A Pilot Study Examining a Culture-centric Story to Promote HIV Testing in African American Women in the South.

Abstract

Like many health conditions that disproportionately affect Blackwomen,HIV is one that highlights health inequalities for Black women that persist despite overall improvements in women’s health (Chinn et al., 2021). Despite advances in treatment and prevention, Black women remain disproportionately overrepresented in HIV incidence amongwomen, comprising 54%of newly diagnosed cases in 2020 (CDC, 2022). The prevalence of HIV is highest in the South (CDC, 2022), yetHIV stigma, racial discrimination, poverty, limited access to quality care, and gender inequity perpetuate inequalities and negatively affect HIV prevention, care, and treatment. These social andstructural inequitieshavebeenhampered further by inconsistent efforts to prioritize Black women in the HIV response over the course of the epidemic despite consistent disparities (Bond et al., 2021; Holliday, et al., in press). The disproportionate rates of new infection, and the bold plan of ending the HIV epidemic (Department of Health and Human Services, 2022), warrant continued efforts around “treatment as prevention” as well as efforts targeting the very first stage of the HIV care continuum: diagnosis through increased testing. Populationlevel increases in testing mask less than ideal testing patterns in groups at increased risk for contracting HIV, including Black women (Hall et al., 2015; Kapadia & Landers, 2020). In a nationally representative sample, 67.8% of heterosexual Black women reported “ever” having been tested (Agenor et al., 2019). However, lifetime testingdoesnot account for testing in thepast year or testing among those at “recent” risk. A study examining themedian interval since last testing for peoplewith recent risk found 1,047 and 534 days for women and Black respondents, respectively (Pitasi et al., 2018), offering evidenceof delayed testing that has implications for delayed diagnosis and treatment. An analysis of CDC’s National Health Interview Survey reported that only 21%of Blackwomenwere tested in 2017 comparedwith 6% of White women (Kaiser Family Foundation, 2020). The National Survey on HIV in the Black Community (NSHBC) found annual testing to be 40%amongwomen (Ojikutu et al., 2020), and the COVID-19 pandemic has led to further declines in testing (CDC, 2022). The NSHBC found that higher perceived risk was associated with higher testing. However, a study of younger Black women aged 18–29 years found that neither high-risk sex nor “high-risk”male partners were associated with HIV testing (Jones et al., 2020). Although Black women may be more likely to be tested compared with other groups, these findings are indicative of testing inconsistencies and gaps in prevention and perceived risk. The “test and treat” strategy has implications for diagnosis and linkage to care, as well as prevention among people at increased risk for contracting HIV. Increased, focused testing can serve as a gateway to pre-exposure prophylaxis (PrEP), a proven biomedical strategy to prevent HIV. As a prerequisite, HIV testing is an ideal entry point for PrEP evaluation. However, neither testingnor PrEP adoption is ideal amongBlackwomen,with rates of adoption ranging from 3% to 8.2% (CDC, 2021; Townes et al., 2021). Despite the greatest HIV burden, the South has the lowest PrEP coverage (Siegler et al., 2018). These findings suggest that lack of testing leads to missed opportunities to identify PrEP-eligible individuals. Low HIV testing and PrEP uptake among Black women will require novel approaches to reduce Data may be provided via a request to the corresponding author.