PROJECT ABSTRACT/SUMMARY
Women living with HIV (WLWH) in the South have the lowest rates of viral suppression among women in all
regions in the United States (US). To date, HIV care engagement and antiretroviral (ART) adherence
interventions aimed at decreasing viral suppression disparities for WLWH in the South are few in number and
have failed to consider the women's diverse social locations. Social location, a key concept in intersectional
frameworks, refers broadly to contextual factors and the position people occupy in a social hierarchy based on
their intersecting identities and social determinants of health like gender-, race/ethnic-, and class inequities;
geographic location; and HIV-related stigma. Guided by an intersectional framework, the overall objective of
this application is to develop targeted HIV care engagement and ART adherence messaging for WLWH from
diverse social locations in the South. Specifically, this project is to be implemented in rural and non-rural
regions of North Carolina, one of the nine southern states that continues to drive the US epidemic and has a
substantial percentage (46%) of people most impacted by HIV living outside large urban areas. The specific
aims are to: 1) determine the social locations and decision-making processes for HIV care engagement and
ART adherence as reported by WLWH in the South; 2) develop highly targeted messages to enhance
engagement in HIV care and ART adherence for WLWH in the South; and 3) assess the comprehensibility,
acceptability and personal relevance of the targeted HIV care engagement and ART adherence messaging.
For the first aim, in-depth interviews (n=36) will be conducted with cis and transgender WLWH from diverse
social locations in the South to inform the development of perceptual mapping surveys. For the second aim,
perceptual mapping surveys will be administered to cis and transgender WLWH (n=108), analyzed, and used
to create perceptual maps generated from multidimensional scaling software. Perceptual mapping and vector
message modeling is a novel method that produces mathematical, three-dimensional models, resulting in the
development of highly targeted messages. For the third aim, focus groups (n=30) will be conducted to assess
the comprehensibility, acceptability, and personal relevance of the targeted messaging. The proposed
research is innovative in its conceptual orientation to addressing the intersecting identities and social
determinants of health for WLWH in the South and novel application of perceptual mapping and vector
modeling method. The proposed research is significant because it is expected to provide highly targeted HIV
care engagement and ART adherence messages aimed at decreasing viral suppression disparities for WLWH
in the South.
