Efficacy of an adapted HIV/STD prevention intervention for incarcerated women: Findings from the project POWER study

Background: Incarcerated women face disproportionate HIV/STD burden, and interventions are needed to reduce rates of infection. This study adapted an evidence-based intervention for women (Project SAFE), and tested the efficacy of the adapted intervention (POWER) with incarcerated women. POWER is an HIV/STD prevention intervention focusing on the influence of substance abuse, power inequity in relationships, interpersonal violence, mental health, and social support on risk. We hypothesized that participation in POWER will increase condom use and decrease risky behavior. Methods: The study randomized 523 incarcerated women to the eight-session POWER intervention plus four post-release booster calls, or to a single-session control intervention providing standard HIV/STD prevention information. Women were followed for up to 6 months post-release. Mixed effects models were used to examine intervention efficacy among 357 participants with one or more post-release interviews. Results: Participants had a mean age of 34 years (range 18-59), and 56% were white and 37% African American. Relative to control participants, POWER participants had lower odds of unprotected sex outside of monogamous relationship (OR=0.62, p=.02), and greater odds of condom use with primary partners (OR=1.80, p=.01) at follow-up. POWER participants also reported fewer sex partners at follow-up than control participants (p=0.058). There were no significant intervention effects on knowledge about partner's HIV status, multiple concurrent partners, drug use before sex, number of unprotected intercourse acts, or incident STDs. Conclusions: The POWER intervention was successful in reducing sexual risk behaviors. Interventions of this type can be implemented in prisons to reduce HIV/STD burden among women post-release.