PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jurbhealthspringer.comThis journalToc AlertsSubmit OnlineOpen ChoiceThis journal
 
J Urban Health. 2003 September; 80(Suppl 3): iii67–iii76.
PMCID: PMC3456257

Feminization of the HIV epidemic in the United States: Major research findings and future research needs

Abstract

This article describes several HIV prevention interventions that have demonstrated efficacy in reducing women’s risk of HIV and identifies key research questions to be addressed in the area of HIV prevention for women. The article is organized in a question-and-answer format for clarity of presentation. This format is particularly useful in the latter half, which focuses on specific questions that have emerged from past and ongoing research among women. Some of these research questions include the following: (a) How can researchers develop effective strategies that can prevent women from relapsing to risky sexual practices? (b) What are effective HIV prevention approaches for Latina women? (c) How can interventions be tailored to the needs of women living with HIV? (d) How can we improve the efficacy and cost effectiveness of comprehensive HIV prevention strategies for reducing HIV and other blood-borne and sexually transmitted infections among women?

Full Text

The Full Text of this article is available as a PDF (77K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Centers for Disease Control and Prevention Follow-up on Kaposi’s sarcoma and Pneumocystis pneumonia. MMWR Morb Mortal Wkly Rep. 1981;30:409–410. [PubMed]
2. Centers for Disease Control and Prevention AIDS in women—United States. MMWR Morb Mortal Wkly Rep. 1990;39:845–846. [PubMed]
3. Guinan ME, Hardy A. Epidemiology of AIDS in women in the United States 1981 through 1986. JAMA. 1987;257:2039–2042. doi: 10.1001/jama.257.15.2039. [Cross Ref]
4. HIV/AIDS Surveillance Report. Atlanta, GA: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1999.
5. Hader SL, Dawn S, Moore JS, Holmberg S. HIV infection in women in the United States: status at the millennium. JAMA, 285:1186–1192.
6. HIV/AIDS Surveillance Report. Atlanta, GA: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1996.
7. Neal JJ, Fleming PL, Green TA, Ward JW. Trends in heterosexually acquired AIDS in the United States, 1988–1995. J Acquir Immune Defic Syndr. 1997;14:465–474.
8. Holmes R, Fawal H, Moon TD, et al. Acquired immunodeficiency syndrome in Alabama: special concerns for black women. South Med J. 1997;90:697–701. [PubMed]
9. Padian N, Marquis L, Francis DP, Anderson ARM, Rutherford GW, O’Malley PM. Male-to-female transmission of human immunodeficiency virus. JAMA. 1987;258:788–790. doi: 10.1001/jama.258.6.788. [PubMed] [Cross Ref]
10. Upchurch DM, Ray P, Reichart C, Celantano DD, Quinn T, Hook EW. Prevalence and patterns of condom use among patients attending a sexually transmitted disease clinic. Sex Transm Dis. 1992;19:175–180. [PubMed]
11. Peterson JL, Grinstead OA, Golden E, et al. Correlates of HIV risk behaviors in black and white San Francisco heterosexuals: the population-based AIDS in Multiethnic Neighborhoods (AMEN) study. Ethnicity Dis. 1992;2:361–370.
12. Jemmott JB, Jemmott LS, Spears H, Hewitt N, Cruz-Collins M. Self-efficacy, hedonistic expectanices, and condom-use intentions among inner-city black adolescent women: a social cognitive approach to AIDS risk behavior. J Adolesc Health. 1992;13:512–519. doi: 10.1016/1054-139X(92)90016-5. [PubMed] [Cross Ref]
13. Catania JA, Coates TJ, Kegeles S, et al. Condom use in multi-ethnic neighborhoods of San Francisco: the population-based AMEN (AIDS in multi-ethnic neighborhoods) study. Am J Public Health. 1992;82:284–287. [PubMed]
14. Nyamathi A, Bennett C, Leake B, Lewis C, Flaskerud J. AIDS-related knowledge, perceptions, and behaviors among impoverished minority women. Am J Public Health. 1993;83:65–71. [PubMed]
15. Graves KL, Hines AM. Ethnic differences in the association between alcohol and risky sexual behavior with a new partner: an event-based analysis. AIDS Educ Prev. 1997;9:219–237. [PubMed]
