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Strengthening HIV Prevention Efforts among Women in the Southern U.S.


Susannah Allison, Ph.D.
Division of AIDS Research


This initiative aims to increase the use of HIV prevention strategies among women in the Southern U.S. by developing and testing interventions to enhance uptake and adherence.


Although the overall incidence rates of HIV infection have been decreasing among cisgender women in the U.S., disparities persist for racial and ethnic minorities, and for transgender women. One out of every five new HIV infections in the U.S. occurs in a cisgender woman. The majority of these infections were attributable to heterosexual contact (85%) and were among African American (57%) women. Transgender women have some of the highest rates of HIV in the U.S., as an estimated 14% of transgender women are living with HIV. The majority of transgender women infected with HIV identified as Black or Hispanic (51% and 29%, respectively), emerging adults (age 20-24; 28%) or young adults (age 25-34; 36%) and acquired HIV through sexual contact (87%). Significant geographic variability also exists in HIV incidence, with the majority of new infections among women in the South.

There are now a number of effective strategies to reduce the risk of HIV acquisition among cisgender and transgender women, with even more strategies in development. However, awareness, uptake, adherence, and persistence to HIV prevention strategies remains low among women in the U.S. A range of factors serve as barriers to the use of HIV prevention strategies among women, including factors from the multiple levels (individual, social, and societal). Inequitable prescription of pre-exposure prophylaxis (PrEP) among racial and ethnic minorities is also evident; in 2016, white women received nearly six times as many PrEP prescriptions as did African American women. Given the ongoing HIV epidemic among women in the Southern U.S., this initiative would call for research to address these gaps in our research efforts.

This initiative would support research to improve the uptake of, adherence to, and persistence to HIV prevention strategies among women in the Southern U.S. by developing and testing interventions designed to address barriers and facilitators to HIV prevention use within this priority population. Research would be encouraged in three areas: implementation science research to better understand how to scale up efficacious HIV prevention for women, research harnessing mass media and strategic communication approaches to improve awareness and uptake, and services research to expand the reach of HIV prevention strategies.