Addressing the nexus of risk: Biobehavioral outcomes from a cluster randomized trial of the Women’s Health CoOp Plus in Pretoria, South Africa


Focus Areas: Ending Gender Violence Health & Wellness

BACKGROUND: HIV prevalence has increased among South African women who use alcohol and other drugs (AOD). However, HIV prevention and treatment efforts have not focused on this population. This study presents the efficacy of the Women’s Health CoOp Plus (WHC+) in a cluster-randomized trial to reduce AOD use, gender-based violence, and sexual risk and to increase linkage to HIV care among women who use AODs, compared with HIV counseling and testing alone.

METHODS: Black African women (N = 641) 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 (WHC+) or HIV counseling and testing alone. Participants were assessed at baseline, 6-months, and 12-months post enrollment.

RESULTS: 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 (ps < 0.05). At 12-month follow-up, the WHC+ arm reported less emotional abuse (p < 0.05). Among a subsample of women, the WHC+ arm was significantly more likely to have a non-detectable viral load (measured by dried blood spots; p = 0.01).

CONCLUSION: 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.

Wechsberg, W. M., C. P. Bonner, W. A. Zule, C. van der Horst, J. Ndirangu, F. A. Browne, T. L. Kline, B. N. Howard and N. F. Rodman (2019). "Addressing the nexus of risk: Biobehavioral outcomes from a cluster randomized trial of the Women's Health CoOp Plus in Pretoria, South Africa." Drug Alcohol Depend 195: 16-26.


Wendee Wechsberg

“We must listen to the communities, the local people, to understand culturally what is going to fit and what is going to be the language of the research, and not just say we know what to do here.”

Felicia Browne

"I am so grateful to have the opportunity to work on applied, gender-focused projects in the community in which I grew up, in hopes of having an impact on HIV, STIs and other health outcomes among African-American adolescent girls and young women."

Courtney Peasant Bonner

“It is an honor and privilege to work with resilient women to develop interventions that reduce their barriers to care and empower them to live healthy lives."