HIV/AIDS in Black and Latina Women in New York City: More Than Just Behavioral Risk

Introduction:  HIV/AIDS disproportionately affects Black and Latina women.  The rate of HIV/AIDS is 20 times higher among Black women, and 4 1/2 times higher among Latinas than whites.  Few studies of HIV in women have examined HIV-positive and negative women to discern which factors actually increase the odds of infection.  While heterosexual transmission is the most frequent transmission category, the exact sexual behaviors which result in transmission have not been elucidated.  Furthermore, there are multiple determinants of HIV infection.  This study compared HIV-infected and uninfected Black and Hispanic women on hypothesized risk factors, and included an open-ended interview to discern additional risk factors. 

Methods:  This mixed methods study, based on Human Ecology Theory, used a matched, case-control design.  HIV-positive women, aged 19 – 50 (N=21) were recruited at HIV-service sites in New York City. They were asked to refer a female friend or relative to the study, who was similar to themselves in age, ethnicity and place of residence (N=20).   Participants completed a questionnaire about behaviors, mental and physical health on the computer, using ACASI.  The questionnaire also included the Sexual Relationship Power Scale (SRPS).  HIV-positive women answered the questions thinking about the time before diagnosis. Data were analyzed using chi-squared and logistic regression.  HIV-positive women also participated in an interview eliciting their perceptions about what places women at risk for HIV and what can be done to reduce risk. These data were analyzed using thematic analysis.

Results:  The two groups of women were similar on age and ethnicity.  HIV-negative women had significantly higher educational levels.   A cumulative risk index was created, based on factors that were significant predictors of HIV in univariate analyses:  psychiatric diagnosis, history of incarceration, trading sex for money, and use of two or more drugs (Pearson R <.001).  Each additional risk factor increased the O.R. of HIV by a factor of 11. Women with lower scores on the SRPS were significantly more likely to be HIV-positive (p<.001).  The interviews provided context for the quantitative findings.   Women said that social factors such as racism and poverty place women at risk, e.g. because of high incarceration rates among Blacks, joblessness and the need to trade sex for money.  Pragmatically, they do not have the time or wherewithal to go to a testing facility, because we want them to be tested.

Conclusions:   This study highlights social/environmental risk factors in women.  Risk reduction interventions should address the women’s insights about risk, and incorporate social factors as well as behavioral risks in testing, prevention and treatment programs.