@article{williams_erasmus-claassen_taylor_browne_wechsberg_myers_parry_washio_2024, title={Perceptions of perinatal alcohol use and treatment needs in Cape Town, South Africa: a qualitative study}, volume={15}, ISSN={["1664-0640"]}, DOI={10.3389/fpsyt.2024.1199647}, abstractNote={BackgroundSouth Africa has one of the world’s highest rates of foetal alcohol spectrum disorders (FASD). Recent evidence also showed that alcohol use during lactation significantly compromises child development in children exposed to alcohol through breastfeeding, independent of prenatal alcohol exposure. This study explored perceptions of perinatal alcohol use and treatment needs in Cape Town, South Africa, to inform the development of an intervention to encourage alcohol abstinence during pregnancy and breastfeeding.}, journal={FRONTIERS IN PSYCHIATRY}, author={Williams, Petal Petersen and Erasmus-Claassen, Lesley-Ann and Taylor, Shantae and Browne, Felicia A. and Wechsberg, Wendee M. and Myers, Bronwyn and Parry, Charles D. H. and Washio, Yukiko}, year={2024}, month={Mar} }
 @article{singer_wechsberg_kline_browne_howard_carney_myers_bonner_chin-quee_2023, title={Binge drinking and condom negotiation behaviours among adolescent girls and young women living in Cape Town, South Africa: sexual control and perceived personal power}, volume={23}, ISSN={["1471-2458"]}, DOI={10.1186/s12889-023-17188-0}, abstractNote={Abstract}, number={1}, journal={BMC PUBLIC HEALTH}, author={Singer, Suzanne E. and Wechsberg, Wendee M. and Kline, Tracy and Browne, Felicia A. and Howard, Brittni N. and Carney, Tara and Myers, Bronwyn and Bonner, Courtney Peasant and Chin-Quee, Dawn}, year={2023}, month={Nov} }
 @article{osakwe_drift_opper_zule_browne_wechsberg_2023, title={Condom Use at Last Sex and Sexual Negotiation Among Young African American Women in North Carolina: Context or Personal Agency}, ISSN={["2196-8837"]}, DOI={10.1007/s40615-023-01693-4}, abstractNote={Abstract}, journal={JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES}, author={Osakwe, Chukwunomso E. E. and Drift, Isa and Opper, Claudia A. A. and Zule, William A. A. and Browne, Felicia A. A. and Wechsberg, Wendee M. M.}, year={2023}, month={Jul} }
 @article{browne_washio_zule_wechsberg_2023, title={HIV-related risk among justice-involved young African American women in the US South}, volume={11}, ISSN={["2194-7899"]}, DOI={10.1186/s40352-023-00228-7}, abstractNote={Abstract}, number={1}, journal={HEALTH & JUSTICE}, author={Browne, Felicia A. and Washio, Yukiko and Zule, William A. and Wechsberg, Wendee M.}, year={2023}, month={Aug} }
 @article{carney_myers_browne_kline_bonner_ndirangu_wechsberg_2023, title={Relationship Between Criminal and Status Offense Behaviors, Substance Use, and HIV Risk Among Adolescent Girls and Young Women in Cape Town, South Africa}, ISSN={["1557-1882"]}, DOI={10.1007/s11469-023-01130}, journal={INTERNATIONAL JOURNAL OF MENTAL HEALTH AND ADDICTION}, author={Carney, Tara and Myers, Bronwyn and Browne, Felicia A. and Kline, Tracy and Bonner, Courtney Peasant and Ndirangu, Jacqueline and Wechsberg, Wendee M.}, year={2023}, month={Aug} }
 @article{ndirangu_gichane_browne_bonner_zule_cox_smith_carney_wechsberg_2022, title={'We have goals but [it is difficult]'. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa}, ISSN={["1369-7625"]}, DOI={10.1111/hex.13422}, abstractNote={Abstract}, journal={HEALTH EXPECTATIONS}, author={Ndirangu, Jacqueline W. and Gichane, Margaret W. and Browne, Felicia A. and Bonner, Courtney P. and Zule, William A. and Cox, Erin N. and Smith, Kevin M. and Carney, Tara and Wechsberg, Wendee M.}, year={2022}, month={Jan} }
 @article{washio_hayashi_atreyapurapu_chang_ma_howard_drift_browne_wechsberg_2022, title={A Scoping Review of Computer-Based and Telecommunication Technology Interventions to Address Drug and Alcohol Misuse and Smoking in Women}, ISSN={["1532-2491"]}, DOI={10.1080/10826084.2022.2076878}, abstractNote={Abstract Background Computer-based and telecommunication technology has become increasingly common to address addiction among women. This review assessed the effect of technology-based interventions on substance misuse, alcohol use, and smoking outcomes among women. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guideline was used to conduct the scoping review. Four databases (PubMed, Web of Science, PsycINFO, and Scopus) were used to search for peer-reviewed articles published in English on computer-based and telecommunication technology use to address substance misuse, alcohol use, and smoking among women. Results A total of 30 articles were selected after the final full-text review from the U.S., England, Japan, and the Netherlands. The types of technology used in the interventions included computer software (standalone or web-based), mobile applications, video calling, phone, and text messaging. Intervention outcomes included alcohol and other substance misuse reduction as polysubstance misuse (n = 5), smoking cessation (n = 10), substance misuse reduction only (n = 6), and alcohol use reduction only (n = 9). The populations reached included women who were pregnant (n = 13), postpartum (n = 4), or non-pregnant (n = 14) ranging from adolescent to adulthood. Interventions that targeted polysubstance misuse showed statistically significant reductions (p < .05). Conclusion Although effective in reducing alcohol and other substance misuse, mixed findings were identified for other outcomes targeting a single substance. Technology-based interventions might maximize their effects by targeting polysubstance misuse and addressing associated contextual issues in the form of a computer-delivered module(s).}, journal={SUBSTANCE USE & MISUSE}, author={Washio, Yukiko and Hayashi, Yusuke and Atreyapurapu, Sravanthi and Chang, Katie and Ma, Tony and Howard, Brittni N. and Drift, Isa and Browne, Felicia A. and Wechsberg, Wendee M.}, year={2022}, month={May} }
 @article{browne_bonner_kline_cox_gichane_wechsberg_2022, title={Alcohol, drug use, and sexual risk among young African American women in North Carolina: is educational attainment protective?}, ISSN={["1745-0136"]}, DOI={10.1080/17450128.2022.2089794}, abstractNote={ABSTRACT Previous research has shown that educational attainment is a protective factor for substance use and sexual risk among adolescents and young adults. Evidence also shows that this relationship may differ by race/ethnicity and gender. This study aimed to elucidate the relationship between educational attainment, substance use, and sexual risk among African American women in emerging adulthood. This study uses cross-sectional data from 646 African American women (aged 18 to 25) enrolled in a randomized trial of a behavioral HIV risk-reduction intervention. At enrollment, participants completed a risk behavior assessment via audio-computer assisted self-interview and provided a urine sample for drug screening. Bivariate logistic regression analyses were conducted to examine substance use and sexual risk factors associated with educational attainment: completing some college or more as compared with completing high school or less. Participants who completed some college or more (52%) were more likely to report heavy alcohol use (four or more drinks in one day) in the past 30 days (OR = 1.48; p = 0.014) and more likely to report alcohol or other drug use just before or during last sex (OR = 1.43; p = 0.026) compared with participants who completed high school or less. Completing some college or more was protective for having a positive urine screen for cocaine (OR = 0.43; p = 0.018) and reporting condomless sex at last sex (OR = 0.71; p = 0.041). Differences in positive marijuana screens, reporting a previous STI, or reporting their partner used alcohol or other drugs at last sex were not statistically significant. The findings reveal notable differences in the magnitude and direction of associations between educational attainment and substance use and sexual risk. Although educational attainment is subject to change because of the frequent pursuit of education during emerging adulthood, the findings may have important implications for tailoring HIV risk-reduction interventions to key populations, such as African American women.}, journal={VULNERABLE CHILDREN AND YOUTH STUDIES}, author={Browne, Felicia A. and Bonner, Courtney Peasant and Kline, Tracy L. and Cox, Erin N. and Gichane, Margaret W. and Wechsberg, Wendee M.}, year={2022}, month={Jun} }
 @article{watkins_browne_kizakevich_howard_turner_eckhoff_wechsberg_2022, title={An Evidence-Based HIV Risk-Reduction Intervention for Young African American Women in the US South Using mHealth: Adaptation and Development Study}, volume={6}, ISSN={["2561-326X"]}, DOI={10.2196/34041}, abstractNote={
            Background
            Young African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women’s CoOp (WC) is an HIV risk–reduction intervention that is proven to be efficacious in various face-to-face formats.
