HIV Prevention among Women at Risk
With HIV incidence in the U.S. remaining steady at about 40,000 infections per year, and women making up an increasingly larger proportion of new infections, the public health community is in dire need of different, creative prevention strategies to address the HIV epidemic among women. Because women who are most at risk (e.g., sex workers, incarcerated women, immigrants, drug users) are also the most marginalized and hard to reach, we should capitalize on the expertise and creativity of local organizations that have access to and experience in dealing with these populations. However, these organizations often lack the support necessary to translate their knowledge and ideas into effective interventions.
To respond to this reality, the National AIDS Fund collaborated with Johnson & Johnson to start a grantmaking initiative called GENERATIONS: Strengthening Women & Families Affected by HIV/AIDS. The goal of GENERATIONS is to help organizations create or adapt HIV preventions for hard-to-reach populations of women. In addition to providing money, GENERATIONS gives organizations access to a "package" of services, including intensive consultation with experts from San Francisco State University and access to evaluators who help measure the new interventions' effectiveness. We're currently funding organizations that work with sex workers, homeless and runaway youth, monolingual Chinese-speaking immigrants working in massage parlors, women with incarcerated partners, and Latina immigrants, among others.
What's especially neat about GENERATIONS is that it allows for ongoing modification and creativity, unlike other funding programs that are more rigid and proscribed. We gave each organization funding for a four-month "formative phase" so they could conduct research on their target population and pilot test their interventions; now we're supporting two years of implementation, expecting that the interventions will continue to be refined as organizations learn more about what works for their population.
Perhaps the most surprising outcome of the formative research is that organizations that have been working with their target population for years—who thought they knew their population inside and out—made unexpected discoveries about the women with whom they work. For example, one organization found that the increasingly hostile, anti-immigration local political environment meant that their clients needed many more stress and crisis management services than before. Another organization's research revealed disturbingly misogynistic attitudes among the male partners of their young, female participants. It's an indication that the social determinants of health for women are continuously changing and that we need to constantly evaluate and revise our HIV prevention work to make sure it continues to meet women's needs and remains effective.
Suzanne Kinsky works as a program officer for the National AIDS Fund.
