- By FYH News Team
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The Black Women First (BWF) initiative, administered by the
Health Resources and Services Administration (HRSA), Ryan White
HIV/AIDS Program (RWHAP), Special Projects of National Significance
(SPNS) with funding from the Minority HIV/AIDS Fund, recently
wrapped up three years of implementing and evaluating bundled
evidence-informed and evidence-based interventions at 12 sites
nationwide. The initiative marked the first-ever national project
dedicated to improving the health outcomes of Black cisgender and
transgender women with HIV. Led by the University of Massachusetts
Lowell (UMass Lowell), with evaluation support from the Boston
University Center for Innovation in Social Work and Health (CISWH)
and implementation expertise and technical assistance from AIDS
United, sites demonstrated bundled interventions featuring
multi-pronged strategies to engage and retain Black women with HIV
into treatment and care. These strategies included:
- Patient navigation, case management, and peer engagement
through technology to access virtual appointments and online
support groups; - Red Carpet Care experiences that provided direct access to
resources, including food, housing, technology and employment; - Services to help manage disclosure and experiences with
stigma; - Trauma-informed care;
- Intimate Partner Violence (IPV) screening and related services;
and - Self-efficacy and health literacy services.
“The strategic bundling of these interventions recognized the
diverse backgrounds, experiences, and culturally relevant care
needs of Black women,” says Serena Rajabiun, Principal
Investigator, UMass Lowell. “Black cisgender and transgender women
with HIV, including those ages 50 and older and non-U.S. born
women, require tailored services to feel supported in treatment and
care.”
The BWF initiative’s approach paid off. After three years, sites
reported marked increases in Black cisgender and transgender
women’s linkage to care within 30 days of HIV diagnosis, retention
in care, well-being, maintenance of viral suppression, stigma
reduction, resiliency, and quality of life. Clients reported
improvements in their health literacy, coping skills, and ability
to access behavioral, clinical, and support services, coupled with
reduced feelings and experiences with stigma and discrimination.
Intervention sites’ success extended beyond HIV, introducing
routinized screenings and linkages to care for common clinical and
behavioral health comorbidities, including substance use disorders,
depression, hypertension, diabetes, obesity, hepatitis C,
osteoporosis, and cervical, breast, and colon cancers.
These successes reflect the strong relationships built by sites
with clients. Interventions were overwhelmingly led and staffed by
Black cisgender and transgender women, while clients were invited
to help develop and refine programming through participation in
surveys, interviews, focus groups, and advisory boards. As Alicia
Downes, Director of Federal Programs at AIDS United, explains, “BWF
initiative sites sought and trusted their clients’ experiences as
Black cisgender and transgender women. They understood best how to
describe their experiences navigating their lives and care.”
As a result, the interventions of the BWF initiative were able
to directly address and support clients’ experiences with dire and
often intergenerational impacts of poverty, interpersonal violence,
racism, and stigma. One participant explained that her site’s
initiative connected her to a support network of other Black women
with HIV with similar experiences. “For the first time, I felt free
to communicate my feelings about HIV. I had friends who supported
me without judgment, checking in to ask, ‘Have you taken your
medications?’” Another participant said she chose to join her
clinic’s community advisory board to continue building their
capacity to reach Black women like her. She says, “My drive to be a
part of the [BWF] initiative is probably because I have lived
experience. I know what it is like to be discriminated against by a
medical team.”
The start of the BWF initiative in 2020 could not have been more
timely. Named a National HIV/AIDS Strategy priority population in
2021, Black women have always borne a disparate burden of HIV. Less
than five years after the start of the epidemic in 1981, the CDC
reported that Black women accounted for over one-half of all AIDS
cases among women, and had a cumulative incidence rate 13.1 times
that of white women. While annual HIV infections have remained
relatively stable among Black women since 2015, rates of new HIV
infections among Black women are 11 times that of white women and
four times that of Latina women. In 2021, Black cisgender women
accounted for 53% of new HIV cases among cisgender women, while
Black transgender women represented over 46% of new HIV cases among
transgender women—staggering numbers considering that Black women
together account for less than 15% of all U.S. women.
