated with a 27% greater reduction in the geometric mean of the sex script (p = 0.03). Further investigation into the effect of lowering sex scripts to reduce sex risk behavior is recommended.
Advertising via Facebook to elicit involvement in clinical trials has demonstrated promise in expanding geographic reach while maintaining confidentiality. The purpose of this study is to evaluate Facebook advertising to reach at-risk, predominately African American or Black women in higher HIV prevalence communities for an HIV prevention clinical trial, and to compare baseline characteristics to those recruited on-the-ground. Maintaining confidentiality and the practical aspects of creating and posting ads on Facebook are described. The advertising strategy targeted multicultural affinities, gender, age, interest terms, and zip codes. We report on results during 205 days. A total of 516,498 Facebook users viewed the ads an average of four times, resulting in 37,133 clicks to the study website. Compared to 495 screened on-the-ground, 940 were screened via Facebook ads, of these, half (n = 477, 50.74%) were high risk, and of those at risk, 154 were randomized into the 6-month clinical trial. Black women comprised 71.60% (n = 673) of the total screened online. Roughly twice as many Black women screened via Facebook compared to on-the-ground, yet, the percentage at high risk was similar. Preliminary data suggest that the extent to which ad headlines and photos tap into authentic social experience, advertising on Facebook can extend geographic reach and provide a comparative sample to women recruited on-the-ground.
Love, Sex, and Choices (LSC) is a 12-episode soap opera video series developed to reduce HIV risk among at-risk Black urban women. We added a video guide commentator to offer insights at critical dramatic moments. An online pilot study evaluated acceptability of the Guide-Enhanced LSC (GELSC) and feasibility of Facebook advertising, streaming to smartphones, and retention. Facebook ads targeted high-HIV-prevalence areas. In 30 days, Facebook ads generated 230 screening interviews: 84 were high risk, 40 watched GELSC, and 39 followed up at 30 days. Recruitment of high-risk participants was 10 per week, compared to seven per week in previous field recruitment. Half the sample was Black; 12% were Latina. Findings suggest GELSC influenced sex scripts and behaviors. It was feasible to recruit young urban women from a large geographic area via Facebook and to retain the sample. We extended the reach to at-risk women by streaming to mobile devices.
BACKGROUND:
Love, Sex, and Choices (LSC) is a soap opera video series created to reduce HIV sex risk in women.
METHODS:
LSC was compared to text messages in a randomized trial in 238 high-risk mostly Black young urban women. 117 received 12-weekly LSC videos, 121 received 12-weekly HIV prevention messages on smartphones. Changes in unprotected sex with high risk partners were compared by mixed models.
RESULTS:
Unprotected sex with high risk men significantly declined over 6 months post-intervention for both arms, from 21-22 acts to 5-6 (p < 0.001). This reduction was 18 % greater in the video over the text arm, though this difference was not statistically significant. However, the LSC was highly popular and viewers wanted the series to continue.
CONCLUSION:
This is the first study to report streaming soap opera video episodes to reduce HIV risk on smartphones. LSC holds promise as an Internet intervention that could be scaled-up and combined with HIV testing.
Love, Sex, and Choices is a 12-episode soap opera video series created as an intervention to reduce HIV sex risk. The effect on women’s HIV risk behavior was evaluated in a randomized controlled trial in 238 high risk, predominately African American young adult women in the urban Northeast. To facilitate on-demand access and privacy, the episodes were streamed to study-provided smartphones. Here, we discuss the development of a mobile platform to deliver the 12-weekly video episodes or weekly HIV risk reduction written messages to smartphones, including; the technical requirements, development, and evaluation. Popularity of the smartphone and use of the Internet for multimedia offer a new channel to address health disparities in traditionally underserved populations. This is the first study to report on streaming a serialized video-based intervention to a smartphone. The approach described here may provide useful insights in assessing advantages and disadvantages of smartphones to implement a video-based intervention.
The majority of all adolescent and young adult women (90%) with HIV were infected by unprotected sex with an infected male partner (Centers for Disease Control and Prevention [CDC], 2010b). As of 2008, the epidemic had disproportionately affected Black women, who were 14% of the population of women in the United States but comprised 67% of women with HIV infection. It is estimated that in a lifetime, 1 in 30 Black women will be infected with HIV (CDC, 2010a). Innovative approaches to reduce sexual transmission of HIV to this population are needed.
This paper will report on the development of an audio computer-assisted self-interview (ACASI) that was programmed to (a) assess and categorize the level of HIV sexual risk (ranging from no risk to very high risk) by executing an algorithm based on criteria risk behaviors, and (b) deliver video feedback in the form of an entertaining soap opera tailored to the level of HIV risk and type of partner. We tested the accuracy of the prototype to correctly categorize the risk level and deliver the appropriate video. Finally, we compared the feasibility and acceptability of completing the ACASI and viewing the near feature-length video on a small handheld computer to that of a laptop and a desktop using systematic sampling assignment. The objective of the latter was to compare whether the experience of completing a roughly half-hour long ACASI and viewing a relevant video on the small 4.5-inch screen of a handheld device would be equally acceptable to that of the much larger touch screens of a Tablet Personal Computer (PC; 12-inch screen), or desktop computer (15-inch screen) in a population of young adult urban women.
