Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Jessy Dévieux

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Elena Bastida

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Consuelo Beck-Sague

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Florence George

Fourth Advisor's Committee Title

Committee Member


Pre-exposure prophylaxis, PrEP, HIV, community health, risk reduction intervention, community based research, women of color, Black women, Miami, South Florida, alcohol and other drug use, HIV risk perceptions, HIV susceptibility, HIV knowledge, PrEP attitudes, PrEP knowledge

Date of Defense



The U.S. HIV epidemic is characterized by regional, racial, and ethnic disparities. HIV rates are disproportionately higher in the South and Black and Hispanic populations are most impacted. Moreover, the intersectional identity of being a Black or Hispanic woman living in the South has been associated with profound disparities in HIV impact. Prior to the advent of the biomedical HIV prevention tool pre-exposure prophylaxis (PrEP) in 2012, women were limited in their options for female-controlled HIV prevention strategies. Despite the proven efficacy of PrEP, utilization in women is significantly lower than other at-risk groups. In the present study, secondary analysis was conducted using exploratory cross-sectional survey data as well as quantitative and qualitative pre- and post-intervention data from a pilot study conducted as part of the NIAAA funded study “Optimizing PrEP Utilization Among Alcohol and Other Drug Using Women of Color”.

In Aim 1, we explored the association between HIV and PrEP related knowledge and attitudinal factors and HIV risk. We found that increased risk for HIV was associated with higher HIV knowledge, higher risk perception, and more positive PrEP attitudes. HIV risk was found to decrease as PrEP knowledge increased. In Aim 2, we assessed the preliminary efficacy of a one-on-one HIV risk reduction intervention for women, “Talking PrEP with Women of Color in Miami,” in a sample of Black women. We found evidence that the intervention was efficacious in improving risky behaviors, knowledge, and attitudes related to sexual risk taking. A qualitative process evaluation of the intervention in Aim 3 identified factors motivating, facilitating, and acting as barriers to PrEP use and established that participants found the intervention to be acceptable and beneficial. We also found that Black women may lack the social support identified as a key facilitator of PrEP use but, in the absence of support, high perceptions of risk serve as facilitators for use and adherence.

Findings from this study can be used to inform educational content development for future HIV risk reduction interventions and improve challenges associated with attrition in interventions targeting at-risk ethnic minority women with a myriad of unmet social needs.








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