The University of South Florida College of Public Health is conducting the HER Study across four Florida counties
In February 2009, Stephanie Marhefka, PhD, associate professor at the University of South Florida (USF) College of Public Health, attended a Florida Perinatal HIV Nurses meeting hoping to gain a better understanding of the research needs associated with pregnant women living with HIV. She left with a challenge that she and a team of co-investigators would later solve through the Healthy Relationships- Extending the Reach (HER) Study.
The challenge confronting researchers was that some HIV-positive women have not disclosed their status to their sexual partners and need skills and support to do so. Some women who fall into this category are referred to Healthy Relationships, a behavioral intervention developed by Dr. Seth Kalichman and disseminated through the Centers for Disease Control and Prevention’s Diffusion of Effective Behavioral Interventions (DEBI) program. During five, two-hour sessions, participants meet in small groups to learn and rehearse skills that will help them disclose their status to family members and friends and practice safer sexual behaviors.
“While this CDC program has many merits, one major downside is that women in rural or less urban areas often cannot access group-based DEBIs,” said Marhefka, principal investigator for the HER Study.
Stephanie Marhefka, PhD, USF College of Public Health
With funding from a National Institute of Mental Health intervention development grant, the HER Study is testing whether group-based video conferencing can be used to fill a much-needed gap in Florida and other states.
USF public health faculty members Julie Baldwin, PhD, Eric Buhi, PhD, and Getachew Dagne, PhD, along with Robert Gluekauf, PhD, from Florida State University, are co-investigators for the HER Study. They lead a team of students who serve as data managers, community and university liaisons, and project coordinators. Technical support is provided by Florida State.
The study offers an adapted version of the Healthy Relationships Program, Healthy Relationships Video Group to HIV-positive women. Study participants must be willing to individually visit community-based intervention stations and complete the group program with facilitators and other HIV-positive women through a specialized Internet-based video phone.
Think Skype, but with private rooms, educational materials and more. The video phone is user-friendly and previous experience with computers is not required. However, each community station is outfitted with a study liaison who sets up the equipment, helps participants as needed, and serves as the onsite coordinator.
The program funds seven community stations across four Florida counties—Alachua (Gainesville), Hillsborough (Tampa), Pinellas (Clearwater-St. Petersburg) and Polk (Lakeland). County health departments and not-for-profit organizations house the stations and provide the on-site coordinator.
It’s about connections.
“I really don’t have anyone one to talk to about this, my fiancé just doesn’t understand. I am glad that I can talk to everyone here [at the HER study].”
The Healthy Relationships Video-Group hosted its first session in February 2011. Since then, more than 50 women committed to six, 2-hour ‘meetings’ over a three-week period. As a result, they bonded, gained confidence, and learned tactics to help them share their HIV positive status with loved ones when it is safe and smart to do so and to practice safer-sex skills.
In the beginning, naysayers didn’t think the Healthy Relationships Video Group would be effective without the benefit of physical touch for support and bonding, Marhefka said. Likewise, they didn’t know how effective condom application and role playing could be conducted on a video monitor.
The Her Study women proved it could be done.
The group developed their own version of sign language. When a hug is needed, a participant forms a circle with her arms stretched above her head, clasping one wrist and forming a fist with the free hand.
By splitting the video screen and using extra-large condom models (dildos), correct condom application can be taught.
Likewise, role playing is made possible by changing the screen configuration so each role play participant sees only a close-up of the other person interacting with her.
It’s about empowerment.
“I got the courage to leave my boyfriend after meeting the girls in the group.”
The program has an overall satisfaction rate of more than 90 percent, with some women reporting they prefer the video over an in-person small group session. Apparently, the private rooms provide an environment that is less distracting and participants are not as likely to talk over one another.
The program is funded through May 2013. Data are still being collected, but preliminary evidence indicates that “women who participated increased their behavioral intentions and self-effectiveness related to engaging in safer sexual behavior and practicing disclosure decision-making skills,” said Marhefka.
It’s a safe haven.
One participant explained how she ‘lived a lie’ for many years, hiding her status and medications. It was only in the past couple of years that she decided to ‘come clean’ and revealed her status to her 12-step sponsor. Soon after coming clean, she saw the HER Study poster and said, “I know I am where I am supposed to be.”
Marhefka would like to see the program go national, with community-based intervention stations positioned across the country. Ideally, she said, they could deliver health promotion programs for any type of health and wellness concern—diabetes, breast cancer, domestic abuse, eating disorders, and other conditions.
The benefit of HIV-negative clients using the stations as well is that the stigma of attending an intervention station for HIV-related programs will removed, Marhefka said. “Intervention stations will simply become a community resource where people go for health education and support. “
– Story by Natalie Preston-Washington, MPA, College of Public Health
