the willow program gina m. wingood ralph j. diclemente emory university funded by nimh (1 r01...

The WiLLOW Program

Gina M. Wingood

Ralph J. DiClemente

Emory University

Funded by NIMH (1 R01 MH54412)

Family Consortium on HIV/AIDS

Colleagues• Isis Mikhail, MD, DrPH, MPH1

• Donna Hubbard-McCree, PhD, MPH2

• Susan Davies, PhD, MPH1

• Delia Lang, PhD, MPH2

• Edward Hook, III, MD, MPH3

• Angela Caliendo, PhD, MD4

• Special thanks to all the young women who participated in the WiLLOW program and all the dedicated staff who made this program possible

______1School of Public Health, University of Alabama at Birmingham2Emory University, Rollins School of Public Health3School of Medicine, University of Alabama at Birmingham4School of Medicine, Emory University

The WiLLOW Program

W = Women

i = Involved in

L = Life

L = Learning from

O = Other

W = Women

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.

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

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

- HIV positive

-Female

-Receiving Clinical Care

Eligible-Sexually active- 18- 50

Not Eligible

Can Attend- Sessions

- Follow-ups

BaselineAssessment

(N=383)

Sexual Risk Red.Intervention

AdherenceComparison

6-moFU

6-moFU

Unable toParticipate

12-moFU

12-moFU

Research Design: Randomized Controlled Trial

Recruitment SitesRecruited 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

Data Collection

Data collected at baseline, 6- and 12-months follow-up.

Type of Data Data Source Data

1. Self-report Interview Outcomes, Mediators, Mod.

2. Biological Vaginal Swabs STDs: CT,GC,TV

3. Biological Emit II Urine Screen Current Drug Use

4. Biological Pregnancy Screen Pregnancy

5. Clinical Medical Chart CD4, VL, OI

6. Direct Observation Condom Use Skills Measure of Condom Skills

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

Compensation

• Transportation to and from each session• Catered lunch• Child care• $50 compensation• Personal Gifts

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

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).

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

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

Session 1: Social Support

• Benefits of Social Support

• Barriers to Social Support

• Qualities of a Supportive Person

• Reducing Burnout of Support Givers

Session 2: Stressors

What Stresses You Out????- Children- Relationships- Financial- Their health

Session 2: Coping with Stress

STRESSOR

Is it Changeable?

Yes No

Change what you Change what you

DO THINK

Changing What You Think• R = Relax

• E = Express yourself

• L = Let others help

• A = Allow positive thoughts

• X = eXercise

Coping Strategies

Coping Strategy Activity Gift

Relax Relaxation tape Relaxation tape,candle,oils

Express emotions Talking,Writing PrePaid telephone cards, stationary, journal

Let others help Social support Social support network

Allow + thoughts + Affirmations + Affirmation Willow tree

eXercise Walk, Dance CD or cassette tapes of:

Electric slide/Macarena

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

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

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