Empowering Black Women Through HIV Prevention

For the recent AIDS 2024 conference from the International AIDS Society, we spoke with Nishita Dsouza, PhD, MPH, postdoctoral research fellow in the Columbia University School of Social Work Social Intervention Group. Her research priorities focus on the creation and implementation of livable communities, systems, and environments for minoritized populations and encouraging the dissemination of evidence-based findings and translational research across sectors that include nonhealth sectors, transportation, and housing.

At AIDS 2024, she presented the poster, “Investigating Group Modality Dose Effects of an HIV/STI Intervention for Black Women in Community Supervision in New York City, NY: a Moderation Analysis,” the research behind which housing status and food insecurity were investigated for their influence on a behavioral HIV/STI prevention intervention for Black women through the E-WORTH program, or Empowering African-American Woman on the Road to Health.

This transcript has been lightly edited for clarity.

Transcript

Can you tell us about the E-WORTH intervention?

The Empowering African American Women on the Road to Health intervention, also known as E-WORTH, is a 6-session behavioral HIV/STI [sexually transmitted infection] prevention intervention. There's a computerized component that is personalized to each participant to make it more relatable, but the main modality that the intervention takes place is in group sessions, which are 5 group sessions delivered after the first introductory session. However, if any of the participants miss a group session, they're able to complete an individualized makeup session on the computer. Sessions have a wide range of topics, but the core components include risk reduction, safety planning, empowerment, negotiating, and goal setting.

Can you discuss the importance of having culturally tailored HIV/STI prevention interventions, especially for women?

The importance of culturally tailored interventions by race and gender and other identities is really evidenced by widening disparities in HIV/STI rates, and the importance of really customizing and tailoring the curriculum to the unique life circumstances that these individuals face. For example, Black women face a lot of intersectional stigma that results in unique risk factors and unique barriers to care that these interventions should account for.

The E-WORTH invention specifically was designed for Black women with criminal legal system involvement. Many of them have challenges securing housing and have many unmet basic needs. And so as a result, there are higher rates of transactional sex or higher rates of just sex for survival in this population. So, an important element to consider when designing curriculum is the power imbalances that these women face. Other barriers would include lack of access to insurance, lack of access to transportation, and income challenges more broadly.

Do factors such as age, education, employment, or marital status also play a role?

Absolutely. There are statistical associations that we see with all of these factors, each of them individually. These factors, largely—except for marital status—they are social determinants of health, which, in large part, encompass how we live our lives and are responsible for the outcomes that we see. An issue such as structural racism, for example, really drives disparities in education, employment, things like that, because of the way that we've designed our cities and communities to have an inequitable distribution of resources.

With that in mind, populations with, for example, challenges with employment, that might result in their inability to attend treatment or to make sessions because they are perhaps juggling wage work or other types of informal work that just have more unpredictable schedules. So it's really important to keep in mind that all of these factors independently may look innocuous on paper, but when they're intertwined do really create this very complex and dynamic life that is very different than others who have different levels of privilege we might not see.