By Katharine Webster
Asst. Prof. of Public Health Serena Rajabiun
is leading a team of researchers and community partners that has won a four-year, $3.9 million grant from the U.S. Department of Health and Human Services to improve care and treatment coordination for Black women with HIV.
Rajabiun, principal investigator on the grant, has been working on HIV treatment access for vulnerable populations, including recent immigrants and people experiencing homelessness, for nearly two decades.
As advisors and research partners, they will work with 12 community-based organizations and health centers across the U.S. to improve Black women’s access to antiretroviral drugs, address the women’s other health and social needs, and help them maintain treatment over time, Rajabiun says.
AIDS United, Boston University’s School of Social Work, and Impact Marketing & Communications are also partners on the grant, which was awarded by the Department of Health and Human Services Health Resources and Services Administration, HIV/AIDS Bureau.
Black women have higher HIV infection rates than any other group of women, and 92 percent of them are infected by male sexual partners, according to the U.S. Centers for Disease Control and Prevention
. That’s in part because of where they live, Rajabiun says.
“The HIV epidemic is hitting particularly hard in the South, where there are higher levels of poverty, greater insurance disparities and few states with expanded Medicaid,” she says.
Rajabiun and Wangari Walter say structural racism and community attitudes are also major barriers to prevention and treatment for Black women.
“Black women experience everything from stigma to structural racism, inadequate access to health care, provider bias and intimate partner violence. All of these things affect health outcomes,” Wangari Walter says. “The models of care that we will be using really allow for engagement and retention of Black women.”
Central to those care models are community health workers, including other women living with HIV. Serving as part of a care and treatment team that includes doctors, social workers and case managers, “peer navigators” are trained to help the women navigate a fragmented health and social service system.
The peer navigators will help to link the women to care; address their unmet social needs, including lack of housing, food and employment; and help them stay involved in treatment.
“If we can get people fed, housed and employed, we see better health outcomes,” Rajabiun says. “That should seem like common sense, but the COVID-19 pandemic has exposed our lack of investment in not just the medical resources, but the social resources that help people improve their health.”
The peer navigators will also work to reduce the stigma surrounding the disease, both among the population they’re serving and in their communities – because that stigma can prevent Black women from seeking treatment or taking medication that prevents HIV transmission, Rajabiun says.
“HIV shouldn’t be stigmatizing, but because it’s often incorrectly associated with particular identities such as being gay, using injection drugs or being a sex worker, in our society it still has a negative connotation,” she says.
The peer navigators will be diverse, just like their patients, Wangari Walter says.
“One of the strengths this project has is thinking about how to better coordinate health and social services for Black women, recognizing that Black women are not a homogenous group,” she says.
The various sites will also provide services to address other conditions that can affect Black women’s health and their ability to stay in treatment for HIV, including providing trauma-informed care for women who are victims of intimate partner violence, mental health services, treatment for substance use and addiction, and treatment for other diseases that often accompany HIV, such as hepatitis C.
Different centers will select specific groups of interventions, based on research, to best address the needs of their local populations. UML and its partners will support training on those interventions, evaluate their implementation, identify gaps in care, and examine the effect on health outcomes for the women, as well as whether there is a reduction in the stigma surrounding the disease. Then, they will help to disseminate the results.
“The beauty of doing this work and really trying to implement comprehensive care is that you have to think about how to meet the clients where they are, and the sites have been able to pivot during the COVID-19 pandemic and meet those needs,” Wangari Walter says.
Rajabiun and Wangari Walter have collaborated before with AIDS United, BU’s School of Social Work and Impact Marketing on community-engaged, multi-site research projects involving people with HIV. Tucker, principal investigator at the university's Center for Population Health
, is a valuable partner for her experience leading large studies looking at health disparities in communities of color.
Rajabiun, who has a lengthy career working on access to HIV treatment for vulnerable populations, recently did similar research with three HIV centers on using trained peers to help cis- and transgender women of color gain access to antiretroviral drugs and to retain the women in treatment. Transgender women of color, who face multiple stigmas, are at higher risk for HIV, she says.
Wangari Walter has done quantitative, national research on access to treatment for women with HIV and alcohol use disorders, and qualitative research with Black women on the role of alcohol use in the transmission of HIV. Her research involves improving health outcomes for communities of color, indigenous people and other socially and economically disadvantaged groups.