HIV risk and the PrEP continuum among Women who use Drugs (WWUD) in the U.S. South: A mixed-method study

HIV infection among women who use drugs (WWUD) in the US South is a critical public health issue. Individual and contextual risks vary among WWUD affecting HIV-related risk/protective behavior (e.g., condomless sex, social support) and impact access to HIV prevention healthcare resources (PrEP). WWUD are PrEP indicated, but their PrEP continuum outcomes (i.e. awareness, acceptability, uptake) remain low. WWUD have complex proximal (e.g., syringe sharing) and distal (e.g., negative experiences in healthcare settings) HIV risk/resilience experiences that require further examination to develop effective interventions. The proposed mixed-method research aims to study HIV risk/resilience, healthcare barriers/facilitators, and PrEP continuum disparities among WWUD in the US South, employing a strengths-based analytical lens to inform multi-level HIV prevention and PrEP promotion initiatives. To do so, I will first describe HIV risk and the PrEP continuum by identifying particularly at-risk WWUD using quantitative approaches gained from training (e.g., latent class analyses) with southern National HIV Behavioral Surveillance data (Aim 1). Next, I will explore multi-level barriers/facilitators in HIV prevention-related healthcare, HIV risk, and PrEP continuum via qualitative healthcare go-along interviews with a purposively selected sample of PrEP indicated WWUD in New Orleans, LA (Aim 2). Subsequently, I will explore institutional practices related to WWUD identified barriers/facilitators to HIV prevention-related healthcare seeking, HIV risk, and PrEP continuum utilizing institutional ethnography (Aim 3). This proposed research will facilitate application of training objectives towards my long-term career goal of becoming an independent NIH-funded HIV prevention investigator. My career development plan, including an expert team of mentors, (Drs. Latkin, Bowleg, Theall, German, Baral), centers the following training objectives: 1) develop comprehensive expertise in theory application, mixed-methods study design approaches, and advanced ethnographic methodology (e.g., go-along interviews); 2) develop advanced statistical theory and methods to conduct quantitative analyses (e.g., latent class analysis); 3) gain expertise in multi-level theory and ethnographic methods(e.g., institutional ethnographies); and 4) develop skills needed for a successful academic career in mixed-method HIV interventional research with people who use drugs (e.g., research bioethics, multi-stakeholder dissemination, and grant writing).