          }, number={5}, journal={JMIR FORMATIVE RESEARCH}, author={Watkins, Rebecca L. and Browne, Felicia A. and Kizakevich, Paul N. and Howard, Brittni N. and Turner, Leslie B. and Eckhoff, Randall and Wechsberg, Wendee M.}, year={2022}, month={May} }
 @article{harris_laks_stahl_bagley_saia_wechsberg_2022, title={Gender Dynamics in Substance Use and Treatment: A Women's Focused Approach}, volume={106}, ISSN={["1557-9859"]}, DOI={10.1016/j.mcna.2021.08.007}, abstractNote={Gender impacts substance use initiation, substance use disorder development, engagement with treatment, and harms related to drug and alcohol use. Using the biopsychosocial model of addiction, this review provides a broad summary of barriers and facilitators to addiction services among women. It also reviews substance use among pregnant and parenting women and approaches to care. Given the increasing rates of substance use among women, there is a need to implement and scale-up gender-responsive addiction programming and pursue advocacy at the policy level that addresses the root drivers of substance use inequities among women.}, number={1}, journal={MEDICAL CLINICS OF NORTH AMERICA}, author={Harris, Miriam T. H. and Laks, Jordana and Stahl, Natalie and Bagley, Sarah M. and Saia, Kelley and Wechsberg, Wendee M.}, year={2022}, month={Jan}, pages={219–234} }
 @misc{wechsberg_drift_howard_myers_browne_bonner_carney_ndirangu_washio_2022, title={Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa}, volume={19}, ISSN={["1660-4601"]}, DOI={10.3390/ijerph19148661}, abstractNote={Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa.}, number={14}, journal={INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH}, author={Wechsberg, Wendee M. and Drift, Isa and Howard, Brittni N. and Myers, Bronwyn and Browne, Felicia A. and Bonner, Courtney Peasant and Carney, Tara and Ndirangu, Jacqueline and Washio, Yukiko}, year={2022}, month={Jul} }
 @article{browne_gichane_shangase_ndirangu_bonner_wechsberg_2022, title={Social Determinants of Alcohol and Other Drug Misuse Among Women Living with HIV in Economically Underserved Communities in Cape Town, South Africa: A Cross-Sectional Study}, ISSN={["1573-3254"]}, DOI={10.1007/s10461-022-03869-1}, abstractNote={This study aimed to understand how social determinants-the economic and social factors that affect health and well-being-are associated with self-reported and biological alcohol and other drug misuse in South Africa among women living with HIV. Logistic regression analyses were performed using baseline data from an implementation science trial conducted from 2015 to 2018 with 480 Black and Coloured women who were living with HIV and reported recent alcohol or other drug misuse. Educational attainment, type of housing, access to running water, food insecurity, and housing instability were examined. Women with higher education had reduced odds of any drug misuse-both biological (aOR: 0.53; 95% CI: 0.33-0.84) and self-reported (aOR: 0.37; 95% CI: 0.22-0.64). Women living in formal housing had increased odds of a positive alcohol screening test (aOR: 1.92; 95% CI: 1.16-3.18) and women with housing instability had increased odds of self-reported alcohol misuse-daily (aOR: 1.99; 95% CI: 1.18-3.35) and weekly (aOR:1.91; 95% CI: 1.19-3.07). Food insecurity was associated with reduced odds of self-reported alcohol misuse (aOR: 0.40; 95% CI: 0.25-0.64) and increased odds of self-reported drug misuse (aOR: 2.05; 95% CI: 1.16-3.61). These findings indicate the complexity of the relationship between social determinants and alcohol and other drug misuse, and may have implications for addressing social and structural determinants as part of multilevel interventions focused on reducing alcohol and other drug misuse among key populations of women in South Africa.}, journal={AIDS AND BEHAVIOR}, author={Browne, Felicia A. and Gichane, Margaret W. and Shangase, Nosipho and Ndirangu, Jacqueline and Bonner, Courtney Peasant and Wechsberg, Wendee M.}, year={2022}, month={Nov} }
 @article{nyblade_ndirangu_speizer_browne_bonner_minnis_kline_ahmed_howard_cox_et al._2022, title={Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa}, volume={22}, ISSN={["1471-2458"]}, DOI={10.1186/s12889-022-14236-z}, abstractNote={Abstract}, number={1}, journal={BMC PUBLIC HEALTH}, author={Nyblade, Laura and Ndirangu, Jacqueline W. and Speizer, Ilene S. and Browne, Felicia A. and Bonner, Courtney Peasant and Minnis, Alexandra and Kline, Tracy L. and Ahmed, Khatija and Howard, Brittni N. and Cox, Erin N. and et al.}, year={2022}, month={Oct} }
 @article{bonner_fisher_carney_browne_gichane_howard_turner_wechsberg_2021, title={"Because all mothers is not the same": The development and implementation of an in loco parentis informed consent procedure to enroll adolescent girls and young women to participate in HIV research}, volume={93}, ISSN={["1095-9254"]}, DOI={10.1016/j.adolescence.2021.11.001}, abstractNote={Abstract}, number={1}, journal={JOURNAL OF ADOLESCENCE}, author={Bonner, Courtney Peasant and Fisher, Celia B. and Carney, Tara and Browne, Felicia A. and Gichane, Margaret W. and Howard, Brittni N. and Turner, Leslie and Wechsberg, Wendee M.}, year={2021}, month={Dec}, pages={234–244} }
 @article{washio_browne_ndirangu_kline_wechsberg_2021, title={Antiretroviral Therapy (ART) Adherence and Prenatal Alcohol Use among Women Who Are Pregnant with HIV in South Africa}, volume={18}, ISSN={["1660-4601"]}, DOI={10.3390/ijerph18147446}, abstractNote={This brief report emphasizes the need to focus on women with HIV who are pregnant who use alcohol or other drugs. A recently completed implementation science study tested a gender-focused behavioral intervention, the Women’s Health CoOp (WHC), to improve antiretroviral therapy (ART) adherence and reduce alcohol use among women with HIV. The study identified 33 participants who had a positive pregnancy test result at the baseline assessment, of whom five participants remained pregnant during the 6-month duration of the study. Of the 33 pregnant participants at the baseline assessment, 55% reported past-month alcohol use, with 27% reporting a history of physical abuse and 12% reporting a history of sexual abuse. The five women who remained pregnant at 6 months showed improved ART adherence and reduced prenatal alcohol use. The gender-focused WHC intervention shows promise as a cost-effective, sustainable, behavioral intervention to address these intersecting syndemic issues. Future research should focus on identifying the needs of women with HIV who are pregnant who use alcohol or other drugs and developing tailored evidence-based behavioral interventions such as the WHC for preventing FASD in addition to improving ART adherence in this key population of women and reducing the economic burden on society.}, number={14}, journal={INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH}, author={Washio, Yukiko and Browne, Felicia A. and Ndirangu, Jacqueline and Kline, Tracy L. and Wechsberg, Wendee M.}, year={2021}, month={Jul} }
 @article{wechsberg_browne_bonner_washio_howard_drift_2021, title={Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters}, ISSN={["1548-3576"]}, DOI={10.1007/s11904-021-00558-x}, abstractNote={Abstract}, journal={CURRENT HIV/AIDS REPORTS}, author={Wechsberg, Wendee M. and Browne, Felicia A. and Bonner, Courtney Peasant and Washio, Yukiko and Howard, Brittni N. and Drift, Isa}, year={2021}, month={Jun} }
 @article{wechsberg_browne_ndirangu_bonner_kline_gichane_zule_2021, title={Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa}, volume={25}, ISSN={["1573-3254"]}, DOI={10.1007/s10461-021-03251-7}, abstractNote={Abstract}, number={SUPPL 3}, journal={AIDS AND BEHAVIOR}, author={Wechsberg, Wendee M. and Browne, Felicia A. and Ndirangu, Jacqueline and Bonner, Courtney Peasant and Kline, Tracy L. and Gichane, Margaret and Zule, William A.}, year={2021}, month={Dec}, pages={276–289} }
 @article{bonner_carney_browne_ndirangu_howard_wechsberg_2021, title={Substance use and depressive and anxiety symptoms among out-of-school adolescent girls and young women in Cape Town, South Africa}, volume={111}, ISSN={["2078-5135"]}, DOI={10.7196/SAMJ.2020.v111i1.14520}, abstractNote={BACKGROUND
There is a high prevalence of substance use among youth in South Africa (SA), and adolescent girls and young women (AGYW) experience high rates of depression and anxiety. Substance use behaviours and mental health are associated with other public health problems among AGYW such as HIV and unintended pregnancy. Therefore, understanding the relationship between substance use and mental health is imperative to improve AGYW's health.


OBJECTIVES
To examine the association between heavy drinking, marijuana, methamphetamine and methaqualone (Mandrax) use and depressive and anxiety symptoms among AGYW aged 16 - 19 years who have dropped out of school in Cape Town, SA.


METHODS
Data for this report come from the baseline data of 500 participants of an ongoing cluster-randomised trial assessing the efficacy of a young woman-focused intervention to reduce substance use and HIV risk. After AGYW consented/assented to participate, they completed a urine drug screen and a baseline questionnaire.


RESULTS
Logistic and negative binomial regressions, controlling for clustering at the neighbourhood level, revealed that frequency of depressive symptoms was significantly and positively related to a positive drug screen for Mandrax (β=0.07; p=0.03). All other associations between the frequency of depressive symptoms and substance use were not statistically significant (ps>0.05). The associations between frequency of anxiety symptoms and substance use were not statistically significant (ps>0.05).


