Community-Based Risk Reduction in Zambia

Following the trial of a sexual risk reduction intervention conducted at the University Teaching Hospital (UTH) in Lusaka, Zambia, this pilot study sought to evaluate the feasibility of conducting the intervention at the Community Health Center (CHC) level. UTH staff implemented assessments and the intervention while CHC staff provided logistic and administrative support. HIV seropositive women (CHC n = 200; UTH n = 612) attended group sessions in which male partners were randomized to a three-session or one-session group intervention arm. At baseline, consistent use of male and female condoms differed between sites (HIV+ UTH, 73%, CHC, 88%, HIV– UTH, 42%, CHC 65%); both sites increased combined condom use at 6 months post baseline and maintained increases over baseline at 12 months. Participants did not differ between sites at baseline on condom attitudes, HIV knowledge or self efficacy. At 12 months post baseline, both sites had improved in attitudes, knowledge and efficacy and participant retention was lower at the UTH site (77% versus 82%). Inconsistent sexual barrier users increased to consistent use at both sites after 6 months (HIV positive UTH, 96%, CHC, 99%, HIV negative UTH, 84%, CHC 100%). At 12 months, HIV negative CHC participants maintained higher levels of condom use in comparison with UTH participants (F = 7.17, p = .001). Results illustrate the feasibility and efficacy of conducting group sexual risk reduction interventions in the Zambian community, and the potential for the use of group interventions in conjunction with existing CHC Voluntary Counseling and Testing (VCT) programs.