Modeling perceptions of social location and decision-making to develop targeted messaging promoting HIV care engagement and ART adherence among women living with HIV in the South

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PROJECT ABSTRACT/SUMMARY Women living with HIV (WLWH) in the South have the lowest rates of viral suppression among women in all regions in the United States (US). To date, HIV care engagement and antiretroviral (ART) adherence interventions aimed at decreasing viral suppression disparities for WLWH in the South are few in number and have failed to consider the women's diverse social locations. Social location, a key concept in intersectional frameworks, refers broadly to contextual factors and the position people occupy in a social hierarchy based on their intersecting identities and social determinants of health like gender-, race/ethnic-, and class inequities; geographic location; and HIV-related stigma. Guided by an intersectional framework, the overall objective of this application is to develop targeted HIV care engagement and ART adherence messaging for WLWH from diverse social locations in the South. Specifically, this project is to be implemented in rural and non-rural regions of North Carolina, one of the nine southern states that continues to drive the US epidemic and has a substantial percentage (46%) of people most impacted by HIV living outside large urban areas. The specific aims are to: 1) determine the social locations and decision-making processes for HIV care engagement and ART adherence as reported by WLWH in the South; 2) develop highly targeted messages to enhance engagement in HIV care and ART adherence for WLWH in the South; and 3) assess the comprehensibility, acceptability and personal relevance of the targeted HIV care engagement and ART adherence messaging. For the first aim, in-depth interviews (n=36) will be conducted with cis and transgender WLWH from diverse social locations in the South to inform the development of perceptual mapping surveys. For the second aim, perceptual mapping surveys will be administered to cis and transgender WLWH (n=108), analyzed, and used to create perceptual maps generated from multidimensional scaling software. Perceptual mapping and vector message modeling is a novel method that produces mathematical, three-dimensional models, resulting in the development of highly targeted messages. For the third aim, focus groups (n=30) will be conducted to assess the comprehensibility, acceptability, and personal relevance of the targeted messaging. The proposed research is innovative in its conceptual orientation to addressing the intersecting identities and social determinants of health for WLWH in the South and novel application of perceptual mapping and vector modeling method. The proposed research is significant because it is expected to provide highly targeted HIV care engagement and ART adherence messages aimed at decreasing viral suppression disparities for WLWH in the South.