CONCLUSIONS
Our findings highlight the need to address substance use, especially Mandrax use and its associated risk, and depression in an integrated, youth-friendly setting.}, number={1}, journal={SAMJ SOUTH AFRICAN MEDICAL JOURNAL}, author={Bonner, C. P. and Carney, T. and Browne, F. A. and Ndirangu, J. W. and Howard, B. N. and Wechsberg, W. M.}, year={2021}, month={Jan}, pages={40–45} }
 @article{gichane_wechsberg_ndirangu_howard_bonner_browne_zule_2021, title={Sustainability of a gender-focused HIV and alcohol risk-reduction intervention in usual care settings in South Africa: a mixed methods analysis}, ISSN={["1360-0451"]}, DOI={10.1080/09540121.2021.1966694}, abstractNote={ABSTRACT Intervention sustainability is a critical yet understudied aspect of implementation science research. To address this gap, we examined the sustainability of the Women’s Health CoOp (WHC), a gender-focused, evidence-based, HIV and alcohol risk-reduction intervention, after an implementation trial. We used a mixed methods design consisting of questionnaires (n = 12), 3 focus groups (n = 11), and a semistructured interview conducted with interventionists implementing the WHC in clinics and substance use treatment programs in Cape Town, South Africa. Five out of 8 facilities implemented the WHC beyond the 6-month implementation period, and 4 were still implementing the WHC as of October 2019. Sustainability ranged from approximately 8 months to more than 3 years. At the most recent assessment, interventionists delivered the intervention to 0–20 participants in the past month. Qualitative findings indicate that long-term sustainability would require support from upper management, staff dedicated to the WHC, and booster trainings. The WHC was sustained postimplementation. Integrating the program into usual care would be feasible; however, human resources, financial, and institutional support would be needed for sustainability. To move implementation science forward, it is essential to determine sustainability beyond the presence and involvement of researchers.}, journal={AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV}, author={Gichane, Margaret W. and Wechsberg, Wendee M. and Ndirangu, Jacqueline and Howard, Brittni and Bonner, Courtney Peasant and Browne, Felicia A. and Zule, William A.}, year={2021}, month={Aug} }
 @article{myers_browne_carney_kline_bonner_wechsberg_2021, title={The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa}, volume={18}, ISSN={["1660-4601"]}, DOI={10.3390/ijerph182111403}, abstractNote={Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.}, number={21}, journal={INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH}, author={Myers, Bronwyn and Browne, Felicia A. and Carney, Tara and Kline, Tracy and Bonner, Courtney Peasant and Wechsberg, Wendee M.}, year={2021}, month={Nov} }
 @article{williams_washio_myers_jaspan_browne_wechsberg_parry_2020, title={Cannabis use and breastfeeding: do we know enough?}, volume={50}, ISSN={["2078-208X"]}, DOI={10.1177/0081246319893934}, abstractNote={Breastfeeding has a multitude of health benefits. It decreases infants’ risks for various health conditions such as mortality in the first 6 months of life (NEOVITA Study Group, 2016), Type 1 and 2 diabetes (Gouveri et al., 2011; Ip et al., 2007), diarrhea (Chapman et al., 2010), obesity (Owen et al., 2005), gastrointestinal illness (Howie et al., 1990; Ip et al., 2007), childhood cancer (Mathur et al., 1993), otitis media, and respiratory infections (Ip et al., 2007; Patel et al., 2015). Many benefits of breastfeeding last throughout a child’s life. Breastfeeding beyond 6 months of age is also associated with lower risk of childhood leukemia (Amitay & Keinan-Boker, 2015) and may contribute to higher IQ in girls (von Stumm & Plomin, 2015). Furthermore, a National Maternal and Infant Health Survey in the United States showed that breastfed infants were less likely to die during the post-neonatal phase than infants receiving human milk substitutes (Chen & Rogan, 2004). Breastfeeding mothers also have lower risk of breast cancer, epithelial ovarian cancer, hypertension, and Type 2 diabetes (Agency for Health care Research and Quality, 2018). Consequently, breastfeeding results in reduction in infant mortality and morbidity, improvements for maternal health, and could save an estimated 820,000 children every year (World Health Organization [WHO], 2017)—making it a vital public health strategy for promoting maternal and infant health.}, number={1}, journal={SOUTH AFRICAN JOURNAL OF PSYCHOLOGY}, author={Williams, Petal Petersen and Washio, Yukiko and Myers, Bronwyn and Jaspan, Heather and Browne, Felicia A. and Wechsberg, Wendee M. and Parry, Charles}, year={2020}, month={Mar}, pages={7–10} }
 @article{gichane_wechsberg_ndirangu_browne_bonner_grimwood_shaikh_howard_zule_2020, title={Implementation science outcomes of a gender-focused HIV and alcohol risk-reduction intervention in usual-care settings in South Africa}, volume={215}, ISSN={["1879-0046"]}, DOI={10.1016/j.drugalcdep.2020.108206}, abstractNote={South Africa has the highest HIV prevalence globally, which disproportionately affects women. Hazardous alcohol use reduces antiretroviral adherence which can lead to adverse health. Few evidence-based interventions addressing hazardous alcohol use and HIV have been implemented in real-world settings. This study aimed to evaluate implementation outcomes from the Women’s Health CoOp (WHC)—an evidence-based gender-focused HIV intervention—which was implemented in Cape Town. We conducted this implementation science trial using a modified stepped-wedge design. Four health clinics were paired with four substance use rehabilitation programs and randomized into four cycles. Women living with HIV and who use alcohol or other drugs were recruited into each cycle (n = 120 each cycle). We assessed adoption, acceptability, appropriateness, cost, and fidelity using a mixed methods approach. Adoption: 100 % of staff trained in the WHC and designated as interventionists delivered one or more workshops. Acceptability: Interventionists found the WHC content beneficial to their patients and the WHC improved connections between clinical units in facilities. Appropriateness: The WHC aligned with facility goals to improve antiretroviral adherence and reduce alcohol use; however, there were implementation challenges, including staff shortages, stigma, and few places to refer women for supportive services. Cost: The cost of implementing the WHC was 20.59 ZAR (1.40 USD) per attendee. Fidelity: Interventionists implemented the WHC with high fidelity and quality. The findings suggest it is feasible to integrate the WHC into usual-care settings. Future efforts to scale up the intervention will need to address social and structural implementation challenges. NCT02733003 approved 1/21/2016.}, journal={DRUG AND ALCOHOL DEPENDENCE}, author={Gichane, Margaret W. and Wechsberg, Wendee M. and Ndirangu, Jacqueline and Browne, Felicia A. and Bonner, Courtney Peasant and Grimwood, Ashraf and Shaikh, Najma and Howard, Brittni and Zule, William A.}, year={2020}, month={Oct} }
 @article{belus_baucom_wechsberg_2020, title={Individual and Relationship Predictors of Couple-Level Sexual Concurrency in Heterosexual South African Couples}, volume={49}, ISSN={["1573-2800"]}, DOI={10.1007/s10508-019-1444-3}, abstractNote={One of the major goals of couple-based HIV prevention programs in sub-Saharan Africa is to reduce outside sex partners, known as sexual concurrency. This cross-sectional study examined sexual concurrency at the couple-level and differentiated couples based on whether neither, one, or both partners engaged in sexual concurrency over the past 6 months. Individual predictors (alcohol use and lifetime history of physical or sexual trauma) and relationship predictors (mistrust, relationship inequity, relationship satisfaction, and sexual satisfaction) were used as predictors of couple-level sexual concurrency. A quantitative investigation using path analysis was carried out with data collected from 286 South African heterosexual couples. Results showed that alcohol use for both sexes, relationship dissatisfaction for women, and mistrust among women were predictive of different types of sexual concurrency. Findings suggest that consideration of the experiences and behavior of both partners may be useful in understanding different reasons for engagement in sexual concurrency.}, number={3}, journal={ARCHIVES OF SEXUAL BEHAVIOR}, author={Belus, Jennifer M. and Baucom, Donald H. and Wechsberg, Wendee M.}, year={2020}, month={Apr}, pages={999–1015} }
 @article{belus_kline_carney_myers_wechsberg_2020, title={Measuring relationship functioning in South African couples: a strategy for improving HIV prevention efforts}, volume={35}, ISSN={["1468-1749"]}, DOI={10.1080/14681994.2017.1419559}, abstractNote={ABSTRACT Over the past decade, there has been increased focus on targeting couples in HIV prevention efforts, particularly in sub-Saharan Africa where HIV transmission primarily occurs through heterosexual contact, in the context of intersecting alcohol use and intimate partner violence (IPV). However, little is known about couples’ general relationship functioning. This understanding is needed to augment couple-based HIV prevention programs and address risk for IPV. This paper presents data on domains of relationship functioning with 300 South African couples who were recruited for an HIV prevention study. Exploratory and confirmatory factor analyses were conducted to determine the relevance of 17 individual items, as well as the overall factor structure of the questions. Results revealed three independent factors of relationship functioning: relationship satisfaction, arguing, and open communication; an overarching construct of relationship functioning for these three domains was not observed in the data. Results provide insight into the structure of relationship functioning questions and subscales that can be used to assess South African adult romantic relationships. This may allow for a greater focus on aspects of relationships within couple-based HIV prevention programs going forward.}, number={1}, journal={SEXUAL AND RELATIONSHIP THERAPY}, author={Belus, Jennifer M. and Kline, Tracy and Carney, Tara and Myers, Bronwyn and Wechsberg, Wendee M.}, year={2020}, month={Jan}, pages={2–14} }
