HIV Transmission Reduction Among Women Living with HIV

Wingood, GM, DiClemente, RJ, MikHail, I, Lang, DL,
Hubbard McCree, D, Davies, SL, Hardin, JW, Hook, EW & Saag, M



Traditional methods of preventing the transmission of STIs and HIV/AIDS tend to focus on decreasing risk behaviors while increasing condom usage among individuals who are HIV negative. Included in those methods are HIV testing, individual counseling and group behavioral interventions. Several such interventions exist for men who have sex with men. Few risk reduction interventions, however, are developed specifically for women who have already tested positive for HIV, despite data that indicate that a growing number of women acquired their infections through heterosexual contact.

WILLOW was designed as a group intervention for African American women, although the original study sample included women of other ethnicities as well.. The intervention incorporates elements of sexual risk reduction and social networking to reduce STI/HIV sexual transmission and to enhance psychosocial mediators and structural factors associated with preventive behaviors over a one-year period.

The original evaluation of WiLLOW was a randomized controlled study including 366 women who were assigned to either the intervention (n=190) or comparison (n=176) conditions. Criteria for eligibility included: HIV+ serostatus; aged 18-50; and sexually active during the past six months. Following a baseline assessment that included face-to-face interviews, STI and drug testing, women were randomly assigned to one of the two conditions. Follow-up assessments were conducted at six and twelve months post intervention.

Over the 12-month follow-up period, women in the intervention group, as compared to their comparison group counterparts, reported fewer incidents of unprotected vaginal intercourse (1.8 vs. 2.5; P=0.022); were less likely to report never using condoms (OR=0.27; P=0.008); had a lower rate of bacterial infections (OR=0.19, P=0.006); reported greater HIV knowledge and condom use self-efficacy, more network members, fewer beliefs that condoms interfere with sex, and fewer partner-related barriers to condom use; and demonstrated greater skill in using condoms.


This program is suitable for use with the adult female populations in clinic or community-based settings that offer HIV/AIDS services to HIV+ women.


Age, Gender
18-50 years of age, 100% female

84.1% African American


Each of the four interactive group sessions is designed to last about four hours. The actual time needed to deliver the program in your setting will vary according to the participation level of the group members themselves.


WILLOW should be delivered by a trained female health educator and an HIV+ female peer educator. The Facilitator's Manuals provide detailed instructions and scripts to help implement the curriculum. There is no intervention-specific training required.

   General Population
   Injection Drug Users & Their Non-injecting Partners
   Gay/Bisexual Men
   STD Clinic Clients
   Other High-Risk Adults

   Treatment Center-Based

   Behavioral Skills Development
   Community Outreach
   Condom Education/Access
   HIV/STD Education
   Needle Cleaning/Exchange
   Self Efficacy/Self-Esteem

   Behavioral Skills Practice
   Group Discussion
   HIV Antibody Testing/Counseling
   Peer Counseling/Instruction
   Role Pay
   Safer Sex Communication/Negotiation


The HAPPA Program Package for this program includes:

  • WILLOW User's Guide
  • Facilitator's Manual
  • Process Evaluation Instrument
  • HAPPA Evaluation Assistance Kit (includes the Evaluation Questionnaire)
  • Original Evaluation Instrument (3)
  • HAPPA Adaptation Workbook

  • Telephone technical support on implementation and evaluation for 1 year