The HIV/AIDS epidemic is increasingly affecting racial and ethnic minority groups and women in the United States. (1, 3) Women are particularly vulnerable to HIV infection not only because they are biologically susceptible,(22, 23) but also because they face a host of social and contextual inequalities that put them at risk for HIV infection.(34) Research shows that alcohol use and abuse are associated with risky sexual behaviors that increase the risk of HIV transmission.(8, 9, 12-16) To date, substance use and HIV prevention approaches aimed at reducing HIV related risk behaviors and the early detection and diagnosis of HIV have shown an effect on reducing HIV transmission. However, despite gains in research and practice, there is limited empirical evidence on: (a) the association between alcohol use and HIV risk and protective behaviors across different subpopulations of women (e.g. racial and ethnic groups, age spectrum);and (b) differences in HIV related knowledge, perceptions of alcohol use as a risk factor for HIV, and HIV testing decision making among women living in high versus low HIV risk communities. Using quantitative and qualitative research methods, this study aims to: (1) identify the association between alcohol use and HIV risk and protective behaviors in a national sample of women;and (2) describe the intersection of alcohol use, HIV related knowledge and HIV testing decision making between two samples of African American women residing in high and low HIV risk communities in Massachusetts. The study is guided by social ecological theory which will provide an important lens for examining interrelations between individual, interpersonal, organizational, community, and societal level factors contributing to the disproportionate burden of HIV/AIDS among women. Data from the 2009 National Health Interview Survey (NHIS) will be used in the quantitative analysis. Qualitative data will be derived from primary data collection in focus groups with African American women in eight Massachusetts communities. Prevention of HIV infection is a formidable public health challenge with great potential benefit. In accordance with the current National HIV/AIDS Strategy, (44) and the 2012 Trans-NIH Plan for HIV-Related Research,(45) this research seeks to provide new knowledge on the prevention of HIV/AIDS among populations disproportionately affected by the HIV/AIDS epidemic with an emphasis on analysis across women of different groups. This research also contributes to NIAAA's overall mission, objectives, and 2009-2014 strategic plan by expanding knowledge about individual and contextual factors associated with HIV infection.(46) This research will provide new knowledge in alcohol use and HIV/AIDS research by informing individual and contextual factors that influence HIV transmission in order to better develop gender specific HIV prevention approaches to reduce the transmission of and susceptibility to HIV infection among women.
This research will provide a richer understanding of the relationship between alcohol use and HIV risk and protective behaviors, and inform both policy and practice fields on how to integrate gender into programs focused on reducing alcohol-related HIV risk behavior. This research will identify alcohol use and HIV prevention gaps and inform initiatives that should be intensified to meet the present challenges in the prevention of HIV/AIDS among women. This work will inform effective design and approaches for substance use and HIV prevention strategies for women who may not traditionally be targeted.