Introduction: Expanded access to efficacious interventions is needed for women living with human immunodeficiency virus (WLH) in the United States. Availability of ''prevention with (human immunodeficiency virus [HIV)] positives'' interventions in rural/remote and low HIV prevalence areas remains limited, leaving WLH in these communities few options for receiving effective behavioral interventions such as Healthy Relationships (HR). Offering such programs via videoconferencing groups (VGs) may expand access. This analysis tests the effectiveness of HR-VG (versus wait-list control) for reducing sexual risk behavior among WLH and explores intervention satisfaction. Subjects and Methods: In this randomized controlled trial unprotected vaginal/anal sex occasions over the prior 3 months reported at the 6-month follow-up were compared across randomization groups through zero-inflated Poisson regression modeling, controlling for unprotected sex at baseline. Seventy-one WLH were randomized and completed the baseline assessment (n = 36 intervention and n = 35 control); 59 (83% in each group) had follow-up data. Results: Among those who engaged in unprotected sex at 6-month follow-up, intervention participants had approximately seven fewer unprotected occasions than control participants (95% confidence interval 5.43-7.43). Intervention participants reported high levels of satisfaction with HR-VG; 84% reported being ''very satisfied'' overall. Conclusions: This study found promising evidence for effective dissemination of HIV risk reduction interventions via VGs. Important next steps will be to determine whether VGs are effective with other subpopulations of people living with HIV (i.e., men and non-English speakers) and to assess cost-effectiveness. Possibilities for using VGs to

Women living with HIV (WLH) face challenges related to stigma, disclosure of HIV status, and negotiating safer sex. Several effective behavioral interventions, such as Healthy Relationships (HR), help WLH address these challenges and are disseminated by the U.S. Centers for Disease Control and Prevention's (CDC) Diffusion of Effective Behavioral Interventions (DEBI) project. However, many WLH living in poor urban or rural locations cannot access interventions such as HR, because implementation is not feasible. Video-conferencing technology holds promise for expanding access to effective behavioral interventions for WLH. Following a systematic adaptation to the video-conferencing format, this pilot study tested the delivery of HR via video-group (VG) among WLH. The video-conferencing based intervention, HR-VG, consisted of six, two-hour sessions led by two facilitators, and used structured activities and video-clips to build disclosure and safer sex skills. Four minority WLH received HR-VG at four different community-based intervention sites in a private room equipped with a video-phone (VP) for participating in HR-VG and a desktop computer for completing assessments via Audio Computer-Assisted Self Interview (ACASI). Participants completed a baseline assessment prior to HR-VG, and post-session assessment after each HR-VG session. The post-intervention assessment and video-focus group were completed following the last HR-VG session. Facilitators completed an assessment after each HR-VG session and an open-ended questionnaire following HR-VG. HR-VG was implemented in its entirety with minimal challenges. Both participants and facilitators reported feeling either “very comfortable” or “completely comfortable” with the technology and the overall intervention. Participants also reported high levels of unity and togetherness among the group. These preliminary findings suggest VG delivery of HR for WLH is both feasible and highly valued by participants. A follow-up randomized controlled trial is underway to test the feasibility and efficacy of HR-VG with a larger sample of WLH.

Minority female youth are significantly affected by the HIV epidemic. The purpose of this pilot study was to explore sexual behavior practices, disclosure of HIV status, attitudes about disclosure, and knowledge of HIV disclosure laws among female youth with HIV (YWH). Findings suggest that the majority of YWH studied have been sexually active since their HIV diagnosis, although the nature and extent of sexual activity varied. Rates of nondisclosure to sexual partners varied based on the type of question asked, but at least some of the YWH in this sample reported sexual activity with a partner who was unaware of the participant's HIV status. YWH appear to be more likely to disclose before, as opposed to after, sexual activity. Although most YWH believe disclosure to sexual partners is important for a variety of reasons, many reasons exist for nondisclosure, including fear of rejection and limited communication skills. The majority of YWH in this sample were aware of the potential legal ramifications of nondisclosure although fear of legal repercussions was not the most important factor related to disclosure. These findings favor the implementation of HIV disclosure interventions over the enactment of HIV criminalization laws as a strategy for reducing HIV transmission.

Advancements in HIV medicine has led to an increased desire and/or need to work for many people living with HIV. Despite the importance of work, relatively little attention has been devoted to specifically examining employment status as a social determinant of health. Unemployment/underemployment are associated with societal circumstances known to increase both the risk for acquiring and prevalence of HIV and other co-morbidity. Research indicates that being employed and use of vocational services is associated with positive physical and mental health outcomes. However, these positive outcomes can dissipate under poor or unstable work conditions. Transitions into or out of the workforce can also increase the risk of poor health associated with stress and potential disruptions or loss of access to critical health care. Given that individuals disproportionately impacted by HIV are also impacted by labor market discrimination, social exclusion, and poverty, there is an emerging sense of urgency to better respond to the employment needs of people living with HIV. This book chapter (a) reviews research related to employment as a social determinant of health, (b) provides an overview of the client-focused considering work model, (c) highlights key employment services, and (d) discusses implications for policy, service delivery and research.