 @article{myers_carney_johnson_browne_wechsberg_2020, title={Service providers' perceptions of barriers to the implementation of trauma-focused substance use services for women in Cape Town, South Africa}, volume={75}, ISSN={["1873-4758"]}, DOI={10.1016/j.drugpo.2019.102628}, abstractNote={Abstract Background A substantial number of South African women with substance use disorders also report psychological trauma related to experiences of physical and sexual abuse. Trauma-focused substance use programmes may support recovery from co-occurring substance use disorders and psychological trauma, yet integrated programmes are not widely available in South Africa. As part of the process of developing a trauma-focused substance use programme for South African women, we explored service providers’ views of the feasibility of implementing trauma-focused substance use interventions within usual care settings in Cape Town, including potential barriers that need to be considered when planning for implementation. Methods We conducted 16 in-depth interviews with key informants responsible for planning or delivering substance use, psychological trauma or gender-based violence services to women in Cape Town. Guided by Extended Normalisation Process Theory, interviews explored participants’ perceptions of the potential value of trauma-focused substance use programmes, the feasibility of their implementation, and factors that may facilitate or hinder the implementation of trauma-focused substance use programmes. Qualitative data were analysed using the framework approach. Results Three themes emerged: (1) Potential for the implementation of trauma-focused substance use programmes, describing participants’ views of the acceptability of these programmes; (2) Capacity for intersectoral collaboration, which participants considered necessary for limiting barriers to implementation; and (3) Co-operation with community structures to enhance capability for implementation. Conclusion Findings show potential for implementing trauma-focused substance use interventions in South Africa, however context-specific capacity and capability barriers need to be considered and addressed for implementation to be successful.}, journal={INTERNATIONAL JOURNAL OF DRUG POLICY}, author={Myers, Bronwyn and Carney, Tara and Johnson, Kim and Browne, Felicia A. and Wechsberg, Wendee M.}, year={2020}, month={Jan} }
 @article{wechsberg_browne_ndirangu_bonner_minnis_nyblade_speizer_howard_myers_ahmed_2020, title={The PrEPARE Pretoria Project: protocol for a cluster-randomized factorial-design trial to prevent HIV with PrEP among adolescent girls and young women in Tshwane, South Africa}, volume={20}, ISSN={["1471-2458"]}, DOI={10.1186/s12889-020-09458-y}, abstractNote={Abstract}, number={1}, journal={BMC PUBLIC HEALTH}, author={Wechsberg, Wendee M. and Browne, Felicia A. and Ndirangu, Jacqueline and Bonner, Courtney Peasant and Minnis, Alexandra M. and Nyblade, Laura and Speizer, Ilene S. and Howard, Brittni N. and Myers, Bronwyn and Ahmed, Khatija}, year={2020}, month={Sep} }
 @article{myers_carney_browne_wechsberg_2019, title={A trauma-informed substance use and sexual risk reduction intervention for young South African women: a mixed-methods feasibility study}, volume={9}, ISSN={["2044-6055"]}, DOI={10.1136/bmjopen-2018-024776}, abstractNote={ObjectivesSexual and physical trauma and substance use are intersecting risks for HIV among young women. This study assesses the feasibility, acceptability and preliminary effects of a novel trauma-informed substance use and sexual risk reduction intervention for young South African women.}, number={2}, journal={BMJ OPEN}, author={Myers, Bronwyn and Carney, Tara and Browne, Felicia A. and Wechsberg, Wendee M.}, year={2019}, month={Jun} }
 @article{wechsberg_bonner_zule_horst_ndirangu_browne_kline_howard_rodman_2019, title={Addressing the nexus of risk: Biobehavioral outcomes from a cluster randomized trial of the Women's Health CoOp Plus in Pretoria, South Africa}, volume={195}, ISSN={["1879-0046"]}, DOI={10.1016/j.drugalcdep.2018.10.036}, abstractNote={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.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.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).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.}, journal={DRUG AND ALCOHOL DEPENDENCE}, author={Wechsberg, Wendee M. and Bonner, Courtney Peasant and Zule, William A. and Horst, Charlie and Ndirangu, Jacqueline and Browne, Felicia A. and Kline, Tracy L. and Howard, Brittni N. and Rodman, Nathaniel F.}, year={2019}, month={Feb}, pages={16–26} }
 @article{carney_browne_myers_kline_howard_wechsberg_2019, title={Adolescent female school dropouts who use drugs and engage in risky sex: effects of a brief pilot intervention in Cape Town, South Africa}, volume={31}, ISSN={["1360-0451"]}, DOI={10.1080/09540121.2018.1500008}, abstractNote={ABSTRACT Female adolescents from socioeconomically underserved communities in Cape Town, South Africa, who have dropped out of school, use substances, and engage in risky sex behaviour are at risk of HIV. Tailored gender-focused HIV behavioural interventions for this key population are needed to mitigate these risk factors. A pilot trial of a woman-focused risk-reduction intervention for adolescents was conducted (N = 100), with a one-month follow-up appointment. Participants in the intervention group attended two group workshops. Data were examined for significant differences within and between the groups. At baseline, 94% of participants tested positive for cannabis, 17% were HIV-positive and 11% were pregnant. Ninety-two participants returned for 1-month follow-up. At follow-up, the proportion who tested positive for cannabis use decreased significantly in both the intervention (p = 0.07) and control groups (p = 0.04). Impaired sex with any partner (p = 0.02), or with main partner (p = 0.06) decreased among the intervention group. Impaired sex with a main partner was less likely in the intervention group (p = 0.07) in the regression model. In conclusion, findings indicate a need for HIV prevention interventions among out-of-school female adolescents. Intervention acceptability was high, and there were some decreases in sexual risk behaviour among intervention participants which is promising. Future intervention research with this key population involving larger sample sizes and longer follow-up periods will help to determine intervention efficacy. Trial registration: Uniform Trial Number identifier: NCT02677025.}, number={1}, journal={AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV}, author={Carney, Tara and Browne, Felicia A. and Myers, Bronwyn and Kline, Tracy L. and Howard, Brittni and Wechsberg, Wendee M.}, year={2019}, month={Jan}, pages={77–84} }
 @article{bonner_browne_ndirangu_howard_zule_speizer_kline_wechsberg_2019, title={Exploring the associations between physical and sexual gender-based violence and HIV among women who use substances in South Africa: the role of agency and alcohol}, volume={31}, ISSN={["1360-0451"]}, DOI={10.1080/09540121.2019.1595512}, abstractNote={ABSTRACT Objective: South Africa has the highest prevalence of HIV among women, the highest prevalence of gender-based violence (GBV), and the highest rates of per capita alcohol consumption in the world. The nuanced associations between GBV, alcohol misuse, and HIV must be explored and protective factors identified. This study examines the associations between physical and sexual GBV and HIV infection and explores how alcohol misuse and sexual agency may mediate the GBV-HIV association. Method: Participants were 361 Black African women (Mean age = 28.39, SD = 7.92) who reported using alcohol and/or drugs weekly in the past 3 months, engaging in condomless sex, and having a boyfriend. Women were recruited from disadvantaged communities in Pretoria, South Africa. Individuals who met the eligibility criteria and enrolled in the study consented and completed a computer-assisted personal interview assessing GBV, alcohol misuse, and sexual agency and underwent HIV testing (i.e., blood test). Results: The indirect effect of physical assault on HIV status at enrollment through alcohol misuse was significant (log odds = 0.23, SE = 0.12, 95% CI [0.0151, 0.4998]). Conclusions: HIV prevention efforts focusing on reducing alcohol misuse may be more effective, which might reduce the HIV burden among this group of vulnerable South African women.}, number={11}, journal={AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV}, author={Bonner, Courtney Peasant and Browne, Felicia A. and Ndirangu, Jacqueline W. and Howard, Brittni and Zule, William A. and Speizer, Ilene S. and Kline, Tracy and Wechsberg, Wendee M.}, year={2019}, pages={1369–1375} }
 @misc{meyer_isaacs_el-shahawy_burlew_wechsberg_2019, title={Research on women with substance use disorders: Reviewing progress and developing a research and implementation roadmap}, volume={197}, ISSN={["1879-0046"]}, DOI={10.1016/j.drugalcdep.2019.01.017}, abstractNote={Research on women with substance use disorders has expanded, yet knowledge and implementation gaps remain. Drawing from topics discussed at the 2017 meeting of InWomen’s in Montreal, Canada, this article reviews key progress in research on substance use among women, adolescents, and families to delineate priorities for the next generation of research. The field has seen significant accomplishments in multiple domains, including the management of pregnant women with substance use and comorbid psychiatric disorders, caring for neonates in opioid withdrawal, greater inclusion of and treatment options for LGBTQ + communities, gendered instrumentation, and gender-focused HIV interventions for adolescent girls and women. Women who use alcohol and other drugs often experience other comorbid medical conditions (chronic Hepatitis C and HIV), contextual confounders (intimate partner violence exposure, homelessness, trauma), and social expectations (e.g., as caretakers) that must be addressed as part of integrated care to effectively treat women’s substance use issues. Although significant advances have been made in the field to date, gender-based issues for women remain a neglected area in much of substance abuse research. Few dedicated and gender-focused funding opportunities exist and research has been siloed, limiting the potential for collaborations or interdisciplinary cross-talk. Given renewed attention to substance use in the context of the burgeoning opioid epidemic and shifts in global politics that affect women’s substance use, the field requires a strategic rethink to invigorate a pipeline of future research and researchers.}, journal={DRUG AND ALCOHOL DEPENDENCE}, author={Meyer, Jaimie P. and Isaacs, Krystyna and El-Shahawy, Omar and Burlew, A. Kathleen and Wechsberg, Wendee}, year={2019}, month={Apr}, pages={158–163} }
