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The WiLLOW Program. Gina M. Wingood Ralph J. DiClemente Emory University Funded by NIMH (1 R01 MH54412) Family Consortium on HIV/AIDS. Colleagues. Isis Mikhail, MD, DrPH, MPH 1 Donna Hubbard-McCree, PhD, MPH 2 Susan Davies, PhD, MPH 1 Delia Lang, PhD, MPH 2 Edward Hook, III, MD, MPH 3

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The willow program l.jpg

The WiLLOW Program

Gina M. Wingood

Ralph J. DiClemente

Emory University

Funded by NIMH (1 R01 MH54412)

Family Consortium on HIV/AIDS

Colleagues l.jpg

  • Isis Mikhail, MD, DrPH, MPH1

  • Donna Hubbard-McCree, PhD, MPH2

  • Susan Davies, PhD, MPH1

  • Delia Lang, PhD, MPH2

  • Edward Hook, III, MD, MPH3

  • Angela Caliendo, PhD, MD4

  • Special thanks to all the young women who participated in the WiLLOW program and all the dedicated staff who made this program possible


    1School of Public Health, University of Alabama at Birmingham

    2Emory University, Rollins School of Public Health

    3School of Medicine, University of Alabama at Birmingham

    4School of Medicine, Emory University

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The WiLLOW Program

W= Women

i= Involved in

L = Life

L = Learning from

O = Other

W= Women

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  • The WiLLOW program originates from the belief that historically women have learned about life and about how to cope with life’s challenges by having relationships with other women. These interactions, connections, and friendships are important sources of inspiration and evolve into a sense of support, kinship and sisterhood that are the essence of WiLLOW.

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To test the efficacy of a sexual risk-reduction and coping enhancement program for women living with HIV to:

(a) enhance coping skills,

(b) improve quality of life,

(c ) increase safer sex,

(d) reduce (STDs) over a 12-month follow-up

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Eligibility Criteria

  • Women

  • Living with HIV

  • 18 – 50 years of age

  • All were receiving clinical care

  • Reported having unprotected vaginal sex in the past 6 months

  • Provided written informed consent

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Not Eligible

Unable to


  • - HIV positive

  • Female

  • Receiving

  • Clinical Care

  • Eligible

  • Sexually

  • active

  • 18- 50

  • Can Attend

  • Sessions

  • - Follow-ups

Sexual Risk Red.















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Recruitment Sites

Recruited for 3 years from 1997 – 2000 at several sites:

  • Atlanta

    - Ponce de Leon Clinic

    - Health Department

  • Alabama

    - Birmingham - 1917 clinic

    - Montgomery - Montgomery AIDS Outreach

    - Mobile

    - Anniston

    - Health Department – Cooper Green clinic

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Data Collection

Data collected at baseline, 6- and 12-months follow-up.

Type of DataData SourceData

  • Self-report Interview Outcomes, Mediators, Mod.

  • Biological Vaginal Swabs STDs: CT,GC,TV

  • Biological Emit II Urine Screen Current Drug Use

  • Biological Pregnancy Screen Pregnancy

  • Clinical Medical Chart CD4, VL, OI

  • Direct Observation Condom Use Skills Measure of Condom Skills

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Intervention Logistics

- A trained health educator and peer educator co-facilitated implementing the program sessions

- 4 sessions: Sexual risk reduction & coping

- 4 sessions: Adherence comparison

- All sessions were 4 hours in length

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  • Transportation to and from each session

  • Catered lunch

  • Child care

  • $50 compensation

  • Personal Gifts

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Involving Community Based Organizations in Prevention Programs

  • Sista Love: An ASO that provides prevention education to women living with HIV

  • Jerusalem House: An ASO that provides housing to women living with HIV

  • HIV Specialty Clinic Advisory Boards: Women living with HIV who were peer advocates of prevention, education and care

  • Local Domestic Violence Shelters

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Transactional Model of Stress and Coping Programs(Folkman & Lazarus)

Stressful events are defined as person-environment

transactions in which a stressor is mediated by two

processes, an individual's appraisal of the potential threat

of the stressor (primary appraisal) and their appraisal of

their personal resources and their perceived ability cope to

with the stressor (secondary appraisal).

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Session 1: Enhancing Gender Pride Programs

  • Discuss joys of being a woman – compassionate, strong, nurturing, integrity

  • Discuss challenges of being a women – reliance on males, multiple roles

  • Goal setting – planning for the future

  • Values – freedom, faith, family

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Session 1: Social Support Programs

  • Identified who is in their social support network

  • Defined types of support social support

  • Identified types of social support provided by members

  • Who they would like to bring into their social support network

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Session 1: Social Support Programs

  • Benefits of Social Support

  • Barriers to Social Support

  • Qualities of a Supportive Person

  • Reducing Burnout of Support Givers

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Session 2: Stressors Programs

What Stresses You Out????

  • Children

  • Relationships

  • Financial

  • Their health

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Session 2: Coping with Stress Programs


Is it Changeable?

Yes No

Change what you Change what you


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Changing What You Think Programs

  • R = Relax

  • E = Express yourself

  • L = Let others help

  • A = Allow positive thoughts

  • X = eXercise

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Session 3: Change What You Do-- Communication Programs

  • Assertive Communication

  • Use of “I statements”

  • Refusing unsafe sexual advances

  • Initiating conversations on safer sex

  • Negotiating safer sex

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Session 4: ProgramsCondoms & Relationships

  • Proper and consistent condom use skills

    O = Open

    P = Pinch

    R = Roll

    A = After sex

    H = Hold

  • Using condoms protects their health as well as partners

  • Safer Sex Jeopardy – reinforced factural knowledge

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Thank You Programs

Wingood GM, DiClemente RJ. The WiLLOW Program. Eds. Pequegnat W, Szapocznik J. Working with families in the era of HIV/AIDS. Sage Publications, Inc. Pp. 281-301.

  • Healthy relationships/Unhealthy relationships

  • Local domestic violence services