AIDS is the leading cause of death among women aged 25-34 years in New York City, which is also the epicenter of pediatric AIDS. The epidemic of HIV infection among poor, inner-city women and children has made HIV antibody counseling and testing of these women a critical, but controversial method of primary prevention. These women pose special problems for prevention initiatives because they seldom see themselves at risk. The question of whether counseling and testing can promote constructive AIDS awareness and risk reduction in the inner-city female intravenous drug users (IVDUs) and partners of IVDUs remains a compelling but problematic one, deserving serious empirical investigation. In the proposed study, a model that integrates social and ethnic factors with individual psychological factors has been developed to predict HIV test decision-making and risk-reduction behavior.
Specific aims of the proposed research are to: (1) Identify the social, psychological and cultural determinants of women's decisions to accept or refuse HIV counseling and testing; (2) Evaluate the impact of knowledge of HIV serostatus on contraceptive practices and childbearing and risk-reduction decisions; and (3) Identify the social, cultural, psychological and practical barriers to women's initial adoption and maintenance of HIV risk-reduction behavior. A longitudinal prospective study with a repeated measures design will be used. Approximately 3400 women will be recruited from the gyn, family planning and other clinics at three inner-city hospitals in NYC. HIV-related knowledge, attitudes and behaviors, social support and psychological distress will be assessed in women who accept and refuse HIV testing at baseline and at 3-month follow-up. Women who consent to be tested will be interviewed 7-10 days following notification of test results to assess immediate distress related to serostatus. Qualititative methods will be employed with women who fail to return for test result notification and those who continue to engage in high-risk sexual and needle behaviors. Information gathered from the proposed study will provide a framework for the development of socioculturally-sensitive, community-based interventions, particularly the use of testing as a primary prevention strategy for promoting risk-reduction.
