Predicting HIV testing in low threshold community contexts among young African American women living in the Southern United States

ABSTRACT

Southern U.S. African American women have disproportionately high HIV infection rates, and increasing HIV testing is a prevention priority. Research suggests that optimal testing conditions involve reaching out to community members and offering free tests in private, supportive contexts with minimal delays for results. These conditions were implemented with young African American women (N = 223, M age = 20.4 years) living in disadvantaged areas of a Southern U.S. city to identify participant characteristics associated with test choice. Participants were recruited using Respondent Driven Sampling. Structured field interviews assessed personal and social network characteristics, sexual practices, substance use, and behavioral impulsivity (assessed by a delay discounting task). A free HIV test was then offered, and test choice was the outcome variable. Testing was accepted by 69%, which exceeded the national lifetime test rate for this population by 7.4% (p < .05). All were sero-negative. Test refusal (31%) was associated with poorer educational performance, greater impulsivity (discounting), less social network encouragement to use birth control (ps < .05), and lower engagement in sexual risk behaviors (p < .10). Test choice did not differ by substance involvement. Thus, low threshold community testing promoted acceptance among this priority population, although a minority with specific characteristics likely need additional incentives for test acceptance.

KEYWORDS:

• HIV/AIDS
• community HIV testing
• African-American women
• young adults
• choice architecture
• delay discounting

Acknowledgements

This research was supported in part by the U.S. Centers for Disease Control and Prevention [cooperative agreement #5U48 DP001915] awarded to the UAB Prevention Research Center/Center for the Study of Community Health and by the UAB Center for AIDS Research CFAR, an NIH funded program [P30 AI027767] made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, and OAR. Study design and data collection were conducted when all authors were affiliated with the Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL and the UAB Prevention Research Center/Center for the Study of Community Health and the UAB Center for AIDS Research. Portions of the research were presented at the annual meeting of the American Psychological Association, August 2016, Denver, CO. The authors thank Cathy A. Simpson, Ph.D. and Ms. Julie Hope for contributing to measurement development and Michael J. Mugavero, M.D., M.H.Sc. for arranging clinic-based HIV testing through the UAB 1917 Clinic.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported in part by the U.S. Centers for Disease Control and Prevention [cooperative agreement #5U48DP001915] awarded to the UAB Prevention Research Center/Center for the Study of Community Health and by the UAB Center for AIDS Research, an NIH funded program [P30 AI027767] made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, and OAR.