16. Scheidt DM, Windle M. Individual and situational markers of condom use and sex with nonprimary partners among alcoholic inpatients: findings from the ATRISK study. Health Psychol. 1997;15:185–192. doi: 10.1037/0278-6133.15.3.185. [PubMed] [Cross Ref]
17. Wingood GM, DiClemente RJ. The influence of psychosocial factors, alcohol, drug use on African-American women’s high-risk sexual behavior. Am J Prev Med. 1998;15(1):54–59. doi: 10.1016/S0749-3797(98)00027-0. [PubMed] [Cross Ref]
18. Fullilove R, Fullilove M, Bowser B, Gross S. Risk of sexually transmitted disease among black adolescent crack users in Oakland and San Francisco, California. JAMA. 1990;263:851–855. doi: 10.1001/jama.263.6.851. [PubMed] [Cross Ref]
19. Amaro H. Love, sex and power: considering women’s realities in HIV prevention. Am Psychol. 1995;50:437–447. doi: 10.1037/0003-066X.50.6.437. [PubMed] [Cross Ref]
20. Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27:539–565. [PubMed]
21. Miller L, Neaigus A. Networks, resources and risk among women who use drugs. Soc Sci Med. 2001;52:967–978. doi: 10.1016/S0277-9536(00)00199-4. [PubMed] [Cross Ref]
22. Amaro H, Raj A. On the margin: power and women’s HIV risk reduction strategies. Sex Roles. 2000;42:723–749. doi: 10.1023/A:1007059708789. [Cross Ref]
23. Stein Z. HIV prevention: the need for methods women can use. Am J Public Health. 1990;80:460–462. [PubMed]
24. Wingood GM, DiClemente RJ. Partner influences and gender-related factors associated with noncondom use among young adult African-American women. Am J Comm Psychol. 1998;26(1):29–51. doi: 10.1023/A:1021830023545. [Cross Ref]
25. Wyatt GE. The sociocultural context of African American and White American women’s rape. J Social Issues. 1992;48:77–91.
26. Zierler S, Witbeck B, Mayer K. Sexual violence against women living with or at risk for HIV infection. Am J Prev Med. 1996;12:304–310. [PubMed]
27. Wingood GM, DiClemente RJ. Rape among African-American women: sexual, psychological and social correlates predisposing survivors to HIV infection. J Women’s Health. 1998;7:1–8. doi: 10.1089/jwh.1998.7.1. [Cross Ref]
28. Wingood GM, DiClemente RJ. The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. Am J Public Health. 1997;87(6):1016–1018. [PubMed]
29. Wingood GM, DiClemente RJ, Hubbard McCree D, Harrington K, Davies S. Dating Violence and African-American Adolescent Females’ Sexual Health. Pediatrics. 2001;107:E72–E75. doi: 10.1542/peds.107.5.e72. [PubMed] [Cross Ref]
30. Wingood GM, DiClemente RJ. Relationship characteristics associated with noncondom use among young adult African-American women. Am J Comm Psychol. 1998;26:29–53. doi: 10.1023/A:1021830023545. [Cross Ref]
31. Misovich S, Fisher J, Fisher W. Close relationships and elevated HIV risk: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997;1:72–107. doi: 10.1037/1089-2680.1.1.72. [Cross Ref]
32. Carey M, Maisto S, Kalichman S, Forsyth A, Wright E, Johnson B. Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women. J Consult Clin Psych. 1997;65:531–541. doi: 10.1037/0022-006X.65.4.531. [PMC free article] [Cross Ref]
33. DiClemente RJ, Wingood G. A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. JAMA. 1995;274:1271–1276. doi: 10.1001/jama.274.16.1271. [PubMed] [Cross Ref]
34. Hobfoll S, Jackson A, Lavin J, Britton P, Shepherd J. Reducing inner-city women’s AIDS risk activities: a study of single, pregnant women. Health Psychol. 1994;13:397–403. doi: 10.1037/0278-6133.13.5.397. [PubMed] [Cross Ref]
35. Kalichman S, Kelly J, Hunter T, Murphy D, Tyler R. Culturally tailored HIV/AIDS risk-reduction messages targeted to African-American urban women: impact on risk sensitization and risk reduction. J Consult Clin Psychol. 1993;61:291–295. doi: 10.1037/0022-006X.61.2.291. [PubMed] [Cross Ref]
36. Kelly J, Murphy D, Washington C, Wilson T, Koob J, Davis D. The effects of HIV/AIDS for high-risk women in urban clinics. Am J Public Health. 1994;84:1918–1922. [PubMed]
