Improving the health equity of Black women with innovative HIV prevention community engagement strategies

Funding for this project was made possible by The Center for Place-Based Initiatives, a program of the Department of Population Health at Dell Medical School identifying and supporting local solutions to local problems, in collaboration with the efforts of the Texas Black Women’s Health Initiative.

African American women bear the largest burden of HIV infection, HIV/AIDS diagnosis, and AIDS-related mortality among women. The CDC (2017) reports that African-American women make up 62 percent of women diagnosed with HIV in the U.S., White women account for 18 percent, with Latinas at 14 percent. Geographically, southern states account for an estimated 44 percent of all people living with an HIV diagnosis in the U.S. despite having only about one-third of the overall U.S. population. HIV Diagnosis rates for people in the South are higher than for Americans overall. Eight (Texas is ranked 4th) of the 10 states with the highest rates of new HIV diagnoses are in the South, as are the 10 metropolitan statistical areas with the highest rates. African Americans are severely affected by HIV in the South, accounting for 54 percent of new HIV diagnoses in 2014. Black women face an equally disproportionate burden of the disease in the south, accounting for 69 percent of all HIV diagnoses among women.

Austin/Travis County is ranked 3rd with the highest HIV prevalence cases and 6th of Texas counties with the highest prevalence rates (24.5). In 2015, there were 316 Black women living with HIV in Travis County, representing 53 percent of women living with HIV, while Black women are only 9 percent of the female population. Twenty-five percent of Black women in Travis County were diagnosed with HIV late in the progression of the disease. The highest prevalence rates can be found in Austin zip codes 78723, 78724, 78725 and 78742 –78 percent are among African American women infected by heterosexual transmission.

Challenges to the health equity among African American women in Travis County mirror national barriers to HIV prevention, including:

  • lack of awareness of HIV status,
  • stigma of HIV, fear and discrimination
  • greater number of people living with HIV in African American communities
  • some African American communities continue to experience high rates of sexually transmitted diseases (STD’s)
  • social determinants of health, such as the poverty rates are higher among African Americans limiting healthcare access, housing and prevention education
  • medical mistrust and misperceptions of the disease
  • until recently, female-controlled forms of HIV prevention was practically non-existence with the exception of microbicides and the use of female condoms requiring partner negotiation. PrEP, a pill taken daily has been shown to reduce the risk for HIV infection in people who are at high risk by up to 99 percent, however underserved populations are often not aware of PREP’s existence nor have access
  • disproportionate rates of African-American men at heightened risk for mass incarceration. African American men are five times as likely as white men to be diagnosed with HIV, individuals with criminal justice involvement are at greater risk for contracting HIV than general population.

Although progress has been made in prevention efforts, after three decades of the epidemic there is no cure for HIV and the African American community continues to be at significant risk. It is critical to alleviate the burden of HIV/AIDS among African American women by developing and rigorously testing the demonstrated efficacy of culturally appropriate HIV prevention interventions to reduce HIV-related risks among black women.

The purpose of this study is to gain the insights from Black women regarding the viability of a culturally-relevant HIV prevention community mobilization campaign, K.I.S.S. (keep it safe and sexy) & Tell. This multi-faceted intervention is designed to impact HIV disparities among Black women by reducing HIV risk behavior and facilitating community support for their health and well-being.  Based upon the principles of inductive reasoning in grounded theory analysis, this formative research study will use focus groups (to generate themes, procedures, refine curricula and measures for a future randomized clinical trial testing of K.I.S.S. & Tell.

Community-based participatory research (CBPR) will  guide the research process. The primary rationale for involving communities is that they have a right to respect and protection based on a true and meaningful partnership with the researchers. Black women members of the community will be invited to serve in an advisory capacity to ensure the cultural and contextual nuances of the research project. Community advisory board members will represent professionals serving predominately the Black community working in the HIV/AIDS-related fields-community-based organizations (CBOs), HIV/AIDS network leaders, Faith Based Health Ministries and members of the Black community invested in the elimination of HIV among Black women. An integral part of the research design will be the active participation of the community advisory board, reflecting consumers and experts whose contribution to the research project will ensure that participant’s worldviews were integrated for “cultural congruence.” The inclusion of a community advisory board and respect for targeted communities in research have been identified as a necessary step to address the vulnerability of groups of constituencies.

Participants will receive health information, community support, and contribute to the development of a HIV prevention intervention to help reduce the HIV disparities among Black women. The study may benefit the participants who may feel supported by shared experiences and benefit from the information delivered. The benefits to society are to identify the most appropriate messaging strategies to engage African American women in HIV prevention efforts and to ascertain the acceptability of biomedical forms of prevention form the perspectives of a population disproportionately impacted by a public health crisis.