Ultimately, the results of the BWF initiative will further the
U.S. Department of Health and Human Services’ (HHS) Ending the
HIV Epidemic (EHE) and the Health Resources and Services
Administration’s (HRSA) Strategy to Address Intimate Partner
Violence. A special institute about BWF, entitled “Ryan White
HIV/AIDS Program (RWHAP) Black Women First Initiative: Promoting
Care for Women, by Women,” will take place during the United States
Conference on HIV/AIDS (USCHA), at the Marriott Marquis in
Washington, DC, on September 7, 2023, from 8:00 AM to 11:00 AM.
Participants in the session will hear about activities and outcomes
of the BWF initiative overall, and from each of the sites, as
follows:
- TogetHER by Abounding Prosperity, Inc. in Dallas, TX
- G.E.M.S. (Goal Setting, Empowerment, and Motivating my Sisters)
by AccessMatters in Philadelphia, PA - Black Women’s Health Initiative by AIDS Care Group in Chester,
PA - Women Evolving by AIDS Foundation of Chicago in Chicago,
IL - The WHIP Program (Women’s Health Initiative) by Alliance for
Positive Change, NYC - SHE Program (Sisterhood for Health Equity) by the City of
Philadelphia in Philadelphia, PA - B.WOW! (Black Women Organized for Wellness!) by Grady Health
System in Atlanta, GA - Care and Treatment Services (CATS) NOLA by Institute of Women
& Ethnic Studies in New Orleans, LA - Black Women First Initiative by Positive Impact Health Centers
in Atlanta, GA - SIGH (Sisters Inspiring Growth and Healing) by Quality
Comprehensive Health Center in Charlotte, NC - HERS+ (Health, Empowerment, and Recovery Services plus) by UCSF
Women’s HIV Program in San Francisco, CA - Stepping Stones by Volunteers of America, SE Louisiana in New
Orleans, LA
“From the start, HRSA funded sites represented Black women’s
diverse, intersectional identities and experiences,” adds Downes.
“The sites’ multifaceted, bundled interventions engendered trust,
providing Black women access to a support network that encouraged
engagement in an array of clinical and behavioral health services
that extended beyond HIV treatment.”
“We are proud to have supported the adaptation of these
successful interventions,” says Rajabiun. “Their strategies will
provide frontline service agencies across the U.S. access to
replicable, innovative solutions to engage and retain in treatment
and care historically underserved Black women with unmet clinical
and behavioral health needs.”
###
About University of Massachusetts, Lowell (UML):
UMass Lowell is a national research university offering its
more than 18,000 students bachelor’s, master’s and doctoral degrees
in business, education, engineering, fine arts, health, humanities,
sciences and social sciences. UML’s Center for Population
Health’s mission and vision is to establish long-term
interventions in diverse populations, that effectively reduce the
prevalence of diseases and improve overall quality of health and
well-being.
About AIDS United:
AIDS United has the singular mission of ending the HIV epidemic in
the United States through strategic grant-making, capacity
building, and policy and advocacy. AIDS United bridges policy with
grant-making and capacity building; linking the world of HIV
service and community-based organizations with the public health,
medical, advocacy and social justice communities to respond to the
domestic HIV epidemic. Learn more about AIDS United here.
About the Center for Innovation in Social Work & Health
at BUSSW
CISWH is dedicated to expanding the impact of social work in health
care and public health in order to improve the health and
well-being of vulnerable populations nationally and globally. CISWH
seeks to improve outcomes, patient experience, and population
health; reduce costs; and promote health equity and social justice.
The Center supports social work leadership in health through
cross-sector collaboration with public health, medicine, health
economics, technology, and other relevant disciplines. The Center
accomplishes its mission through research, community partnerships,
policy development, and by providing technical assistance and
educational opportunities. Learn more here.
Serena Rajabiun Principal Investigator (PI), University of
Massachusetts Lowell (UML)
This project is supported by the Health Resources and Services
Administration (HRSA) of the U.S. Department of Health and Human
Services (HHS) award # U90HA39727. The contents are those of the
author(s) and do not necessarily represent the official views of,
nor an endorsement, by HRSA/HHS, or the U.S. Government. Visit
TargetHIV.org/BlackWomen for more information.
Serena Rajabiun University of Massachusetts, Lowell, Center for Population Health 978-934-3289 serena_rajabiun@uml.edu
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