Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
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Education
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BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
STAND : A peer educator training curriculum for sexual risk reduction in the rural south
AbstractSmith, M. U., & DiClemente, R. (n.d.).Publication year
2000Journal title
Preventive MedicineVolume
30Issue
6Page(s)
441-449AbstractBackground. The incidence of AIDS in rural areas continues to increase rapidly, with teenagers continuing to report high rates of sexual risk behaviors. Unfortunately, there is a dearth of effective HIV prevention programs targeting youth in rural settings where there are often formidable barriers to sex education programs. This paper describes a theoretically based intervention designed to meet the needs of rural youth. Methods. Students Together Against Negative Decisions (STAND) is a 28-session teen peer educator training program implemented in a rural county in a southeastern state, promoting both abstinence and sexual risk reduction. The theoretical foundation of the curriculum includes both Diffusion of Innovations Theory and the Transtheoretical Model, focusing on both individual and community norm change. STAND is teen-centered and skills- based; activities focus on active learning. Educator trainees are selected on the basis of their opinion leadership within their peer group, resulting in a training group of both virgin and sexually active teens, balanced for gender and matched to the racial proportions of the school. Results. Acceptance and participation in STAND suggest that adolescents in rural communities can be accessed through community-based interventions, that they are willing to participate in such intensive programs, and that they perceive the intervention as valuable and enjoyable. Moreover, the STAND program has thrived in a relatively conservative rural environment, and has had a positive impact on adolescents' sexual risk taking. Results from a pilot study showed significantly greater increases in condom use self-efficacy (16% vs a 1% decrease among controls) and in consistent condom use (+28% vs +15%). Adolescent trainees also reported a sevenfold larger increase in condom use (+213% vs +31%) and a 30% decrease in unprotected intercourse compared to a 29% increase among controls. Conclusions. STAND represents a new genre of HIV prevention program, one that utilizes complementary theoretical models to develop a program that targets both individual- and community-level change for rural adolescents. (C) 2000 American Foundation and Academic Press.Abstinence and safer sex among adolescents [1] (multiple letters)
AbstractBerman, S. M., Gunn, R. A., Aral, S. O., Cameron, P., Cameron, K., Panzer, R. A., Moore, T. L., Masdeu, J. C., Jemmott, J. B., Jemmott, L. S., Fong, G. T., & DiClemente, R. (n.d.).Publication year
1999Journal title
Journal of the American Medical AssociationVolume
281Issue
16Page(s)
1485-1488Abstract~Adolescents and HIV : Theory-based approaches to education of nurses
AbstractStewart, K. E., DiClemente, R., & Ross, D. (n.d.).Publication year
1999Journal title
Journal of Advanced NursingVolume
30Issue
3Page(s)
687-696AbstractHIV infection is increasingly prevalent in adolescents, and primary prevention programmes have been most effective when based on existing theories, including social cognitive theory (SCT). Nurses play an important role in assessing adolescents' risk for HIV infection and in recommending preventive behaviour change, if their comfort with these activities is increased. Practising nurses (n = 88, mean age = 40-8) from a university medical centre and surrounding hospitals participated in either a didactic or SCT-based workshop and a vignette-based assessment. Utilizing a randomized controlled design, this study compared the effectiveness of the two types of workshops by measuring HIV-related knowledge and attitudes, as well as comfort with and intent to perform HIV-related risk assessments. Differences in comfort and intent based on target patients' cultural descriptors were also evaluated. The SCT-based workshops yielded more positive results for all four outcome variables at the 8-week follow-up (F2,71 = 4.27, P < 0.02). Cultural stereotyping also appeared to play a role in nurses' intent to perform assessments (F2,74 = 11.81, P < 0-001). Suggestions for improving the workshops and incorporating other theory-based approaches are discussed.Aids knowledge among black drug users : An issue of reliability
