Economic empowerment as an HIV prevention intervention among African American women

Background/Objectives: Women at risk for HIV infection and other STIs are disproportionately young, African American, living in poverty, and living in the South. Poverty is associated with declining psychological health, including depression and stress, as well as high-risk sexual behaviors (e.g., exchanging sex for money or drugs). This study provides information to develop an HIV/STI risk reduction micro-enterprise intervention for at-risk African American women living in the southeast.

Methods: Qualitative research was conducted to determine the best approach in implementing an economic empowerment program as an HIV prevention intervention. Focus groups (n=16) and in-depth individual interviews (n=12) were conducted with women who either exchanged sex for drugs, money, and/or housing and/or were unemployed. Women were recruited from public housing in an urban southeastern city. Focus group discussions and interviews addressed a broad range of topics, including barriers to finding a job, various sources of income used to support their family, and sexual behaviors.

Results: Most of the women had less than a high school diploma and had a monthly household income <$500. Barriers to obtaining work included lack of transportation, education, and discrimination. The women received financial support from their sexual partners for housing, food, and transportation. All women were tested for STIs, including HIV, but several of the women had exchanged sex for drugs. Women expressed that any intervention designed for them should include self esteem, job training, and social skills.

Conclusions/Implications: The project outcomes suggest the importance of examining structural approaches to HIV prevention.