37. Belcher L, Kalichman S, Topping M, et al. A randomized trial of a brief HIV risk reduction counseling intervention for women. J Consult Clin Psych. 1998;66:856–861. doi: 10.1037/0022-006X.66.5.856. [Cross Ref]
38. Sikkema K, Kelly J, Winett R, Solomon L, Cargill V, Roffman R. Outcomes of a randomized community-level HIV prevention invention for women living in 18 low-income housing developments. Am J Public Health. 2000;90:57–63. [PubMed]
39. Miller KS, Clark LF, Moore JS. Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents. Fam Plann Perspect. 1997;5:212–214. doi: 10.2307/2953397. [PubMed] [Cross Ref]
40. Belgrave FZ. Relational theory and cultural enhancement interventions for African-American adolescent girls. Public Health Rep. 2002;17:S76–S81. [PMC free article] [PubMed]
41. Adimora AA, Schoenbach VJ. Contextual factors and the black-white disparity in heterosexual HIV transmission. Epidemiology. 2002;13:707–712. doi: 10.1097/00001648-200211000-00016. [PubMed] [Cross Ref]
42. Gorbach PM, Stoner BP, Aral SO, Whittington WL, Holmes KK. “It takes a village”: Understanding concurrent sexual partnerships in seattle, Washington. Sex Transm Dis. 2002;29:453–462. [PubMed]
43. Potterat JJ, Zimmerman-Rogers H, Muth SQ, et al. Chlamydia transmission: concurrency, reproduction number, and the epidemic trajectory. Am J Epidemiol. 1999;150:1331–1339. [PubMed]
44. Ghani AC, Swinton J, Garnett GP. The role of sexual partmership networks in the epidemiology of gonorrhea. Sex Transm Dis. 1997;24:45–56. doi: 10.1097/00007435-199701000-00009. [PubMed] [Cross Ref]
45. Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11:641–648. doi: 10.1097/00002030-199705000-00012. [PubMed] [Cross Ref]
46. Koumans E, Farley T, Gibson J, et al. Characteristics of persons with syphilis in areas of persisting syphilis in the United States: sustained transmission associated with concurrent partnerships. Sex Transm Dis. 2001;28:497–503. [PubMed]
47. Laumann EO, Gagnon JH, Michael RT, Michaels S. The Social Organization of Sexuality. Chicago, IL: University of Chicago Press; 1994.
48. Current Population Survey. Marital Status and Living Arrangements: March 1998. Washington, DC: US Bureau of the Census; 1998. pp. 20–514.
49. Aral SO, Wasserheit JN. Interactions among HIV, other sexually transmitted diseases, socioeconomic statue, and poverty in women. In: O’Leary A, Jemmott LS, editors. Women at Risk. New York, NY: Plenum Press; 1995. pp. 13–41.
50. Aral SO. Sexual behavior in sexually transmitted disease research: an overview. Sex Transm Dis. 1994;21:S59–S64. [PubMed]
51. Mays VM, Cochran SD. Issues in the perception of AIDS risk and risk reduction activities by black and Hispanic/Latina women. Am Psychol. 1988;43:949–957. doi: 10.1037/0003-066X.43.11.949. [PubMed] [Cross Ref]
52. Wingood GM, DiClemente RJ. Cultural, gender, and psychosocial influences on HIV-related behavior of African-American female adolescents: implications for the development of tailored prevention programs. Ethmicity Dis. 1992;2(4):381–388.
53. Krieger N. Racial and gender discrimination: risk factors for high blood pressure. Soc Sci Med. 1990;30(12):1273–1281. doi: 10.1016/0277-9536(90)90307-E. [PubMed] [Cross Ref]
54. Diaz RM. Latino gay men and psycho-cultural barriers to AIDS prevention. In: Levine MP, Nardi PM, editors. In Changing Times: Gay Men and Lesbians Encounter HIV/AIDS. Chicago, IL: University of Chicago Press; 2000. pp. 221–224.
55. Lauby J, Smith PJ, Stark M, Person B, Adams J. A community-level HIV prevention intervention for inner-city women: results of the women and infants demonstration trial. Am J Public Health. 2000;90:216–222. [PubMed]
56. Shain R, Piper J, Newton E, et al. A randomized controlled trial of a behavioral intervention to prevent sexually transmitted disease among minority women. N Engl J Med. 1999;340:93–100. doi: 10.1056/NEJM199901143400203. [PubMed] [Cross Ref]
57. El-bassel N, Witte SS, Gilbert L, Wu E, Chang M, Hill J, Steinglass P. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Pub Health. 2003;93:963–969. [PubMed]
