Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Mary Jo Trepka

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Jessy G. Dévieux

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Erica L. Gollub

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Boubakari Ibrahimou

Fourth Advisor's Committee Title

Committee member

Fifth Advisor's Name

Purnima Madhivanan

Fifth Advisor's Committee Title

Committee member

Keywords

Latinas, Foreign-born, HIV, Risk behaviors, High Impact Prevention, HIV testing, HIV screening, pregnant women, perinatal, mother-to-child transmission

Date of Defense

4-19-2017

Abstract

The prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Latina women in the United States (US) are not only disproportionately affected by human immunodeficiency virus (HIV) infection, but also underutilize HIV prevention services, such as HIV testing. Data are limited on the differences in HIV risk among Latinas by country of birth, and opportunities still exist to prevent transmission of HIV and reduce HIV-related disparities. This dissertation describes the risk behaviors, testing behaviors, and test results among women tested for HIV at public sites in Florida. Additionally, it compares these characteristics by HIV testing site type among pregnant women. Multivariable logistic regression was used to estimate the adjusted odds ratios (AOR) and associated 95% confidence intervals for the outcome variables of risk behaviors, previous testing, and positive HIV test results.

Of the total 209,954 records, 184,037 were from women not currently pregnant, of which 87,569 (45.6%) were among non-Hispanic Blacks (NHBs), 47,926 (26.0%) non-Hispanic Whites (NHWs), and 41,117 (22.3%) Latinas. Women who reported previous HIV testing had decreased odds of being Latina compared to NHW women (AOR 0.90; 95% confidence interval [CI] 0.87, 0.94), and testing event results indicate that foreign-born Latina women were significantly less likely to report partner risk (AOR 0.42; 95% CI: 0.40-0.54) than US-born Latina women. Of the 24,863 records of pregnant women, 10,199 (41.1%) were among Latinas, 6,796 (27.4%) were among NHB, and 6,631 (26.7%) were among NHW. The testing records indicated that Latina and NHB women had decreased odds of reporting partner risk than NHW women (Latina: AOR 0.20; 95% CI: 0.14-0.28; and NHB: AOR 0.14; 95% CI: 0.10-0.21), and records of women tested in prisons/jails had higher odds of reporting previous HIV testing compared to prenatal care sites (AOR 1.86; 95% CI: 1.03-3.39).

Reported risk behaviors varied by race/ethnicity and Latina country of origin. Knowledge of these differences can enhance current testing and prevention strategies for women, and aid in targeting HIV prevention messaging, program decision-making, and allocation of resources, corresponding to the central approach of High Impact Prevention and the National HIV/AIDS Strategy.

Identifier

FIDC001938

Available for download on Tuesday, July 17, 2018

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