What Do Women Want from HIV Prevention Programs?
What Do Women Want from HIV Prevention Programs?
In a new study, Black and Latina women in high-HIV-risk communities voice the need for structural approaches to preventing HIV infection.
In the US, Black women are 15 times more likely, and Latina women 3 times more likely, to contract HIV than white women.
To close the gap and reach the goal of zero HIV transmissions, “we need to listen to our study participants just as much as we listen to PhDs or MDs,” says Jasmine Abrams, assistant professor of community health sciences.
“Their perspectives are just as valuable and needed in discussions on how to end the HIV pandemic,” she says. “Without them, we will continue creating effective interventions that go largely unused and unnoticed by those they were created for.”
Now, a new study published in the journal BMC Public Health and led by Abrams shares insights from focus groups of Black and Latina women at high risk of HIV infection in high–HIV rate East Coast cities, reporting what they themselves feel they need from HIV prevention programs.
The 288 focus group participants in the 2009-2010 HIV Prevention Trials Network Study in the Bronx, Newark, Washington, DC, Raleigh, and Atlanta pointed, first and foremost, to structural issues that they felt needed to be addressed before taking on individual-level prevention.
Abrams says one comment, from a Black woman in Raleigh, sticks with her: “If you sit there and tell me, ‘OK, I understand that you’re having problems paying the bill and I understand you’re out here doing this, so how about I help you get into some job training… I’ll find resources to help you better your situation so that you’re not struggling here and feeling like you need to take up slack with selling sex or end your depression by using drugs…’ I just would like them to offer some real resources that are reachable for women…” the participant said.
“It made me think about how much we have neglected structural factors in domestic HIV prevention, such as housing stability, education, employment, income, food security, etc.,” Abrams says, noting that a great deal of evidence shows that taking on these factors has been effective in low-middle income countries. “We spend billions of dollars annually working toward finding a cure for HIV, but we don’t spend nearly as much money on prevention—a problem for which we already have multiple solutions,” she says.
“I believe we could benefit from addressing structural risk factors for HIV before and alongside addressing behavioral risk factors—especially for women of color,” Abrams says. “Imagine if women were first asked about and assisted with their housing stability, employment and income, healthcare access, and food access, while we were also providing access to HIV prevention or treatment resources. In my opinion, that would be the ultimate game changer.”
While the main theme that emerged in the study was the importance of structural issues, the researchers also noted numerous other insights related to making HIV prevention programs more engaging and accessible.
For instance, several women mentioned that programs could be more engaging by focusing on the pleasurable aspects of sex. “As a researcher who seeks to honor participant preferences in interventions, it is exciting to ask myself, ‘What would prevention look like if we centered pleasure in prevention?’” Abrams says.
The study was co-authored by Danielle Haley, assistant professor of community health sciences.
The other co-authors are: Michelle Odlum of the Columbia University School of Nursing; Emily Tillett of the University of Maryland; Jessica Justman of the Columbia University Mailman School of Public Health; Sally Hodder of West Virginia University; Linda Vo of the Emory University School of Medicine; Ann O’Leary of the Centers for Disease Control and Prevention Division of HIV/AIDS Prevention; Paula M. Frew of the University of Nevada School of Public Health; and the original HIV Prevention Trials Network 064 Study team.