58. Dilorio C, Resnicow K. Keepin’ It REAL! A mother-adolescent HIV prevention program. In: Pequegnat W, Szapocznik J, editors. Working With Families in the Era of HIV/AIDS. Newbury Park, CA: Sage Publications; 2000. pp. 113–132.
59. Vanter N, Gonzales V, Merzel C, Parikh NS, Celantano D, Greenberg J. Effect of an STD/HIV behavioral intervention on women’s use of the female condom. Am J Public Health. 2002;92:109–115. [PubMed]
60. Sweat M, Dennison J. Reducing HIV incidence in developing countries with structural and environmental interventions. AIDS. 1995;9:S225–S257.
61. Hanenberg R, Rojanapithaykorn W, Kunasol P, Sokal D. Impact of Thailand’s HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet. 1993;344:243–245. doi: 10.1016/S0140-6736(94)93004-X. [PubMed] [Cross Ref]
32. Census 2000 Redistricting Data. Washington, DC: US Bureau of the Census; 2000.
63. Projections of the Resident Population by Race, Hispanic Origin and Nativity. Washington, DC: US Bureau of the Census; 2000.
64. Amaro H, Torre A. Public health needs and scientific opportunities in research on Latinas. Am J Publich Health. 2002;92:525–529. doi: 10.2105/AJPH.92.4.525. [Cross Ref]
65. Day JC. Population Projections of the United States by Age, Sex, Race and Hispanic Origin: 1995–2050. Washington, DC: US Bureau of the Census; 1996.
66. Falcon A, Aguirre-Molina M, Molina CW. Latino health policy: beyond demographic determinism. In: Aguirre-Molina M, Molina CW, Zambrana RE, editors. Health Issues in the Latino Community. San Francisco, CA: Jossey-Bass; 2001. pp. 3–22.
67. Wilson TE. Sexual and reproductive behavior of women with HIV infection. Clin Obstet Gynecol. 2001;44:289–299. doi: 10.1097/00003081-200106000-00014. [PubMed] [Cross Ref]
68. Jeffrey K, Kalichman SC. Behavioral research in HIV/AIDS primary and secondary prevention: recent advances and future directions. J Consult Clin Psych. 2002;70:626–639. doi: 10.1037/0022-006X.70.3.626. [Cross Ref]
69. Kalichman SC, Rompa D, Cage M, DiFonzo K, Simpson D, Austin J. Effectiveness of an intervention to reduce HIV transmission risks in HIV positive persons. Am J Prev Med. 2001;21:84–92. doi: 10.1016/S0749-3797(01)00324-5. [PubMed] [Cross Ref]
70. Wingood GM, DiClemente RJ. The WILLOW Program: mobilizing social networks of women living with HIV to enhance coping and reduce sexual risk behavior. In: Pequegnat W, Szapocznik J, editors. Working With Families in the Era of HIV/AIDS. Newbury Park, CA: Sage Publications; 2000. pp. 281–299.
71. Logan TK, Cole J, Leukefeld C. Women, sex and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research. Psychol Bull. 2002;128:851–885. doi: 10.1037/0033-2909.128.6.851. [PubMed] [Cross Ref]
72. Prendergast M, Urada D, Podus D. Meta-analysis of HIV risk-reduction interventions within drug abuse treatment programs. J Consult Clin Psych. 2001;69:389–405. doi: 10.1037/0022-006X.69.3.389. [Cross Ref]
73. Wingood GM, DiClemente RJ. Rape among African-American women: sexual, psychological and social correlates predisposing survivors to STD/HIV. J Women’s Health. 7(1):77–84.
74. Raj A, Silverman J, Wingood GM, DiClemente RJ. Prevalence and correlates of relationship abuse among a community-based sample of low-income African-American women. Violence Against Women. 1999;5(3):272–291. doi: 10.1177/10778019922181220. [Cross Ref]
75. Stein Z. Editorial: Family planning, sexually transmitted diseases, and the prevention of AIDS—divided we fail? Am J Public Health. 1996;86:783–784. doi: 10.2105/AJPH.86.6.783. [PubMed] [Cross Ref]
76. Dawson SG, Callander N, Roche C, Kingsland T, Desmond N. Integrated sexual healthcare: the development and review of one model of service delivery. Int J STD AIDS. 2000;11:428–434. doi: 10.1258/0956462001916191. [PubMed] [Cross Ref]
77. Mann D. Integrating HIV prevention, STD and family planning services: comprehensive efforts in Philadelphia. Am J Public Health. 1997;87:692–692. [PubMed]
78. Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial. Lancet. 1995;346:530–536. doi: 10.1016/S0140-6736(95)91380-7. [PubMed] [Cross Ref]

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine