Reimagining HIV Prevention: Unveiling Opportunities to Strengthen Sexual Reproductive Health Services and Promote HIV Prevention among Cisgender Black Women at risk for HIV in Maryland

PROJECT SUMMARY Cisgender Black women in the United States (US) shoulder a significant burden of HIV and sexually transmitted infections (STIs), with persistent disparities driven by stigma, implicit bias, and structural barriers. The disproportionate impact of HIV/STIs among Black women in the US underscores a stark race disparity that requires urgent action to address social and structural determinants of health (SSDHs). Maryland, a priority state for the Ending the HIV Epidemic (EHE) initiative, has struggled to mitigate these disparities despite significant prevention efforts. HIV prevention efforts in the United States have often been siloed and focused on individual behavior modification, leaving significant gaps in addressing the complex interplay between individual, structural, and social determinants of health that contribute to the disproportionate burden of HIV and STIs among Black women. This R36 dissertation proposal seeks to bridge this gap by conducting a convergent mixed-methods study to gain a comprehensive understanding of how existing SRH services can be adapted or expanded to better address the prevention needs of Black women at risk for HIV in Maryland. By examining the current availability, accessibility, and acceptability of SRH services for this population, this study aims to identify gaps in service provision and explore the personal experiences and perspectives of Black women who have accessed or attempted to access SRH services. The findings from this research will inform the development of evidence- based recommendations for adapting or expanding existing SRH services to integrate HIV testing and prevention strategies into broader SRH services, for an improved prevention approach that appeals to vulnerable populations and accounts for social, structural, interpersonal, and individual factors. This study aligns with EHE efforts and the National Institute of Mental Health (NIMH) Division of AIDS Research (DAR) priorities, as it aims to inform the development targeted interventions for Black women at risk for HIV in Maryland. By employing a scientifically rigorous, theory-based approach, the findings will contribute to the development of interventions that contribute to both proximal and long-term distal outcomes for HIV prevention.