Understanding Perceptions of HIV Risk, PrEP, and PrEP use among African American Women Attending an HBCU

修改后的项目总结/摘要部分 尽管在艾滋病毒预防和治疗方面取得了进展，但黑人/非裔美国妇女仍然 不成比例地受到艾滋病毒感染的影响。虽然许多生物和行为因素塑造了女性的艾滋病毒 个人层面的风险、健康的社会决定因素，包括贫困、生活在低收入社区、 心理健康状况不佳，以及缺乏包括暴露前预防(PrEP)在内的关键艾滋病毒预防服务的知识和获得机会，可能会导致这种不成比例的负担。非裔美国妇女不仅面临更高的风险，而且获得PrEP的机会也不公平，特别是那些生活在美国南部低收入社区的妇女。此外，很少有非洲裔美国妇女，包括HBCU的学生(他们中的许多人在低收入社区长大)，意识到PrEP。尽管PrEP在预防艾滋病毒传播方面非常有效，但在2019年，美国只有10%可以受益于PrEP的女性开了PrEP(CDC，2022)。增加预防接种的机会对年轻妇女(35岁以下)尤其重要，她们经历了妇女感染艾滋病毒的41%。由于HBCU主要服务于年轻女性(2021年HBCU学生中%为女性)，而且许多学生来自低收入社区，HBCU是接触到PrEP服务不足的重要人群的理想环境。为了提高HBCU女性的PrEP利用率，需要更多的研究来了解她们PrEP的使用率较低。关于黑人大学女生使用PrEP的数据有限。此外，需要更多的非裔美国人艾滋病毒预防研究人员，因为他们可能更熟悉影响黑人社区的因素，因为他们有共同的文化和生活经历。因此，拟议项目的主要目标是吸引和指导HBCU的非裔美国女学者参与研究，以评估黑人大学女性对PrEP的知识和态度、对艾滋病毒风险的感知、HIV检测行为和PrEP感染的可能性。为了实现这一主要目标，拟议的项目还将为这些学者的PrEP交付研究方案奠定基础，该方案建立在现有的基于社区的PrEP交付方案(IFE4Her)的基础上。为了适应这一计划，我们将进行形成性研究，为HBCU女性量身定做一项基于同行的PrEP消息活动。这些目标将通过2个具体目标来实现：1)创建和支持一支高技能的非裔美国人艾滋病毒预防研究人员队伍，以解决非洲裔美国人社区在使用预防战略方面的研究差距，包括PrEP，重点是HBCU。这一目标将通过一系列有组织的培训以及由北卡罗来纳大学CFAR和相关教师(NCCU RCMI的长期合作伙伴)提供的持续咨询和指导来实现。2)通过开展一项混合方法(焦点小组、关键线人访谈和调查)的定制研究，了解参加HBCU的非裔美国女性的PrEP知识、态度、信息偏好和分娩需求，从而使IFE4Her基于同伴的PrEP沟通策略适用于HBCU女性。这项研究将为非常有前途的RCMI调查人员开发适合HBCU的干预措施，以降低接受HBCU治疗的女性的艾滋病毒风险而启动一系列研究。

Modified Project Summery/Abstract Section Despite advancements in HIV prevention and treatment, Black/African American women remain disproportionally affected by HIV infection. While many biological and behavioral factors shape women’s HIV risk at the individual level, social determinants of health including poverty, living in low-income communities, poor mental health, and lack of knowledge of and access to critical HIV prevention services including preexposure prophylaxis (PrEP) may drive this disproportionate burden. African American women are not only at increased risk but also have inequitable access to PrEP, particularly those living in low-income neighborhoods in the US South. Furthermore, few African American women, including students at HBCUs (many of whom grew up in low-income communities), are aware of PrEP. Although PrEP is highly effective in preventing the spread of HIV, only 10% of women in the US who could benefit from PrEP were prescribed it in 2019 (CDC, 2022). Increasing PrEP access is especially important for young women (under age 35), who experience 41% of all HIV infections among women. As HBCUs serve predominantly young women (64% of HBCU students were female in 2021) and many of their students come from low-income communities, HBCUs are an ideal context to reach an important population underserved by PrEP. To improve PrEP utilization among HBCU women, more research is needed to understand their low use of PrEP. Limited data exist about Black college women’s use of PrEP. Additionally, more African American HIV prevention researchers are needed because they may be more familiar with factors impacting Black communities due to their shared culture and life experiences. Thus, the primary goal of the proposed project is to engage and mentor African American female scholars from an HBCU in research to assess Black college women’s knowledge of and attitudes toward PrEP, perception of HIV risk, HIV testing behaviors, and likelihood of PrEP uptake. In service of this primary aim, the proposed project will also lay the foundation for a program of PrEP delivery research for these scholars, building on an existing community-based PrEP delivery program (IFE4Her). To adapt this program, we will conduct formative research to tailor a peer-based PrEP messaging campaign for HBCU women. These goals will be achieved through 2 Specific Aims: 1) To create and support a cadre of highly skilled African American HIV prevention researchers to address research gaps in the use of prevention strategies including PrEP, in African American communities, focusing on HBCUs. This aim will be achieved through a series of structured trainings and ongoing consultations and mentorship provided by UNC CFAR and associated faculty, longtime partners of the NCCU RCMI. 2)To adapt the IFE4Her peer-based PrEP communication strategy for HBCU women by conducting a mixed-methods (focus groups, key informant interviews, and surveys) tailoring study to understand PrEP knowledge, attitudes, messaging preferences, and delivery needs of African American women attending a HBCU. This study will catapult a body of research for highly promising RCMI investigators to develop HBCU-appropriate interventions to reduce HIV risk among women attending HBCUs.