AbstractWang, M. Q., Collins, C. B., Kohler, C. L., DiClemente, R., & Wingood, G. (n.d.).Publication year
1999Journal title
Psychological reportsVolume
84Issue
1Page(s)
121-124AbstractThis study examined the reliability of an inventory measuring AIDS-related knowledge among 553 black drug users. Data were collected from a socially high-risk community in Birmingham, Alabama. The KR-20 reliability scores were computed from the inventory for each drug-use group. The KR-20 reliabilities ranged from .39 to .57. These findings may suggest that the inconsistent reports of the predictive power of AIDS knowledge among drug users reported in previous studies might be related to the low internal consistencies of the inventory.Changes in incarcerated adolescents' human immunodeficiency virus knowledge and selected behaviors from 1988 to 1996
AbstractLanier, M. M., Pack, R. P., & DiClemente, R. (n.d.).Publication year
1999Journal title
Journal of Adolescent HealthVolume
25Issue
3Page(s)
182-186AbstractData were collected from juveniles in Alabama and Florida correctional facilities. The samples were closely demographically matched. Analysis indicated significant increases in knowledge about human immunodeficiency virus between 1988 and 1996 and increased sexual risk behaviors. Knowledge levels were lower for ethnic minority groups and boys, suggesting ethnic- and gender-specific pedagogical aids are needed.Evaluation of the exposure effects of a theory-based street outreach HIV intervention on African-American drug users
AbstractDiClemente, R., Collins, C., Kohler, C., DiClemente, R., & Wang, M. Q. (n.d.).Publication year
1999Journal title
Evaluation and Program PlanningVolume
22Issue
3Page(s)
279-293AbstractThe Street Outreach to Drug Abusers - Community AIDS Prevention (SODA - CAP) Project implemented and evaluated an HIV-prevention intervention aimed at current drug users. The intervention was developed using social cognitive theory and the transtheoretical model of change. The outreach team assessed individuals' stages of change for the target behaviors and they were given stage-appropriate role-model stories. The program effects were evaluated using a quasi-experimental design with a repeated, cross-sectional sampling method in which community surveys were administered at baseline, 12 and 22 months. Multivariate statistical models were developed for four outcomes (condom use with main and other partners, treatment entry, and stopping all drug and alcohol use). Exposure to intervention was a significant predictor for condom use with other partners and for stopping drug and alcohol use.Prevalence and correlates of relationship abuse among a community-based sample of low-income African American women
AbstractAnita, R., Silverman, J. G., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
1999Journal title
Violence Against WomenVolume
5Issue
3Page(s)
272-291AbstractThis study examined the relationship between social and economic power and incidence of male-perpetrated abuse among low-income African American women with partners (N = 102). Relationship abuse was common among participants; 48% reported verbal abuse, threats of physical abuse, or physical abuse in the past 3 months. Findings also illustrated that disempowerment of women, particularly in relationships, increases female vulnerability to abuse. Regression analyses revealed lower education, partner jealousy, and lower partner empathy account for significant variance in relationship abuse in the past 3 months. Results suggest that social and contextual issues must be included in our examination of male abuse of female partners.Sexually transmitted diseases, unintended pregnancy, and adolescent health promotion.
AbstractDiClemente, R., Santelli, J. S., DiClemente, R. J., Miller, K. S., & Kirby, D. (n.d.).Publication year
1999Journal title
Adolescent medicine (Philadelphia, Pa.)Volume
10Issue
1Page(s)
87-108, viAbstractAdolescence is a critical period in the development of sexual behaviors that may lead to acquiring sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and to unintended pregnancy. Understanding adolescent sexual behavior is essential for understanding adolescents' risk of pregnancy and STD/HIV infection and for planning and evaluating health promotion activities. This chapter reviews the sexual behaviors and psychosocial factors associated with STDs and unintended pregnancy among adolescents as well as school-, community-, and clinic-based interventions designed to reduce risk behaviors and promote adolescent sexual health.The psychological basis of health promotion for adolescents.
