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BMC Public Health. 2016 Aug 17;16(1):803. doi: 10.1186/s12889-016-3364-7.

Socioecological factors influencing women's HIV risk in the United States: qualitative findings from the women's HIV SeroIncidence study (HPTN 064).

Author information

1
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA. pfrew@emory.edu.
2
Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA. pfrew@emory.edu.
3
Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA. pfrew@emory.edu.
4
Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA. pfrew@emory.edu.
5
Department of Health Studies, Texas Woman's University, CFO Bldg - 1007, PO Box 425499, Denton, TX, 76204, USA.
6
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 1760 Haygood Road, Suite 300, Atlanta, 30322, GA, USA.
7
Department of Behavioral Sciences and Health Education, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, 30322, GA, USA.
8
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA.
9
SisterLove, Inc, 3709 Bakers Ferry Rd, SW, Atlanta, GA, 30331, USA.
10
Department of Medicine, UNC School of Medicine, University of North Carolina Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27599, USA.
11
George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue NW, Suite 500, Washington, DC, 20052, USA.
12
National Institute of Allergy and Infectious Diseases, Washington, DC, USA.
13
Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
14
Hubert Department of Global Health, Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.
15
Emory Center for AIDS Research, Emory University, 1518 Clifton Road NE, Suite 8050, Atlanta, GA, 30322, USA.
16
West Virginia University School of Medicine, One Medical Center Drive, HSC-South 2244, Morgantown, WV, 26506, USA.

Abstract

BACKGROUND:

We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework.

METHODS:

We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18-44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices.

RESULTS:

The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways.

CONCLUSIONS:

Multilevel syndemic factors contribute to women's vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk.

TRIAL REGISTRATION:

Clinicaltrials.gov, NCT00995176.

KEYWORDS:

HIV risk reduction; HIV/AIDS; Minorities; Sexual health; Socioecological model; Women

PMID:
27530401
PMCID:
PMC4988035
DOI:
10.1186/s12889-016-3364-7
[Indexed for MEDLINE]
Free PMC Article

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