Abstract

The majority of recently reported HIV cases among women in the United States are minority women in the South. Between 2000 and 2003, 35,241 women were diagnosed with HIV/AIDS and account for approximately 25% of those living the AIDS virus. Additionally, the disease is far more heavily concentrated in young heterosexual women of color living in the Southeastern United States. In North Carolina, African-American women make up a growing proportion of newly reported HIV infections with infection rates 14 times higher for this population than that of white women. Further, the HIV epidemic is increasingly making an impact in girls aged 13 to 19 years, particularly in the South where 8% of new diagnoses occur in this age group, a rate four times higher than the rest of the United States. Nowhere is the HIV/AIDS epidemic more visible than in women prisoners who are 15 times more likely to be HIV-infected compared to women in the general population. Also of note, prison facilities located in the southern U.S. had the second largest number of newly identified HIV+ tests overall in 1999. Despite tremendous advances in reducing mortality from AIDS in the general population, AIDS remains a major cause of death for women who are or who have been incarcerated. The proposed study addresses the urgent need for enhanced HIV-prevention interventions in this population. Specifically, we will adapt and tailor an HIV risk reduction nurse-delivered prevention intervention originally developed for HIV-negative women; deliver it to 330 HIV-positive women in North Carolina, 220 of whom attend a local health department HIV clinic and 110 of whom are incarcerated; and evaluate the efficacy of the intervention using a randomized wait list comparison design with a six-month follow-up period. Additionally, we will identify behavioral, social, and contextual conditions that may have contribute to risk for HIV infection in a subgroup of recently diagnosed HIV-positive young women in the Southeastern US; and explore with the same subgroup, their ideas regarding ways to prevent HIV with the intent of identifying approaches other than individual-level approaches. Data sources include survey questionnaires for the sample of 330 subjects and an in-depth, semi-structured interview for a subgroup of 30 subjects. Data will be collected at enrollment into the study (T1), and at 1, 3 and 6 months following the intervention (T2, T3, T4). At Baseline, subjects receive the complete survey interview in the clinic in which they receive health care; at T2 and T3, subjects will be contacted by phone for information on the primary outcome variable (number of unprotected sexual intercourse and number of concurrent sexual partners); and at T4, they will receive the complete survey instrument administered in their home.