At the recent International AIDS Society AIDS 2024 conference, we spoke with Nishita Dsouza, PhD, MPH, a postdoctoral fellow in the Social Intervention Group at Columbia University School of Social Work. Her research focuses on creating and implementing livable communities, systems, and environments for minority populations and promoting the dissemination of evidence-based knowledge and translational research across multiple sectors, including non-health, transportation, and housing.
At the AIDS 2024 conference, she presented the poster “Examining group modality dose effects of a community-supervised HIV/STI intervention for Black women in New York City, NY: a moderation analysis.” This is the research that examined the influence of housing and food insecurity on a behavioral HIV/STI prevention intervention for Black women as part of the E-WORTH (Empowering African-American Woman on the Road to Health) program.
This transcript has been lightly edited for clarity.
Transcript
Can you tell us about the E-WORTH intervention?
The Empowering African American Women on the Road to Health intervention, also known as E-WORTH, is a 6-session behavioral HIV/STI prevention intervention. There is a computer-based component that is customized for each participant to make it more relatable, but the intervention occurs primarily in group sessions, meaning 5 group sessions after the initial introductory session. However, if participants miss a group session, they can complete an individualized catch-up session on the computer. Sessions cover a wide range of topics, but core components include risk reduction, safety planning, empowerment, negotiation, and goal setting.
Can you explain the importance of culturally appropriate HIV/STI prevention measures, especially for women?
The importance of culturally adapted interventions by race, gender, and other identities is highlighted by the growing disparities in HIV/STI rates, and it is important to truly tailor curriculum to the unique circumstances of these people. Black women, for example, face many intersectional stigmas that lead to unique risk factors and unique barriers to care that should be considered in these interventions.
The E-WORTH invention was specifically designed for black women who are involved in the criminal justice system. Many of them have trouble finding housing and many of their basic needs are unmet. As a result, there is more transactional sex or more survival sex in this population. An important element to consider when designing the curriculum is the power imbalances these women face. Other barriers include lack of access to insurance, lack of access to transportation, and income issues in general.
Do factors such as age, education, employment or marital status also play a role?
Absolutely. We see statistical associations in all of these factors, in every single one. These factors are largely – with the exception of marital status – social determinants of health, which to a large extent encompass the way we live and are responsible for the outcomes that we see. For example, a problem like structural racism leads to inequalities in education, employment and the like because we have designed our cities and communities in such a way that resources are distributed unequally.
In that sense, people who have issues with the world of work, for example, may not be able to go to treatment or sessions because they may be juggling wage labor or other types of informal work with more unpredictable work schedules. So it’s really important to keep in mind that all of these factors may look harmless on paper independently, but when they’re intertwined, it actually creates this very complex and dynamic life that’s very different from other people who have other privileges that we may not see.
