Social, behavioral, and geographic characteristics and barriers to care among HIV-infected women enrolled in the women of color initiative, a special project of national significance

Background and Methods: In September 2009, the Health Resources and Services Administration, (HRSA) HIVAIDS Bureau funded 10 programs to engage and retain women of color (WoC) living with HIV in care and a National Evaluation and Technical Assistance Center. The Center developed a standardized multi-site survey. The data come from WoC enrolled in 9 programs between January, 2010 - December, 2012, 6 urban and 3 rural, with high HIV prevalence. Baseline sociodemographic, risk behaviors, barriers to care, and HIV care status were compared between urban/rural sites. Specific barriers were compared to risk behaviors, education, and HIV care status. Findings: The 633 women enrolling from urban areas (N=415) were different from rural areas (N=218). Most were Non-Hispanic Black (68.8%), but in urban areas, there were significantly more Latinas (30.0%/5.0%), foreign-born (10.0%/4.6%), currently single (86.5%/78.0%), less than HS education (43.9%/32.6%), unemployed (62.2%/40.8%), and domestic violence (19.5%/10.2%). There were significant differences in 26/30 barriers to care, where urban women reported all barriers at higher rates than rural women. There were no geographical differences in health insurance (69.1%/66.1%) and sex or drug risks. Greatest barriers to care indicated discomfort (need more information, get back on track on your own, might be judged, learn to live with it, and felt embarrassed/uncomfortable). Lower education and unprotected sex were associated with higher barriers. Conclusions: Women with HIV in urban areas experience harsher living experiences, sociodemographic disadvantage, and greater barriers to HIV care. Further analyses may explain geographic differences and improve retention in care programs.