Early knowledge of HIV status is critical to prevent transmission to others, to link those who are HIV positive to medical care and services that can reduce morbidity and mortality and improve quality of life, and to reduce health care expenditure. Consistently, the National HIV/AIDS strategy has established a goal of increasing the awareness of HIV status in Americans from 79% to 90% in the next four years. The proposed research is in direct response to PA-11-119, "HIV/AIDS Testing and Follow-up Among the Underserved in the United States," and proposes to investigate the acceptability, feasibility, and initial efficacy of a rapid HIV testing and counseling protocol in residents of domestic violence shelters. Intimate partner violence (IPV) is a pervasive public health problem, and a growing body of research highlights the association between IPV and HIV/STI risk (e.g., increased unprotected sexual occasions, sex with risky partners, trading sex, multiple partners). Further, IPV is associated with many barriers to receiving adequate health care (e.g., transport difficulties, child care needs, safety issues, lack of health insurance). Domestic shelters present an opportune setting for providing health care services for women, providing a safe and supportive environment for testing, while addressing many of the barriers to testing and linkage to care faced by shelter residents. RESPECT-2 is an evidence- based CDC Diffusion of Effective Behavioral Interventions (DEBI), utilizing a client-focused, interactive HIV risk reduction counseling model delivered in conjunction with rapid testing. Residents of domestic shelters, however, face distinct HIV risk factors, such as difficulty in negotiating condom use out of fear of retaliation from their abuser, and thus needs to be tailored to meet the specific needs of shelter residents. Thus, in the proposed exploratory/developmental research plan, we aim to expand RESPECT-2 for our target population (i.e., RESPECT-IPV), and to collect preliminary data on RESPECT-IPV + rapid testing's feasibility, acceptability, and initial efficacy in a sample of 100 high-risk shelter women. Predictors of acceptability (e.g., PTSD symptoms, substance use, IPV severity, prior testing history, HIV knowledge, HIV risk behavior, HIV anxiety, stage of change) will also be explored. Our primary hypotheses are that RESPECT-IPV will be associated with reduced unprotected vaginal or anal sex occasions at 1-week and 3-months post-shelter and fewer cases of vaginal trichomoniasis 3-months after leaving shelter.
The proposed research investigates the feasibility, acceptability, and an initial efficacy of an innovative rapid HIV testing and counseling protocol (i.e., RESPECT-IPV) with a vulnerable, underserved population (i.e., women in domestic violence shelters). Offering rapid HIV testing and counseling within domestic shelters provides access to a significant population of women with an overall high risk for HIV infection while significantly reducing many of the barriers to testing and linkage of care faced by shelter residents. The testing and counseling protocol is innovative in that it addresses many of the distinct HIV risk factors relevant to shelter residents (e.g., difficulty in negotiating condom use out of fear of retaliation from abuser);it also attends to the future sustainability and dissemination of RESPECT-IPV in having trained personnel from community- based CDC supported counseling, testing, and referral sites conduct the testing and counseling protocol.