AbstractDiClemente, R., & DiClemente, R. J. (n.d.).Publication year
1999Journal title
Adolescent medicine (Philadelphia, Pa.)Volume
10Issue
1Page(s)
13-22, vAbstractTemporal trends in adolescent morbidity and mortality and the psychological factors that underlie adolescents' risk-taking behavior are reviewed in this chapter. Theoretical models useful for understanding risk-taking behavior and developing effective preventive interventions are described. Finally, intervention strategies, both on individual and community level, are identified that may enhance adolescent health promotion efforts.Frequency of alcohol use and its association with STD/HIV-related risk practices, attitudes and knowledge among an African-American community-recruited sample
AbstractMorrison, T. C., DiClemente, R., Wingood, G. M., & Collins, C. (n.d.).Publication year
1998Journal title
International Journal of STD and AIDSVolume
9Issue
10Page(s)
608-612AbstractThe aim was to determine the association between frequency of alcohol use in the past 30 days and HIV-related risk behaviours among adults in an African-American community. Data were collected by trained street outreach workers, from 522 persons in 4 areas selected on the basis of 7 health and criminal justice indicators of high risk for HIV, STD and substance abuse, and drug-related arrests. A survey assessed demographics, substance use, sexual behaviour, HIV knowledge, attitudes and depression. Subjects reporting using drugs other than alcohol (n = 201) were excluded from analyses to avoid the confounding influence of polysubstance use. Of the remaining 321 subjects (mean age = 37.1; 58.5% were male), 43.6% reported no alcohol use in the past 30 days, with 37.4% and 19.0%, respectively, having used alcohol 16 days in the past 30 days. Alcohol use frequency (no alcohol, 1-15 days, 16-30 days in past month) was significantly associated with being male, STD history, non-use of condoms, higher perceived risk of HIV, lower condom use self-efficacy, multiple sex partners in the past 30 days, and lower HIV-related knowledge. Frequent alcohol use, in the absence of other drugs, is associated with higher levels of HIV risk behaviours. Though an underserved population with respect to HIV prevention and, given the prevalence of alcohol use, the findings suggest that programmes need to target frequent alcohol users to reduce their HIV-associated risk behaviours and enhance HIV risk-reduction knowledge and attitudes associated with the adoption of HIV prevention practices.Gender-related correlates and predictors of consistent condom use among young adult African-American women : A prospective analysis
AbstractDiClemente, R., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
1998Journal title
International Journal of STD and AIDSVolume
9Issue
3Page(s)
139-145AbstractThe present study examined the correlates of consistent condom use among African-American women and prospectively evaluated the stability of these significant variables to predict consistent condom use at 3-month follow-up. A sample of 128 African-American women, 18-29 years of age completed a baseline interview and 3 months later completed a similar follow-up interview (n = 100). Compared to women who were inconsistent condom users, women who were consistent condom users were more likely to: have high assertive communication skills (OR = 13), desire not becoming pregnant (OR = 8.6), have high sexual self-control over condom use (OR = 7.6), perceive having control over their partners' use of condoms (OR = 6.6), be younger (OR = 5.8), and report having a partner that was not committed to the relationship (OR = 3.3). Prospective analyses identified baseline level of condom use as the best predictor of condom use at 3-month follow-up. Women who were consistent condom users at baseline were 6.3 times as likely to be consistent condom users at 3-month follow-up. In conclusion, HIV prevention programmes for women need to be gender specific and need to be implemented before high-risk behaviours are established and may be more difficult to modify.Monetary incentives : A useful strategy for enhancing enrolment and promoting participation in HIV/STD risk reduction interventions
AbstractDiClemente, R., DiClemente, R. J., & Wingood, G. M. (n.d.).Publication year
1998Journal title
Sexually transmitted infectionsVolume
74Issue
4Page(s)
239-240Abstract~Partner influences and gender-related factors associated with noncondom use among young adult african american women
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
1998Journal title
American journal of community psychologyVolume
26Issue
1Page(s)
29-51AbstractWe examined the partner influences and gender-related correlates of noncondom use among African American women. The prevalence of noncondom use was 45.3%. Women whose sexual partners were noncondom users were four times more likely to believe that asking their partner to use a condom implied he was unfaithful, three times as likely to have a partner who resisted using condoms, three times more likefy to receive AFDC, twice as likefy to be sexually nonassertive, three times more likefy to believe that it was not difficult to find an "eligible" African American man, and three times as likefy to have had one sexual partner. HIV prevention tailored towards African American women should address these partner influences and gender-related factors.Preventing sexually transmitted infections among adolescents : A clash of ideology and science
AbstractDiClemente, R., & DiClemente, R. J. (n.d.).Publication year
1998Journal title
Journal of the American Medical AssociationVolume
279Issue
19Page(s)
1574-1575Abstract~Rape among African American women : Sexual, psychological, and social correlates predisposing survivors to risk of STD/HIV