 @article{belus_baucom_carney_carrino_wechsberg_2018, title={A Model of Heterosexual Adaptive Relationship Functioning in South Africa: Implications for HIV Prevention Interventions}, volume={30}, ISSN={["1931-762X"]}, DOI={10.1080/19317611.2018.1530324}, abstractNote={Abstract Objectives: Couple-based HIV prevention efforts are an important HIV prevention strategy in South Africa but there is a lack of understanding as to what constitutes healthy relationships in South African sociodisadvantaged communities. Methods: To address this, 8 focus group discussions were conducted with 27 men and 23 Black African women living in a large disadvantaged community in Cape Town, South Africa. Results: A model of adaptive relationship functioning is put forth, which involves four primary relationship components that emerged as central to healthy relationships: active relationship building, emotional support/display, communication, and problem-solving. Conclusions: The results of this study can inform couple-based HIV prevention efforts.}, number={4}, journal={INTERNATIONAL JOURNAL OF SEXUAL HEALTH}, author={Belus, Jennifer M. and Baucom, Donald H. and Carney, Tara and Carrino, Emily and Wechsberg, Wendee M.}, year={2018}, pages={398–411} }
 @article{speizer_zule_carney_browne_ndirangu_wechsberg_2018, title={Changing sex risk behaviors, gender norms, and relationship dynamics among couples in Cape Town, South Africa: Efficacy of an intervention on the dyad}, volume={209}, ISSN={["0277-9536"]}, DOI={10.1016/j.socscimed.2018.05.024}, abstractNote={South Africa continues to experience new HIV infections, with the highest risk among Black Africans living in poor communities. Most HIV prevention interventions target women or men separately and only a small number target couples jointly. This study examines varying strategies to engage women and men around HIV prevention and improved couple interactions. The study comprises three arms: (1) a couple-based intervention delivered to women and men jointly; (2) women and men both offered a gender-focused intervention that is delivered to them separately; and (3) an intervention offered to women only and their male partners receive standard HIV testing and counseling (comparison arm). Between June 2010 and April 2012, men were identified in and around drinking establishments in a large disadvantaged community in Cape Town and asked to participate in the study if they drink regularly, had recent unprotected sex with their partner, and have a female partner who was willing to participate in the study. A total of 299 couples completed the baseline assessment and 276 were included in the analysis of sexual risk, partner communication, conflict resolution, and gender norm outcomes at baseline and six-month follow-up. Couples that participated in the couple-level intervention and couples where both partners received the intervention separately had better couple-level gender norms than couples in the comparison arm (women only receive intervention). Further, couples in the couple-level intervention and the both partners exposed separately arms were more likely to have the man only report consistent condom use than neither partner report consistent condom use than couples in the comparison arm. Community-based HIV prevention intervention programs need to consider strategies to engage women and men and, if feasible, reach both partners jointly. Couple-level interventions are promising to improve gender norms and subsequently improve health outcomes, including reduced HIV risk among women, men, and couples.}, journal={SOCIAL SCIENCE & MEDICINE}, author={Speizer, Ilene S. and Zule, William A. and Carney, Tara and Browne, Felicia A. and Ndirangu, Jacqueline and Wechsberg, Wendee M.}, year={2018}, month={Jul}, pages={95–103} }
 @article{zule_speizer_browne_howard_wechsberg_2018, title={Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis}, volume={45}, ISSN={["1537-4521"]}, DOI={10.1097/OLQ.0000000000000881}, abstractNote={
            Background
            High rates of alcohol and other drug use contribute to the ongoing generalized human immunodeficiency virus epidemic in South Africa. Despite the general link between alcohol use and condomless sex, findings from event-level studies of the relationship between alcohol use and condomless sex during the same encounter have been inconsistent.
          }, number={12}, journal={SEXUALLY TRANSMITTED DISEASES}, author={Zule, William A. and Speizer, Ilene S. and Browne, Felicia A. and Howard, Brittni N. and Wechsberg, Wendee M.}, year={2018}, month={Dec}, pages={786–790} }
 @article{myers_carney_browne_wechsberg_2018, title={Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women}, volume={12}, ISSN={["1177-889X"]}, DOI={10.2147/PPA.S175852}, abstractNote={Purpose To develop a trauma-informed substance use and sexual risk reduction intervention for young South African women at risk of HIV. Patients and methods Guided by the ADAPT-ITT framework for intervention development, we selected four focus groups (n=26) to assess the service needs and preferences of trauma-exposed young women (aged 18–25 years) who use substances. We used findings to develop a needs-based and contextually appropriate intervention. In addition four focus groups (n=30) were selected to explore potential service users’ views of this intervention and recommendations for improving acceptability and appeal. Expert stakeholders were also consulted. Results Young women described therapeutic, self-care, and social support needs for coping with traumatic experiences and reducing substance- and sexual-related risks for HIV and further trauma. To address these needs, we expanded the Women’s Health Co-Operative (WHC; an evidence-based HIV prevention program) to include trauma-related psychoeducation; cognitive-behavioral strategies for coping with the emotional impact of trauma, stress, and substance use craving; social support strategies; and self-care components to help young women create a life with purpose. This novel and expanded six-session group-based intervention is called the trauma-informed WHC. Focus group participants and expert stakeholders viewed the trauma-informed WHC as highly relevant and acceptable. They provided recommendations for modifications to the intervention structure and reformatting of intervention materials to enhance the intervention’s appeal and the feasibility of reaching and retaining young women in the program. Conclusion Engaging women as potential service users in the process of developing a trauma-informed substance use and sexual risk reduction intervention helped identify service needs not commonly addressed in trauma-informed substance use interventions but critical for recovery and local relevance. It also enhanced the acceptability and appeal of the intervention. While potentially acceptable, the trauma-informed WHC requires feasibility testing before establishing its efficacy in a larger trial.}, journal={PATIENT PREFERENCE AND ADHERENCE}, author={Myers, Bronwyn and Carney, Tara and Browne, Felicia A. and Wechsberg, Wendee M.}, year={2018}, pages={1997–2006} }
 @article{wechsberg_browne_carney_myers_minnis_macdonald_ndirangu_turner_howard_rodman_2018, title={The Young Women's Health CoOp in Cape Town, South Africa: Study protocol for a cluster-randomised trial for adolescent women at risk for HIV}, volume={18}, ISSN={["1471-2458"]}, DOI={10.1186/s12889-018-5665-5}, abstractNote={South Africa remains the global epicentre of HIV infection, and adolescent women have the highest incidence of HIV in the country. South Africa also has high rates of alcohol and other drug (AOD) use, violence, and gender inequality. Violence converges with AOD use, gender inequities and other disparities, such as poverty, to increase sexual risk and poor educational attainment for adolescent women. This study seeks to test the efficacy of peer recruitment and cofacilitation of the Young Women's Health CoOp (YWHC), a comprehensive gender-focused intervention to reduce HIV risk behaviours and increase the uptake of HIV counselling and testing (HCT) among out-of-school, adolescent women who use AODs. The YWHC is facilitated by local research staff and supported by peers. This cluster-randomised trial is enrolling participants into two arms: a control arm that receives standard HCT, and an intervention arm that receives the YWHC. Participants are enrolled from 24 economically disadvantaged communities in Cape Town, South Africa. These geographically distinct communities serve as clusters that are the units of randomisation. This study uses adolescent peer role models and research field staff to recruit marginalised adolescent women. At baseline, participants complete a questionnaire and biological testing for HIV, recent AOD use, and pregnancy. The core intervention is delivered in the month following enrollment, with linkages to health services and educational programmes available to participants throughout the follow-up period. Follow-up interviews and biological testing are conducted at 6 and 12 months post enrollment. The study findings will increase knowledge of the efficacy of a comprehensive HCT, gender-focused programme in reducing AOD use, victimisation, and sexual risk behaviour and increase uptake services for out-of-school, adolescent women who use AODs. The trial results could lead to wider implementation of the YWHC for vulnerable adolescent women, a key population often neglected in health services. Trial registration no: NCT02974998 , November 29, 2016.}, journal={BMC PUBLIC HEALTH}, author={Wechsberg, Wendee M. and Browne, Felicia A. and Carney, Tara and Myers, Bronwyn and Minnis, Alexandra and MacDonald, Robert and Ndirangu, Jacqueline W. and Turner, Leslie B. and Howard, Brittni N. and Rodman, Nathaniel}, year={2018}, month={Jul} }
