Safer sex strategies for women: The hierarchical model in methadone treatment clinics

Abstract

Women clients of a methadone maintenance treatment clinic were targeted for an intervention aimed to reduce unsafe sex. The hierarchical model was the basis of the single intervention session, tested among 63 volunteers. This model requires the educator to discuss and demonstrate a full range of barriers that women might use for protection, ranking these in the order of their known efficacy. The model stresses that no one should go without protection. Two objections, both untested, have been voiced against the model. One is that, because of its complexity, women will have difficulty comprehending the message. The second is that, by demonstrating alternative strategies to the male condom, the educator is offering women a way out from persisting with the male condom, so that instead they will use an easier, but less effective, method of protection. The present research aimed at testing both objections in a high-risk and disadvantaged group of women. By comparing before and after performance on a knowledge test, it was established that, at least among these women, the complex message was well understood. By comparing baseline and follow-up reports of barriers used by sexually active women before and after intervention, a reduction in reports of unsafe sexual encounters was demonstrated. The reduction could be attributed directly to adoption of the female condom. Although some women who had used male condoms previously adopted the female condom, most of those who did so had not used the male condom previously. Since neither theoretical objection to the hierarchical model is sustained in this population, fresh weight is given to emphasizing choice of barriers, especially to women who are at high risk and relatively disempowered. As experience with the female condom grows and its unfamiliarity decreases, it would seem appropriate to encourage women who do not succeed with the male condom to try to use the female condom, over which they have more control.

Ourselves, our bodies, our realities: an HIV prevention intervention for women with severe mental illness

“…35 Another safety concern that has been suggested, but only recently tested, regarding presentation of multiple preventive options has been that women offered an array of choices may opt for methods of HIV prevention that are less well established, and they may abandon options like the male condom. 36 For example, when presented with information about microbicide use, women might opt to use this less-proven method in lieu of a male condom. 37 This has been termed "migration from the male condom."…”

“…However, empirical evidence suggests otherwise, at least among populations other than commercial sex workers. 36,38 In an empirical study in a large sexually transmitted infection (STI) clinic in Philadelphia, Pennsylvania, Latka and colleagues 38 have shown that fears of migration from the male condom may be unfounded.…”

A Brief Sexual Barrier Intervention for Women Living with AIDS: Acceptability, Use, and Ethnicity

“…These results support existing behavioral intervention research involving sexual education, including sexual negotiation skills, 35 female-controlled methods, 12,36,37 and hierarchical counseling. 10,11,38 Anecdotal reports during the intervention indicated increased awareness of the importance of safer sex in their sexual relationships following the intervention, and additional condoms and N-9 spermicides were generally requested at the final session. Although trial basis use of N-9 spermicides did not result in a more favorable evaluation of specific products, participants in the intervention increased their will- ingness to use products with characteristics common to N-9 spermicides.…”

“…2 At the onset of the HIV/AIDS pandemic, safer sex interventions designed to restrict transmission of HIV and other STDs primarily relied on promoting abstinence or increasing condom use by the uninfected. Later approaches included hierarchical interventions (e.g., New York State Department of Health AIDS Institute's Hierarchical Method of Prevention), [8][9][10][11] which presented a ranking of sexual protection methods from the safest, male and female condoms, to the most risky, spermicides based on nonoxynol-9. Most evaluations of hierarchical approaches have found that male condom use continues, and the overall proportional rates of protected sex acts was significantly increased following intervention.…”

“…Most evaluations of hierarchical approaches have found that male condom use continues, and the overall proportional rates of protected sex acts was significantly increased following intervention. [10][11][12] However, most hierarchical interventions have not evaluated these findings beyond 6 months.…”