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
1998Journal title
Journal of Women's HealthVolume
7Issue
1Page(s)
77-84AbstractThe aim of this study was to examine the association of rape of adult African American women and sexual, psychologic, and social factors that predispose them to risks of sexually transmitted diseases, including human immunodeficiency virus (HIV). This cross-sectional study, conducted between February and December 1993, recruited 165 African American women, 18-29 years of age, from an African American community of low socioeconomic status in San Francisco, California. Women completed a face-to-face interview. The prevalence of adult rape (rape experienced after age 15) in this sample was 14%. Compared with women who did not report a history of adult rape, women who reported such a history were significantly more likely to report HIV-related sexual, psychologic, and social experiences. Specifically, adult rape survivors were nearly 6 times more likely to have had sex 10 or more times in the past 3 months, 3 times as likely to report never using condoms during the past 3 months, 3.3 times less likely to use condoms consistently during the past 3 months, to have used a condom at last intercourse, and to use condoms when intoxicated, nearly 3 limes less likely to negotiate condom use, 11 times as likely to have a partner who was physically abusive, nearly 10 times more likely to believe that there were no eligible African American males with whom to establish a relationship, and more than 3 times as likely to believe that sex was unenjoyable. HIV-related social and behavioral interventions for women may be more effective if they address all sexual violence against women, including rape, and provide resources for women who are rape survivors.Revisiting the intersection between domestic abuse and HIV risk [2] (multiple letters)
AbstractDiClemente, R., Molina, L. D., Basinait-Smith, C., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
1998Journal title
American journal of public healthVolume
88Issue
8Page(s)
1267-1268Abstract~The influence of psychosocial factors, alcohol, drug use on African- American women's high-risk sexual behavior
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
1998Journal title
American journal of preventive medicineVolume
15Issue
1Page(s)
54-59AbstractObjectives: The present study examines psychosocial and behavioral influences, particularly drug and alcohol use, as correlates of inconsistent condom use and having multiple sexual partners during the past month among African-American women. Methods: This cross-sectional study, conducted between May and June 1996, recruited a convenience sample of 180 African- American women in Birmingham, Alabama. Women completed a face-to-face interview that assessed alcohol and drug use, sexual behaviors, depression, condom use, and negotiation skills. Results: The majority of women, 51.6% (n = 93), had used either alcohol or drugs during the previous month. Many women, 31.1%, consumed alcohol, 18.3% used marijuana, and 8.3% had smoked crack within the past month. Nearly 42.7% of women used condoms inconsistently in the past month and 13.3% of women had multiple sexual partners within the past month. A logistic regression model predicting inconsistent condom use indicated that women were less likely to use condoms if they consumed alcohol between 20 and 30 days of the month (OR = 2.8, 90% CI = 1.3-5.9) and if they had not negotiated condom use (OR = 32.4, 90% CI = 7.9-131.6). The logistic regression model predicting multiple sexual partners indicated that women were more likely to have multiple sexual partners if they had smoked crack in the past month (OR = 5.3, 90% CI = 1.6-18.2). Conclusion: HIV sexual risk-reduction interventions for African-American women need to address the overlapping epidemics of drugs, alcohol, and STDs. Additionally, HIV sexual risk reduction efforts should be incorporated into existing drug and alcohol treatment programs and STD clinics.Adolescents with psychiatric disorders and the risk of HIV
AbstractBrown, L. K., Danovsky, M. B., Lourie, K. J., DiClemente, R., & Ponton, L. E. (n.d.).Publication year
1997Journal title
Journal of the American Academy of Child and Adolescent PsychiatryVolume
36Issue
11Page(s)
1609-1617AbstractObjective: To review literature relevant to human immunodeficiency virus (HIV)-associated risk behaviors among adolescents with psychiatric disorders and psychological influences on risk behaviors. Method: This report is based on review of 66 articles, which comprise all of the relevant literature in the English language. Results: Although the sero-prevalence of HIV in adolescents with psychiatric disorders is unknown, studies indicate that adolescents with psychiatric disorders are at greater risk than their peers because of increased rates of unsafe sexual practices, impulsivity, self- destructive attitudes, cognitive immaturity, high rates of substance use, self-cutting behavior, and the sequelae of sexual abuse. Conclusion: Directions are proposed for the design of developmentally appropriate, clinically oriented HIV prevention interventions based on the relationships between psychological dysfunction, social stressors, and HIV risk behaviors.Centers for Disease Control and Prevention Partnerships with External Behavioral and Social Scientists. Roles, Extramural Funding, and Employment
AbstractRugg, D. L., Levinson, R., DiClemente, R., & Fishbein, M. (n.d.).Publication year
1997Journal title
American PsychologistVolume
52Issue
2Page(s)