 @article{carney_myers_kline_johnson_wechsberg_2017, title={Aggressive behaviour among drug-using women from Cape Town, South Africa: ethnicity, heavy alcohol use, methamphetamine and intimate partner violence}, volume={17}, ISSN={["1472-6874"]}, DOI={10.1186/s12905-017-0447-2}, abstractNote={Women have generally been found to be the victims of violence, but scant attention has been paid to the characteristics of women who perpetrate aggression and violence. In South Africa, violence is a prevalent societal issue, especially in the Western Cape. This study aimed at identifying factors that were associated with aggression among a sample of 720 substance-using women. We conducted multivariate logistic regression to identify factors that are significantly associated with these behaviours. Ethnicity (Wald Χ2 = 17.07(2), p < 0.01) and heavy drinking (Wald Χ2 = 6.60 (2), p = 0.01) were significantly related to verbal aggression, methamphetamine use was significantly related to physical (Wald Χ2 = 2.73 (2), p = 0.01) and weapon aggression (Wald Χ2 = 7.94 (2), p < 0.01) and intimate partner violence was significantly related to verbal (Wald Χ2 = 12.43 (2), p < 0.01) and physical aggression (Wald Χ2 = 25.92 (2), p < 0.01). The findings show high levels of aggression among this sample, and highlight the need for interventions that address methamphetamine, heavy drinking and intimate partner violence among vulnerable substance-using women.}, journal={BMC WOMENS HEALTH}, author={Carney, Tara and Myers, Bronwyn and Kline, Tracy L. and Johnson, Kim and Wechsberg, Wendee M.}, year={2017}, month={Sep} }
 @article{wechsberg_ndirangu_speizer_zule_gumula_peasant_browne_dunlap_2017, title={An implementation science protocol of the Women's Health CoOp in healthcare settings in Cape Town, South Africa: A stepped-wedge design}, volume={17}, ISSN={["1472-6874"]}, DOI={10.1186/s12905-017-0433-8}, abstractNote={HIV persists as a public health emergency in South Africa, especially among women of childbearing age. In response to the HIV epidemic, the Joint United Nations Programme on HIV/AIDS has put forth the 90–90-90 global goals to achieve an AIDS-free generation by 2020. This goal aspires to have 90% of people living with HIV diagnosed; 90% of those who test positive on sustained antiretroviral therapy (ART); and 90% of those on ART be virally suppressed. Ensuring access to ART is an important first step in reducing HIV incidence, especially among vulnerable populations such as women who use substances and bear the burden of HIV in South Africa. Additionally, alcohol and other drug (AOD) use and exposure to gender-based violence are associated with increased risk of HIV infection and reduced adherence to ART. However, no research has estimated ART adherence rates for women who use substances in South Africa since the government approved the provision of ART to all people living with HIV. The Women’s Health CoOp (WHC) is an evidence-based, woman-focused, behavioral intervention that addresses the intersecting risks of AODs, sex behaviors, and violence and victimization, with the primary goal of increasing skills and knowledge to reduce substance abuse and HIV risks and to improve ART adherence. The WHC has been packaged for further dissemination. This article describes the study protocol used to assess the feasibility and acceptability of implementing the WHC intervention into standard of care in Cape Town health clinics and substance abuse rehabilitation centers to reduce HIV risk behavior and increase ART adherence among women who use substances and are living with HIV. Because few of the interventions that demonstrate efficacy for HIV prevention and ART adherence in randomized trials are sustainable, studies to adapt and test intervention variations are needed to determine the best strategies for implementing them in real-world, high-risk settings. However, implementation in real-world settings presents challenges. Consequently, intervention developers should consider the strengths and limitations of their anticipated implementation setting by engaging with key stakeholders before, during, and after the adaptation and implementation process when developing and attempting to scale-up interventions. NCT 02733003 and date approved 1/21/2016.}, journal={BMC WOMENS HEALTH}, author={Wechsberg, Wendee M. and Ndirangu, Jacqueline W. and Speizer, Ilene S. and Zule, William A. and Gumula, Winnifred and Peasant, Courtney and Browne, Felicia A. and Dunlap, Laura}, year={2017}, month={Sep} }
 @article{wechsberg_browne_zule_novak_doherty_kline_carry_raiford_herbst_2017, title={Efficacy of the Young Women's CoOp: An HIV Risk-Reduction Intervention for Substance-Using African-American Female Adolescents in the South}, volume={26}, ISSN={["1547-0652"]}, DOI={10.1080/1067828x.2016.1260511}, abstractNote={ABSTRACT HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a risk-reduction intervention, the Young Women's CoOp (YWC), relative to a nutrition control. In efficacy analyses adjusting for baseline condom use, at three-month follow-up participants in the YWC were significantly less likely to report sex without a condom at last sex relative to control. There were mixed findings for within-group differences over follow-up, underscoring the challenges for intervening with substance-using female youths.}, number={3}, journal={JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE}, author={Wechsberg, Wendee M. and Browne, Felicia A. and Zule, William A. and Novak, Scott P. and Doherty, Irene A. and Kline, Tracy L. and Carry, Monique G. and Raiford, Jerris L. and Herbst, Jeffrey H.}, year={2017}, pages={205–218} }
 @article{wechsberg_peasant_kline_zule_ndirangu_browne_gabel_horst_2017, title={HIV Prevention Among Women Who Use Substances And Report Sex Work: Risk Groups Identified Among South African Women}, volume={21}, ISSN={["1573-3254"]}, DOI={10.1007/s10461-017-1889-0}, abstractNote={This cross-sectional study presents baseline data from women (n = 641) in a community-based randomized trial in Pretoria, South Africa. Women were eligible if they reported recent alcohol or other drug (AOD) use and condomless sex. Latent class analyses were conducted separately for those who reported sex work and those who did not. Among those who reported sex work, a Risky Sex class (n = 72, 28%) and Low Sexual Risk class (n = 190, 73%) emerged. Those in the Risky Sex class were more likely to report that their last episode of sexual intercourse was with their boyfriend (vs. a client/other partner) compared with the Low Sexual Risk class (p < 0.001). Among participants who did not report sex work, a Drug-Using, Violence-Exposed, and Impaired Sex class (n = 53; 14%) and Risky Sex and Moderate Drinking class (n = 326; 86%) emerged. The findings suggest that interventions for women who engage in sex work should promote safer sexual behavior and empowerment with main partners. Women who use AODs, experience physical or sexual violence, and have impaired sex may be a key population at risk for HIV and should be considered for tailored behavioral interventions in conjunction with South Africa’s plan to disseminate HIV prevention methods to vulnerable women. Trial Registration: ClinicalTrials.gov registration NCT01497405.}, number={2}, journal={AIDS AND BEHAVIOR}, author={Wechsberg, Wendee M. and Peasant, Courtney and Kline, Tracy and Zule, William A. and Ndirangu, Jacqueline and Browne, Felicia A. and Gabel, Colby and Horst, Charles}, year={2017}, month={Nov}, pages={S155–S166} }
 @article{wechsberg_horst_ndirangu_doherty_kline_browne_belus_nance_zule_2017, title={Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa}, volume={12}, ISSN={["1940-0640"]}, DOI={10.1186/s13722-017-0077-x}, abstractNote={Abstract}, journal={ADDICTION SCIENCE & CLINICAL PRACTICE}, author={Wechsberg, Wendee M. and Horst, Charles and Ndirangu, Jacqueline and Doherty, Irene A. and Kline, Tracy and Browne, Felicia A. and Belus, Jennifer M. and Nance, Robin and Zule, William A.}, year={2017}, month={Apr} }
 @article{myers_carney_wechsberg_2016, title={"Not on the agenda": A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa}, volume={30}, ISSN={["1873-4758"]}, DOI={10.1016/j.drugpo.2015.12.019}, abstractNote={Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women's use of health services.We conducted four focus groups with young women (aged 16-21) who used AODs and were recruited from two township communities in Cape Town. We also conducted 14 in-depth interviews with health and social welfare service planners and providers. Discussion topics included young women's use of health services and perceived influences on service use. Qualitative data were analysed using a framework approach.The findings highlighted structural, contextual, and systemic influences on the use of health services by young women who use AODs. First, young women were absent from the health agenda, which had an impact on the provision of women-specific services. Resource constraints and gender inequality were thought to contribute to this absence. Second, gender inequality and stigma toward young women who used AODs led to their social exclusion from education and employment opportunities and health care. Third, community poverty resulted in the emergence of perverse social capital and social disorder that limited social support for treatment. Fourth, the health care system was unresponsive to the multiple service needs of these young women.To reach young women who use AODs, interventions need to take cognisance of young women's risk environment and health systems need to adapt to respond better to their needs. For these interventions to be effective, gender must be placed on the policy agenda.}, journal={INTERNATIONAL JOURNAL OF DRUG POLICY}, author={Myers, Bronwyn and Carney, Tara and Wechsberg, Wendee M.}, year={2016}, month={Apr}, pages={52–58} }
