Perspectives on HIV Testing Among WIC-Enrolled Postpartum Women: Implications for Intervention Development

Abstract

Low-income minority women are disproportionately represented among those living with HIV in the U.S and also at-risk for substance abuse and intimate partner violence – collectively called the SAVA syndemic which may impede HIV testing uptake. Views about HIV testing were assessed among women (ages 18–29) enrolled in a federally funded nutrition program for women, infants and children (WIC) in a large Mid-Atlantic city. A survey (n=80) and 3 focus groups were conducted in WIC offices located in neighborhoods with high HIV prevalence. Among this primarily minority sample, most would be interested in getting an HIV test if offered at WIC. Benefits included knowing one’s HIV status, convenience, and accessible location while transportation and peer/ partner encouragement were enabling factors. Barriers included privacy concerns and intimate partner violence. Findings will be used to design an intervention to promote HIV testing among women who attend WIC and that proactively addresses reported barriers.

Gender-based violence and engagement in biomedical HIV prevention, care and treatment: a scoping review

“…A number of the studies found that experiences of violence were associated with reduced HIV testing among women [30, 33, 34, 36, 39]. Qualitative studies described how fear of a violent reaction from one’s partner in the event of a positive test result contributed to reduced rates of HIV testing [43, 44]. A cross-sectional study by Turan et al (2011) supported these findings by demonstrating that anticipated stigma (defined as break-up of marriage/relationship and physical violence from a partner) upon testing positive for HIV was associated with refusing to test for HIV [27].…”

“…Seven studies found no significant relationship between experiences of violence and uptake of HIV testing among women [28, 29, 32, 41, 42, 44, 62]. Two of these studies utilized longitudinal designs.…”

Associations between sexual identity, living with disability, bully victimisation, and HIV status and intimate partner violence among residents in Nigeria

“…A pointer to this complexity is the observed association between unknown HIV status and increased risk for sexual violence. Prior studies had demonstrated that sexual violence is associated with increased risk for HIV infection [53] and that gender-based violence impedes uptake of HIV testing [54] due to the fear of a violent reaction from one's partner in the event of a positive test [55,56]. These prior studies had associated physical violence with these highlighted risk [57][58][59] while the current study suggests that sexual violence may also reduce the likelihood of getting tested for HIV infection.…”

Perinatal HIV Service Coordination: Closing Gaps in the HIV Care Continuum for Pregnant Women and Eliminating Perinatal HIV Transmission in the United States

“…Because infrastructure and funding streams for various types of care are often siloed, novel care and reimbursement models may be needed to bridge the gap for patients and providers. Examples include implementation of HIV testing at Special Supplemental Nutrition Program for Women, Infants, and Children sites and family planning clinics [38][39][40] ; integration of preconception care into HIV care 14,41 ; and integration of perinatal HIV prevention into state syringe-access programs. 42 Although pregnant women with HIV are more likely to be linked to HIV care than nonpregnant women with HIV, linkage can be late or absent, 25 and some women may not receive recommended perinatal prevention interventions (eg, ART, scheduled cesarean delivery, intrapartum zidovudine) because of provider-or facility-related issues.…”

“…Because infrastructure and funding streams for various types of care are often siloed, novel care and reimbursement models may be needed to bridge the gap for patients and providers. Examples include implementation of HIV testing at Special Supplemental Nutrition Program for Women, Infants, and Children sites and family planning clinics 38 -40 ; integration of preconception care into HIV care 14,41 ; and integration of perinatal HIV prevention into state syringe-access programs. 42…”