147-153AbstractThe Centers for Disease Control and Prevention (CDC) must have strong external partnerships with behavioral and social scientists to refine and carry out its research and programmatic mission. This article examines funding, employment, and other mechanisms used to develop and foster such partnerships. The authors describe in detail funding mechanisms (especially the often-used cooperative agreement and contracting mechanisms) and identify specific sources of information about funding opportunities. Furthermore, they describe several different long- and short-term employment mechanisms that can be used to link CDC staff and external behavioral scientists. Finally, external behavioral and social scientists can serve in important roles as members of CDC advisory committees, peer reviewers of funding applications, and consultants; examples of these opportunities are also provided.Child sexual abuse, HIV sexual risk, and gender relations of African- American women
AbstractDiClemente, R., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
1997Journal title
American journal of preventive medicineVolume
13Issue
5Page(s)
380-384AbstractIntroduction: A cross-sectional study was conducted to examine the association between childhood abuse, HIV-related sexual risks, and gender relations among African-American women. Methods: The sample 165 African- American women, 18-29 years of age, were recruited by street outreach from a lower socioeconomic community in San Francisco, CA. A face-to-face interview was administered to assess HIV/STD-sexual risk practices, alcohol use, physical abuse, affective health, and relationship commitment. Childhood sexual abuse was defined as experiencing forced sex prior to age 16. Results: The prevalence of childhood sexual abuse in this sample was 13.3%. Compared to women who were not abused during childhood, women who reported a history of childhood sexual abuse were 1.5 times more likely to have had an abortion, 1.4 times more likely to report having an STD, 2.4 times as likely to report having greater than two lifetime STDs, 3.8 times as likely to have a history of anal sex, 2.6 times as likely to worry about acquiring HIV, 3.9 times more likely to believe their partner did not care for them, twice as likely to doubt the longevity of their relationship, 5.1 times as likely to have a partner who had been physically abusive within the previous 3 months, 2.6 times as likely to have a partner who was physically abusive when asked to use condoms, and 1.5 times as likely to consume three or more glasses of alcohol at one time. Conclusions: Awareness of a woman's history of child sexual abuse can assist in making appropriate medical and social referrals and can lead to the development of more tailored HIV prevention programs for African-American women.Condom use by black adolescents
AbstractDiClemente, R., Diclemente, R. J., Lodico, M., Grinstead, O. A., Harper, G., Rickman, R. L., & Evans, P. E. (n.d.).Publication year
1997Journal title
ACOG Clinical ReviewVolume
2Issue
2Abstract~Depressive symptoms as correlates of polydrug use for blacks in a high- risk community
AbstractWang, M. Q., Collins, C. B., DiClemente, R., Wingood, G., & Kohler, C. L. (n.d.).Publication year
1997Journal title
Southern Medical JournalVolume
90Issue
11Page(s)
1123-1128AbstractBackground. This study examined the relationship between depressive symptoms and polydrug use (alcohol, marijuana, and cocaine) among blacks in a high-risk community. Methods. A street sample (N = 570) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug use behavior during the past 30 days, as well as about their depressive symptoms during the past week. Results. Odds ratios and logistic regressions, adjusted for age and sex, were used to assess the relationship between depressive symptoms and drug and polydrug use (drug use involving cocaine). Results showed that depressive symptoms are significantly associated with polydrug use. However, depressive symptoms were not associated with alcohol use or with the combination of alcohol and marijuana use. Conclusions. Depressive symptoms are related to polydrug use involving cocaine, though the causal relationship is uncertain. Previous reports on depressive symptoms and alcohol or marijuana may be inconclusive.Multiple drug use and depression : Gender differences among African-Americans in a high-risk community
AbstractWang, M. Q., Collins, C. B., DiClemente, R., Wingood, G., & Kohler, C. L. (n.d.).Publication year
1997Journal title
Journal of Alcohol and Drug EducationVolume
43Issue
1Page(s)
87-96AbstractThis study compared gender differences associated with depression and multiple drug use (alcohol, marijuana, and cocaine) among African-Americans in a high-risk community. A street sample (N= 553) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug-use behavior in the past 30 days, as well as about their depressive symptoms during the past week. Two-way factorial analysis of variance and follow-up tests showed that depression scores were significantly higher for women than for men among all levels of drug use. This difference was greatest when drug use involved cocaine and/or crack.Reflections on the design and reporting of STD/HIV behavioral intervention research
AbstractO'Leary, A., DiClemente, R., & Aral, S. O. (n.d.).Publication year
1997Journal title
AIDS Education and PreventionVolume
9Issue
1 SUPPL.Page(s)
1-14Abstract~The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
1997Journal title
American journal of public healthVolume
87Issue
6Page(s)
1016-1018AbstractObjectives. This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women. Methods. Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif. Results. Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships. Conclusions. HIV prevention programs for women should address domestic violence prevention strategies.