 @article{doherty_myers_zule_minnis_kline_parry_el-bassel_wechsberg_2016, title={Seek, Test and Disclose: knowledge of HIV testing and serostatus among high-risk couples in a South African township}, volume={92}, ISSN={["1472-3263"]}, DOI={10.1136/sextrans-2014-051882}, abstractNote={Objectives HIV testing and disclosure of results to partners is an important strategy in HIV prevention but is under-researched within heterosexual partnerships. To address this gap, we describe patterns of HIV testing, discrepancies between beliefs and biologically confirmed HIV status of each partner, and characteristics of mutually correct knowledge of HIV status among heterosexual couples in a high-prevalence community. Methods The study recruited 290 high-risk heterosexual couples in stable relationships from a township in Cape Town, South Africa. Male patrons of shebeens (drinking establishments) were approached to participate with their main partner in an intervention designed to reduce substance use, violence and unsafe sex. All participants were tested for HIV at baseline and asked about their partner's past HIV testing and current status. Using the couple as the unit of analysis, we conducted logistic regression to identify partnership and individual characteristics associated with having mutually correct knowledge of partner's HIV status. Results Half (52%) of women and 41% of men correctly knew whether their partner had ever been tested for HIV. 38% of women, 28% of men and in 17% of couples, both members reported mutually correct knowledge of their partner's HIV status. Correlates of correct knowledge included married/cohabitating (aOR 2.69, 95% CI 1.35 to 5.40), both partners HIV-negative (aOR 3.32 (1.38 to 8.00)), women's acceptance of traditional gender roles (aOR 1.17 (1.01 to 1.40)) and men's relationship satisfaction (aOR 2.22 (1.01 to 4.44)). Conclusions Findings highlight the need to improve HIV testing uptake among men and to improve HIV disclosure among women in heterosexual partnerships. Trial registration number ClinicalTrials.gov registration NCT01121692.}, number={1}, journal={SEXUALLY TRANSMITTED INFECTIONS}, author={Doherty, Irene A. and Myers, Bronwyn and Zule, William A. and Minnis, Alexandra M. and Kline, Tracy L. and Parry, Charles D. and El-Bassel, Nabila and Wechsberg, Wendee M.}, year={2016}, month={Feb}, pages={5–11} }
 @article{wechsberg_zule_el-bassel_doherty_minnis_novak_myers_carney_2016, title={The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township}, volume={161}, ISSN={["1879-0046"]}, DOI={10.1016/j.drugalcdep.2016.02.017}, abstractNote={This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence.Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners.At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm.A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.}, journal={DRUG AND ALCOHOL DEPENDENCE}, author={Wechsberg, Wendee M. and Zule, William A. and El-Bassel, Nabila and Doherty, Irene A. and Minnis, Alexandra M. and Novak, Scott D. and Myers, Bronwyn and Carney, Tara}, year={2016}, month={Apr}, pages={307–315} }
 @article{wechsberg_el-bassel_carney_browne_myers_zule_2015, title={Adapting an evidence-based HIV behavioral intervention for South African couples}, volume={10}, ISSN={["1747-597X"]}, DOI={10.1186/s13011-015-0005-6}, abstractNote={In South Africa, heterosexual couples are at risk for HIV infection and transmission through substance use, gender-based violence and traditional gender roles, and sex risk behaviors such as having multiple partners and unsafe sex.To address these interconnected HIV risks among heterosexual couples, we used the ADAPT framework to modify an existing, efficacious women's HIV prevention intervention (the Western Cape Women's Health CoOp) to include components of an evidence-based couple's intervention from the United States (Project Connect) and components from the Men as Partners program that has been used successfully in South Africa. We conducted focus groups with men, women and couples, and obtained feedback from a long-standing Community Collaborative Board (CCB) to guide the synthesis of elements of these three interventions into a new intervention. We then piloted the adapted intervention for feasibility and acceptability.The new intervention is called the Couples' Health CoOp. This intervention targets men who use alcohol and other drugs and engage in unprotected sex, and their main female sex partners. The intervention addresses substance use, sex risk, HIV and other sexually transmitted infections, gender roles, gender-based violence, communication skills, and goal-setting activities to increase sexy (eroticize) safe-sex behaviors. The Couples' Health CoOp also includes "voices" from the focus group members to ground the intervention in the experiences of these at-risk couples. In addition, it utilizes a participant handbook that reiterates workshop content and includes homework assignments for couples to complete together to increase problem-solving skills within their relationship, and to improve their sexual relationship and help sustain HIV risk-reduction strategies. All of these adaptations were based on participants' suggestions made during formative work and pilot testing.The Couples' Health CoOp is a couple-based HIV prevention intervention that targets alcohol and other drug use to reduce sexual risk, reduce gender-based violence and offer alternatives for conflict resolution, promote healthy relationships, and modify traditional gender roles in South Africa.NCT01121692 .}, journal={SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY}, author={Wechsberg, Wendee M. and El-Bassel, Nabila and Carney, Tara and Browne, Felicia A. and Myers, Bronwyn and Zule, William A.}, year={2015}, month={Feb} }
 @article{myers_jones_doherty_kline_key_johnson_wechsberg_2015, title={Correlates of Lifetime Trauma Exposure Among Pregnant Women from Cape Town, South Africa}, volume={13}, ISSN={["1557-1882"]}, DOI={10.1007/s11469-015-9544-3}, abstractNote={A cross-sectional survey of 298 pregnant women from Cape Town, South Africa was conducted to examine socio-demographic, reproductive health, mental health, and relationship correlates of lifetime trauma exposure and whether these correlates vary as a function of age. Overall, 19.8% of participants reported trauma exposure. We found similarities and differences in correlates of trauma exposure among women in emerging adulthood and older women. Prior termination of pregnancy was associated with trauma exposure in both age groups. Difficulties in resolving arguments, lifetime substance use, and a prior sexually transmitted infection were associated with trauma exposure among women in emerging adulthood. In contrast, depression and awareness of substance abuse treatment programmes were associated with trauma exposure among older women. These findings highlight the need for interventions that prevent and treat trauma exposure among vulnerable women. Such interventions should be tailored to address the correlates of trauma exposure in each age group.}, number={3}, journal={INTERNATIONAL JOURNAL OF MENTAL HEALTH AND ADDICTION}, author={Myers, Bronwyn and Jones, Hendree E. and Doherty, Irene A. and Kline, Tracy L. and Key, Mary E. and Johnson, Kim and Wechsberg, Wendee M.}, year={2015}, month={Jun}, pages={307–321} }
 @article{reed_myers_novak_browne_wechsberg_2015, title={Experiences of Violence and Association with Decreased Drug Abstinence Among Women in Cape Town, South Africa}, volume={19}, ISSN={["1573-3254"]}, DOI={10.1007/s10461-014-0820-1}, abstractNote={Drug abuse is a contributing factor in women’s HIV risk in low-income communities in Cape Town, South Africa. This study assessed whether experiencing violence is associated with reduced drug abstinence among adult women (n = 603) participating in a randomized field trial for an HIV prevention study in Cape Town. In relation to drug abstinence at 12-month follow-up, multivariable regression models were used to assess (1) baseline partner and non-partner victimization, and (2) victimization at 12-month follow-up among participants reporting baseline victimization. Baseline partner (AOR = 0.6; 95 % CI 0.4–0.9) and non-partner victimization (AOR = 0.6; 95 % CI 0.4–0.9) were associated with a reduced likelihood of drug abstinence at follow-up. Among participants who reported victimization at baseline, those no longer reporting victimization at follow-up did not differ significantly in drug abstinence compared with those who reported victimization at follow-up. The study findings highlight the lasting impact of victimization on women’s drug use outcomes, persisting regardless of whether violence was no longer reported at follow-up. Overall, the findings support the need for the primary prevention of violence to address the cycle of violence, drug use, and HIV among women in this setting.}, number={1}, journal={AIDS AND BEHAVIOR}, author={Reed, Elizabeth and Myers, Bronwyn and Novak, Scott P. and Browne, Felicia A. and Wechsberg, Wendee M.}, year={2015}, month={Jan}, pages={192–198} }
 @article{wechsberg_deren_myers_kirtadze_zule_howard_el-bassel_2015, title={Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions}, volume={69}, ISSN={["1077-9450"]}, DOI={10.1097/qai.0000000000000627}, abstractNote={Abstract:The use of alcohol and other drugs (AODs) is an important driver of gender disparities in HIV prevalence. Consequently, there is a need for women-specific HIV interventions that are conceptualized to address (1) women's risk behavior, their roles in sexual relationships, and gender power dynamics and (2) other issues commonly faced by women who use AODs, such as gender-based violence and victimization. This article presents the evolution of HIV prevention intervention research with women who use AODs. It looks at 3 generations of women-focused HIV research interventions, including first-generation projects that started in the 1990s, second-generation efforts where projects expanded in scope and included adaptions of evidence-based interventions for global relevance, and finally third-generation projects currently underway that combine biobehavioral methods and are being implemented in real-world settings. Because women who use AODs continue to report risk behaviors related to HIV, emphasis should be placed on training scientists to conduct gender-specific studies, increasing funding for new studies, and advocating to ensure that stigma-free services are available for these at-risk women.}, journal={JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES}, author={Wechsberg, Wendee M. and Deren, Sherry and Myers, Bronwyn and Kirtadze, Irma and Zule, William A. and Howard, Brittni and El-Bassel, Nabila}, year={2015}, month={Jun}, pages={S128–S139} }
