Abstract - New strategies are needed to understand the interplay of multiple barriers to HIV care engagement
and viral suppression for diverse women living with HIV in the South. The South is a high-risk geographic area,
with more than half of the new HIV diagnoses in the U.S., and incidence rates unchanged in a decade. Across
the South, low resources, economic disparities, and racial/ethnic dynamics present challenges to ending the
HIV epidemic. While research to date has identified factors independently associated with HIV care outcomes
for women, our study will examine the simultaneous interplay of factors among women living with HIV in the
South, in order to prioritize targets for intervention across racial/ethnic groups. Thus, the overall objectives of
the proposed research are to: (1) examine psychosocial, structural, and behavioral comorbidities associated
with three key outcomes along the HIV care continuum: (a) HIV care engagement, (b) viral suppression, and
(c) biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load); and (2) and to
identify whether unique combinations of these comorbidities form syndemics that vary by race/ethnicity. We
propose a secondary analysis of 2015-2019 data from the Medical Monitoring Project, a population-based
study of persons living with HIV, focused on six Southern states: FL, GA, NC, MS, TX, and VA (N=~2,082).
We have two Specific Aims. Aim 1 will quantitatively assess racial/ethnic disparities in HIV care
engagement, viral suppression, and biobehavioral transmission risk among women in the six Southern states
by (a) describing proportions of each outcome among Hispanic, non-Hispanic Black, non-Hispanic White, and
other/multiracial women; (b) estimating associations between race/ethnicity, psychosocial, structural, and
behavioral factors, and the three key outcomes; and (c) testing whether race/ethnicity moderates the
association between psychosocial, structural, and behavioral factors and each of the three outcomes. Aim 2
will assess syndemic conditions experienced by women of different racial/ethnic groups by: (a) conducting
latent class analyses to identify unique combinations of social and structural factors that may form a syndemic
and that may vary by race/ethnicity, and (b) using regression analyses to test whether these emergent latent
classes predict the three outcomes along the HIV Care Continuum.
This R15 AREA study will strengthen the research environment by growing research mentorship, an
academic-community network of collaborators, and a pipeline for quantitative research in health inequities and
HIV at UNCG and will provide opportunities for active research involvement for undergraduate students with
structured, collaborative mentorship throughout the project. Ultimately, this R15 AREA study will foster the
development of evidence-based strategies to improve HIV care continuum outcomes by providing the
foundational data to prioritize intervention strategies to address combinations of barriers experienced by
diverse women in the South. Future clinical trials will test these potential interventions.
