Exploring HIV risk in drug-using Black women with an incarcerated partner

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DESCRIPTION (provided by applicant): African-American drug-using women bear a high prevalence of sexually-transmitted HIV. The proposed study, led by a new investigator, will explore the processes through which the incarceration of a primary sexual partner shapes these women's vulnerability to sexually-transmitted HIV. This topic's origins lie in the following emerging findings and trends: (1) A growing body of research has concluded that the high burden of sexually-transmitted HIV borne by African-American women in the general population is created, in part, by rising incarceration rates among African-American men, men with whom these women tend to form sexual partnerships; (2) Drug-using African-American women are particularly likely to be "exposed" to partner incarceration, given that they tend to form sexual relationships with drug-using African-American men, a group that faces an unusually high risk of incarceration; and (3) By synthesizing literature from several disciplines, it is possible to trace multiple plausible - though currently untested - pathways linking partner entry into prison to African-American drug-using women's vulnerability to sexually-transmitted HIV. This synthesis suggests that the incarceration event catalyzes changes in women's drug use, economic status, social status, [children's welfare,] and emotional well-being, and that these changes, in turn, shape women's sexual relationships and HIV risk. To date, however, no research has explored the impact of partner incarceration on drug-using African-American women's vulnerability to sexually-transmitted HIV. By studying 35 African-American drug- using women over the course of an [11-month] period after their partner has entered prison, the proposed longitudinal qualitative study will: (1) Explore the processes through which partner entry into prison shapes women's drug use, economic status, social status (e.g., experiences with stigma), [children's welfare], emotional status, and other dimensions of their lives (collectively referred to as "women's status") over time; and (2) Describe women's trajectories of sexual relationships and HIV risk in the months after losing a partner to prison, and investigate the processes through which their changing status (documented in Aim 1) shapes these trajectories. Each participant will take part in 4 waves of data collection over an [11-month] period. Baseline data collection will occur within 2 months of partner incarceration; follow-up interviews will occur every [2 to 4] months thereafter. One-on-one semi-structured qualitative interviews will be the primary mode of data collection. Qualitative methods are uniquely suited to achieving project aims because they facilitate discovery, and elicit rich descriptions of participants' perspectives. At each wave of data collection, women will complete a Timeline that describes the chronology of salient events and processes discussed in the interview, and answer select closed-ended questions. A longitudinal design is optimal since the impact of partner incarceration on women's status may change over time, as might women's sexual relationships and HIV risk. This project will lay the foundation for interventions to reduce HIV among drug-using African-American women. PUBLIC HEALTH RELEVANCE: The proposed project will expand research on the determinants of sexually-transmitted HIV among African-American drug-using women to include a potentially powerful and relatively common but unstudied exposure: partner incarceration. It may also open up new arenas for high-impact interventions to reduce HIV in this population of women. The project responds to 3 NIDA priority areas: (1) elucidating the inter-relationships of criminal justice system involvement, drug use, and HIV among African-Americans; (2) strengthening scientific knowledge of the determinants of HIV infection among non-injection drug users (the sample will include non-injectors and injectors); and (3) identifying the causes of the disproportionate burden of HIV borne by African-American drug users.