 @article{wechsberg_doherty_myers_morgan-lopez_emanuel_carney_kline_zule_2014, title={Contextualizing gender differences and methamphetamine use with HIV prevalence within a South African community}, volume={25}, ISSN={["1873-4758"]}, DOI={10.1016/j.drugpo.2013.10.016}, abstractNote={This study was conducted in a large Black African township outside of Cape Town, South Africa, where HIV infection has been endemic at extremely high levels for years. Problems associated with high HIV prevalence are compounded by gender inequality and high rates of gender-based violence exacerbated by heavy alcohol use and increasing methamphetamine use. Informal drinking establishments (known as shebeens) were geocoded and mapped. Based on visual examination, we identified 36 neighbourhoods, each of which contained between three to seven drinking venues clustered together. Neighbourhoods were separated from each other by at least 200 m. We randomly selected 30 of the 36 neighbourhoods. Outreach workers screened males in shebeens and screened their female partners. This analysis includes 580 study participants recruited from 30 neighbourhoods between 2010 and 2012. All participants completed a baseline questionnaire that included individual-level, couple-level, and neighbourhood-level measures of alcohol and other drug use, HIV infection, and HIV risk behaviours. Multilevel fixed effects regression analyses stratified by gender were conducted to examine correlates of HIV infection. Women were twice as likely as men to be HIV infected, yet they reported fewer sex partners. Neighbourhood prevalence of HIV was correlated with greater likelihood of HIV infection among women, but not men. Neighbourhood methamphetamine use was marginally associated with HIV among women but not among men. At the individual level, heavy alcohol use was marginally associated with HIV infection among men but not among women. Having an HIV positive partner was the strongest correlate of being HIV positive among both men and women. Findings from this study underscore the need for policy makers to direct scarce resources to the communities, places within communities, and populations, especially vulnerable women, where the impact on HIV prevention and onward transmission will be greatest.}, number={3}, journal={INTERNATIONAL JOURNAL OF DRUG POLICY}, author={Wechsberg, Wendee M. and Doherty, Irene A. and Myers, Bronwyn and Morgan-Lopez, Antonio A. and Emanuel, Andrea and Carney, Tara and Kline, Tracy L. and Zule, William A.}, year={2014}, month={May}, pages={583–590} }
 @article{myers_kline_doherty_carney_wechsberg_2014, title={Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa}, volume={14}, ISSN={["1471-244X"]}, DOI={10.1186/1471-244x-14-100}, abstractNote={Initiation of treatment for substance use disorders is low among young women from disadvantaged communities in Cape Town, South Africa. Yet little is known about the factors that influence perceived need for treatment (a determinant of treatment entry) within this population. Baseline data on 720 young, drug-using women, collected as part of a randomized field experiment were analyzed to identify predisposing, enabling and health need factors associated with perceived need for treatment. Overall, 46.0% of our sample perceived a need for treatment. Of these participants, 92.4% wanted treatment for their substance use problems but only 50.1% knew where to access services. In multivariable logistic regression analyses, we found significant main effects for ethnicity (AOR = 1.54, 95% CI = 1.05-1.65), income (AOR = 0.96, 95% CI = 0.93-0.99), anxiety (AOR = 1.22, 95% CI = 1.05-1.45), and not having family members with drug problems (AOR = 1.45, 95% CI = 1.05-2.04) on perceived need for treatment. When the sample was stratified by methamphetamine use, income (AOR = 0.87, 95% CI = 0.79-0.96), awareness of treatment services (AOR =1.84, 95% CI = 1.03-3.27), anxiety (AOR =1.41, 95% CI = 1.06-1.87) and physical health status (AOR = 6.29, 95% CI = 1.56-25.64) were significantly associated with perceived need for treatment among those who were methamphetamine-negative. No variables were significantly associated with perceived need for treatment among participants who were methamphetamine-positive. A sizeable proportion of young women who could benefit from substance use treatment do not believe they need treatment, highlighting the need for interventions that enhance perceived need for treatment in this population. Findings also show that interventions that link women who perceive a need for treatment to service providers are needed. Such interventions should address barriers that limit young women’s use of services for substance use disorders.}, journal={BMC PSYCHIATRY}, author={Myers, Bronwyn and Kline, Tracy L. and Doherty, Irene A. and Carney, Tara and Wechsberg, Wendee M.}, year={2014}, month={Apr} }
 @article{wechsberg_jewkes_novak_kline_myers_browne_carney_lopez_parry_2013, title={A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: a randomised trial of the Women's Health CoOp}, volume={3}, ISSN={["2044-6055"]}, DOI={10.1136/bmjopen-2013-002622}, abstractNote={Objective To assess the impact of the Women's Health CoOp (WHC) on drug abstinence among vulnerable women having HIV counselling and testing (HCT). Design Randomised trial conducted with multiple follow-ups. Setting 15 communities in Cape Town, South Africa. Participants 720 drug-using women aged 18–33, randomised to an intervention (360) or one of two control arms (181 and 179) with 91.9% retained at follow-up. Interventions The WHC brief peer-facilitated intervention consisted of four modules (two sessions), 2 h addressing knowledge and skills to reduce drug use, sex risk and violence; and included role-playing and rehearsal, an equal attention nutrition intervention, and an HCT-only control. Primary outcome measures Biologically confirmed drug abstinence measured at 12-month follow-up, sober at last sex act, condom use with main and casual sex partners, and intimate partner violence. Results At the 12-month endpoint, 26.9% (n=83/309) of the women in the WHC arm were abstinent from drugs, compared with 16.9% (n=27/160) in the Nutrition arm and 20% (n=31/155) in the HCT-only control arm. In the random effects model, this translated to an effect size on the log odds scale with an OR of 1.54 (95% CI 1.07 to 2.22) comparing the WHC arm with the combined control arms. Other 12-month comparison measures between arms were non-significant for sex risk and victimisation outcomes. At 6-month follow-up, women in the WHC arm (65.9%, 197/299) were more likely to be sober at the last sex act (OR1.32 (95% CI 1.02 to 1.84)) than women in the Nutrition arm (54.3%, n=82/152). Conclusions This is the first trial among drug-using women in South Africa showing that a brief intervention added to HCT results in greater abstinence from drug use at 12 months and a larger percentage of sexual activity not under the influence of substances. Trial registration number NCT00729391 ClinicalTrials.gov}, number={5}, journal={BMJ OPEN}, author={Wechsberg, Wendee M. and Jewkes, Rachel and Novak, Scott P. and Kline, Tracy and Myers, Bronwyn and Browne, Felicia A. and Carney, Tara and Lopez, Antonio A. Morgan and Parry, Charles}, year={2013} }
 @article{myers_kline_browne_carney_parry_johnson_wechsberg_2013, title={Ethnic differences in alcohol and drug use and related sexual risks for HIV among vulnerable women in Cape Town, South Africa: implications for interventions}, volume={13}, ISSN={["1471-2458"]}, DOI={10.1186/1471-2458-13-174}, abstractNote={Alcohol and other drug (AOD) use among poor Black African and Coloured women in South Africa compounds their sexual risk for HIV. Given South Africa’s history of ethnic disparities, ethnic differences in sex risk profiles may exist that should be taken into account when planning HIV risk reduction interventions. This paper aims to describe ethnic differences in AOD use and AOD-related sexual risks for HIV among vulnerable women from Cape Town, South Africa. Cross-sectional data on 720 AOD-using women (324 Black African; 396 Coloured) recruited from poor communities in Cape Town were examined for ethnic differences in AOD use and AOD-related sexual risk behavior. Ethnic differences in patterns of AOD use were found; with self-reported drug problems, heavy episodic drinking and methamphetamine use being most prevalent among Coloured women and cannabis use being most likely among Black African women. However, more than half of Black African women reported drug-related problems and more than a third tested positive for recent methamphetamine use. More than a third of women reported being AOD-impaired and having unprotected sex during their last sexual encounter. Coloured women had four-fold greater odds of reporting that their last sexual episode was AOD-impaired and unprotected than Black African women. In addition, close to one in two women reported that their sexual partner was AOD-impaired at last sex, with Coloured women having three-fold greater odds of reporting that their partner was AOD-impaired at last sex than Black African women. Findings support the need to develop and test AOD risk reduction interventions for women from both ethnic groups. In addition, findings point to the need for tailored interventions that target the distinct profiles of AOD use and AOD-related sex risks for HIV among Black African and Coloured women.}, journal={BMC PUBLIC HEALTH}, author={Myers, Bronwyn and Kline, Tracy L. and Browne, Felicia A. and Carney, Tara and Parry, Charles and Johnson, Kim and Wechsberg, Wendee M.}, year={2013}, month={Feb} }