Program Profile: Women’s Health CoOp Plus (Pretoria, South Africa)

This is a woman-focused behavioral intervention designed to reduce alcohol and drug use, gender-based violence, and sexual risk. The program is rated Ineffective. There were no statistically significant differences between the treatment and comparison groups in sexual abuse by a boyfriend, being beaten by a boyfriend, or daily drug use. However, compared with the comparison group, the treatment group was statistically significantly less likely to report emotional abuse by a boyfriend.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Site

The Women’s Health CoOp Plus (WHC+) is a woman-focused behavioral intervention designed to reduce use of alcohol and other drugs, gender-based violence, and sexual risk, while also increasing linkage to HIV care among program participants. The WHC+ intervention takes place in Pretoria, South Africa, which was chosen as the target site because it is an area where HIV infection and alcohol and drug use are highly prevalent (Wechsberg et al., 2011).

Services Provided

The program is an extension of the Women’s Health CoOp. WHC+ provides similar services as in the original program model but also includes added behavioral components such as linkage to care and the initiation and adherence to antiretroviral therapy for women with HIV [following the seek, test, treat, and retain (STTR) model] (Wechsberg et al., 2019; Wechsberg et al., 2017).

The WHC+ intervention consists of the standard HIV counseling and testing protocol, which includes pretesting, rapid HIV testing, postcounseling, and a brief syndromic tuberculosis screening. In addition, participants are provided with two individual intervention sessions about 1 week apart from each other. These individual sessions take place at the intervention site, last 1 hour, and are facilitated by a multilingual female interventionist from the community. The goal of the sessions is to educate participants about the risks of alcohol and drug use. The program educates women on how alcohol and other drug use increases their risk of gender-based violence. Gender-based violence can in turn increase women’s risk for HIV (through coerced condomless sex or rape) while also impairing their ability to seek HIV care. The WHC+ is designed to help women navigate the nexus of alcohol and drug use, gender-based violence, and sexual risk that can contribute to HIV risk (Wechsberg et al., 2019).

To achieve these goals, sessions include risk-reduction strategies, role-play, and rehearsal. Risk reduction strategies include training participants on sexual negotiation, proper condom use, and violence prevention approaches. Additionally, participants create a personalized action plan that includes specific approaches they would take to reduce risk in the future. Finally, in addition to the two in-person sessions, study staff members also aim to provide case management either in person or by phone at least monthly to the participant and refer participants to substance abuse rehabilitation facilities.