Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention medication, but Black women (BW), the
group of women at highest HIV risk in the U.S., show disparately low rates of PrEP uptake. Many eligible BW
are unaware of PrEP. Further, mounting evidence suggests that for many BW, PrEP use will require successful
navigation of partner, provider and substance-use related barriers. Yet, behavioral interventions to increase
BW’s PrEP use are virtually nonexistent. There is a dire need for evidence-based interventions (EBI) that
address social-structural and contextual factors that impede BW’s PrEP uptake. As a communication scientist,
I harness the power of communication to impact psychosocial factors in HIV prevention. My training and
experience are heavily concentrated on individual level theory and effects. But, communication is a potentially
powerful vehicle for addressing social-structural and contextual factors that impact HIV prevention. My training
plan centers on gaining competence in 1) social-structural theoretical frameworks (Primary Mentor: Dr. Lisa
Bowleg; 2) HIV prevention in drug using populations (Mentor: Dr. Irene Kuo); 3) culturally-tailored behavioral
intervention development and testing (Mentor: Dr. Gina Wingood). Guided by Theory of Gender and Power,
Intersectionality Frameworks and Social Cognitive Theory, the proposed research seeks to: 1) understand the
social-structural and contextual barriers to BW’s PrEP uptake; and 2) design an intervention that leverages
BW’s agency to overcome these barriers. I propose to adapt Sisters Informing Sisters about Topics on AIDS
(SISTA), a widely implemented gender- and culture specific HIV prevention EBI. SISTA is a 5-session
cognitive-behavioral intervention to increase condom use through gender and ethnic pride, HIV education,
condom negotiation and assertiveness skills training, sexual self-control, and condom use efficacy in the
context of partner resistance. I propose a 3-phase study to understand social-structural and contextual barriers
to BW’s PrEP uptake (Aim 1), adapt SISTA to address overcoming these barriers (Aim 2), and determine the
acceptability and feasibility of the adapted intervention, SISTA-P (Aim 3). Phase I comprises in-depth
interviews with adult (ages 18+) BW who are at risk for HIV (N = 30) to understand how partners, HCP, and SU
facilitate and hinder PrEP uptake. In Phase 2, I plan to adapt SISTA, in consultation with an expert panel, to
address efficacy and skills for overcoming these barriers (SISTA-P). In Phase 3, I will pilot test SISTA-P to
establish feasibility and acceptability among adult BW who are at risk for HIV, with 3 cycles of theater testing
(N = 15/cycle). All phases will be conducted in Washington, DC in collaboration with The Women’s Collective,
a community-based organization that provides health and social services for women of color who are living
with or at risk for HIV. TWC has extensive experience with outreach, care navigation, recruitment, and EBIs,
including SISTA. A significant contribution of the proposed research is that it centers BW’s voices and attends
to bolstering their agency to overcome barriers to HIV prevention that they experience.