Promoting health service linkages among underserved African-American women at high risk for HIV

Background: African American women sex traders are a highly vulnerable population for HIV and other sexually transmitted infections. Drug use, homelessness and violent victimization contribute to serious health problems among this population, and present significant barriers to seeking and receiving needed services. Methods: We implemented a 5-year randomized intervention trial to test two strengths-based case management approaches designed to increase health service linkages and reduce risk for HIV among African American women sex traders. Participants were recruited through targeted sampling strategies. Data were collected through confidential face-to-face baseline interviews, and 3 and 6 month follow-ups. 562 women were enrolled between 2007 and 2010. Results: The mean age of the sample was 39 years. Participants reported substantial levels of health problems indicative of high services need: 90% met criteria for substance dependence in the past year; 46% reported significant physical health problems in the 90 days prior to interview; 74% reported significant mental health problems (depression, anxiety, trauma) in the past 90 days; and 20% reported being HIV positive. Early analyses of follow-up data indicate that 63% achieved a primary service linkage in the 6-month study period; 39% made a linkage with substance abuse treatment, regardless of intervention assignment and specific barriers to care. Significant reductions in drug use and sexual risk behaviors were also reported at 3 months, and these reductions were maintained at the 6-month follow-up contact. Conclusions: Given the well-established link between substance abuse and high risk behaviors for HIV, the results of this study are promising.