Good Living for Women: GLOW

ABSTRACT – RESEARCH PROJECT 2 (Sexual Health) Women living with HIV (WWH) face disproportionate threats to sexual and reproductive health compared to women without HIV, including sexually transmitted infections (STIs) and poor perinatal outcomes. There is evidence that health behaviors measured individually, including antiretroviral (ART) use, substance use, and sexual risk behaviors, are associated with STI risk, immune dysregulation, and worse pregnancy outcomes. However, multi-dimensional health behaviors such as ART adherence, substance use, and sexual behaviors typically co-occur, and it is critical to understand the effect of co-occurring health behaviors on sexual and reproductive health among WWH. Sub-groups of WWH with distinct patterns in co-occurring health behaviors can be identified and defined as “health behavior classes” (HBCs) using latent class analysis, a statistical method used to identify unobserved (i.e., latent) subgroups in a population based on patterns in categorical data. Prior research on HBCs in general suggests HBC membership predicts a variety of health outcomes and moderates the effectiveness of behavioral interventions; yet, no research has examined HBCs composed of behaviors specifically relevant to sexual and reproductive health among reproductive age WWH. This research project will use data from STAR to identify HBCs underlying the co-variation in substance use, ART use, and sexual risk behaviors among reproductive age WWH. In addition, we will assess social determinants of health, depression, and baseline pregnancy status as predictors of HBC membership, and test if HBC membership predicts longitudinal health outcomes, including sexual and reproductive health (e.g., STIs), immune health (e.g., T cell subsets and ratios), and perinatal health (e.g., low infant birth weight) among WWH. We will also characterize WWH belonging to HBCs by sociodemographic characteristics, including age and HIV acquisition route, for the purposes of tailoring future group- and technology-based interventions to be relevant to WWH based on their distinct HBCs. Overall, the purpose of this study is to address disparities in sexual and reproductive health among WWH by facilitating the identification and tailoring of ideal biobehavioral interventions to address the unique profiles of behavioral risk and resiliency among a diverse cohort of reproductive age WWH.