Pilot trial of an intervention to increase HIV engagement and reduce Intimate Partner Violence among Black women living with HIV

点击翻译按钮获取中文摘要

Black women living with HIV (LWH) continue to experience disparities in exposure to intimate partner violence (IPV) and sub-optimal HIV care engagement. Black women LWH are twice as likely to experience IPV than non-HIV infected Black women. IPV experiences among Black women LWH are associated with decreased access to social support resources and impaired mental and physical health. Many Black women LWH and exposed to IPV also experience chronic exposure to internalized and anticipated stigmas. HIV-related stigma is associated with low rates of HIV care engagement due to fears of disclosure. While IPV-related stigma can prevent women from planning for safety or engaging informal or formal resources. There has been limited attention to the role of IPV or the effects of stigma as a barrier to Black women engaging in HIV care. Cognitive behavioral approaches (CBA) are efficacious to reducing stigma, improving IPV safety strategies, and increasing HIV care engagement, yet interventions designed for Black women LWH and experiencing IPV are lacking. Furthermore, few CBA interventions leverage the existing resilience of Black women LWH using a sources of strength framework. The overarching aim of this research is to conduct: a) component testing of an intervention among Black women with lived experiences of HIV and IPV; and b) a pilot study to evaluate acceptability, feasibility and preliminary efficacy of a 7-session small group-based CBA intervention to reduce HIV and IPV stigma and subsequently increase IPV safety strategies and HIV care engagement. The intervention uses a mnemonic (COPE) to teach techniques to appraise social and environmental stressors which includes real and perceived HIV and IPV stigma, and strategies for altering distorted thinking, problem- solving, bolstering positive social support, and scheduling safety strategies linked to rewards. COPE is delivered by a trained community health worker, which allows for scalability. We will enroll and randomize 80 IPV-exposed Black women LWH into the experimental CBA or control condition. Inclusion criteria are: (a) self- report female sex at birth, (b) self-report Black race, (c) aged 18 to 44 (d) documentation of HIV positive status confirmed with Oraquick test, (e) recent IPV exposure (12 months) as measured by HARK score >=1, (f) self- report <=1 HIV care appointment in previous 12 months. All participants will complete an immediate post- condition, 3 and 6-month follow-up assessments. The overall impact of this innovative intervention is high: it addresses the impact of violence exposure on HIV care engagement among Black women LWH, a priority of the NHAS. The proposed study is relevant to the persistent HIV epidemic that disproportionately impacts Black women LWH. The study intervention is scalable and easily implemented by community-based organizations and health departments.