Walcott’s team will develop and test a culturally relevant behavioral intervention, consisting of several educational modules, to encourage uptake of PrEP (pre-exposure prophylaxis), a medication proven to be highly effective at preventing human immunodeficiency virus (HIV) when taken as prescribed.

“Black women are disproportionately affected by the HIV epidemic, yet they are significantly less likely to be prescribed or use PrEP,” Walcott said. “This population experiences unique vulnerabilities including living in communities with higher HIV viral loads, systemic inequities and socioeconomic challenges, yet they are often overlooked in HIV prevention efforts, which tend to focus on same gender loving men.”

Walcott’s approach to HIV prevention is driven by lessons learned from her earlier work, including a study focused on women living with HIV in Alabama. This research illuminated the ways in which social and community-related factors such as poverty, stigma, lack of employment opportunities and insufficient access to transportation influence HIV acquisition, engagement in HIV care and HIV health outcomes.

“Lack of transportation can undermine one’s ability to secure and keep a job, which further limits access to resources for daily living such as money, housing, health insurance and food,” Walcott said. “This can result in engaging in transactional sex, forming relationships with partners that sell drugs, or even selling drugs to gain access to resources. These behaviors increase the likelihood of being incarcerated, which further impairs one’s ability to be employed in the future and increases vulnerability for HIV acquisition. This vicious cycle can significantly undermine both HIV prevention and treatment efforts.”

Walcott’s proposed study, called “PrEP-WISE” (short for pre-exposure prophylaxis for women in charge of sexual decision making and engagements), seeks to develop and test a culturally and contextually relevant behavioral intervention to motivate cisgender Black women to access and use PrEP.

An interdisciplinary team of researchers, HIV prevention experts, faith-based organizations and community collaborators will work together to develop the intervention, which will help women reduce their vulnerability to HIV, regardless of their social and economic circumstances.

A Community Centered Approach

The project’s first phase involves conducting in-depth interviews with 25 cisgender Black women and 10 healthcare providers across New York State. These discussions will explore experiences, barriers and facilitators in HIV prevention and care, with a focus on identifying gaps and opportunities to improve PrEP uptake. Providers involved in the study will include medical professionals, pharmacists and peer navigators, representing diverse perspectives along the entire HIV care continuum.

“To effectively support Black women in assessing HIV risk and accessing care, we must engage the entire process,” Walcott said. “This includes raising awareness, helping women access HIV prevention services, and ensuring long term medication adherence and support.

“By involving a variety of stakeholders, our study aims to identify and understand the nuanced challenges that Black women face, including systemic barriers within healthcare systems as well as social-cultural factors including gender norms and power dynamics in relationships. This comprehensive approach ensures that our intervention will reflect the real-world experiences of those it seeks to serve.”

Because the intervention is focused on prevention, Walcott is working to engage participants upstream.

“In addition to reaching out to medical providers, I’m also actively visiting community spaces such as salons, churches and corner stores to share information about the project,” Walcott said. “I’ve been very encouraged by community members’ willingness to help spread the word.”

Planning a Comprehensive Intervention

The team will use information gathered during the interviews to develop educational and capacity-building modules addressing the medical aspects of PrEP, as well as broader factors influencing HIV risk. The four-part intervention will also include peer support.

“Our goal is to empower women holistically,” Walcott said. “By addressing systemic inequities and providing resources beyond medication, we aim to develop an educational program that enables achievable, sustainable care and overall wellbeing.”

The anticipated intervention will be peer-led and delivered either in person or online, depending on preferences expressed during the interviews. Based on reviews of existing literature, Walcott’s team proposes topics such as:

• Assessing HIV vulnerability: Helping participants evaluate their own personal level of risk, with respect to environmental and social factors, as well as the risk level of their partner/s.
• Gender norms and power dynamics: Building skills to communicate effectively with health providers and sexual partners about HIV prevention.
• PrEP basics: Combating stigma, understanding the medication and reducing barriers to its use.
• Financial literacy: Offering tools to enhance financial stability and overall health security.

Improving communication between women and healthcare providers is a key aspect of the proposed intervention.

“This work is about more than preventing HIV — it’s about empowering women to take control of their health,” Walcott said. “Many women face challenges in accessing PrEP due to insufficient provider awareness or reluctance to prescribe the medication. By fostering dialogue and education, our intervention aims to help bridge these gaps between women and providers across the health care continuum.”

Once the intervention is finalized, Walcott’s team will evaluate the efficacy of the intervention through a randomized controlled trial involving 160 cisgender Black women in New York State. Findings will provide insights for public health practitioners, policymakers and organizations aiming to advance HIV prevention and health equity.

Engaging community partners and stakeholders, such as cisgender Black women, HIV/AIDS organizations, healthcare providers and faith-based groups, is a key part of the project’s strategy to create a robust support network. Existing collaborators on the project include the New York State Department of Health, the Alliance for Positive Health and Callen-Lorde Community Health Center.

Source: University at Albany