Engagement and Retention of High-Risk Women with Syndemic Issues in Trauma-Informed HIV Interventions

Introduction: Synergistic interactions between Substance Abuse, Violence and HIV/AIDS (SAVA syndemic) are closely linked with HIV infection and treatment engagement among women. Further, women face racial disparities in rates of HIV infection and HIV-related treatment outcomes. Sexual risk reduction interventions and HIV treatment engagement/retention interventions aimed at high-risk women of color can be effective in reducing HIV-risk and improving treatment outcomes. Yet, women affected by the SAVA syndemic may face difficulties with retention. It is critical to understand factors associated with missed appointments so researchers can better design interventions to reduce HIV-related disparities. This presentation will provide analyses from data on two intervention studies: (1) a clinical trial of an IPV-HIV risk reduction intervention and (2) a pilot intervention on improving linkage to and engagement in HIV care for women.

Methods: For study 1, 55 women reporting partner violence and sexual risk behavior were randomized to an intervention (n = 27) or a control group (n = 28). The analytical sample includes the 27 women assigned to the intervention. For study 2, 2 groups were enrolled in 2 pilot intervention groups. The sample includes 12 women living with HIV/AIDS (WLHA).

Results: Bivariate analyses were conducted between baseline characteristics and HIV prevention treatment engagement/retention in study 1. Women reporting higher average proportion of unprotected sex (t(19) = 3.85, p = .001), lesser use of condom influence strategies (t(22) = -2.32, p = .001), greater number of post-traumatic stress disorder symptoms (t(23) = 1.75, p = .09), and higher average alcohol intake (t(23) = 1.85, p = .08) were less likely to engage in treatment. Women retained in treatment were more likely to report being sexually abused as a child (χ2 (1, N = 27) = 4.70, p = .04) and had lower average alcohol intake than women who attended fewer sessions (t(22) = -3.73, p = 07). Proportions were calculated on baseline data in study 2. Women in the pilot intervention screened positive for current/recent partner violence (83%), emotional or physical abuse in the past 3 months (66.7%), illicit drug use in the past 3 months (88.3%), and were classified as moderately to severely depressed (66.7%) and had moderate to severe anxiety (66.7%); only 1 in 6 women completed all intervention sessions. The second pilot with 6 more WLHA is ongoing.

Conclusions: Findings will improve trauma-informed risk reduction interventions by pointing to factors that may enhance or impede high-risk women’s full participation in interventions.