These results could provide support for the use of emerging small handheld technologies, such as cell phones (available with a 4.3-inch screen), to deliver a video-based intervention, particularly when privacy and portability are desired. This prototype accomplishes the goals of targeting an intervention to a population of urban young adult African American women, and tailoring the message to an individual’s HIV risk and type of partner.
Sexual pressure among young urban women represents adherence to gender stereotypical expectations to engage in sex. Revision of the original five-factor Sexual Pressure Scale was undertaken in two studies to improve reliabilities in two of the five factors. In Study 1 the reliability of the Sexual Pressure Scale for Women-Revised (SPSW-R) was tested, and principal components analysis was performed in a sample of 325 young, urban women. A parsimonious 18-item, four-factor model explained 61% of the variance. In Study 2 the theory underlying sexual pressure was supported by confirmatory factor analysis using structural equation modeling in a sample of 181 women. Reliabilities of the SPSW-R total and subscales were very satisfactory, suggesting it may be used in intervention research.
The purpose of this study was to develop a soap opera video, A Story about Toni, Mike, and Valerie, designed to communicate HIV risk reduction themes. The study evaluated viewing the video and responding to audio computer assisted self-interview (ACASI) on a handheld computer. The sample was 76 predominately African American women, aged 18–29, in sexual relationships with men. Data were collected in urban neighborhoods in the northeastern United States. A pretest-posttest control group design with systematic assignment indicated statistically significant reduction in expectations to engage in unprotected sex in the experimental group. The handheld computer was found to be acceptable to view the near feature length video and complete ACASI. To date, no study has reported on use of video and ACASI on a handheld device to reduce HIV risk. The significance is the potential to stream health promotion videos to personal devices, such as cell phones.
This study explored reasons women engaged in unprotected sex with male partners they distrusted and perceived to engage in HIV risk behaviors. Seven focus groups were held in public housing and neighborhood centers in the urban Northeast with 43 African American and Latina women. Content analysis was conducted by open and axial coding. Barrett’s theory of power as knowing participation in change and sex script theory guided interpretation. Results indicated that Patterns of Unprotected Sex is a usual practice to maintain hope, sensuality, intimacy, strategic gain, and stability with a male partner. In low power sex scripts the salient risks of HIV were buried under an awareness of oneself as having to satisfy a man and accept cheating. High power sex scripts involved women’s awareness of themselves as worthy of self care with diverse choices. High power scripts can be integrated into normative sex scripts as exemplars of more powerful ways of being and acting to reduce HIV risk.
The purpose of this study was to develop the Sexual Pressure Scale (SPS) as a valid and reliable measure of gender stereotypical expectations to engage in sexual behavior. Data were collected using audio computer-assisted self-interview in 306 urban women, aged 18 to 29. Exploratory principal components analysis with varimax rotation yielded 19 items consisting of five factors: Condom Fear, Sexual Coercion, Women’s Sex Role, Men Expect Sex, and Show Trust, accounting for 62% of the variance. Divergent and convergent validity were supported, respectively, by negative relationships of SPS factors with dyadic trust and positive relationships with sexual victimization and sexual risk behavior. Alpha reliability was .81; factor reliabilities ranged from .63 to .82. A valid assessment of sexual pressure can suggest the extent to which stereotypical gender expectations structure women’s freedom to explore partner and condom use choices.
This article discusses young urban women’s HIV sexual risk behavior in the context of a social environment that is replete with stereotypical gender expectations to have sex [10]. In this context, unprotected sex is viewed as necessary in securing and maintaining dyadic male-female relationships [11]. Further, HIV sexual risk is considered in the context of heightened emotions that may be characteristic of intimate partner relationships [4]. Sex script theory [12,13] and Barrett’s theory of power as knowing participation in change [14,15] are integrated into a framework to explain young adult urban woman’s unprotected sexual behavior, particularly with men they perceive to be engaging in HIV risk behavior. Application of this framework helps to explain how powerful sex scripts can influence women to act consistently to reduce HIV risk while enjoying their relationships with men.
This study was designed to examine the relationships of sexual imposition, dyadic trust, and sensation seeking with HIV sexual risk behavior in 257 young urban women. Interviews were conducted using Audio Computer-Assisted Self-Interview (ACASI). Hierarchical multiple regression revealed that sexual imposition, dyadic trust, and sensation seeking explained 18.3% of the variance in sexual risk behavior. Although sexual imposition was positively related to sexual risk, pressure to satisfy a male partner sexually was more common than physical coercion. Dyadic trust was negatively related, indicating that women engaged in sexual risk behavior with men they distrusted. Sensation seeking was positively related to sexual risk. Findings suggest the need for enhancing awareness of non–sexually imposing relationship alternatives and incorporating thrill and excitement in health promotion messages.
The Audio Computer Assisted Self-Interview (ACASI) is a computer application that allows a research participant to hear survey interview items over a computer headset and read the corresponding items on a computer monitor. The ACASI automates progression from one item to the next, skipping irrelevant items. The research participant responds by pressing a number keypad, sending the data directly into a database. The ACASI was used to enhance participants’ sense of privacy. A convenience sample of 257 young urban women, ages 18 to 29 years, were interviewed in neighborhood settings concerning human immune deficiency virus (HIV) sexual risk behaviors. Notebook computers were used to facilitate mobility. The overwhelming majority rated their experience with ACASI as easy to use. This article will focus on the use of ACASI in HIV behavioral research, its benefits, and approaches to resolve some identified problems with this method of data collection.