The Women’s Health CoOp Plus: Combination HIV Prevention for Women Who Use Alcohol and Other Drugs in Pretoria, South Africa


HIV prevalence has increased among South African women who use alcohol and other drugs (AOD). However, HIV prevention and treatment efforts have not specifically focused on this population. Significant progress has been made toward the UNAIDs 90-90-90 goals[1], yet psychosocial factors such as AOD use, gender-based violence (GBV), gender inequality, and sexual risk create barriers to achieving these benchmarks, especially among women.

Our Solution

The Women’s Health CoOp (WHC) is an evidence-based, woman-focused and cue-card driven HIV behavioral intervention that addresses AOD use, GBV, and sexual risk, with the primary goal of increasing skills and knowledge to reduce HIV risk among women who use AODs. The WHC has been adapted for multiple populations, named a best-evidence intervention by the Centers for Disease Control and Prevention, and included in the United States Agency for International Development’s compendium of prevention interventions that are recommended for use in Africa. [2][3][4]

This study tested the efficacy of the Women’s Health CoOp, Plus (WHC+) linkage to care and the promotion of Antiretroviral Therapy (ART) initiation and adherence as an important biobehavioral advancement, compared with HIV counseling and testing (HCT) alone. Six-hundred and forty-one Black African women were recruited from 14 geographic clusters in Pretoria, South Africa, and underwent either an evidence-based gender-focused HIV prevention intervention that included HIV counseling and testing (the WHC+) or standard HCT alone. Participants were assessed at baseline, 6-months, and 12-months post enrollment.


At 6-month follow-up, the WHC+ arm (vs. HCT) reported more condom use with a main partner and sexual negotiation, less physical and sexual abuse by a boyfriend, and less frequent heavy drinking. At 12-month follow-up, the WHC+ arm reported less emotional abuse. Among a subsample of women, the WHC+ arm was significantly more likely to have a non-detectable viral load (measured by dried blood spots).


The findings demonstrate the WHC+’s efficacy to reduce HIV risk among women who use AODs in South Africa. Substance abuse rehabilitation centers and health centers that serve women may be ideal settings to address issues of gender-based violence and sexual risk as women engage in substance use treatment, HIV testing, or HIV care. Our current implementation science study in Cape Town, South Africa seeks to do just that!


Funded by NIDA R01DA032061
PI: Wendee M. Wechsberg, PhD, MPH


Wechsberg, W. M., Bonner, C. P., Zule, W. A., van der Horst, C., Ndirangu, J., Browne, F. A., ... & Rodman, N. F. (2019). Addressing the nexus of risk: Biobehavioral outcomes from a cluster randomized trial of the Women’s Health CoOp Plus in Pretoria, South AfricaDrug and alcohol dependence195, 16-26.



[1] Joint United Nations Programme on HIV/AIDS (UNAIDS). (2017). Ending AIDS: Progress towards the 90-90-90 targets. Global AIDS update.

[2] Centers for Disease Control and Prevention. (2014). Compendium of evidence-based HIV behavioral interventions.

[3] Lyles, C.M., Kay, L.S., Crepaz, N., Herbst, J.H., Passin, W.F., Kim, A.S., ...Mullins, M.M. (2007). Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000–2004. American Journal of Public Health97(1), 133-143.

[4]  USAID (2009).  Integrating Multiple Gender Strategies to Improve HIV and AIDS Interventions: A Compendium of Programs in Africa. International Center for Research on Women, Geneva, Switzerland.