Challenges of a Hidden Epidemic: HIV Prevention Among Women in the United States

Hodder, Sally; Justman, Jessica; Haley, Danielle F.; Adimora, Adaora A.; Fogel, Catherine Ingram; Golin, Carol E.; O'Leary, Anne; Soto-Torres, Lydia; Wingood, Gina M.; El‐Sadr, Wafaa

doi:10.1097/qai.0b013e3181fbbdf9

Cited by 78 publications

(66 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Women at elevated risk of HIV acquisition in the United States may not perceive themselves at risk, particularly if this risk is due to male sexual partner or network characteristics. 43 It is likely that these women would not have been identified through recruitment methods, such as flyers, which require women to self-select for screening. Moreover, 38% of women reported anal sex in the prior 6 months at baseline, which is higher than existing cross-sectional estimates among the general population of women in the United States, with 20% reporting anal sex in last 12 months.…”

Section: Discussionmentioning

confidence: 99%

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

Haley

Golin

El‐Sadr

et al. 2014

Journal of Women's Health

Self Cite

View full text Add to dashboard Cite

Background: The challenge of identifying and recruiting U.S. women at elevated risk for HIV acquisition impedes prevention studies and services. HIV Prevention Trials Network (HPTN) 064 was a U.S. multisite, longitudinal cohort study designed to estimate HIV incidence among women living in communities with prevalent HIV and poverty. Venue-based sampling (VBS) methodologies and participant and venue characteristics are described. Methods: Eligible women were recruited from 10 U.S. communities with prevalent HIV and poverty using VBS. Participant eligibility criteria included age 18-44 years, residing in a designated census tract/zip code, and self-report of at least one high-risk personal and/or male sexual partner characteristic associated with HIV acquisition (e.g., incarceration history). Ethnography was conducted to finalize recruitment areas and venues. Results: Eight thousand twenty-nine women were screened and 2,099 women were enrolled (88% black, median age 29 years) over 14 months. The majority of participants were recruited from outdoor venues (58%), retail spaces (18%), and social service organizations (13%). The proportion of women recruited per venue category varied by site. Most participants (73%) had both individual and partner characteristics that qualified them for the study; 14% were eligible based on partner risk only. Conclusion: VBS is a feasible and effective approach to rapidly recruit a population of women at enhanced risk for HIV in the United States. Such a recruitment approach is needed in order to engage women most at risk and requires strong community engagement.

show abstract

Section: Discussionmentioning

confidence: 99%

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

Haley

Golin

El‐Sadr

et al. 2014

Journal of Women's Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…11,21 A few studies focus on women exclusively, but are more focused on HIV acquisition, 22 and none focus on WOC who are disproportionally affected by HIV/AIDS. 15,22 This article extends the literature by examining factors associated with both retention and suppression in a prospective cohort of WOC followed for 1 year in eight of the nine HRSA demonstration programs across the country.…”

mentioning

confidence: 99%

Factors Associated with Retention and Viral Suppression Among a Cohort of HIV+ Women of Color

Blank

Fletcher

Verdecias

et al. 2015

AIDS Patient Care and STDs

View full text Add to dashboard Cite

Access to sustained HIV medical care is critical to achieving viral suppression. However, a variety of factors may impede or facilitate retention in care or becoming virally suppressed. Though retention and suppression are often treated separately, this study examined both in a cohort of 921 HIV + women of color who participated in eight demonstration programs across the US. For women who met the inclusion criteria, 83% (n = 587) were retained and 73% (n = 357) were virally suppressed. Average age of women retained was 40.9, and 41.9 for those virally suppressed. The majority were African American/Black or Hispanic/Latina, single, and had no children less than 18 years of age, had health insurance, a high school degree or higher, were stably housed, and unemployed. Some factors associated with retention in care were indecision about seeking HIV medical care (AOR = 0.42) and having children under the age of 18 (AOR = 0.59). Some factors associated with being virally suppressed were living with others (AOR = 0.58), current substance abuse (AOR = 0.38), and fair/poor health (AOR = 0.40). The findings suggest different processes and social mechanisms may influence retention and viral suppression. Interventions seeking to improve retention in care may require tailored program components and strategies that focus on improving viral suppression.

show abstract

“…[7][8][9][10][11][12][13][14][15][16] Partner-related or sexual network factors have also been shown to be important in HIV risk among women, including sexual partner drug use, partner incarceration, concurrent sexual partnerships and assortative mixing (e.g., sex with other people from the same race and/or ethnicity). 7,9,[17][18][19][20] Limited data are available on the longitudinal occurrence of syndemic factors among women and how these factors relate to sexual risk over time. 21 Increasing our knowledge of these relationships can help guide screening approaches for syndemic factors and address these interacting factors in designing HIV prevention interventions.…”

Section: Introductionmentioning

confidence: 99%

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

et al. 2015

View full text Add to dashboard Cite

on behalf of the HVTN 906 study team ABSTRACT Limited data are available on the longitudinal occurrence of syndemic factors among women at risk for HIV infection in the USA and how these factors relate to sexual risk over time. HVTN 906 was a longitudinal study enrolling 799 HIV-uninfected women in three cities. Assessments were done at baseline, 6, 12, and 18 months to assess syndemic factors (low education, low income, unemployment, lack of health insurance, housing instability, substance use, heavy alcohol use, partner violence, incarceration) and sexual risk outcomes. For each sexual risk outcome, a GEE model was fit with syndemic factors or syndemic score (defined as sum of binary syndemics, ranging from 0 to 9), visit, study site, age and race/ethnicity as predictors to examine the multivariable association between syndemic factors and outcomes over time. Odds of unprotected sex while drunk or high were significantly higher when women reported lack of health insurance, substance and heavy alcohol use and partner violence. Housing instability, substance and heavy alcohol use, partner violence and recent incarceration were associated with higher odds of having multiple sexual partners. Odds of sex exchange were significantly higher in the presence of unemployment, housing instability, low education, lack of health insurance, substance and heavy alcohol use, partner violence and incarceration. Housing instability, substance and heavy alcohol use, and partner violence were significantly associated with higher odds of unprotected anal sex. Odds of having a recent STI were significantly higher when women reported housing instability and partner violence. There were significantly higher odds of the reporting of any risk outcomes during follow-up with higher syndemic score. This study highlights a group of women experiencing multiple poor social and health outcomes who need to be the focus of comprehensive interventions.

show abstract

Challenges of a Hidden Epidemic: HIV Prevention Among Women in the United States

Cited by 78 publications

References 42 publications

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

Factors Associated with Retention and Viral Suppression Among a Cohort of HIV+ Women of Color

HIV Sexual Risk and Syndemics among Women in Three Urban Areas in the United States: Analysis from HVTN 906

Contact Info

Product

Resources

About